age 2 – Innovative Strategies to Improve Long-term Outcomes in High-risk Infants in the Neonatal Intensive Care Unit Led by Terrie E. Inder, MBChB, MD, Chair of the Department of Pediatric Newborn Medicine at Brigham and Women’s Hospital, a team including neonatologists, infant and child development experts, nutritionists, rehabilitation specialists, and providers in many other disciplines is employing a wide range of strategies to optimize long-term outcomes for high-risk infants who spend their first weeks and months in the neonatal intensive care unit. Page 3 – The Impact of Nutritional Supplementation on the Metabolic Environment in Pregnant and Lactating Obese Women In an effort to improve short- and long-term outcomes of babies and mothers impacted by maternal obesity, neonatologists in the Brigham and Women’s Hospital Department of Pediatric Newborn Medicine are devising strategic interventions to address metabolic dysregulation in pregnant and lactating obese women. Page 4 – Brain Imaging Study Measures Fetal Brain Development in Congenital Heart Disease, Informs Neuroprotective Approaches Neonatologists in the Department of Pediatric Newborn Medicine at Brigham and Women’s Hospital are leading studies to better understand underlying brain abnormalities in babies with congenital heart disease (CHD) and ultimately improve neurodevelopmental outcomes. Page 5 – Novel Studies Using Breastmilk Analysis Aim to Optimize Neurodevelopment in Preterm Infants Studies led by neonatologists in the Department of Pediatric Newborn Medicine at Brigham and Women’s Hospital are analyzing the nutritional composition of breastmilk, with a goal of conducting future studies using individualized fortification of breastmilk for optimal growth and neurodevelopment of preterm infants in the Neonatal Intensive Care Unit (NICU). 2 | Neonatology Advances Led by Terrie E. Inder, MBChB, MD, Chair of the Department of Pediatric Newborn Medicine at Brigham and Women’s Hospital (BWH), a team including neonatologists, infant and child development experts, nutritionists, rehabilitation specialists, and providers in many other disciplines at BWH is employing a wide range of strategies to optimize long-term outcomes for high-risk infants who spend their first weeks and months in the neonatal intensive care unit (NICU). “With medical advances, three out of four babies born between one and one and a half pounds today will survive, but many will suffer from long-term challenges, including developmental delays, learning difficulties in school, and other issues,” said Dr. Inder, who is dual board certified in neonatology and pediatric neurology. “Using serial imaging, we have led extensive research in brain development in preterm and critically-ill babies to help guide our new initiatives and ensure that our NICU environment and practices are designed to support these babies’ critical brain development.” Recent significant findings from serial brain imaging studies conducted by Dr. Inder and her team include: • Preterm birth disrupts cortical development in a regionally specific fashion with abnormalities evident by term-equivalent postpartum age. This disruption is influenced by both antenatal growth and postnatal course. (Ann Neurol. 2015 Jan; 77(1):154-62.); • A complex pattern of regional vulnerabilities in brain development may contribute to the diverse and long-lasting neurobehavioral consequences that can occur after very premature birth (Neuroimage. 2015 Apr 1;109:469-79.); • White matter tract integrity is associated with later attentional abilities in very preterm children (Neuroimage. 2016 Jan 1;124(Pt A):75-84.). Improving Outcomes through Technology and New Advances Techniques used to enhance brain development in infants in the BWH NICU include: • Magnetic resonance imaging (MRI) is typically performed on day four and day 10 for at-risk infants and is used to assess extent of injury, response to therapy, and recommendations for rehabilitation; • Auditory exposure, such as reading to the baby and exposing them to a normally noisy environment in the NICU has been shown to benefit language development; • Clinical trials, including the study of the bumetanide in the effectiveness in seizure control and a Phase II study using reinfusion of autologous stems cells from cord blood to more broadly study the impact on the brain environment Innovative Strategies to Improve Long-term Outcomes in High-risk Infants in the Neonatal Intensive Care Unit in infants who have suffered brain injury. BWH will be the site for most of the MRI readings for this latter study. Groundbreaking NICU Redesign BWH’s NICU team cares for approximately 3,000 preterm and critically-ill infants each year. In 2017, BWH will open its newly redesigned NICU, built to specifically support the NICU team’s goals and programs. Advanced technological advances in the NICU include: • Continuous electroencephalography (EEG) monitoring to optimize neurodevelopment; • Near-infrared spectroscopy for cerebral blood flow monitoring; • Dedicated magnetic resonance imaging (MRI). Terrie E. Inder, MBChB, MD Chair, Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital Terrie E. Inder, MBChB, MD, leads an expert team to employ strategies that