Children's Husband-Wife Neuro Team Uses Novel MRI Technology to Identify Early Fetal Brain Development

A fetus may have hidden neurological difficulties unknown to obstetricians.

A husband and wife team at Children’s National Health System focuses on identifying the earliest signs of impaired fetal brain development in high-risk pregnancies in order to develop the safest management plans for pregnancy and the earliest hours and days after birth.  The hospital uses innovative imaging technologies to evaluate the fetus and the newborn using biomarkers that until now have been unavailable to most clinicians aiming to deliver the best possible care during these critical life phases.

Adré J. du Plessis, MBChB, MPH, Chief, Division of Fetal and Transitional Medicine, and Catherine Limperopoulos, PhD, Director of the Advanced Pediatric Brain Imaging Research Laboratory, have targeted fetal brain growth trajectories to establish the earliest indications that a fetal brain  is in jeopardy of disturbed development.  The ultimate goal is to pinpoint the at-risk fetal brain before irreversible injury occurs.

“During a fetal brain insult there comes a point where a cascade of biochemical processes is unleashed. Beyond this point, containing brain injury becomes like putting out a forest fire.  Our goal is to identify the problem before that critical time point is reached,” du Plessis says.

“The fundamental point of departure for our work is identification of the fetus and the newborn at risk for brain injury before that injury happens,” says du Plessis. “Of all the organs, the brain is the least forgiving when it comes to injury. There is currently no cure for brain injury. Our entire focus is on identifying insult before it becomes irreversible injury. As such we are in pursuit of truly preventive neuroprotection strategies rather than rescue or salvage.”

Limperopoulos says advanced fetal magnetic resonance imaging (MRI) is becoming an important clinical tool to measure brain development in healthy fetuses during the second and third trimesters of pregnancy. The researchers are engaging in novel MRI techniques that will provide vital information to healthcare providers to counsel patient effectively and base rational decisions regarding potential medical and surgical procedures.

“We want a safe birth,” says Limperpoulos. “We are capturing signs and symptoms that will identify the fetus or newborn en route to a significant brain insult before she or he suffers irreversible injury. Until now we haven’t had the technology to identify signs of trouble with enough warning to reliably do something about it,” she adds.  One major area of concern is failure of oxygen and nutrient supply to the fetal brain in pregnancies complicated by conditions such as complex congenital heart disease or placental failure. In large studies of pregnancies complicated by congenital heart disease, these researchers’ imaging techniques have identified  very early signs of failing brain development, signs that currently go undetected by conventional techniques.

Du Plessis, Limperopoulos and the team at Children’s National are unique in their focus on the potentially hazardous transition from fetal to neonatal life.  With the aid of these innovative brain imaging techniques, the future coordination of informed, rational, and effective care of the immature brain appears within reach.