UNDERSTANDING NEUROBEHAVIORAL DEFICITS IN PRETERM INFANTS THROUGH IMAGING

通过影像学了解早产儿的神经行为缺陷

• 批准号: 7350657
• 负责人: TERRIE E INDER
• 金额: $ 56.66万
• 依托单位: WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-04-01 至 2013-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7350657
• 关键词: Address; Age; Age-Years; Anisotropy; Anxiety; Area; Atlases; Attention deficit hyperactivity disorder; Autistic Disorder; Behavioral; Biological Markers; Birth; Brain; Brain Injuries; Brain region; Cerebral Palsy; Cerebrospinal Fluid; Cerebrum; Child; Childhood; Clinical; Cognition; Cohort Studies; Corticospinal Tracts; Data; Data Set; Delayed Memory; Depth; Development; Developmental Disabilities; Diffusion; Diffusion Magnetic Resonance Imaging; Dorsal; Enrollment; Evolution; Female; Functional disorder; Gestational Age; Image; Impaired cognition; Impairment; Incidence; Infant; Injury; Language Development; Lead; Learning Disabilities; Magnetic Resonance; Magnetic Resonance Imaging; Measurable; Measurement; Measures; Mental Depression; Mental Retardation; Methods; Microscopic; Motor; Motor Cortex; Nature; Neonatal; Neonatal Intensive Care; Neurobiology; Neurodevelopmental Impairment; Neurologic; Newborn Infant; Nuclear; Occipital lobe; Outcome; Perinatal Exposure; Pharmaceutical Preparations; Population; Premature Birth; Premature Infant; Prevalence; Public Health; Radial; Rate; Relative (related person); Research Design; Risk; Scanning; Schizophrenia; Sensitivity and Specificity; Services; Sex Characteristics; Structure; Surface; Testing; Time; United States National Institutes of Health; Visual; Week; Weight; Withdrawal; age group; aged; base; brain volume; cohort; comparison group; day; design; developmental disease; disability; executive function; experience; functional outcomes; gray matter; improved; indexing; infancy; male; morphometry; neurobehavioral; postnatal; response to injury; social; social skills; visual motor; white matter

DESCRIPTION (provided by applicant): Preterm birth is a major public-health issue because of its increasing incidence combined with the frequent occurrence of subsequent behavioral, neurological, and psychiatric challenges faced by surviving infants. Approximately 10-15% of very preterm children (born < 30 weeks gestational age) develop cerebral palsy, and 30 - 60% of very preterm children experience cognitive impairments. These impairments include visual-motor problems, attentional difficulties, impaired memory, delayed acquisition of language, executive dysfunction, learning disabilities, poor social skills, and higher rates of social withdrawal, anxiety and depression. In addition, an increased prevalence of developmental disorders such as attention deficit/hyperactivity disorder, autism and schizophrenia, has been described in the preterm population. These adverse outcomes are related to white matter (WM) and grey matter (GM) injury sustained during the neonatal period and its effects on subsequent brain development. We seek to develop imaging biomarkers, measurable during infancy, that provide sensitivity and specificity in identifying infants at risk for poor neurodevelopmental outcome. The biomarkers will consist of the following magnetic resonance (MR) imaging measures: 1) conventional T1- and T2-weighted images, 2) volumetry (volumes for cortical GM, deep nuclear GM, myelinated WM, unmyelinated WM, and cerebrospinal fluid), 3) diffusion tensor imaging (apparent diffusion coefficient, relative anisotropy, axial and radial diffusivity), and 4) surface-based morphometry (integrated folding index, average sulcal depth, cortical surface area, percentage of buried cortex). The main cohort of this study will consist of 120 very preterm infants born < 30 weeks gestational age. They will undergo MR studies soon after birth, at 30 weeks postmenstrual age (PMA), 34 weeks PMA, and term equivalent. Infants enrolled during Year 1 (n = 30) will also be imaged at age 4 years. The MR indices listed above will be compared with MR data from healthy control subjects and clinical outcome data obtained at term equivalent and 2 and 4 years of age. The proposed studies are designed to engender a deeper understanding of the nature and timing of cerebral injury, laying the groundwork for the development of neuroprotective strategies and improving clinical practices. The longitudinal design will allow us to study both structural abnormalities and compensatory changes in response to injury. Identification during the newborn period of infants at high risk for poor developmental outcome will allow early targeting of therapy services to these infants. If successful, the proposed studies will lead to improved outcomes for prematurely-born infants. Project Narrative: This study is designed to use magnetic resonance imaging to improve our understanding of the brain injury sustained by prematurely-born infants. This understanding has the potential to improve clinical practices and assist with the development of medications to reduce injury in these babies, ultimately reducing disabilities. It will also help identify those infants who are at high risk for developing cerebral palsy or mental retardation so they can be provided early access to therapy services.

描述(由申请人提供)：早产是一个重大的公共卫生问题，因为它的发病率不断增加，而且存活的婴儿随后面临的行为、神经和精神方面的挑战也经常发生。大约10%-15%的极早产儿(出生和30周胎龄)发展为脑性瘫痪，30%-60%的极早产儿经历认知障碍。这些障碍包括视觉运动问题、注意力障碍、记忆力受损、语言习得延迟、执行功能障碍、学习障碍、社交技能差，以及较高的社交退缩、焦虑和抑郁发生率。此外，在早产儿中，注意缺陷/多动障碍、自闭症和精神分裂症等发育障碍的患病率也有所增加。这些不良后果与新生儿期所遭受的白质(WM)和灰质(GM)损伤及其对随后大脑发育的影响有关。我们寻求开发在婴儿期可测量的成像生物标记物，在识别神经发育不良的风险婴儿时提供敏感性和特异性。生物标志物将包括以下磁共振(MR)成像指标：1)常规T1和T2加权图像，2)体积测量(皮质GM、深层核GM、有髓WM、无髓WM和脑脊液的体积)，3)扩散张量成像(表观扩散系数、相对各向异性、轴向和径向扩散系数)，以及4)基于表面的形态测量(综合折叠指数、平均沟深度、皮质表面积、埋皮质百分比)。这项研究的主要队列将包括120名出生在30周的极早产儿。他们将在出生后不久、月经后30周(PMA)、PMA 34周以及同等年龄段接受磁共振检查。在第一年登记的婴儿(n=30)也将在4岁时进行成像。上面列出的MR指数将与健康对照受试者的MR数据以及在相同期限和2岁和4岁时获得的临床结果数据进行比较。拟议的研究旨在加深对脑损伤的性质和时机的了解，为制定神经保护策略和改进临床实践奠定基础。纵向设计将使我们能够研究结构异常和损伤反应的代偿性变化。在新生儿期发现发育不良的高危婴儿，将有助于及早针对这些婴儿提供治疗服务。如果成功，拟议中的研究将改善早产儿的结局。项目简介：这项研究旨在使用磁共振成像来提高我们对早产儿大脑损伤的理解。这一认识有可能改善临床实践，并有助于开发药物以减少这些婴儿的伤害，最终减少残疾。它还将有助于识别那些患有脑瘫或智力低下的高危婴儿，以便他们能够及早获得治疗服务。