Preterm Fetal Growth Restriction and Developmental Care

描述(由申请人提供)：胎儿生长受限(FGR)增加了已经存在的早产风险，对婴儿的生存、整体功能和后来的学习能力造成了严重影响。在美国每年12%的早产儿中，超过5%的早产儿由于胎盘功能不全而未能在子宫中正常发育。这些婴儿对新生儿重症监护病房(NICU)构成了直接的重大挑战；70%以上的婴儿将继续发展为学习障碍并需要特殊教育服务。据推测，NICU的压力环境可能会加剧FGR婴儿的低反应阈值，并危及本已受损的大脑发育。拟议的项目将测试NICU对这类婴儿进行干预的有效性。它将包括努力使所有护理个性化到婴儿的敏感阈值，从而改善神经纤维束发育(MRI)和神经生理功能(EEG)。这反过来预计会导致更好的行为适应。30名FGR早产儿将被随机分为发育护理(E)组或标准护理(C)组。所有婴儿都将在出生后7天内(基线)进行研究，并在2周校正年龄(2w CA)时再次进行研究(结果)。FGR-E组有望在2w CA时在神经行为、电生理和脑结构三个领域表现出更好的发展。此外，FGR婴儿将与先前研究中两个年龄点都有可比数据的适合胎龄(AGA)早产儿的样本进行比较。将比较FGR和AGA、C和E组，以确定干预效果的样本特定方面。这可能会导致更好地理解干预措施与样本特定风险因素的相互作用。将在各自领域的背景变量、干预和结果之间检查关系和预测性成功。重复测量多变量分析领域将被用来评估样本，群体和时间效应以及它们之间的相互作用。将使用判别函数分析、典型相关分析、多元回归和通径分析来建立领域和跨年龄关系的模型，并预测干预效果。预计结果将显示，通过减轻压力，干预对FGR婴儿的脑部影响。预计这将使他们在功能和大脑结构发育方面与AGA同龄人更接近。这项研究将对了解降低FGR婴儿长期功能性疾病的方法以及确定促进妊娠末期大脑发育的机会具有重要意义。

DESCRIPTION (provided by applicant): Fetal growth restriction (FGR) increases the already substantial risk of prematurity for infants' survival, overall function and later learning competence. Of the 12% of prematurely born infants in the US each year, more than 5% failed to grow appropriately in the womb due to placental insufficiency. These infants present immediate significant challenges to Newborn Intensive Care Units (NICU); more than 70% will go on to develop learning disabilities and require special educational services. It is postulated that the NICU's stressful environment may exacerbate the FGR infant's low threshold of reactivity and jeopardize already compromised brain development. The proposed project will test the effectiveness of an in-NICU intervention for such infants. It will consist of efforts to individualize all care to the infant's thresholds of sensitivity and to thereby improve neural fiber tract development (MRI) and neurophysiologic functioning (EEG). This in turn is expected to result in better behavioral adaptations. Thirty FGR preterm infants will be randomized to either a Developmental Care (E) or Standard Care (C) group. All infants will be studied within 7 days of birth (baseline) and again at 2 weeks corrected age (2w CA) (outcome). The FGR-E group is expected to show better development at 2w CA in the 3 domains to be tested, neurobehavior, electrophysiology, and brain structure. Furthermore, the FGR infants will be compared to a sample of appropriate in growth for gestational age (AGA) preterm infants for whom comparable data are available at both age points from a previous study. The FGR and AGA C and E groups will be compared in order to identify sample specific aspects of the intervention effects. This might lead to better understanding of the intervention's interaction with sample specific risk factors. The relationship and predictive success will be examined among background variables, intervention, and outcomes in the respective domains. Repeated measures multivariate analysis of variance by domain will be employed to assess sample, group and time effects as well as their interactions. Discriminate function analysis, canonical correlation, multiple regression as well as path analysis will be employed in order to model domain and across age relationships, and to predict intervention effectiveness. Results are expected to show brain-based effects of the intervention for the FGR infants, mediated by stress reduction. This is expected to bring them closer in functioning and brain structural development to their AGA peers. The study will be significant in understanding ways to reduce long-term functional morbidities in FGR infants, as well as in identifying opportunities for enhancing last trimester brain development.