Newborn Brain Symposium Packs the House at Wong Kerlee

Newborn brain development is a hot topic in the world of neonatal and pediatric medicine these days as attested on Wednesday, Sept. 2, when more than 200 people packed the Wong Kerlee International Conference Center for the first-ever Care of the Newborn Brain Symposium at Loma Linda University Children’s Hospital. According to Dorothy Forde, MSN, clinical educator for the neonatal intensive care unit (NICU), the significance of the event reaches far beyond the Inland Empire. “This was actually the very first newborn brain symposium in all of Southern California,” Forde observes. “The conference covered a variety of topics,” notes Andrew Hopper, MD, co-medical director of the Neuro NICU at LLUCH. “Afternoon breakout sessions covered neuro-diagnostic techniques including the use of amplitude-integrated EEG and near-infrared spectroscopy to measure cerebral tissue oxygen saturation, diagnosis and recognition of seizures, and neuroprotective care in action.” Raylene Phillips, MD, also a co-medical director of the Neuro NICU at LLUCH, describes the context for the current increased interest in the newborn brain. “Historically,” Phillips observes, “neonatology has focused on caring for immature lungs and hearts, but has paid relatively less attention to the very immature and rapidly growing brain. We have learned a great deal about the best ways to care for other vital organs, and now we must include the care and protection of the newborn brain.” Hopper and Phillips have collaborated with the department of child neurology to create a Neuro NICU at LLUCH for this purpose. The symposium was another way to increase knowledge and awareness about the importance of the newborn brain. Billed as a one-day course “for those who want to journey into the brain of the neonate,” a promotional flyer for the symposium promised an investigation into “the exciting new science of neurocritical care and brain monitoring” to enable practioners to “treat and even prevent neurological impairments for some babies.” The babies in question are perinatal or neonatal infants. In general, during the period between the 28th week of gestation and the seventh day of life, babies are considered perinatal. From the seventh day through the first month of life, they are called neonates. The symposium’s distinguished guest faculty members included: • Alexis Davis, MD, MS, Epi, associate NICU medical director at Good Samaritan Hospital, San Jose, and • Courtney Wusthoff, MD, MS, Epi, assistant professor of neurology and neurological sciences at the Lucile Packard Children’s Hospital, Stanford University Loma Linda University School of Medicine faculty members included: • Adam Czynski, DO, assistant professor of pediatrics, division of neonatology • Donna A. Goff, MD, assistant professor of pediatrics, division of cardiology • Andrew O. Hopper, MD, co-medical director, Neuro NICU, LLUCH, and professor of pediatrics, division of neonatology • Paggie Kim, MD, assistant professor, department of pediatric radiology and neuroradiology • Raylene Phillips, MD, co-medical director, Neuro NICU, LLUCH, and assistant professor of pediatrics, division of neonatology, and • Smyrna Tuburan, MD, assistant professor, department of pediatric radiology Davis and Wusthoff addressed the audience during morning and afternoon sessions and joined Loma Linda faculty members in panel discussions throughout the day. In pointing out that stroke is sort of a catch-all term used to describe lots of different things, Wusthoff noted that arterial ischemic stroke accounts for 80 percent of perinatal strokes, but other, less common brain injuries such as intracerebral hemorrhage and sinovenous thrombosis are also classified as stroke. She added that neonatal stroke occurs at a rate of one in every 3,000 births while perinatal stroke is far more common, occurring in one of every 200 births. “Perinatal stroke is a completely different beast than an adult stroke, with better outcomes,” she noted. Wusthoff also observed that babies who have a stroke are at far greater risk of hypoglycemia than those who do not. In her morning presentation, Davis talked about the role of therapeutic hypothermia, the process of lowering a patient’s body temperature in order to achieve desirable health outcomes through reducing or preventing injury. In the afternoon, she discussed the role of amplitude-integrated electroencephalography (aEEG). The process involves a continuous monitoring of brain function through electrodes attached to the scalp. It allows physicians and nurses to detect the onset of potential anomaly or injury in the earliest stages when preventive measures are often most effective. Phillips discussed the groundbreaking work of neuroprotective care at LLUCH. “This is a structured, nursing-driving program using evidence-based, developmentally-appropriate care,” she observed, “with a focus on safeguarding the integrity of developing neuronal systems to optimize development and help prevent brain injury.” After discussing several of those systems—such as protecting babies from excessive sound and light, decreasing pain and stress, optimizing nutrition, and protecting their sleep—Phillips added that the most important strategy is to involve parents. “A major stress on hospitalized babies stems from separation from their parents,” she pointed out. “When the bonding process is interrupted during critical periods of development, neuropsychological development is impaired, with results that can last a lifetime. One of the best ways to reestablish the connection between hospitalized babies and their parents is through skin-to-skin contact—sometimes called Kangaroo Care.” Perhaps no one is more pleased with the way the conference turned out than Forde. From her point of view, hosting the event in such a large venue required something of a leap of faith. “We are extremely gratified,” Forde said of the large turnout. “The comments we received were all very positive. We are planning to make this an annual event.”