Modeling Prematurity

NeuroLogic
Summer 2016

Shenandoah Robinson, MD

Shenandoah “Dody” Robinson, MD

Faced with the choice of any specialty during her medical training, Shenandoah “Dody” Robinson decided to pursue neurosurgery because it was the one most closely associated with what it means to be human. “It’s tremendously rewarding and a real privilege to be able to help people optimize their ability to communicate and move, all by using surgical techniques,” she says.

Working with children is an additional honor, she adds. After meeting her young patients in the clinic, hospital or even neonatal intensive care unit, she often follows them throughout their development. Consequently, maximizing their outcome doesn’t mean just getting them through to the other side of an acute illness, she says—it’s more about giving them the best chances to succeed as they grow. In her clinical practice, Robinson specializes in the surgical treatment of epilepsy and spasticity. These disorders often arise from early events that impact development and affect all aspects of a child’s life, including socialization, education and family interactions.

As a new member of the Johns Hopkins Department of Neurosurgery faculty, in addition to her clinical skills, Robinson will be bringing with her the long-running research program she’s developed to understand how to optimize the recovery of the developing brain after early insults. Toward that goal, she and her colleagues have developed several animal models to recapitulate prenatal injury that can lead to epilepsy, spasticity and related disorders. Recently, the team reported a model that replicates many of the deficits seen in children with encephalopathy of prematurity, an umbrella term that encompasses central nervous system abnormalities associated with preterm birth. By inducing transient systemic hypoxia-ischemia through uterine artery occlusion and placental inflammation with intra-amniotic lipopolysaccharide injections midgestation, the researchers found that the resulting offspring displayed central nervous system damage with characteristic white matter, gait and imaging abnormalities reminiscent of children born extremely preterm.

This and other models the team works with have allowed them to gain insight into which prenatal insults are responsible for various injuries and also what treatments might be effective in alleviating them. For example, numerous studies led by Robinson have shown that erythropoietin, the glycoprotein hormone responsible for red blood cell production, also has a neuroprotective function, supporting the genesis, survival and differentiation of neurons and oligodendrocytes. Although this hormone is already in phase III clinical trials for infants born before 28 weeks gestation, it’s unclear which other neonates and infants might benefit from its use and how dosing needs to be tailored to particular conditions. Robinson and her team are currently trying to answer these questions in the lab.

Robinson collaborates with a variety of specialists, including pediatric neurologists, developmental pediatricians, orthopaedic surgeons and others, and hopes that her research findings will help each child achieve his or her best long-term outcome. “Maximizing the child’s comfort, independence and function,” she says, “is our primary goal.”

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