Fetal Brain MRI as a Predictor of Late Neurodevelopmental Outcome in Congenital Heart Disease

胎儿脑 MRI 作为先天性心脏病晚期神经发育结果的预测因子

• 批准号: 10364835
• 负责人: Caitlin Rollins
• 金额: $ 46.45万
• 依托单位: BOSTON CHILDREN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-01-01 至 2026-12-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10364835
• 关键词: 2 year old; 7 year old; Adolescence; Adult; Advanced Development; Affect; Anatomy; Area; Attention; Birth; Brain; Brain Hypoxia-Ischemia; Cardiac; Cell Compartmentation; Cells; Cerebrum; Child; Childhood; Congenital Abnormality; Data; Data Set; Development; Employment; Executive Dysfunction; Fetus; Foundations; Genetic; Genetic Status; Health; High Prevalence; Impairment; Intervention; Knowledge; Live Birth; Location; Magnetic Resonance Imaging; Measures; Medical; Mental Health; Modeling; Morbidity - disease rate; Nature; Neurobiology; Neurodevelopmental Disability; Neurodevelopmental Impairment; Neurons; Oligodendroglia; Operative Surgical Procedures; Outcome; Outcome Measure; Pathology; Pathway interactions; Patients; Perinatal; Population; Predictive Value; Process; Property; Quality of life; Recording of previous events; School-Age Population; Services; Severities; Socioeconomic Status; Special Education; Structural Congenital Anomalies; Structural defect; Structure; Surface; Survivors; System; Techniques; Therapeutic; Thick; Variant; brain abnormalities; brain magnetic resonance imaging; brain volume; clinical care; clinical development; clinical risk; cognitive function; cohort; congenital heart disorder; disability; executive function; experience; fetal; in utero; indexing; individual patient; innovation; myelination; neonate; nerve stem cell; neurodevelopment; neuroimaging; personalized medicine; postnatal; prenatal; primary outcome; processing speed; risk stratification; secondary outcome; skills; social cognition; therapy design; tool; white matter

PROJECT SUMMARY/ABSTRACT Congenital heart disease is the most common birth defect, affecting 0.5-2% of all live births. As medical and surgical advances have dramatically increased survival, the burgeoning population of children and adults with congenital heart disease has exposed a high prevalence of neurodevelopmental disabilities in survivors. By adolescence, more than 2 out of every 3 children with critical congenital heart disease experience deficits requiring developmental/special education services. As these children reach adulthood, their disabilities may limit educational opportunities, employment, and quality of life. Abnormal fetal brain development may contribute to neurodevelopmental disability in patients with congenital heart disease. Neonates with congenital heart disease have abnormal brain structure before surgery. Neurobiological processes that lay the foundation for long-term structural brain organization begin in utero. Components of fetal brain critical for this process, in particular neural progenitor cells, premyelinating oligodendrocytes, and subplate neurons, are sensitive to hypoxia-ischemia, rendering this system vulnerable to prenatal circulatory disturbances. The impact of abnormal fetal brain development on long-term brain structure and function in congenital heart disease is unknown. To date, there are no congenital heart disease cohorts that have been studied in both the fetal period and later in childhood when these deficits are typically detected. This proposal will leverage an existing fetal MRI cohort, including children both with and without congenital heart disease, to acquire long-term neuroimaging and neurodevelopmental data at 7 years of age, thereby determining the fetal contribution to long-term outcome. Specifically, the proposed study will investigate 1) the association between fetal brain structure and school-age structural brain connectivity; 2) the relationship between fetal brain structure and school-age neurodevelopmental functioning; and 3) the potential for a clinical risk stratification tool harnessing measures available in utero to predict school-age neurodevelopmental outcome. The overarching hypothesis is that abnormal fetal brain structure is associated with long-term differences in structural brain connectivity and neurodevelopmental functioning in congenital heart disease. This project will support the development of clinical risk stratification and advance the development of interventions designed to protect the brain in children with congenital heart disease.

项目总结/摘要 先天性心脏病是最常见的出生缺陷，影响所有活产婴儿的0.5-2%。医疗和 外科手术的进步大大提高了生存率， 先天性心脏病暴露了幸存者神经发育障碍的高患病率。通过 在青少年时期，每3名患有严重先天性心脏病的儿童中就有2名以上的儿童存在缺陷， 需要发展/特殊教育服务。当这些孩子长大成人，他们的残疾可能 限制教育机会、就业和生活质量。 胎儿脑发育异常可能导致先天性神经发育障碍 心脏病患有先天性心脏病的新生儿在手术前大脑结构异常。 神经生物学过程奠定了长期结构性脑组织的基础，开始于子宫内。 胎儿大脑的组成部分对这一过程至关重要，特别是神经祖细胞， 少突胶质细胞和亚板神经元对缺氧缺血敏感，使该系统容易受到缺氧缺血的影响。 产前循环障碍胎儿脑发育异常对远期脑结构的影响 在先天性心脏病中的作用尚不清楚。到目前为止，还没有先天性心脏病队列 在胎儿期和儿童期都进行了研究，那时这些缺陷通常会被检测到。 该提案将利用现有的胎儿MRI队列，包括患有和不患有先天性 心脏病，在7岁时获得长期神经成像和神经发育数据，从而 确定胎儿对长期结果的贡献。具体而言，拟议的研究将调查1） 胎儿大脑结构和学龄期大脑结构连接之间的关系; 2） 胎儿大脑结构和学龄期神经发育功能之间的关系; 3）临床研究的潜力 风险分层工具利用子宫内可用的措施来预测学龄期神经发育 结果。最重要的假设是，异常的胎儿大脑结构与长期 先天性心脏病患者大脑结构连接和神经发育功能的差异。 该项目将支持临床风险分层的发展，并促进 旨在保护先天性心脏病儿童大脑的干预措施。