Publications

Neonatal pain, stress, and neurobehavioral outcomes

Neonatal Sucrose and Internalizing Behaviors at 18 Months in Children Born Very Preterm
This study looked at whether early-life pain and the use of oral sucrose for pain relief in the NICU affect toddler behavior in children born very preterm. Researchers followed 192 children and reviewed detailed NICU records, including how many painful procedures each infant experienced and how much sucrose they were given.

They found that sucrose use was not linked to behavior at 18 months, but infants who went through more painful procedures showed slightly higher levels of anxiety-related behaviors as toddlers. Sucrose did not appear to lessen the long-term impact of early pain.
The findings suggest the need for better pain-management strategies in the NICU that not only help during procedures but also support children’s long-term emotional development.

McLean MA, Ranger M, Bone JN, Selvanathan T, Au-Young SH, Chau CMY, Chau V, Ly L, Kelly E, Synnes A, Miller SP, Grunau RE. Neonatal Sucrose and Internalizing Behaviors at 18 Months in Children Born Very Preterm. JAMA Netw Open. 2025 Apr 1;8(4):e254477. doi: 10.1001/jamanetworkopen.2025.4477. PMID: 40208592; PMCID: PMC11986768

Preterm 

Associations of Bronchopulmonary Dysplasia and Infection with School-Age Brain Development in Children Born Preterm
This study examined how bronchopulmonary dysplasia (BPD) and early infections affect brain development and learning in children born very preterm. A group of 164 children was followed to age 8, when they completed cognitive, memory, motor, and visual-motor tests along with brain imaging.

The results showed that BPD was linked to poorer motor and visual-motor skills, while early infections were linked to lower IQ and weaker working memory. Brain scans revealed different patterns of white-matter changes for each condition, helping explain the specific difficulties children experienced.

The study shows that early medical complications affect the developing brain in distinct ways, highlighting the importance of targeted support and interventions for children born preterm.

Kim C, Ufkes S, Guo T, Chau V, Synnes A, Grunau RE, Miller SP. Associations of Bronchopulmonary Dysplasia and Infection with School-Age Brain Development in Children Born Preterm. J Pediatr. 2025 Jun;281:114524. doi: 10.1016/j.jpeds.2025.114524. Epub 2025 Feb 27. PMID: 40023219.

Punctate White Matter Abnormality in Moderate-to-Late Preterm Infants
This study examined how common white matter abnormalities are in moderate-to-late preterm infants, a group that makes up the largest share of preterm births but is often overlooked in brain-development research. Researchers followed 101 infants who received brain MRI scans soon after birth and again around their due date.

They found that white matter abnormalities were much more common than expected, appearing in about 40% of infants. Many of these abnormalities became smaller or harder to see by the later scan, meaning they may be easily missed if imaging is only done at term-equivalent age. The abnormalities also followed a consistent pattern, most often appearing in the back of the brain.
These findings suggest that early MRI may be important for detecting subtle brain injuries in moderate-to-late preterm infants and that more research is needed to understand how these findings relate to later development.

Kennedy E, Guo T, Williams S, Selvanathan T, Alsweiler JM, Bloomfield FH, Battin M, Dubowitz D, Miller SP, Morgan C, Perry D, Stott NS, Harding JE; MR DIAMOND and MoPED Study Groups. Punctate White Matter Abnormality in Moderate-to-Late Preterm Infants. Ann Neurol. 2025 Aug;98(2):329-340. doi: 10.1002/ana.27261. Epub 2025 Jun 9. PMID: 40488346; PMCID: PMC12278191.

Association of Early-Life or Term-Equivalent White Matter Injury With Neurodevelopmental Outcomes in Very Preterm Infants
This study examined whether brain injuries seen on MRI soon after birth or at term-equivalent age are better at predicting later development in children born very preterm. Researchers followed 393 infants who received two MRI scans in the NICU and later completed developmental testing at 3 years of age.

They found that white matter injuries detected shortly after birth, especially injuries located at the front of the brain, were linked to higher odds of delays in thinking and motor skills at age 3. These associations were not seen on the later MRI done around the time the baby would have reached full term.

The findings suggest that MRI scans done early in the NICU may offer more useful information for identifying which infants are at higher risk for developmental challenges and may benefit from earlier support and intervention.

Selvanathan T, Oloomi S, Guo T, Ufkes S, Chau V, Branson H, Synnes A, Ly LG, Kelly EN, de Vries LS, Grunau RE, Miller SP. Association of Early-Life or Term-Equivalent White Matter Injury With Neurodevelopmental Outcomes in Very Preterm Infants. Neurology. 2025 Sep 9;105(5):e214016. doi: 10.1212/WNL.0000000000214016. Epub 2025 Aug 20. PMID: 40834343.

Cumulative caffeine exposure predicts neurodevelopmental outcomes in premature infants
Caffeine is commonly given to premature babies to help with breathing, and it may also support brain development. This study found that preterm infants who received higher overall caffeine exposure in the NICU had better motor, language, and thinking skills at 30 months of age. They were also less likely to have developmental delays. These benefits were seen even after accounting for how early babies were born and how sick their lungs were. Caffeine dose was not linked to differences seen on early brain MRI, suggesting benefits may occur in other ways. The findings suggest that higher or longer caffeine treatment might help brain development, but more research is needed to guide dosing.

Ostrem BEL, Odell E, Grelli KN, Kramer K, Chan N, Jiang F, Xu D, Barkovich AJ, Barkovich MJ, Ferriero DM, Gano D. Cumulative caffeine exposure predicts neurodevelopmental outcomes in premature infants. Pediatr Res. 2025 Sep 20. doi: 10.1038/s41390-025-04387-1. Epub ahead of print. PMID: 40975732.

