Dr. Sarah Dubner completed her undergraduate degree at Tufts University, where she majored in Physics. During medical school at the University of Pennsylvania, her interest in epidemiology and clinical research led her to study bone health in children with chronic disease. Following residency, Dr. Dubner practiced as a general pediatrician in the Stanford Divisions of Neonatal and Developmental Medicine and Developmental-Behavioral Pediatrics where she cared for preterm and other high-risk neonates and children in the neonatal intensive care units, developmental evaluation and follow up clinics, and neurodevelopmental foster care clinics. In 2017, she entered subspecialty training as a clinical fellow in Developmental-Behavioral Pediatrics. In fellowship, she conducts clinical research focused on diffusion MRI tractography measures of brain white matter microstructure and neurodevelopmental outcomes in children born preterm, under the mentorship of Dr. Heidi Feldman.
- Developmental-Behavioral Pediatrics
Honors & Awards
Pediatric Research Loan Repayment Program Award, National Institutes of Health (2018-2020)
Tashia and John Morgridge Endowed Postdoctoral Fellow, Clinical Trainee Research Award, Stanford Maternal Child Health Research Institute (2018-2020)
Young Investigator Travel Award, Pediatric Academic Societies (2019)
Research Grant Award, Society for Developmental-Behavioral Pediatrics (2019-2021)
Residency, University of Washington, Seattle Children's Hospital, Pediatrics (2011)
Medical Education, University of Pennsylvania, School of Medicine (2008)
Undergraduate, Tufts University, Physics (2000)
Current Research and Scholarly Interests
Dr. Dubner seeks to understand how early-life experiences impact children's developing brain connections in order to design interventions to promote healthy developmental trajectories. Prior to fellowship, she practiced as a general pediatrician caring for preterm and other high-risk neonates and children in the Stanford neonatal intensive care units, developmental evaluation and follow up clinics, and neurodevelopmental foster care clinics. As a fellow in Developmental-Behavioral Pediatrics, her current projects focus on the role of perinatal inflammation in brain white matter microstructure and neurodevelopmental outcomes in children born preterm.
White matter microstructure and cognitive outcomes in relation to neonatal inflammation in 6-year-old children born preterm.
2019; 23: 101832
Cognitive outcomes in preterm (PT) children have been associated with microstructural properties of white matter. PT children who experienced neonatal inflammatory conditions have poorer cognitive outcomes than those who did not. The goal of this study was to contrast white matter microstructure and cognitive outcomes after preterm birth in relation to the presence or absence of severe inflammatory conditions in the neonatal period.PT children (n = 35), born at gestational age 22-32 weeks, were classified as either PT+ (n = 12) based on a neonatal history of inflammatory conditions, including bronchopulmonary dysplasia, necrotizing enterocolitis or culture positive sepsis, or PT- (n = 23) based on the absence of the three inflammatory conditions. Full term (FT) children (n = 43) served as controls. Participants underwent diffusion MRI and cognitive testing (intelligence, reading, and executive function) at age 6 years. The corpus callosum was segmented into 7 regions using deterministic tractography and based on the cortical projection zones of the callosal fibers. Mean fractional anisotropy (FA) and mean diffusivity (MD) were calculated for each segment. General linear models with planned contrasts assessed group differences in FA, MD and cognitive outcomes. Pearson correlations assessed associations of white matter metrics and cognitive outcome measures.FA was significantly lower and MD was significantly higher in PT+ compared to PT- or FT groups in multiple callosal segments, even after adjusting for gestational age. Executive function scores, but not intelligence or reading scores, were less favorable in PT+ than in PT- groups. Among the entire sample, occipital FA was significantly correlated with IQ (r = 0.25, p < 0.05), reading (r = 0.32, p < 0.01), and executive function (r = -0.28, p < 0.05) measures. Anterior frontal FA and superior parietal FA were significantly correlated with executive function (r = -0.25, r = 0.23, respectively, p < 0.05).We observed differences in the white matter microstructure of the corpus callosum and in the cognitive skills of 6-year-old PT children based on their history of neonatal inflammation. Neonatal inflammation is one medical factor that may contribute to variation in long-term neurobiological and neuropsychological outcomes in PT samples.
