Converging data suggest recovery from injury in the preterm brain. We used functional Magnetic Resonance Imaging (fMRI) to test the hypothesis that cerebral connectivity involving Wernicke's area and other important cortical language regions would differ between preterm (PT) and term (T) control school age children during performance of an auditory language task. Fifty-four PT children (600 -1250 g birth weight) and 24 T controls were evaluated using an fMRI passive language task and neurodevelopmental assessments including: the Wechsler Intelligence Scale for Children -III (WISC -III), the Peabody Individual Achievement Test -Revised (PIAT-R) and the Peabody Picture Vocabulary Test -Revised (PPVT-R) at 8 years of age. Neural activity was assessed for language processing and the data were evaluated for connectivity and correlations to cognitive outcomes. We found PT subjects scored significantly lower on all components of the WISC -III (p < 0.009), the PIAT-R reading comprehension test (p = 0.013), and the PPVT-R (p = 0.001) compared to term subjects. Connectivity analyses revealed significantly stronger neural circuits in PT children between Wernicke's area and the right inferior frontal gyrus (R IFG, Broca's area homologue) and both the left and the right supramarginal gyri (SMG) components of the inferior parietal lobules (p ≤ 0.02 for all). We conclude that PT subjects employ neural systems for auditory language function at school age differently than T controls; these alterations may represent a delay in maturation of neural networks or the engagement of alternate circuits for language processing.

Objective: Owing to resident work-hour reductions and more permanent personnel in the newborn intensive care unit (NICU), we sought to determine if pediatric housestaff are missing learning opportunities in procedural training due to non-participation.Study Design: A prospective, observational study was conducted at an academic NICU using self-reported data from neonatal personnel after attempting 188 procedures on 109 neonates, and analyzed using Fisher's exact and w 2 -tests.Result: Housestaff first attempted 32% of procedures (P<0.001) and were less likely to make attempts early in the academic year (P<0.001).There was no significant difference in attempts based on urgency of situation (P ¼ 0.742). Of procedures performed by non-housestaff personnel, 93% were completed while housestaff were present elsewhere in the unit. Conclusion:Pediatric housestaff performed the minority of procedures in the NICU, even in non-urgent situations, and were often uninvolved in other procedures, representing missed learning opportunities.

The longstanding tradition of hands-on procedural training is an integral part of clinical education in all fields of medicine. Allowing inexperienced physicians-in-training to perform clinical procedures has been justified based on the needs of future patients, potentially at some cost or burden to the patient involved in the training. This practice may appear, at times, to conflict with the physician's obligation to act in the best interests of the patient at hand. However, an ethical analysis centered on an example of an extremely low-birthweight newborn requiring intubation and other procedures lends support to this practice, provided several qualifications are met. The qualifications include adequate preparation, appropriate supervision, minimization of risks, honesty with families, the avoidance of exploitation, and justice in patient selection. Also, the obligation to the patient at hand is such that, in certain situations, the needs of that patient should outweigh any educational considerations. The analysis and arguments put forth should have relevance to clinical training in all branches of medicine and surgery.