Sarah E. Dubner

All Publications

• Skin-to-Skin Holding in Relation to White Matter Microstructure in Infants Born Preterm. Neurology Travis, K. E., Lazarus, M. F., Scala, M., Marchman, V. A., Bruckert, L., Velasco Poblaciones, R., Dubner, S. E., Feldman, H. M. 2025; 105 (8): e214138

  Abstract

  Preterm birth is associated with altered white matter development and long-term neurodevelopmental impairments. Skin-to-skin care has known benefits for physiologic regulation and bonding in preterm infants, but impacts on early brain structure remain unclear. The aim of this study was to describe the association between in-hospital skin-to-skin care and white matter microstructure in very preterm infants, focusing on frontolimbic tracts involved in stress regulation and socioemotional development.The design was a single-center retrospective observational analysis of clinical data from the electronic medical records and diffusion MRI scans. Participants were infants born at <32 weeks gestational age (GA) who received a routine predischarge MRI. Skin-to-skin care was quantified as duration per instance and daily exposure rate (in minutes) before the MRI was obtained. Diffusion MRI assessed mean diffusivity (MD) and fractional anisotropy (FA) in the cingulum, anterior thalamic radiations (ATRs), and uncinate fasciculus. Hierarchical regression models evaluated associations between skin-to-skin care and white matter metrics, adjusting for GA, medical acuity, postmenstrual age at scan, and MRI coil type.A total of 88 preterm infants (mean GA 29 weeks; 49% female) were included. Skin-to-skin care duration per instance was positively associated with MD in the cingulum (B = 0.002, 95% CI 0.0004-0.003, ΔR2 = 0.080) and ATRs (B = 0.002, 95% CI 0.0003-0.003, ΔR2 = 0.057). Skin-to-skin care daily exposure rate was also positively associated with ATR MD (B = 0.038, 95% CI 0.001-0.076, ΔR2 = 0.046). Both skin-to-skin metrics were negatively associated with ATR FA (duration: B = -0.0005, 95% CI -0.001 to -0.0001, ΔR2 = 0.046; rate: B = -0.016, 95% CI -0.028 to -0.004, ΔR2 = 0.075). No significant associations were found for the uncinate fasciculus. Findings remained significant after adjusting for socioeconomic status and visitation frequency and after excluding infants with white matter injury.Skin-to-skin care was associated with neonatal white matter microstructure in specific frontolimbic tracts. Limitations include the retrospective design and single-center setting. Future studies should consider how early caregiving experiences, such as skin-to-skin care, may influence brain development in preterm infants.

  View details for DOI 10.1212/WNL.0000000000214138

  View details for PubMedID 40991888

• Skin-to-skin holding in relation to white matter connectivity in infants born preterm. medRxiv : the preprint server for health sciences Travis, K. E., Lazarus, M. F., Scala, M., Marchman, V. A., Bruckert, L., Poblaciones, R. V., Dubner, S., Feldman, H. M. 2025

  Abstract

  Background and Objectives: Preterm birth is associated with altered white matter development and long-term neurodevelopmental impairments. Skin-to-skin care (kangaroo care) has well-documented benefits for physiological stability and bonding, but its association with neonatal brain structure remains unclear. This study explored the association between in-hospital skin-to-skin care and neonatal white matter microstructure in frontal and limbic pathways that are linked to stress regulation and socio-emotional development, processes potentially influenced by affective touch during skin-to-skin care.Methods: This retrospective study analyzed electronic medical records and diffusion MRI data collected from 86 preterm infants (<32 weeks gestational age) in a single NICU. Skin-to-skin care exposure was quantified as total duration (minutes/instance) and rate (minutes/day) of sessions. Diffusion MRI scans obtained before hospital discharge assessed mean diffusivity (MD) and fractional anisotropy (FA) in the cingulate, anterior thalamic radiations (ATR), and uncinate fasciculus. Hierarchical regression models examined associations between skin-to-skin care and white matter microstructure, adjusting for gestational age, health acuity, postmenstrual age at scan, and MRI coil type. Sensitivity analyses controlled for socioeconomic status and NICU visitation frequency.Results: Skin-to-skin care duration was positively associated with MD in the cingulate (B = 0.002, p = 0.016) and ATR (B = 0.002, p = 0.020). Skin-to-skin care rate was also positively linked to MD in the ATR (B = 0.040, p = 0.041). Skin-to-skin care duration and rate were not associated with FA in the cingulate but skin-to-skin duration and rate were negatively associated with FA in the ATR (duration: B =-0.001, p = 0.020; rate: B =-0.017, p = 0.008). No significant associations were found for the uncinate fasciculus. Findings remained robust after adjusting for socioeconomic status and visitation frequency.Discussion: This study provides novel evidence linking in-hospital experiences of skin-to-skin care to neonatal white matter development. These findings have important implications for understanding how family-centered neuroprotective practices, such as skin-to-skin care, may affect brain development to improve long-term developmental outcomes.

