BRAIN Planning Grant for the Developing World

描述(申请人提供)：围产期窒息是发展中国家新生儿死亡和发病率的主要原因。围产期窒息的幸存者有很高的智力低下、脑瘫和其他神经发育障碍的发生率。对照试验和荟萃分析得出结论，早期干预计划可以预防或减少高危婴儿的认知损害。这些计划是美国立法规定的，也是发达国家的护理标准。然而，在发展中国家和全世界大多数高危婴儿中，早期干预计划很少。在发展中国家进行的一项小型随机对照试验的初步证据表明，以家庭为基础的早期干预计划改善了围产期窒息幸存者的神经发育结果(智力发育指数)，但尚无确凿证据。这项名为为发展中国家改善受损神经发育(脑)计划赠款的脑研究计划旨在确定有神经发育障碍风险的婴儿，并评估在发展中国家实施创新干预试验的可行性。利用阿拉巴马大学伯明翰分校、赞比亚大学、赞比亚大学教学医院和赞比亚卢萨卡卢萨卡市区健康管理小组之间建立的合作关系，将进行试点研究，以确定围产期窒息后神经发育障碍的发生率和类型。此外，学习伙伴课程(或类似课程)将根据赞比亚人口进行调整。两名研究护士将获得学习伙伴课程的认证，成为培训师，这样他们就可以指导父母。一名赞比亚临床医生将接受培训，并获得心理训练师证书。将进行试点研究，以验证调整后的课程，并实施以家庭为基础的家长提供的干预。这项建议旨在为实施一项创新的、具有成本效益的、以家庭为基础的早期干预试验的大型随机对照试验产生初步数据，该试验针对围产期窒息后存活的婴儿。这项提议的长期目标是扩大研究合作，建立可持续的能力，以预防或减少围产期窒息和儿童神经发育障碍的其他重要原因造成的神经发育后遗症。如果在发展中国家被证明有效，以家庭为基础的早期干预计划有可能以比更昂贵的特殊教育服务更低的成本改善世界各地许多高危婴儿的认知能力。

DESCRIPTION (provided by applicant): Perinatal asphyxia is a leading cause of neonatal mortality and morbidity in developing countries. Survivors of perinatal asphyxia have high rates of mental retardation, cerebral palsy, and other neurodevelopmental disorders. Controlled trials and meta-analyses conclude that early intervention programs prevent or minimize cognitive impairment in high-risk infants. These programs are legislatively mandated in the United States and are the standard of care in developed nations. However, early intervention programs are rarely available in developing countries and to most at-risk infants worldwide. Preliminary evidence from a small, randomized controlled trial conducted in a developing country suggests that a program of home-based early intervention improves neurodevelopmental outcome (Mental Developmental Index) in survivors of perinatal asphyxia but conclusive evidence is not available. This proposal, the Brain Research to Ameliorate Impaired Neurodevelopment (BRAIN) Planning Grant for the Developing World, aims to identify infants at risk for neurodevelopmental disorders and to evaluate the feasibility of implementing an innovative intervention trial in a developing nation. Utilizing established collaborations between researchers at the University of Alabama at Birmingham, University of Zambia, University Teaching Hospital in Zambia, and the Lusaka Urban District Health Management Team in Lusaka, Zambia, pilot studies will be performed to determine the incidence and types of neurodevelopmental impairments following perinatal asphyxia. Additionally, the Partners for Learning curriculum (or similar curriculum) will be adapted to the Zambian population. Two research nurses will be certified with the Partners for Learning curriculum to become trainer-of-trainers so they can instruct the parents. A Zambian clinician will receive training and certification as a psychometric trainer-of-trainers. Pilot studies will be performed to validate the adapted curriculum and to implement a home-based parent-provided intervention. This proposal is intended to generate the preliminary data for the implementation of a large, randomized controlled trial of an innovative, cost effective, home-based, early intervention trial in infants who survive following perinatal asphyxia. The long-term goal of this proposal is to broaden research collaborations and to build sustainable capacity to prevent or reduce neurodevelopmental sequelae resulting from perinatal asphyxia and other important causes of neurodevelopmental impairment in children. If proven effective in developing countries, a home-based early intervention program has the potential of improving cognitive capacity in many at-risk infants worldwide at a cost lower than more expensive special education services.