Neurodevelopment Among Infants with Deformational Plagiocephaly

畸形斜头畸形婴儿的神经发育

• 批准号: 7122510
• 负责人: MATTHEW Louis SPELTZ
• 金额: $ 48.23万
• 依托单位: SEATTLE CHILDREN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2005
• 资助国家: 美国
• 起止时间: 2005-09-14 至 2010-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7122510
• 关键词: age difference; behavior test; brain morphology; cephalometry; clinical research; computed axial tomography; congenital oral /facial /cranial defect; developmental neurobiology; disease /disorder etiology; family structure /dynamics; gender difference; human subject; infant human (0-1 year); intelligence tests; longitudinal human study; magnetic resonance imaging; micrencephaly; neuropsychological tests; postnatal growth disorder; preschool child (1-5); prognosis; socioeconomics

DESCRIPTION (provided by applicant): Deformational plagiocephaly (DP) refers to cranial asymmetry believed to be attributable to external forces molding the malleable infant skull. Suspected casual factors include pre-natal factors (e.g., intrauterine constraint), post-natal events (e.g., invariant positioning during sleep) and/or underlying neuropathology. Initial studies of the neurodevelopment of children with DP have found evidence for significant deficits, but methodological problems limit the interpretation of these studies; potential explanations for such findings are unclear. Further investigation is necessary to refine etiological hypotheses and to provide clinicians and parents with accurate information regarding the neurodevelopmental correlates of DP. Several factors indicate the need for rather immediate study of these issues: the rapidly increasing rate of DP (and/or increasing awareness of and parental worry about the condition), the proliferation of associated medical treatments (helmets and craniofacial surgery), the possibility of preventable developmental problems, and the implication of causal association with the American Academy of Pediatrics "Back to Sleep" campaign. In this 5-year longitudinal study, we would like to investigate these issues by recruiting 300 infants with DP and 325 matched controls, following them from age 6 to 36 months. A subgroup of DP cases will be imaged using MRI (n= 46) and compared to controls by sharing data with another NIH-funded study of normal brain development. Specific aims are: (1) Compare the neurodevelopment of infants/toddlers with and without DP using a multi-domain model of neuropsychological development; (2) Among infants with DP, determine the association between neurodevelopmental status and severity of cranial asymmetry (assessed by both clinical judgment and skull imaging); (3) Develop and test a predictive model of 36-month neurodevelopmental outcomes for infants with DP; (4) Evaluate the perceived facial appearance of infants with and without DP (does the condition produce noticeable effects on facial appearance, as many parents fear?); (5) Develop and test a predictive model of parent participation in elective treatments (i.e., what parent/family and infant medical factors best predict treatment participation?) and (6) Using MRI, compare the brain structure and volume of infants with and without DP; among cases, examine relations among brain structure/volume, skull asymmetry, and neuropsychological status.

描述（由申请人提供）：变形性斜头畸形（DP）是指颅骨不对称，据信是由于外力塑造了可塑性婴儿颅骨。可疑的偶然因素包括产前因素（例如，宫内节育）、产后事件（例如，睡眠期间不变的定位）和/或潜在的神经病理学。对DP儿童神经发育的初步研究发现了明显缺陷的证据，但方法学问题限制了对这些研究的解释;对这些发现的潜在解释尚不清楚。进一步的调查是必要的，以完善病因学的假设，并提供临床医生和家长的准确信息，神经发育相关的DP。有几个因素表明需要对这些问题进行相当直接的研究：DP的快速增加（和/或父母对这种情况的认识和担忧增加），相关药物治疗（头盔和颅面手术）的扩散，可预防的发育问题的可能性，以及与美国儿科学会“恢复睡眠”运动的因果关系。在这项为期5年的纵向研究中，我们希望通过招募300名DP婴儿和325名匹配的对照组来调查这些问题，从6岁到36个月。将使用MRI（n= 46）对DP病例亚组进行成像，并通过与另一项NIH资助的正常大脑发育研究共享数据与对照组进行比较。具体目标是：（1）使用神经心理发育的多领域模型比较有和没有DP的婴儿/幼儿的神经发育;（2）在有DP的婴儿中，确定神经发育状态与颅骨不对称严重程度之间的关系。（通过临床判断和颅骨成像评估）;（3）开发和测试DP婴儿36个月神经发育结果的预测模型;（4）评估患有和没有DP的婴儿的感知面部外观（这种情况是否会像许多父母担心的那样对面部外观产生明显的影响？）(5)开发并测试父母参与选择性治疗的预测模型（即，哪些父母/家庭和婴儿医学因素最能预测治疗参与？）（6）应用MRI对患与不患DP的婴儿进行脑结构和体积的比较，并在病例中探讨脑结构/体积、颅骨不对称性和神经心理状态之间的关系。