An interdisciplinary fetal neonatal neurology collaborative promotes integrative life-course brain health

Abstract

A proposed interdisciplinary fetal neonatal neurology collaborative offers life-course brain health training across three time-sensitive teaching opportunities. The educational organization includes a broad representation of inter-related fields. Formal training will re-enforce career-long learning that fosters creative thinking. Acquiring a life-course perspective of brain health can contribute solutions to the global public health crisis involving neurological and mental health disorders across the lifespan. Teaching transdisciplinary interventions begins with parental childhood and reproductive health which will influence the maternal-placental-fetal triad throughout pregnancy into labor and delivery. The second teaching opportunity focuses on the symptomatic minority who receive neonatal neurocritical care and convalescent care. The third educational cluster focuses on improving clinical skills as the unrecognized majority of children present over the preschool years with continued development through the school years. Teaching preventive neurology and mental health introduce proactive interventions that more effectively support rescue and reparative choices into adulthood. The science of uncertainty will be taught to all stakeholders that integrates information to improve critical thinking skills. This tripartite interdisciplinary educational program will help trainees distinguish adverse effects from neurodegeneration on primary fetal neuroplasticity mechanisms from secondary pathways based on systems-science. Supervised clinical experiences during each rotation will supplement didactic teaching with input from each trainee's mentoring committee. Future providers will learn to anticipate adaptive from maladaptive disease pathways to prepare for career-long experiences. Curriculum topics will focus on brain health strategies that differentiate resilience from vulnerability based on time-dependent gene-environment interactions. Attention to structural, social and environmental drivers of health will incorporate intersectionality perspectives into equitable neuroprotective plans. Training will engage, educate and empower women to improve brain health for themselves and their children. This interdisciplinary collaborative program will apply real-world situations to encourage research development that will narrow the knowledge-practice gap. Continuity of brain care bundles will enable providers, women, and their families to achieve brain health across each and successive generations. A lower global burden of neurologic and mental health disorders will contribute to an improved quality of life with greater economic prosperity.

Keywords: fetal-neonatal neurology; intersectionality; life-course brain health; neural exposome; transdisciplinary care.

Figure 1

(A) A pictorial representation of the human life cycle depicts the dynamic interactions that connect developmental and aging processes. Representative images begin with the fertilized ovum and blastocyst, continuing through embryonic and fetal development. Following birth, images of the life cycle of women and their partners follow developmental and aging time periods are offered that will be repeated across successive generations [modified from (12)]. (B) Healthy (green color) women’s health practices help reduce unhealthy (red color) health choices over women’s life cycle for themselves and their children. Parent’s childhood health influences reproductive, pregnancy, childhood and adult health with intergenerational effects. Endogenous and exogenous toxic stressor interplay through gene–environment interactions is tracked across each life cycle with adaptive and maladaptive neuroplasticity expressions. GDM, gestational diabetes; GWS, gestational weight gain: PCOS, polycystic ovarian syndrome; T1, first trimester; T2, second trimester; T3, third trimester [modified from (11)].

Figure 2

Interlocking puzzle pieces represent synergy among three integrated clusters of a proposed IFNNC. Time-sensitive approaches will enhance life-course brain health. Knowledge of toxic stressor interplay considers combined effects of the internal exposome comprised of biological factors with the external exposome represented by environmental factors. Primary and subspecialty providers partnering with parents include physicians, nurses, midwives, therapists, doulas, social workers, child-life specialists and family advocates. Brain care bundles adjust to the child’s health and disease initially over the first 1,000 days with collective input among disciplines. Perinatal pathologists for example benefit from consultation with neuropathology and neuroembryology colleagues. Engineers and computer science experts offer artificial intelligence with machine learning to assist epidemiologic and statistical investigations for research and public health policy efforts. Shared decisions with patients and families introduce humanistic and ethics-based values through storytelling applied to transdisciplinary care with agency. Transition after formal education with career-long experiences by providers strengthen neurologic and mental health outcomes. Adult neurology and mental health provider membership with a proposed IFNNC maintain important developmental origins of health and disease perspectives during each person’s workplace experiences through retirement and senescence. Diagnostic and neurotherapeutic choices across the lifecycle benefit from this proposed IFNNC approach for life-course brain health [modified from (111, 128)].