EARLY PREDICTION OF CP
CP 的早期预测
基本信息
- 批准号:7960433
- 负责人:
- 金额:$ 2.85万
- 依托单位:
- 依托单位国家:美国
- 项目类别:
- 财政年份:2009
- 资助国家:美国
- 起止时间:2009-07-01 至 2010-06-30
- 项目状态:已结题
- 来源:
- 关键词:AgeBrainBrain InjuriesCerebral PalsyChildChronicChronic lung diseaseClinicalClinical ResearchClinical assessmentsComputer Retrieval of Information on Scientific Projects DatabaseContractureCounselingDevelopmentDevelopmental Delay DisordersDiagnosisDiagnosticElectroencephalographyEtiologyFamilyFunctional Magnetic Resonance ImagingFundingGrantGuidelinesHawaiiHeadHearingHemorrhageHereditary DiseaseHospitalizationImageIncidenceInfantInfectionInjuryInstitutionInterventionIntraventricularIschemic-Hypoxic EncephalopathyLaboratoriesLengthLifeLungLung diseasesMagnetic Resonance ImagingMeasuresMedicalMeta-AnalysisMethodsMonitorMovementMuscle CrampMusculoskeletalNeurologicNeurologistOutcomePatientsPeriventricular LeukomalaciaPredictive ValuePreventiveQuadriplegiaResearchResearch InfrastructureResearch PersonnelResourcesRiskScreening procedureSensorySourceSpecificityStagingSupportive careSyndromeSystemTestingUltrasonographyUnited States National Institutes of HealthVisualbasefeedingfollow-upimprovedintrapartumnutritionpreventtool
项目摘要
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.
Cerebral palsy (CP) is considered a clinical syndrome caused by a preceding brain injury early in brain development that results in static neurological deficits. These deficits usually involve the somatomotor system manifesting as hemi-, di- or quadriplegia. Cerebral palsy can also manifest as hypertonicity and contractures, sensory deficits, hearing and visual difficulties, feeding problems and global developmental delay and other chronic medical problems such as lung disease.
The most common cause of cerebral palsy is a hypoxic-ischemic brain injury, periventricular leukomalacia or intraventricular and/or parenchymal hemorrhage that occurs in the first year of life. Less common etiologies are genetic disorders, infections and intrapartum injuries. The current treatments of cerebral palsy are targeted to maintaining function, relieving contractures, improving nutrition and providing developmental supportive care, but to date there is no cure or preventive guideline. Moreover, supportive measures and family counseling is delayed since cerebral palsy can be diagnosed only at the age of 18-24 months. If an intervention or cure was discovered that could prevent the development of cerebral palsy, this intervention would be delayed due to the lack of a predictive diagnostic assessment within the first six months of life.
Until about ten years ago, there was still no clinical, laboratory or imaging study that could accurately predict the development of cerebral palsy in the first six months of life. Head ultrasound, EEG and functional MRI were tested for their predictive value before the actual diagnosis of cerebral palsy, however, the low sensitivity of these studies showed that they are not useful as screening tools.
Heinz F.R. Prechtl, an Austrian neurologist, developed a clinical assessment method to study the spontaneous movements of preterm and term infants. Monitoring of cramped synchronized generalized movements and fidgety movements resulted in 100% sensitivity and 95% specificity in predicting cerebral palsy. These studies were repeated by two other groups with similar results. A meta-analysis of predictive tools for cerebral palsy identified Prechtl's method as the most superior assessment that showed higher positive predictive value (PPV) than head ultrasound or MRI. These studies have not been repeated in the USA.
Our aim in this proposal is to assess the predictive value of Prechtl's method in preterm and term infants with and without lung disease, who are at risk for development of cerebral palsy in Hawaii. We will compare the incidence of pulmonary diseases and cerebral palsy and observe any relationship between the development of lung disease and brain injury. We will identify at risk infants and observe their generalized movements according to Prechtl's assessment. We will conduct a 2-year longitudinal follow up of our patients and interpret the predictive value of our assessment based on the diagnosis of cerebral palsy. We will compare the sensitivity and PPV of head ultrasound and the assessment of generalized movements.
