What have we learned so far in the ELGAN Study?
Why do children who are born very early (at less than 28 gestational weeks) have more difficulty than full-term children learning to walk, succeeding in schoolwork, and developing social and communication skills? This was the guiding question of the Extremely Low Gestational Age Newborn Study.
With the help of our ELGAN families, we started to answer this question by looking for events before and around the time of these early births. Then we measured developmental skills around 2 years of age and again at about age 10. Using math calculations (statistics), we tried to discover if children with difficulties during childhood were more likely to have been exposed to something in particular before or around the time of birth.
Now that we've received new funds to see how ELGAN children are doing as teens, we'd like to tell you about some discoveries thus far. This information is also published in scientific and medical journals read by physicians, nurses, teachers, psychologists, and others whose professions involve service to children and their families. These writings explain discoveries about particular groups of children, rather than about any individual child.
A Focus on Inflammation
The major findings from ELGAN explore how inflammation early in life is related to brain development. Inflammation is the body's way of defending itself against infection and other damaging influences, such as irritating chemicals. But inflammation can sometimes injure the body. By measuring inflammation-related proteins in the blood of ELGAN participants, obtained during the first weeks in NICU, we discovered that:
- ELGAN children who were exposed to more than one day of inflammation in the first month of life are more likely to develop cerebral palsy1, more likely to have development difficulties, and more likely to have an attention problem at 2 years of life2, than children without inflammation.
- ELGAN children who were exposed to more than one day of inflammation in the first month of life are more likely to have difficulty on tests of thinking and learning skills. 3
- The size of parts of the brain that contain nerve cells (gray matter) and contain the brain’s wiring system (white matter) appear to be somewhat smaller among those with strong evidence of inflammation in the blood after birth.
- We now are looking at the possible role of inflammation in explaining why ELGAN children have higher than expected rates of epilepsy, autism, language delays, and difficulties with ability to read social cues for some.
- We also are looking for reasons why many babies born very early develop inflammation in the first month of life.
This information has led to clinical trials of medicines or treatments that may help reduce problems from inflammation (Juul SE, et al Neuroprotective potential of erythropoietin in neonates; design of a randomized trial. Matern Health Neonatol Perinatol. 2015 Dec 2;1:27). Thus, discoveries from the ELGAN Study are pointing the way to medical treatments that might someday prevent cerebral palsy and learning difficulties among children born at extremely low gestational ages.
Future newsletters, and postings on the ELGAN family website, will provide additional information about past and ongoing ELGAN Study discoveries.
1. Kuban KC, O'Shea TM, Allred EN, et al. Systemic inflammation and cerebral palsy risk in extremely preterm infants. J. Child Neurol 2014; 29:1692-1698.
2. O'Shea TM, Joseph RM, Kuban KC, et al. Elevated blood levels of inflammation-related proteins are associated with an attention problem at age 24 mo in extremely preterm infants. Pediatr Res 2014; 75:781-787.
3. Kuban KJ, RM; O'Shea, TM; Heeren, T; Fichorova, R; Douglass, L; Jara, H; Frazier, JA; Hirtz, D; Rollins, J; Paneth, N; Extremely Low Gestational AGe newborn (ELGAN) Study Investigators. Circulating inflammatory-associated proteins in the first month of life and cognitive impairment at age 10 years in children born extremely preterm. J Pediatr 2016; accepted.