Biography
Dr. Inder is an Associate Professor of Pediatrics, Neurology, and Radiology as well as Neonatal Clinician at St. Louis Children’s Hospital, Washington University. She is noted as author, lecturer, and researcher in the field of the newborn brain. She was born and educated in New Zealand. She graduated with her Bachelor in Medicine and Bachelor in Surgery from the University of Otago, Dunedin, New Zealand as the top graduate in her class.
Dr. Inder completed her Residency in Pediatrics and Fellowship in Newborn Medicine in New Zealand as well as her Ph.D. in “Free Radical Mediated Injury in the Newborn” before undertaking a second residency in child neurology at Children’s Hospital in Boston.
She now leads an internationally recognized research team defining the timing of brain injury in premature and term born babies developing new technologies and interventions to improve long- term outcomes in high-risk infants. An increasing number of at-risk preterm and sick term born infants survive with high rates of neurodevelopmental disability.
In order to apply rational neuroprotective strategies her laboratory aims to define the timing and nature of injury at which to target such interventions as well as the impact of such injury on subsequent cerebral development. This is achieved with a large number of parallel clinical studies in a large 80 bed neonatal intensive care unit based at St. Louis Children's Hospital utilizing bedside technologies such as electroencephalography, optical tomography alongside advanced state of the art magnetic resonance imaging techniques in both the preterm and term born at risk infant. A multidisciplinary team of neonatal attendings, neurologists, radiologists, fellows, M.D./Ph.D. students, occupational therapists, research assistants and research nurses contribute to studies such as the impact of hypothermia and seizures on the injured brain, nature and timing of injury in the preterm brain, the impact of reservoir drainage in post-hemorrhagic hydrocephalus and the potential neuroprotective effect of maternal pomegranate. Dr. Inder is supported by the NIH with multiple R01 awards and is devoted to the training of the next generation of clinical investigators in her field.
Abstract
Understanding Brain Injury and Development in at Risk Infants to Improve Outcomes
Preterm birth is a major public-health challenge because of its increasing incidence combined with frequent occurrence of subsequent behavioral, neurological, and psychiatric challenges faced by surviving infants. To date, the underlying mechanisms responsible for the poor outcomes in these infants remain poorly understood. Neural progenitor or stem cells (NPCs) are known to reside in two regions of the developing brain— the subventricular zone (SVZ) and the hippocampus with the ability to produce new brain cells including neurons, astrocytes and oligodendrocytes in vivo and in vitro. This raises the potential of their role in recovery following brain injury. This potential may be even greater in the immature brain of an infant but has not yet been evaluated.
Thus, we propose to apply complementary magnetic resonance (MR) imaging approaches to detect and quantify the presence of the progenitor or native stem cell region within the preterm infant from shortly after birth until discharge from the hospital several months later. This will be carried out alongside complimentary advanced structural MR imaging to evaluate brain injury and development. The study design with repeated MR imaging of the infants throughout the infant’s course in the intensive care unit will allow characterization of the relationship of this region to both structural abnormalities and compensatory changes in response to early brain injury, perinatal exposures and intensive care therapies. The presence and extent of the progenitor cell region will also be related to neurodevelopmental outcomes in early childhood. If successful, the proposed studies will engender a deeper understanding of the innate neural recovery in the immature brain with in-vivo MR biomarkers of NPC region and its impact on subsequent regional brain structure and neurodevelopmental outcome. These data will assist in providing new understanding of neural recovery and strategies for improving outcomes in preterm infants. In addition, the MR techniques will be capable of being applied in-vivo to any infants at-risk of brain injury or altered brain development.