  View details for DOI 10.1101/2025.03.21.25324424

  View details for PubMedID 40166583

• Maternal mental health and engagement in developmental care activities with preterm infants in the NICU. Journal of perinatology : official journal of the California Perinatal Association Dubner, S. E., Morales, M. C., Marchman, V. A., Shaw, R. J., Travis, K. E., Scala, M. 2023

  Abstract

  To examine associations between maternal mental health and involvement in developmental care in the NICU.Mothers of infants born <32 weeks gestation (n = 135) were approached to complete mental health screening questionnaires at two weeks after admission. Mothers who completed screening (n = 55) were further classified as with (n = 19) and without (n = 36) elevated scores. Mothers' frequency, rate, and duration of developmental care activities were documented in the electronic health record.35% of screened mothers scored above the cutoff for clinical concern on ≥1 measure. No significant differences between the 3 groups were identified for rates, frequency, or amount of all developmental care, kangaroo care, and swaddled holding.Elevated scores on maternal mental health questionnaires did not relate to developmental care. Maternal developmental care engagement may not indicate mental health status. Universal screening for psychological distress is required to accurately detect symptoms in mothers of hospitalized preterm infants.

  View details for DOI 10.1038/s41372-023-01661-0

  View details for PubMedID 37046070

  View details for PubMedCentralID 8552262

• EFFECTS OF POSTNATAL GLUCOCORTICOIDS ON BRAIN STRUCTURE IN PRETERM INFANTS, A SCOPING REVIEW. Neuroscience and biobehavioral reviews Robles, I., Eidsness, M. A., Travis, K. E., Feldman, H. M., Dubner, S. E. 2023: 105034

  Abstract

  Glucocorticoids (GC) are used in neonatal intensive care units to prevent or reduce the severity of chronic lung disease in preterm infants and have been implicated in impaired neurodevelopment. Our objective was to identify what is known about the effects of postnatal GC treatment in human preterm infants on structural brain development and to identify gaps in the literature. Following Arksey and O'Malley's scoping review methodological framework, we searched scientific literature databases for original research on human preterm infants, postnatal GCs, and brain structure. 11 studies assessed the effects of GCs on structural brain outcomes. 56 studies reported brain injury, but not structure. Dexamethasone was consistently associated with decreased total and regional brain volumes, including cerebellar volumes. Hydrocortisone was often, but not always associated with absence of brain volume differences. No studies examined the impact of inhaled GC on brain structure. Additional research on the effects of neonatal GCs after preterm birth on a variety of structural brain measures is required for understanding contributions to neurodevelopment and informing practice guidelines.

