Ruth Grunau

Dr. Ruth Grunau’s multidisciplinary research program addresses the etiology of problems in cognition, executive functions, self-regulation and behavior in children born very preterm (<33 weeks gestation). Specifically, she investigates the role of neonatal pain-related stress in abnormal neurobehavioral development in this vulnerable population. During the late second and third trimesters of fetal life these infants are ex-utero, exposed to developmentally unexpected environmental stimulation, during a critical period of rapid brain development and programming of stress systems. During weeks to months hospitalized in neonatal intensive care, they undergo repetitive pain/stress (~10 invasive procedures per day). Her landmark longitudinal cohort studies established that repetitive procedural pain/stress in very preterm neonates (after accounting for clinical confounders of prematurity), is associated with altered brain microstructure and function in the neonatal period – still evident at school age. Together with experts in neuroimaging, her work shows the importance of early pain/stress in altered thalamic growth and thalamocortical development. At age 8 years, reduced cortical thickness, smaller cerebellar subregional volumes and changes in spontaneous cortical oscillations were linked to greater early pain/stress exposure, and thereby to functional outcomes including working memory and IQ. Moreover, she has found that neonatal pain/stress during this vulnerable window in very preterm neonates is associated with altered programming of the hypothalamic-pituitary-adrenal (HPA) axis indexed by cortisol levels, potentially important for brain function. Currently, her research includes examining short and long-term effects of pharmacologic pain management in neonatal care on brain development and outcomes.