PHYSIOLOGICAL DISTURBANCES ASSOCIATED WITH NEONATAL INTRAVENTRICULAR HEMORRHAGE

与新生儿脑室内出血相关的生理障碍

• 批准号: 7720481
• 负责人: JENNIFER D KAISER
• 金额: $ 20.59万
• 依托单位: UNIV OF ARKANSAS FOR MED SCIS
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-08-01 至 2009-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7720481
• 关键词: Address; Antihypertensive Agents; Birth Weight; Blood Pressure; Brain Injuries; Carbon Dioxide; Caring; Cerebral Palsy; Cerebrovascular Circulation; Cerebrum; Clinical; Clinical Research; Computer Retrieval of Information on Scientific Projects Database; Development; Environmental air flow; Extremely Low Birth Weight Infant; Fractals; Funding; Goals; Grant; Heart Rate; Homeostasis; Hypotension; Incidence; Infant; Institution; Intervention; Learning Disabilities; Life; Living Wills; Mental Retardation; Neonatal; Newborn Infant; Pattern; Physiologic Monitoring; Physiological; Public Health; Randomized Controlled Trials; Research; Research Personnel; Resources; Risk; Series; Source; System; United States National Institutes of Health; Week; cost; day; heart rhythm; intraventricular hemorrhage; nervous system disorder; novel; patient oriented; postnatal; pressure

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Almost 5,000 extremely low birth weight (ELBW, birth weight d1000 g; d2 lbs, 3 ounces) infants per year in the US develop severe intraventricular hemorrhage (IVH) that is associated with mental retardation, cerebral palsy, and learning disabilities. As lifetime care costs in these infants exceed $3 billion, IVH in ELBW infants is a major public health problem. Unfortunately, the incidence of severe IVH in ELBW infants has remained constant over the last decade, and accurately identifying the ELBW infants at highest risk of developing IVH has been difficult. Therefore, the long-term goal of our patient-oriented clinical research is to determine the effects of disturbed physiological phenomena associated with IVH in order to predict those infants most at risk and to develop best care clinical practices that may limit severe brain injury. We hypothesize that reducing alterations and extremes of carbon dioxide, blood pressure, and heart rate, factors that influence cerebral blood flow and cerebral autoregulation in ELBW infants, may mitigate the development of IVH and serve as important predictors of ELBW infants most at risk of developing IVH. This will be investigated through a series of clinical studies that will address: 1) whether normocapnic ventilation vs. traditional hypercapnic ventilation will reduce the develop of severe IVH by shifting the incidence to lower grade or no IVH (randomized controlled trial), 2) whether hypotensive ELBW infants have restored intact cerebral autoregulation or continued pressure-passive cerebral blood flow when blood pressure is normalized, and how the postnatal pattern of development of cerebral autoregulation is altered in hypotensive infants, using our novel continuous physiological monitoring system, and 3) whether altered fractal heart rhythm dynamics will serve as an accurate predictor of impending IVH. We will use our continuous physiological monitoring system developed during our K23 studies to determine cerebral autoregulatory capacity during treatment of hypotension and the developmental pattern of cerebral autoregulation during the first week of life. Heart rhythm dynamics on the first day of life will be determined and its value at a predictor of impending IVH will be evaluated. If successful, our proposed clinical studies will reduce the burden of neurological disease in newborn ELBW infants by developing better care clinical practices and by providing a new accurate predictor of impending IVH, so that high risk infants may be identified and interventions applied to limit the development of IVH.

这个子项目是许多研究子项目中利用 资源由NIH/NCRR资助的中心拨款提供。子项目和 调查员(PI)可能从NIH的另一个来源获得了主要资金， 并因此可以在其他清晰的条目中表示。列出的机构是 该中心不一定是调查人员的机构。 在美国，每年有近5,000名极低出生体重(ELBW，出生体重D1000克；D2磅，3盎司)婴儿发展为严重的脑室出血(IVH)，与智力低下、脑瘫和学习障碍有关。由于这些婴儿的终生护理费用超过30亿美元，ELBW婴儿的IVH是一个主要的公共卫生问题。不幸的是，在过去的十年中，极低出生体重儿的严重IVH发生率一直保持不变，准确识别极易发生IVH的极低出生体重儿一直是困难的。因此，我们以患者为中心的临床研究的长期目标是确定与IVH相关的紊乱生理现象的影响，以便预测哪些婴儿风险最高，并开发出可能限制严重脑损伤的最佳护理临床实践。我们假设，减少影响低出生体重儿脑血流和脑自我调节的二氧化碳、血压和心率的变化和极端，可能会缓解IVH的发展，并可作为低出生体重儿最有可能发生IVH的重要预测指标。我们将通过一系列临床研究来研究这一点，这些研究将涉及：1)通过将发生率转移到较低级别或无IVH(随机对照试验)，常压和传统的高碳酸血症是否会减少严重IVH的发生；2)低血压的ELBW婴儿在血压正常化后是否恢复了完整的脑自动调节或持续的压力被动脑血流，以及使用我们新的连续生理监测系统，低血压婴儿出生后脑自动调节的发育模式如何改变，以及3)心律动力学变化是否将作为即将到来的IVH的准确预测指标。我们将使用我们在K23研究中开发的连续生理监测系统来确定低血压治疗期间的脑自动调节能力，以及生命第一周期间脑自动调节的发育模式。将确定出生第一天的心律动力学，并评估其在预测即将发生的IVH方面的价值。如果成功，我们拟议的临床研究将通过开发更好的护理临床实践和通过提供即将到来的IVH的新的准确预测指标来减轻新生儿ELBW神经疾病的负担，从而可以识别高危婴儿并应用干预措施来限制IVH的发展。