Interview conducted by April Cashin-Garbutt, BA Hons (Cantab)
Please could you give a brief introduction to brain bleeds in premature babies?
Premature babies are born during their third trimester and they are vulnerable to having brain bleeds because their brains are not completely developed. There are some fragile blood vessels that are present in every developing infant, but when the babies are born early, these blood vessels can be subject to changes in blood pressure and changes in breathing patterns and, due to their fragility, they can develop a hemorrhage.
Why do brain bleeds occur once babies are born and not whilst they are in the womb?
Because when the babies are born they have more fluctuations in their blood pressure. They are also usually on a breathing machine. These things can cause changes that are not typically present inside the womb.
How common are brain bleeds in premature babies?
Somewhere between 10 and 20% of premature babies will develop a hemorrhage.
How does the risk of brain bleeds vary with the gestation period?
Babies born before 30 weeks of gestation are at a high risk of brain bleeds. The risk dramatically decreases after 30 weeks of gestation.
How did your research begin into the role of socio-economic factors in the risk of brain bleeds in premature babies?
While working in our hospital, I started taking care of a lot of infants. By exploring a bit on the babies’ home situations, I started realizing that perhaps these infants were not coming from families with the best support network in terms of their socio-economic status and family-support system. This caused me to investigate a little further, particularly because these infants require some very close monitoring and close follow-up after their treatment in the neo-natal stage. I found that some of these infants were not being brought back for regular follow-ups.
I explored this a bit further and looked into the trends in terms of socio-economic make-up. My hypothesis was that most of the babies who had brain bleeds were coming from lower socio-economic backgrounds and lower income households.
What did your research involve?
We looked at all the babies who had surgery for brain hemorrhages over the past 4 years and looked into:
their insurance status
where they lived
their pattern of follow-up appointments after their surgeries
What did your research find?
Our research found that most of the babies came from household which had incomes below the median for our state and for the country. Most of them also had public insurance rather than private insurance.
We also found that the families with public insurance tended to report to the emergency room more frequently as opposed to scheduled outpatient visits. To me that was significant, as it is a very costly way to follow up. When they have problems they are coming to the emergency room rather than attending the routine visits in our office, where we can sometimes detect problems before they get too far.
What impact do you think your research will have?
I think it emphasizes the fact that prematurity is a problem and that some of the consequences of prematurity are long lasting. Many of the infants who have had a brain hemorrhage need long term medical care and are also developmentally disabled.
Our work highlights that this condition disproportionally affects people that are under-privileged.
Do you have plans for further research into this area?
Yes. What we are doing now is looking at whether these trends are replicated on a national level. Our research has currently just been in our hospital.
We have access to a national hospital database looking at premature infants. We do have some preliminary results, but what we are essentially doing is broadening our analysis.
Where can readers find more information?
They can find our research paper here: http://content.karger.com/ProdukteDB/produkte.asp?typ=pdf&doi=342539
They can find more information about John Hopkins Medicine at: http://www.hopkinsmedicine.org/
About Edward Ahn
Edward Ahn, M.D. is a pediatric neurosurgeon at the Johns Hopkins Hospital. He completed his undergraduate studies at Harvard University and received his medical degree from the New York University School of Medicine. He then completed a residency in neurosurgery at the University of Maryland Medical Center and a fellowship in pediatric neurosurgery at the Childrens Hospital Boston, Harvard Medical School.
Now an Assistant Professor of Neurosurgery, Pediatrics, and Plastic Surgery at Johns Hopkins, Dr. Ahn provides surgical treatment to children for neurological disorders. His research focuses on brain hemorrhage in premature infants—its causes, treatments, and sociological factors.
Dr. Ahn was named among Baltimore Magazine’s Top Doctors in 2010 and 2011. He was awarded the 2010 Johns Hopkins Department of Neurosurgery Chairman’s Award for Excellence in Teaching. He is widely published in peer-reviewed journals, frequently guest-lectures at universities, and speaks at national and international conferences. His surgeries have been featured on NPR and NBC-affiliate WBAL-TV.