  View details for DOI 10.1016/j.neubiorev.2023.105034

  View details for PubMedID 36608916

• White matter properties underlying reading abilities differ in 8-year-old children born full term and preterm: A multi-modal approach NEUROIMAGE Brignoni-Perez, E., Dubner, S. E., Ben-Shachar, M., Berman, S., Mezer, A. A., Feldman, H. M., Travis, K. E. 2022; 256

  View details for DOI 10.1016/j.neuroimage.2022.119246

  View details for Web of Science ID 000830858700002

• White matter properties underlying reading abilities differ in 8-year-old children born full term and preterm: A multi-modal approach. NeuroImage Brignoni-Perez, E., Dubner, S. E., Ben-Shachar, M., Berman, S., Mezer, A. A., Feldman, H. M., Travis, K. E. 2022: 119240

  Abstract

  Many diffusion magnetic resonance imaging (dMRI) studies document associations between reading skills and fractional anisotropy (FA) within brain white matter, suggesting that efficient transfer of information across the brain contributes to individual differences in reading. Use of complementary imaging methods can determine if these associations relate to myelin content of white matter tracts. Compared to children born at term (FT), children born preterm (PT) are at risk for reading deficits. We used two MRI methods to calculate associations of reading and white matter properties in FT and PT children. Participants (N=79: 36 FT and 43 PT) were administered the Gray's Oral Reading Test at age 8. We segmented three dorsal (left arcuate and bilateral superior longitudinal fasciculus) and four ventral (bilateral inferior longitudinal fasciculus and bilateral uncinate) tracts and quantified (1) FA from dMRI and (2) R1 from quantitative T1 relaxometry. We examined correlations between reading scores and these metrics along the trajectories of the tracts. Reading positively correlated with FA in segments of left arcuate and bilateral superior longitudinal fasciculi in FT children; no FA associations were found in PT children. Reading positively correlated with R1 in segments of the left superior longitudinal, right uncinate, and left inferior longitudinal fasciculi in PT children; no R1 associations were found in FT children. Birth group significantly moderated the associations of reading and white matter metrics. Myelin content of white matter may contribute to individual differences in PT but not FT children.

  View details for DOI 10.1016/j.neuroimage.2022.119240

  View details for PubMedID 35490913

• Neonatal Inflammation, Corpus Callosum Microstructure, and Language Skills in 2-Year-Old Children Born Preterm Dubner, S. E., Sproul, D., Rickerich, L., Robles, I., Feldman, H., Travis, K. LIPPINCOTT WILLIAMS & WILKINS. 2022: E140-E141

  View details for Web of Science ID 000797424900075

• Impact of the COVID-19 pandemic on developmental care practices for infants born preterm. Early human development Scala, M., Marchman, V. A., Brignoni-Perez, E., Morales, M. C., Dubner, S. E., Travis, K. E. 2021; 163: 105483

  Abstract

  OBJECTIVES: To assess the impact of the COVID-19 pandemic on rates of hospital visitation and rates and durations of developmental care practices for infants born preterm.METHODS: We analyzed electronic medical record data from 129 infants born at less than 32weeks gestational age (GA) cared for in the Lucile Packard Children's Hospital neonatal intensive care unit (NICU) in a COVID-19-affected period (March 8, 2020 to Nov 30, 2020, n=67) and the analogous period in 2019 (n=62). Rates of family visitation and of family- and clinical staff-delivered developmental care were compared across cohorts, adjusting for covariates.RESULTS: Families of infants visited the hospital at nearly half of the rate during 2020 as during 2019 (p=0.001). Infants experienced developmental care less frequently in 2020 vs. 2019 (3.0 vs. 4.3 activities per day; p=0.001), resulting in fewer minutes per day (77.5 vs. 130.0; p=0.001). In 2020, developmental care activities were 5min shorter, on average, than in 2019, p=0.001. Similar reductions occurred in both family- and staff-delivered developmental care. Follow-up analyses indicated that effects persisted and even worsened as the pandemic continued through fall 2020, despite relaxation of hospital visitation policies.CONCLUSIONS: The COVID-19 pandemic has negatively impacted family visitation and preterm infant developmental care practices in the NICU, both experiences associated with positive health benefits. Hospitals should create programs to improve family visitation and engagement, while also increasing staff-delivered developmental care. Careful attention should be paid to long-term follow up of preterm infants and families.

