A magnetic resonance imaging scanner at Arkansas Children's Research Institute is so powerful, researchers say, that it will deactivate credit cards and send metal chairs flying.
But the super-strong magnets inside will help a Little Rock research team explore the mystery of what happens to children who are exposed to opioids in the womb.
Investigators Xiawei Ou and Ashley Acheson will lead a group that will join scientists from around the United States in a preliminary project, called a Phase I study, that dives into prenatal opioid exposure and the brain.
Findings gleaned from their work, including high-tech brain scans, will be used to test approaches for a forthcoming large-scale examination of opioid use and child development.
"There's been a huge increase in kids exposed to this, and we don't really know what the impacts are," said Acheson, who is also an associate professor of psychiatry at the University of Arkansas for Medical Sciences in Little Rock.
"It's a very ambitious and difficult project, but I think it's an important one."
Over the past two decades, a brush fire of opioid addiction has swept across the nation, causing turmoil in families and tens of thousands of overdose deaths.
Alongside those deaths, public health experts are beginning to catalog secondary and tertiary effects thought to be connected, such as infectious disease outbreaks from injectable drug use and a rise in foster care admissions.
Those ripple effects include more babies who show drug withdrawal symptoms when they're born, called neonatal abstinence syndrome. Its incidence in Arkansas has increased almost 15-fold since 2000, according to an Arkansas Department of Health report.
Now, scientists are eager to find out what will happen to those babies as they get older, given the rapid growth of a newborn's brain and past research on better-understood subjects such as prenatal exposure to alcohol.
"Any disruption during the pregnancy -- during the fetal brain development -- may have a profound effect," said Ou, who also is an associate professor of radiology and pediatrics at UAMS.
The Phase I study, Ou and Acheson say, will examine the feasibility of using various research techniques in the long-term project, which could include thousands of participants from several states.
Set to last 18 months, the initial work comprises building partnerships with doctors, and administrators over treatment programs and various agencies; developing assessments; and identifying small groups of children and pregnant women to study, including Arkansans.
The children's brains will be scanned using a state-of-the-art MRI tool that offers sophisticated results. That's set to include scans of fetal brains, which are taken during the third trimester of pregnancy.
Eventually, researchers will look at the scans for brain changes in such areas as how much energy the brain consumes; the extent of myelination (myelin wraps around neurons and helps conduct brain signals); and the thickness of the cerebral cortex, which aids with complex brain function.
MRI scanners have many applications in medicine, including looking for blood vessel damage, brain and spinal injuries, bone infections and cancer. They use magnetization to manipulate protons in the body's hydrogen atoms. Scientists can then track the signals generated by the particles' movements.
The research team will troubleshoot problems that could interfere with a large study, such as persuading infants and toddlers to remain still for several minutes inside a scanner that makes a loud noise.
If kids don't like going to the research site, that's an issue, Acheson said. The research team will gauge how best to recruit people to participate in the study and keep them returning so scientists can gather more data.
That won't be easy within a population dealing with substance use issues, they anticipate. Plans are to work with the UAMS Psychiatric Research Institute and Recovery Centers of Arkansas to connect with possible participants.
"These are very challenging populations to recruit and to retain, so that's really one of the main goals," Ou said.
"We definitely need to build trust between the research staff and the study participant."
ARKANSAS NEWBORNS
Hospitals around the country, including those in Arkansas, have become more vigilant about watching for newborns who may have been exposed to opioids, says Washington Regional Medical Center neonatologist Dr. Christine Culpepper.
For some infants, it can lead to neonatal abstinence syndrome, which is a general term encompassing all types of drug withdrawal in newborns. (Non-opioid narcotics and a few prescription medications can also cause the condition.)
Detecting neonatal abstinence syndrome starts with screenings by obstetricians, who take women's histories regarding alcohol, drug and tobacco use during pregnancy, Culpepper said.
"Moms tend to be pretty honest with it. ... They want what's best for their baby," she said.
"If we know that there was either illicit or prescribed drug use, then we basically tell the nurses, 'hey, this is something we need to watch for.'"
At St. Bernards Healthcare in Jonesboro, neonatologist Dr. Douglas Seglem said he hears of a few possible cases of the syndrome each week. At least one baby a month is offered pharmacological treatment (generally methadone, morphine or buprenorphine) to ease opioid withdrawal symptoms.
Newborns who were exposed to opioids are often "very irritable," have trouble eating and sleeping, experience gastrointestinal problems, have tremors or even convulsions, said Seglem, who is also an associate professor at UAMS.
Babies whose symptoms aren't severe enough to need treatment with medication are placed in calming environments with low light, minimal noise, frequent feeds and swaddling.
Seglem said research will help explain more about the long-term effects of prenatal opioid exposure, but some literature has suggested links to problems like behavioral disorders, such as attention-deficit (hyperactivity) disorder (ADHD). The root cause of such disorders remains undetermined.
"How much of that attentiveness and learning [difference] is due to their environment and how much is due to drug exposure when they were fetuses in the womb -- [it's] hard to separate that out," he said.
NEXT STEPS
The Arkansas research team was awarded more than $516,000 for the study organized through the National Institutes of Health, part of more than 300 grants across 41 states meant to spur scientific advances around opioid addiction.
Academics working directly with the Arkansas group will come from Duke University, Cincinnati Children's Hospital, the University of Illinois at Urbana-Champaign and the University of North Carolina at Chapel Hill.
Arkansas team members will soon travel to Chicago to meet with a consortium of researchers there.
The Phase I and projected Phase II projects make up an initiative called the HEALthy Brain and Child Development Study. The larger effort is to launch in 2021 to follow families for a decade.
For this work, Ou said he's looking forward to the neural imaging component. It's possible that kids' brains are forming differently even when symptoms aren't apparent, he said.
Acheson said his interest in the project came from past work studying families affected by addiction. The scientific community is still learning how drug use, environment, adverse experiences and innate differences interact, he added.
"There's the opioid use disorders now, but then there's the kids and what's going to happen with this next generation," Acheson said.
"I think this project can hopefully shed some light on those things."
Metro on 10/13/2019