forms of CHD, beginning before babies are born, and categorize those conditions that pose the most risk for neurodevelopmental impairment.” As part of the study, fetal magnetic resonance imaging (MRI) is performed twice during pregnancy. The first fetal MRI is in the early third trimester. This MRI measures brain size, growth, and characteristics of multiple regions, including specific areas of the white matter, deep gray matter, and cortex. The second fetal MRI, performed just prior to delivery, determines how these regions change over time and whether abnormalities on the first MRI lead to further impairments in brain development, particularly of the deep gray matter and cortex. “These images provide us with key information on the way the fetal brain changes over time,” said Dr. Ortinau. “We also examine fetal brain development in association with specific aspects of heart physiology that may affect the way the brain is developing. These details will help us understand why brain development is different in CHD and identify who may benefit from neuroprotection.” To assess postnatal neurologic abnormalities, MRI is scheduled after birth (before surgery) and again between three and Brain Imaging Study Measures Fetal Brain Development in Congenital Heart Disease, Informs Neuroprotective Approaches six months of age. Neurodevelopmental outcomes are measured between three and six months of age and again when the babies reach two years of age. Previous Findings The current study builds on previous important findings by Dr. Ortinau and other BWH researchers, including: • Infants with CHD have smaller brain measures in the frontal lobe, parietal lobe, cerebellum, and brain stem (J Thorac Cardiovasc Surg. 2012 Jun;143(6):1264-70.); • Decreased surface area, less folding of the brain, and alterations in sulcal depth are evident prior to cardiac surgery (J Pediatr. 2013 Nov;163(5):1507-10.); • Infants with CHD have the same rates of brain growth in the cerebellum as healthy term infants in the first three months of life after surgical repair for CHD. Nutritional factors appear to play an important role in this growth. (Pediatr Cardiol. 2012 Oct;33(7):1138-46.) Cynthia M. Ortinau, MD Neonatologist, Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital Maps comparing brain folding between infants with CHD and controls. Areas in yellow and red indicate regions where control infants had more folding. 5 | Neonatology Advances Studies led by neonatologists in the Department of Pediatric Newborn Medicine at Brigham and Women’s Hospital (BWH) 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 BWH Neonatal Intensive Care Unit (NICU). “We know that nutrition plays a large role in neurodevelopment and that preterm babies who achieve higher weight gain during their NICU stay have better neurodevelopmental outcomes,” said Mandy Brown Belfort, MD, MPH, a neonatologist in the Department of Pediatric Newborn Medicine. “While breastmilk offers a myriad of advantages, preterm babies given breastmilk tend to gain weight at a slower rate than those given formula.” Currently, the standard of care for preterm infants who are given breastmilk in the NICU is fortification of the breastmilk based on the baby’s gestational age, weight, and demonstrated growth pattern. This assumes, however, that all breastmilk contains the same nutritional components. “The challenge with this practice is that the nutritional composition of an individual mother’s breastmilk can be highly variable day-to-day or even throughout the course of one day,” said Dr. Belfort. “Without analyzing each sample, we have no way of knowing its true nutritional composition.” Novel Studies Using Breastmilk Analysis Aim to Optimize Neurodevelopment in Preterm Infants Pilot Study Supports Trial Design A new pilot study led by Dr. Belfort is using specialized equipment to assess breastmilk composition, including macronutrients like protein and fat that are important for growth and neurodevelopment. The team is collecting data to compare the nutritional components of the breastmilk with the infants’ growth patterns, body composition, and brain growth while they are in the NICU. The pilot study is expected to continue until mid-2016. “Our initial study is designed to examine the babies’ growth patterns based on the breastmilk’s nutritional composition,” said Dr. Belfort. “Those data will give us an indication as to whether individualized fortification of the breastmilk based on routine nutritional analysis is likely to improve the baby’s growth and outcomes.” Data collected from the pilot study will be used to support future clinical trials that will compare the growth of infants given individualized fortification with the growth of infants that are fed following the standard-of-care guidelines. These studies are planned to include long-term follow up after the infants leave the NICU. Building on Previous Findings Current studies build on Dr. Belfort’s previous research, which: • Examined the association between growth patterns in preterm infants in the NICU with neurodevelopmental outcomes (Pediatrics. 2011 Oct;128(4):e899-906.); • Determined