ELGAN 2 Study Results

Participants were 10 years of age

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.

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 full list of all ELGAN Study-related publications can be seen here.

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:

  1. 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.
  2. 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
  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.
  4. We 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.
  5. 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.4 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.

  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(12):1692-1698. doi:10.1177/0883073813513335l 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(6):781-787. doi:10.1038/pr.2014.41
  3. Kuban KC, Joseph RM, O’Shea TM, et al. Circulating Inflammatory-Associated Proteins in the First Month of Life and Cognitive Impairment at Age 10 Years in Children Born Extremely Preterm. J Pediatr. 2017;180:116-123.e1. doi:10.1016/j.jpeds.2016.09.054
  4. Juul SE, Mayock DE, Comstock BA, Heagerty PJ. Neuroprotective potential of erythropoietin in neonates; design of a randomized trial. Matern Health Neonatol Perinatol. 2015;1:27. Published 2015 Dec 2. doi:10.1186/s40748-015-0028-z