The air is cool in the MRI room. The equipment is so loud that anyone undergoing a scan has to wear hearing protection. It is an inhospitable environment for small babies.
Until now, the smallest and most vulnerable babies have not been able to undergo MRI scans, partly because of the risk of their body temperature falling dangerously low during the examination. But for the past few months, Link枚ping has had a specially designed incubator that opens up new possibilities.
Thor Balkhed
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Unlike ordinary incubators, it can be passed through a magnetic resonance scanner, used for magnetic resonance imaging, or MRI.
Jenny Wid茅n
There is only one other MRI-compatible incubator in Sweden, and just a handful in Europe.
鈥淲ith the help of the incubator, we can now perform MRI scans even on babies who are born extremely prematurely. This hasn鈥檛 been possible before. We are very grateful for the donation that made this incubator possible and allows us to develop new research,鈥� says Ulrika 脜d茅n, professor in paediatric medicine and consultant in neonatal care, or neonatology.
When the brain gets off to a tough start
She researches brain development, particularly in children who were critically ill as newborns. Babies born extremely prematurely leave the protected environment of their mother鈥檚 womb more than three months too early. Their organs are immature. To have a chance of surviving, they need intensive care.
鈥淪wedish healthcare has become better at helping the smallest babies survive, but we haven鈥檛 become equally good at creating good conditions for brain development. That is a knowledge gap,鈥� says Ulrika 脜d茅n.
Support at the right time
The research group follows the children鈥檚 development in order to identify at an early stage any need for support with, for example, language, motor skills or communication. For Ulrika 脜d茅n, timing is central.
鈥淭here鈥檚 a view that it鈥檚 good to wait and see how it goes, because you don鈥檛 want to worry the parents. We think that when a child has been this ill, you need to be a little more alert and provide support early,鈥� she says.
Ulrika 脜d茅n has research groups at both Link枚ping University and Karolinska Institutet, which follow different groups of children. The researchers have followed one group for more than 20 years, thereby increasing their understanding of factors that affect early brain development.
Sensory input shapes the brain
The newborn brain develops through sensory input, both in the womb and during the period when the baby would otherwise still have been there.
Thor Balkhed
The researchers therefore work with early interventions in which interaction between parents and their children plays a central role. All neonatal units support parents in having skin-to-skin contact with their baby. Talking and singing to the baby are other examples of activities that can contribute to brain development. The researchers鈥� support programme helps parents recognise their child鈥檚 signals and encourage them to communicate.
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The brain and blood circulation are interconnected
The researchers also want to be able to predict which children will experience difficulties, so that they can provide support even earlier. One of the doctoral students in the research group, Martin Sturm, wants to improve understanding of how circulation works in premature babies and how it may affect brain development.
Thor Balkhed
As long as the baby is in the mother's womb, all oxygenation of the blood takes place in the placenta. The lungs are not used. At birth, the body undergoes an enormous transformation as it adapts to life outside the womb. The first breath is said to be the hardest we take in life. If everything goes as it should, the baby begins to breathe through its lungs. During the first few minutes, the baby鈥檚 blood circulation changes. Martin Sturm is particularly interested in a blood vessel that exists only during foetal development. It forms a kind of shortcut that carries blood past the lungs, which are not yet functioning.
鈥淚n almost all full-term babies, this vessel closes during the first week after birth. But in premature babies, it can remain open for much longer,鈥� says Martin Sturm, who is also a consultant at the neonatal unit at Link枚ping University Hospital.
When blood takes a shortcut
If the foetal blood vessel remains open, it can cause problems because blood also flows to the lungs through this route. This can lead to lung problems. The heart has to work too hard and the baby may develop heart failure.
鈥淩ecirculation through the foetal blood vessel also affects blood flow to the brain and other organs, but there are many questions about how best to manage this. We don鈥檛 know what can be considered normal and what has negative long-term effects on these babies,鈥� says Martin Sturm.
Thor Balkhed
The researchers hope to answer these questions with the help of the MRI-compatible incubator. The incubator keeps the baby warm and safe during transport from the neonatal unit. The entire incubator travels through the MRI scanner, so there is no need for any risky transfers of these vulnerable babies outside the neonatal unit.
The researchers work closely with LiU colleague Professor Tino Ebbers, who has developed new methods for studying blood flow. They hope to use these methods even with the smallest babies, to see how blood flows to different organs during a single heartbeat. This provides insight into how the baby鈥檚 body prioritises the supply of blood to the brain and other organs under different conditions.
鈥淚 hope that by gaining a better understanding of the children鈥檚 physiology, we will eventually be able to support them with appropriate interventions when needed, to give them optimal conditions for development,鈥� says Martin Sturm.
From survival to a good life
Ulrika 脜d茅n has worked in paediatric medicine for 25 years. During that time, the healthcare system has been able to save the lives of ever smaller babies. With each passing decade, the threshold for survival has been moved back by around a week.
Jenny Wid茅n
鈥淏abies born at 22 weeks can now survive. There鈥檚 been great joy in being able to save ever smaller babies. In recent years, the focus has shifted more towards how these children fare. It鈥檚 no longer just about babies surviving, but also about going on to live healthy lives.鈥�
The MRI-compatible incubator was funded with support from the Joanna Cocozza Foundation for Children's Medical Research.
