BRAIN Planning Grant for the Developing World

描述（由申请人提供）：围产期窒息是发展中国家新生儿死亡和发病的主要原因。围产期窒息的幸存者患智力迟钝、脑瘫和其他神经发育障碍的比率很高。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障碍。这些项目是美国法律规定的，也是发达国家的医疗标准。然而，在发展中国家和世界上大多数高危婴儿很少有早期干预方案。在一个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可改善围产期窒息幸存者的神经发育结果（智力发育指数），但尚无结论性证据。这项名为“改善发展中国家受损神经发育的大脑研究（Brain）计划拨款”的提案，旨在识别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。利用伯明翰阿拉巴马大学、赞比亚大学、赞比亚大学教学医院和赞比亚卢萨卡城区卫生管理小组研究人员之间已建立的合作关系，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，成为培训师的培训师，以便指导家长。一名赞比亚临床医生将接受心理测量学培训师的培训和认证。将进行试点研究，以验证经改编的课程，并实施以家庭为基础的家长提供的干预措施。该提案旨在为实施一项大型随机对照试验提供初步数据，该试验是一项创新的、具有成本效益的、以家庭为基础的早期干预试验，用于围产期窒息后存活的婴儿。这项建议的长期目标是扩大研究合作，并建立可持续的能力，以预防或减少由围产期窒息和儿童神经发育障碍的其他重要原因引起的神经发育后遗症。如果在发展中国家被证明是有效的，那么以家庭为基础的早期干预计划就有可能提高全世界许多处于危险中的婴儿的认知能力，而其成本低于更昂贵的特殊教育服务。

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.