  View details for DOI 10.1016/j.earlhumdev.2021.105483

  View details for PubMedID 34649193

• Retrospective Cohort Study of Early Postnatal Hydrocortisone in Infants Born Extremely Preterm and 12 Month Outcomes Dubner, S. E., Scala, M., Feldman, H. M., Travis, K. E. LIPPINCOTT WILLIAMS & WILKINS. 2021: S22

  View details for Web of Science ID 000670615500076

• Retrospective Cohort Study of Early Postnatal Hydrocortisone in Infants Born Extremely Preterm and 12 Month Outcomes Dubner, S. E., Scala, M., Feldman, H. M., Travis, K. E. LIPPINCOTT WILLIAMS & WILKINS. 2021: S22

  View details for Web of Science ID 000656627200076

• Trauma, Autism, and Neurodevelopmental Disorders: Integrating Research, Practice, and Policy (Book Review) JOURNAL OF DEVELOPMENTAL AND BEHAVIORAL PEDIATRICS Book Review Authored by: Dubner, S. E., Youssef, J. 2020; 41 (3): 179

  View details for DOI 10.1097/DBP.0000000000000793

  View details for Web of Science ID 000526690100004

• Reading Abilities in Relation to Quantitative T1 MRI Metrics for Assessing Myelin Content in 8-Year Old Children Born Preterm Travis, K., Dubner, S., Feldman, H. LIPPINCOTT WILLIAMS & WILKINS. 2020: S16

  View details for Web of Science ID 000526852800038

• Neonatal white matter tract microstructure and 2-year language outcomes after preterm birth. NeuroImage. Clinical Dubner, S. E., Rose, J. n., Bruckert, L. n., Feldman, H. M., Travis, K. E. 2020; 28: 102446

  Abstract

  To determine whether variability in diffusion MRI (dMRI) white matter tract metrics, obtained in a cohort of preterm infants prior to neonatal hospital discharge, would be associated with language outcomes at age 2 years, after consideration of age at scan and number of major neonatal complications.30 children, gestational age 28.9 (2.4) weeks, underwent dMRI at mean post menstrual age 36.4 (1.4) weeks and language assessment with the Bayley Scales of Infant Development-III at mean age 22.2 (1.7) months chronological age. Mean fractional anisotropy (FA) and mean diffusivity (MD) were calculated for 5 white matter tracts. Hierarchical linear regression assessed associations between tract FA, moderating variables, and language outcomes.FA of the left inferior longitudinal fasciculus accounted for 17% (p = 0.03) of the variance in composite language and FA of the posterior corpus callosum accounted for 19% (p = 0.02) of the variance in composite language, beyond that accounted for by post-menstrual age at scan and neonatal medical complications. The number of neonatal medical complications moderated the relationship between language and posterior corpus callosum FA but did not moderate the association in the other tract.Language at age 2 is associated with white matter metrics in early infancy in preterm children. The different pattern of associations by fiber group may relate to the stage of brain maturation and/or the nature and timing of medical complications related to preterm birth. Future studies should replicate these findings with a larger sample size to assure reliability of the findings.

  View details for DOI 10.1016/j.nicl.2020.102446

  View details for PubMedID 33035964

• White matter microstructure and cognitive outcomes in relation to neonatal inflammation in 6-year-old children born preterm NEUROIMAGE-CLINICAL Dubner, S. E., Dodson, C. K., Marchman, V. A., Ben-Shachar, M., Feldman, H. M., Travis, K. E. 2019; 23

  View details for DOI 10.1016/j.nicl.2019.101832

  View details for Web of Science ID 000485804400037

• Longitudinal Assessment of Bone Density and Structure in an Incident Cohort of Children With Crohn's Disease GASTROENTEROLOGY Dubner, S. E., Shults, J., Baldassano, R. N., Zemel, B. S., Thayu, M., Burnham, J. M., Herskovitz, R. M., Howard, K. M., Leonarda, M. B. 2009; 136 (1): 123-130

  Abstract

  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 Burnham, J. M., Shults, J., Dubner, S. E., Sembhi, H., Zemel, B. S., Leonard, M. B. 2008; 58 (8): 2518-2527

  Abstract

  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 Dubner, S. E., Shults, J., Leonard, M. B., Zemell, B. S., Sembhi, H., Burnham, J. M. 2008; 11 (2): 302-308

  Abstract

  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