Now, research at Cincinnati Children’s Neurodevelopmental Disorders Prevention Center is showing that advanced imaging of preterm infants can identify those who are most likely to have specific developmental disorders such as cerebral palsy.

Diagnosing developmental disorders typically has to wait until at least age 2, after much of the brain’s plasticity—its early ability to adapt its structure and function—has been lost.

“It’s really a paradigm shift, because the current paradigm is that for newborns at high risk, we have to unfortunately wait until they're 2, 3 or even 5 years of age to know if they’re going to have developmental disorders," says neonatologist and director of the Center Nehal Parikh, DO, MS. “Babies can't tell you what's wrong with them, and from an examination standpoint, until 2 years of age, you can't even get a proper neurological exam that tells you a child has cerebral palsy.”

Parikh’s research focuses primarily on those born at 32 weeks or earlier. More preterm infants are surviving to childhood and adulthood, contributing to a higher prevalence of motor, cognitive, and behavioral or psychiatric abnormalities. 

“We know that most of these developmental disorders occur because of insults to their brain. Most of these insults occur after birth, but some of them occur even before birth,” Parikh says. “So with advances in neuroimaging, such as diffusion magnetic resonance imaging (MRI) or functional MRI, we can sensitively pick up these abnormalities. And a handful of researchers, including my team, have observed that these abnormalities are correlated with diagnoses like cerebral palsy and intellectual impairments.” 

Earlier diagnosis of developmental disorders could make a dramatic difference in a child’s future quality of life. Physical and occupational therapy, speech therapy and other interventions can begin in early childhood and even infanthood, while the child’s brain is rapidly growing and forming.  

“Right now, the paradigm is that we see these babies in the NICU Follow-Up clinic, and then we wait for them to have any early signs of delays, and if they have those delays, we'll start some therapies,” Parikh says. “But that strains the early intervention system, and some kids don't get sufficient therapies. Also, sometimes the right kids don't get them because not all of them show signs or the signs are very nonspecific. So, if we can use these advanced modalities combined with other tests to build prediction models to help identify problems soon after birth, that would basically give us years of early brain development and brain plasticity or malleability—not just knowing that this child is at risk, but also what the risk is, a motor problem versus a cognitive problem versus a behavioral problem.”

With early diagnosis, the child’s healthcare team could tailor aggressive therapy for that child’s specific needs to make the most of the window of opportunity during the brain’s most formative years. Intensive therapies and treatments could be reserved for those at highest risk, conserving vital resources. Even more exciting, early intervention could dramatically reduce symptoms and possibly even prevent some disorders.

“We hope to, at a minimum, reduce the severity of these disorders,” Parikh says. “At best, we could even prevent them. In some cases, we believe we can rewire the brain through targeted therapy and prevent even the development of disorders such as cerebral palsy.”