This assessment will allow us to start supportive measures at an earlier stage of life, thus improving the outcome of children with cerebral palsy. The improvement of their musculoskeletal status and development allow children with cerebral palsy to have a better pulmonary status and will decrease the number and length of hospitalizations mainly due to complications of chronic lung disease.
这个子项目是许多研究子项目中的一个
由NIH/NCRR资助的中心赠款提供的资源。子项目和
研究者(PI)可能从另一个NIH来源获得了主要资金,
因此可以在其他CRISP条目中表示。所列机构为
研究中心,而研究中心不一定是研究者所在的机构。
脑性瘫痪(CP)被认为是一种临床综合征,由大脑发育早期的脑损伤引起,导致静态神经功能缺损。 这些缺陷通常涉及躯体运动系统,表现为偏瘫、双瘫或四肢瘫。 脑瘫还可以表现为高张力和挛缩、感觉缺陷、听力和视觉困难、喂养问题和全面发育迟缓以及其他慢性医学问题,如肺部疾病。
脑瘫最常见的原因是缺氧缺血性脑损伤、脑室周围白质软化或脑室内和/或脑实质出血,发生在生命的第一年。 不太常见的病因是遗传性疾病、感染和产时损伤。 目前治疗脑瘫的目标是维持功能,缓解挛缩,改善营养和提供发育支持性护理,但迄今为止还没有治愈或预防指南。 此外,支持性措施和家庭咨询被推迟,因为脑瘫只能在18-24个月大时诊断。 如果发现可以预防脑瘫发展的干预或治疗方法,则由于在生命的前六个月内缺乏预测性诊断评估,这种干预将被推迟。
直到大约十年前,仍然没有临床,实验室或成像研究可以准确预测婴儿出生后六个月内脑瘫的发展。 在实际诊断脑瘫之前,头部超声、EEG和功能性MRI对其预测价值进行了测试,然而,这些研究的低灵敏度表明它们作为筛查工具并不有用。
海因茨奥地利神经学家Prechtl开发了一种临床评估方法来研究早产儿和足月儿的自发运动。 监测痉挛性同步全身运动和烦躁运动,预测脑瘫的敏感性为100%,特异性为95%。 另外两个小组重复了这些研究,得到了类似的结果。 一项对脑瘫预测工具的荟萃分析表明,Prechtl的方法是最上级的评估方法,其阳性预测值(PPV)高于头部超声或MRI。 这些研究尚未在美国重复。
我们的目的是在这个建议是评估Prechtl的方法在早产儿和足月儿有和没有肺部疾病,谁是在夏威夷发展为脑瘫的风险的预测价值。 我们将比较肺部疾病和脑瘫的发病率,并观察肺部疾病和脑损伤之间的关系。 我们将根据Prechtl的评估确定有风险的婴儿并观察他们的全身运动。 我们将对我们的患者进行为期2年的纵向随访,并根据脑瘫的诊断解释我们评估的预测价值。 我们将比较头部超声的灵敏度和PPV以及全身运动的评估。
这项评估将使我们能够在生命的早期阶段开始支持性措施,从而改善脑瘫儿童的预后。 肌肉骨骼状态和发育的改善使脑瘫儿童的肺部状态更好,并将减少主要由于慢性肺部疾病并发症而住院的数量和时间。
项目成果
期刊论文数量(0)
专著数量(0)
科研奖励数量(0)
会议论文数量(0)
专利数量(0)
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CHARLES RICHARD NEAL其他文献
CHARLES RICHARD NEAL的其他文献
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{{ truncateString('CHARLES RICHARD NEAL', 18)}}的其他基金
CLINICAL TRIAL: PARTICIPANT AND CLINICAL RESOURCES (PCR)
临床试验:参与者和临床资源 (PCR)
- 批准号:
8364966 - 财政年份:2011
- 资助金额:
$ 2.85万 - 项目类别:
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