View details for PubMedID 31075555
- White matter microstructure and cognitive outcomes in relation to neonatal inflammation in 6-year-old children born preterm NEUROIMAGE-CLINICAL 2019; 23
Longitudinal Assessment of Bone Density and Structure in an Incident Cohort of Children With Crohn's Disease
2009; 136 (1): 123-130
The impact of childhood Crohn's disease (CD) on volumetric bone mineral density (vBMD), bone structure, and muscle mass have not been established. The objective of this longitudinal study was to assess musculoskeletal outcomes in an incident cohort of children with CD using peripheral quantitative computed tomography (pQCT).Tibia pQCT was performed in 78 CD subjects (ages, 5-18 years) at diagnosis and in 67 over the subsequent year. pQCT outcomes were converted to sex- and race-specific z scores based on reference data in over 650 controls. Multivariable linear regression models identified factors associated with changes in bone outcomes.At diagnosis, CD subjects had significant deficits in trabecular vBMD (z score, -1.32+/-1.32; P< .001), cortical section modulus (a measure of bone geometry and strength) (z score, -0.44+/-1.11; P< .01), and muscle (z score, -0.96+/-1.02; P< .001) compared with controls. Over the first 6 months, trabecular vBMD and muscle z scores improved significantly (both, P< .001); however, section modulus worsened (P= .0001), and all 3 parameters remained low after 1 year. Increases in muscle z scores were associated with less severe declines in cortical section modulus z scores. Improvements in trabecular vBMD z scores were greater in prepubertal subjects. Glucocorticoids were associated with increases in cortical vBMD.Substantial deficits in trabecular vBMD, cortical bone geometry, and muscle were observed at CD diagnosis. Trabecular vBMD improved incompletely; however, cortical deficits progressed despite improvements in muscle. Glucocorticoids were not associated with bone loss. Therapies to improve bone accrual in childhood CD are needed.
View details for DOI 10.1053/j.gastro.2008.09.072
View details for Web of Science ID 000262028500020
View details for PubMedID 19026647
View details for PubMedCentralID PMC2705767
Bone density, structure, and strength in juvenile idiopathic arthritis
ARTHRITIS AND RHEUMATISM
2008; 58 (8): 2518-2527
To identify determinants of musculoskeletal deficits (muscle cross-sectional area [mCSA], trabecular volumetric bone mineral density [vBMD], and cortical bone strength [section modulus]) in patients with juvenile idiopathic arthritis (JIA) and to determine if cortical bone strength is appropriately adapted to muscle forces.Peripheral quantitative computed tomography (pQCT) of the tibia was performed in 101 patients with JIA (79% female; 24 with oligoarticular JIA, 40 with polyarticular JIA, 18 with systemic JIA, and 19 with spondylarthritis [SpA]) and 830 healthy control subjects; all were ages 5-22 years. Outcomes of pQCT were expressed as sex- and race-specific Z scores. Multivariable linear regression models assessed mCSA and bone status in JIA patients compared with controls and identified factors associated with musculoskeletal deficits in JIA.The median duration of JIA was 40 months; 29% of the JIA patients had active arthritis, and 28% had received glucocorticoid therapy during the previous year. Compared with the controls, the mCSA and section modulus Z scores were significantly lower in patients with polyarticular JIA and those with SpA. Trabecular vBMD Z scores were significantly lower in patients with polyarticular JIA, those with systemic JIA, and those with SpA. Significant predictors of musculoskeletal deficits included active arthritis in the previous 6 months (mCSA), temporomandibular joint disease (mCSA and section modulus), functional disability (mCSA and vBMD), short stature (vBMD), infliximab exposure (vBMD), and JIA duration (section modulus). The section modulus was significantly reduced relative to mCSA in patients with JIA after adjustment for age and limb length.Marked deficits in vBMD and bone strength occur in JIA in association with severe and longstanding disease. Contrary to the findings of previous studies, bone deficits were greater than expected relative to the mCSA, which illustrates the importance of adjusting for age and bone length.
View details for DOI 10.1002/art.23683
View details for Web of Science ID 000259055400037
View details for PubMedID 18668565
View details for PubMedCentralID PMC2705769
Assessment of spine bone mineral density in juvenile idiopathic arthritis: Impact of scan projection
JOURNAL OF CLINICAL DENSITOMETRY
2008; 11 (2): 302-308
Although children with juvenile idiopathic arthritis (JIA) are at risk for vertebral fractures, recent conventional posterior-anterior (PA) spine dual-energy X-ray absorptiometry studies reported minimal areal bone mineral density (aBMD, g/cm2) deficits. Width-adjusted BMD (WA-BMD, g/cm3) represents the bone mineral content (BMC) from the lateral projection, excluding the dense cortical spinous processes, divided by the estimated vertebral body volume based on paired PA-lateral bone dimensions. Therefore, WA-BMD may be more sensitive to JIA effects on the predominantly trabecular vertebral body. Age- and sex-specific Z-scores for spine aBMD and WA-BMD were generated in 84 JIA subjects compared with healthy controls, aged 5-21 yr. JIA was associated with lower mean WA-BMD Z-scores (-0.78, 95% CI: -1.03, -0.53; p<0.001) and aBMD Z-scores (-0.26, 95% CI: -0.49, -0.02; p<0.05), compared with controls. WA-BMD Z-scores were significantly lower than aBMD Z-scores in JIA (p<0.001). A significant JIA by age interaction (p<0.001) indicated that the magnitude of the difference between WA-BMD and aBMD Z-scores was greater in younger subjects. In conclusion, WA-BMD may be more sensitive to disease effects in children because it selectively measures the trabecular-rich vertebral body and is independent of growth-related changes in BMC of the dense spinous processes.
View details for DOI 10.1016/j.jocd.2007.10.005
View details for Web of Science ID 000256640900012
View details for PubMedID 18164636