Fetal neurology

Neonatal neurocritical care considerations for prenatally identified neurological disorders
Better prenatal scans and genetic tests mean more babies are diagnosed with brain conditions during pregnancy. This review explains how doctors care for these newborns before and after birth. Planning includes where delivery should happen and making sure the right specialists are available. After birth, babies may need detailed exams, brain monitoring, imaging, and genetic testing. Care involves a large team, including obstetricians, neonatologists, neurologists, radiologists, genetic specialists, palliative care, and early intervention providers. The authors also point out that we still do not fully understand how many of these conditions progress over time. They call for large, long-term studies across different populations to improve counseling, treatment planning, and outcomes for families.

Gano D, Boardman JP, Agarwal S, Venkatesan C, Tarui T, Chau V, Wusthoff CJ, Lemmon ME, Scelsa B, Vollmer B, Mulkey SB, Scher MS, Hart AR, Peeples ES, Nakwa F, Molloy E, Pardo AC; Newborn Brain Society Guidelines and Publications Committee. Neonatal neurocritical care considerations for prenatally identified neurological disorders. Pediatr Res. 2026 Jan 7. doi: 10.1038/s41390-025-04691-w. Epub ahead of print. PMID: 41501412.

Fetal Intraparenchymal Hemorrhage Imaging Patterns, Etiology, and Outcomes: A Single Center Cohort Study
This study looked at babies diagnosed before birth with bleeding inside the brain using fetal MRI. Researchers examined imaging patterns, possible causes, and long-term outcomes. In most cases, a cause was identified, often twin-to-twin transfusion syndrome, genetic changes, or other maternal or fetal conditions. Certain MRI patterns were linked to specific causes. Among babies who were born and followed over time, many developed motor disabilities such as cerebral palsy or other developmental challenges. The findings show how important detailed fetal brain imaging is for understanding what caused the bleeding and what it may mean for a child’s future. The study also supports genetic testing when no clear cause is found.

Vassar R#, George E#, Mogga A, Li Y, Norton ME, Glenn O*, Gano D*. Fetal Intraparenchymal Hemorrhage Imaging Patterns, Etiology, and Outcomes: A Single Center Cohort Study. Ann Neurol. 2024 Dec;96(6):1137-1147. doi: 10.1002/ana.27072. Epub 2024 Aug 31. PMID: 39215698. #Contributed equally. *Contributed equally.

Hypoxic-Ischemic Encephalopathy (HIE)

Maternal Social Determinants of Health and Risk of Perinatal Hypoxic-Ischemic Encephalopathy
This large study explored whether a mother’s social and neighborhood conditions are linked to the risk of hypoxic-ischemic encephalopathy (HIE), a serious brain injury caused by low oxygen around birth. Surprisingly, babies born to Hispanic mothers had a lower risk of HIE than those born to non-Hispanic White mothers, even after accounting for insurance type, neighborhood disadvantage, and medical factors. Living in more socioeconomically disadvantaged neighborhoods was also linked to a lower risk. These unexpected findings suggest there may be protective factors in some communities that we do not yet understand. Learning what drives these differences could help guide new strategies to prevent HIE and improve newborn brain health.

Gano D, Kuzniewicz MW, Montoya-Williams D, Scheffler A, Fuentes-Afflick E, Wu YW, Cornet MC. Maternal Social Determinants of Health and Risk of Perinatal Hypoxic-Ischemic Encephalopathy. JAMA Neurol. 2025 Jun 16. doi: 10.1001/jamaneurol.2025.1659. Epub ahead of print. PMID: 40522653.

Early Magnetic Resonance Imaging Predicts 30-Month Outcomes after Therapeutic Hypothermia for Neonatal Encephalopathy
Therapeutic hypothermia, or cooling therapy, is used to protect the brain after certain birth-related injuries. This study shows that brain MRI done in the first week of life remains a strong tool for predicting development at 30 months of age. Babies who received cooling therapy had better motor and thinking outcomes overall. Importantly, MRI was just as good at predicting outcomes in babies who received cooling as in those who did not. When the early MRI looked normal, most children went on to have normal motor and cognitive development. These results support using early MRI to guide prognosis and help families understand what to expect.

Bach AM, Fang AY, Bonifacio S, Rogers EE, Scheffler A, Partridge JC, Xu D, Barkovich AJ, Ferriero DM, Glass HC, Gano D. Early Magnetic Resonance Imaging Predicts 30-Month Outcomes after Therapeutic Hypothermia for Neonatal Encephalopathy. J Pediatr. 2021 Nov; 238:94-101.e1. PMID: 34237346.

Ongoing Studies

Adolescent HIE: Adolescent Brain Health After Neonatal Encephalopathy
This study follows teens who were diagnosed with neonatal encephalopathy as newborns. By repeating MRI scans and developmental testing in adolescence, we aim to understand how early brain injury shapes long-term brain health, learning, and motor skills.

We’ll compare newborn MRI findings with brain structure and connectivity in adolescence, and link these results to cognitive, motor, and language outcomes. The goal is to identify early markers that predict long-term development and to help improve follow-up care and intervention strategies for children affected by neonatal encephalopathy.

Adolescent CHD: Brain and Cognitive Health in Teens with Congenital Heart Disease
This study follows adolescents who were born with transposition of the great arteries or single ventricle physiology. By combining MRI scans, cognitive testing, and questionnaires, we aim to understand how early heart surgery and lifelong CHD impact brain development, learning, and well-being in the teenage years.

We’ll link clinical history with brain structure, connectivity, and thinking skills to identify factors that shape long-term outcomes. The goal is to improve follow-up care and support for youth growing up with CHD.