Longitudinal Trajectories of Adolescents Born Preterm

早产青少年的纵向轨迹

• 批准号: 6877156
• 负责人: Mary C Sullivan
• 金额: $ 29.99万
• 依托单位: UNIVERSITY OF RHODE ISLAND
• 依托单位国家: 美国
• 财政年份: 1994
• 资助国家: 美国
• 起止时间: 1994-09-30 至 2008-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6877156
• 关键词: academic achievement; adolescence (12-20); behavior disorders; behavioral /social science research tag; child physical development; child psychology; clinical research; disease /disorder proneness /risk; epidemiology; human morbidity; human subject; longitudinal human study; low birth weight infant human; mathematical model; model design /development; nervous system disorder; outcomes research; performance; postnatal growth disorder; premature infant human; psychomotor disorders; psychomotor function; socioeconomics

DESCRIPTION (provided by applicant): This research continuation into adolescence proposal is a request to follow a unique sample of children born at various degrees of prematurity and late medical risk. We have been following 192 families whose children were born at medical risk, from birth to age 12, with continual funding from NINR. This proposal incorporates the research directions established by the National Institute of Nursing Research's initiative and Healthy People 2010 to develop practice knowledge in health promotion for older children and adolescents. The proposed project is an innovative and unique effort to examine both the transition from early to late adolescence as well as the entire continuation of childhood in a sample of children born at various degrees of medical risk. Results from our research to date inclusive from birth to age 12, provide a comprehensive understanding of specific developmental trajectories and risk and protective processes that exacerbate or ameliorate the impact of cumulative risk on competency outcomes in full term and preterm children. The Specific Aims: (1) Investigate and model developmental trajectories from birth to age 18, in the sample of children born at various degrees of perinatal morbidity. The trajectories of growth, medical, neurological, motor and problem behavior. (2) Examine the models by which cumulative medical and environmental risk, from birth to age 12, have an independent effect on developmental competency constructs of health, academic, social and functional performance at last adolescence. (3) Examine how cumulative protective processes, from age 4 to 18, will have an independent effect and/or mediating effect on cumulative risk, on developmental competency constructs of health, academic, social, and functional performance at late adolescence. Compelling findings from our work support the need for trajectory follow up. For example, physical attainment at adolescence shows some "catch up" growth, yet preterm, especially SGA children, remain smaller and lighter than their peers at age 12. The rate of overweight and obesity rates were three to four times the national average in the preterm group ranging from 32% to 41%. In the motor trajectory, the incidence of motor deficits doubled from 11% at age 8 to 21% at age 12. Our most striking finding has been the importance of cumulative risk and cumulative protective processes heretofore undocumented, in the prediction of competency of early adolescence. Repeated measures using mixed effects models will be used to determine developmental trajectories and test the effects of risk and protection in determining health, academic functioning, and social competency outcomes at age 18. Late adolescence will be an important and necessary addition in developing a total model of development that incorporates both time-specific and cumulative risks as well as protective processes for an entire period of childhood. Such studies are urgently needed to build a broader scientific foundation for nursing interventions. This proposal is very specific in identifying connections between the literature, our prior studies, the need for trajectory follow through, and risk and protection in the understanding child competency outcomes. Based on the cutting edge work of our collaborators in risk contexts, we will develop models where cumulative risk and protective processes are highlighted.

描述（由申请人提供）：这项关于青春期的研究提案的延续是一项要求，以跟踪一个独特的样本，这些样本是在不同程度的早产和晚期医疗风险下出生的儿童。我们一直在跟踪192个家庭，这些家庭的孩子从出生到12岁都有医疗风险，我们一直得到国家儿童研究所的持续资助。该提案结合了国家护理研究所倡议和2010年健康人所确定的研究方向，旨在发展促进大龄儿童和青少年健康的实践知识。拟议的项目是一项创新和独特的努力，旨在研究在不同程度医疗风险下出生的儿童样本中从青春期早期到青春期晚期的过渡以及童年的整个延续。我们迄今为止的研究结果包括从出生到12岁，提供了对特定发展轨迹、风险和保护过程的全面理解，这些风险和保护过程会加剧或改善累积风险对足月和早产儿能力结果的影响。具体目的：(1)调查和模拟从出生到18岁的发育轨迹，在不同程度的围产期发病率的儿童样本中。成长轨迹，医学，神经学，运动和问题行为。(2)检验从出生到12岁累积的医疗和环境风险对青少年健康、学业、社会和功能表现的发展能力建构的独立影响模型。(3)研究从4岁到18岁的累积保护过程如何对青春期后期的累积风险、健康、学业、社会和功能表现的发展能力构建产生独立影响和/或中介作用。我们工作中令人信服的发现支持了轨迹跟踪的必要性。例如，青少年时期的身体素质表现出一定程度的“追赶”增长，但早产儿，尤其是SGA儿童，在12岁时仍然比同龄人更小、更轻。早产儿的超重和肥胖率是全国平均水平的三到四倍，从32%到41%不等。在运动轨迹上，运动缺陷的发生率从8岁时的11%增加到12岁时的21%。我们最引人注目的发现是累积风险和累积保护过程在预测青少年早期能力方面的重要性。使用混合效应模型的重复测量将用于确定发展轨迹，并测试风险和保护在确定18岁时的健康、学业功能和社会能力结果方面的影响。青春期后期将是发展一种综合发展模式的重要和必要补充，这种模式既包括特定时间和累积风险，也包括整个童年时期的保护过程。迫切需要这样的研究来为护理干预建立更广泛的科学基础。这个建议非常具体地确定了文献之间的联系，我们之前的研究，对轨迹跟踪的需求，以及理解儿童能力结果的风险和保护。基于我们合作者在风险背景下的前沿工作，我们将开发出强调累积风险和保护过程的模型。