Baby Brain and Feeding

Can we determine feeding ability of newborns by imaging their brain?

In this publication our purpose was to investigate the use of magnetic resonance imaging (MRI) as a tool for assessing how a baby would develop feeding capabilities. Feeding capability, or lack thereof, is an issue when babies are born before completing 37 weeks of pregnancy, also known as preterm. The reason why this is a problem is because at preterm the brain (cerebrum and cerebellum) is not fully developed. Meaning, for example, if the baby is born around 35 weeks, the brain, an organ which essentially controls our body and senses, still needs time to grow in size and function. Ideally, 39 weeks is best for a healthy pregnancy. Other organs needing time to fully develop are the lungs and liver. Thus, consequences of early birth include: breathing, hearing and vision problems as well as developmental delay and cerebral palsy. For the babies born preterm, they are immediately placed in infant incubators in an effort to minimize stimulation and replicate the mother’s womb. The good news for those trying to get pregnant is that there are ways to prevent premature births which mainly consist of being conscious of lifestyle and possibly modifying habits. More on this in the future.

Depending on the severity of the feeding problem, the baby is either fed orally (by mouth) or by gastrostomy. Gastrostomy is a procedure which consists of inserting a tube (G-Tube) into the baby’s stomach because they are not able to feed orally. Not being able to feed through the mouth can be life threatening especially if the parents are unaware that their baby has feeding difficulties. Swallowing difficulties, also known as dysphagia, can cause the baby to choke on milk or other liquids/food.

In some cases, the reason causing the swallowing difficulty is quite obvious like a brain lesion, damage in the brain. In other cases, no obvious lesion is seen in brain imaging scans such as MRI. Since this is the case, we ask the question. If brain scans do not necessarily indicate that a baby may or may not have dysphagia, then how can they indicate the progress, or outcome, of treatment and therapy? To answer this question an extensive investigation of data from forty-three babies was performed in this study. The qualitative aspect included visual inspection the brain images. The quantitative (measuring size, area and volume) assessment included different regions of the brain as well as additional clinical data for the overall calculations and assessment.

At the end of the study we found some differences between cerebrum and cerebellum size between babies who were orally versus G-Tube fed. However, lesions were not related to swallowing capability. Meaning, a baby could have a big lesion in their brain and have no swallowing disorder while other babies could have no brain lesions and have a swallowing disorder. So, an MRI was not indicative of brain function or dysfunction. To better understand this function or lack thereof we needed to introduce a different type of brain scan. An ideal technology for performing this on these infants is functional near infrared spectroscopy (fNIRS) as we have demonstrated in our other publications listed below.

1.       Nasser Kashou, Dar, Hasenstab, Nahhas, Jadcherla. Somatic stimulation causes fronto-parietal cortical changes in neonates: an fNIRS study. Neurophotonics. 4(1), 011004 (2016). 

2.       Nasser Kashou, Giacherio, Nahhas, Jadcherla. Hand Grasping and Finger Tapping Induced Similar fNIRS Cortical Responses. Neurophotonics, 3 (2) 025006, (2016). 

3.       Nasser Kashou, Giacherio, Optode Placement Effects on fNIRS of Visual Cortex. Neurophotonics, 3 (2) 025005, (2016). 

4.       Jadcherla, Pakiraih, Hasenstab, Dar, Gao, Bates, and Nasser Kashou. Esophageal Reflexes Modulate Fronto-Parietal Cerebral Cortical Response in Neonates: Novel Application of Concurrent fNIRS and Provocative Esophageal Manometry. Am J Physiol Gastrointest Liver Physiol. 2014 May 1.