Risk & Protection in Trajectories of Preterm Infants: Birth to Adulthood

描述（由申请人提供）：每年有超过50万婴儿早产，其中50- 70%有后期损伤，需要专门服务。2005年，美国与早产相关的费用至少为262亿美元。美国医学研究所（Institute of Medicine）最近的一份报告建议，对早产儿进行成年早期的长期结果研究，以确定恢复的程度（如果有的话），并监测他们的发病情况。在这一竞争性更新中，我们回应了这一建议，并提出了第八次研究，在23岁的213名婴儿的独特样本中，按早产和围产期发病率分组，并有一个足月对照组。我们保留了92%的出生后的样本，97%的12岁后的样本。我们现在建议研究早产、病史和环境对青年期成就和缺陷的影响。由发育起源理论提出，我们将研究早产对健康状况不佳和疾病早期发病的影响是否可以通过下丘脑-垂体-肾上腺轴（HPA）功能的改变来解释。具体目的是：(1)确定早产、风险和保护过程对23岁成人健康、功能表现、情绪智力、执行功能和工作能力的影响；(2)确定从出生到23岁的生长、神经系统疾病和心理问题的发育轨迹，并评估累积风险和保护过程的影响；(3)研究HPA功能与早产的关系及其对23岁成人心血管功能、功能表现、情绪智力、执行功能和工作能力的影响。数据将在家访和实验室访问期间收集，使用标准化问卷、访谈和基于客观表现的评估。生物标志物是综合的，包括血液化学，肺功能测试，心肺对运动和代谢功能的反应，以及唾液皮质醇的HPA功能。我们的分析方法将使用混合模型，以确定协变量是否可以预测结果，关系是否随时间变化，以及是否通过协变量的变化来预测结果的主题内变化。鉴于目前的科学状况，这项前瞻性的5组纵向设计将在以风险和保护过程为特征的发育框架内确定从早产和成年期发病的恢复程度。当了解从早产到成年早期的发育轨迹以及影响和阻碍它们的因素时，我们将能够更好地了解长期结果的病因，以确定预防性干预措施的时机和内容。这个项目就是为了实现这个目标而设计的。制定预防科学需要注意婴儿和他们的环境之间的复杂的相互作用在不同时期。因此，该项目与2010年健康人行动计划、国际移民组织和新研究中心的倡议密切相关。公共卫生相关性：每年有超过525,000名婴儿早产，50% - 70%的婴儿有后期损伤，需要专门服务。2005年，美国与早产相关的费用至少为262亿美元，随着更多的早产儿存活下来，预计这一数字还会上升。了解从早产到成年的轨迹，以及影响它们的过程，将使专业人员能够及早识别那些有风险的人，更准确地确定干预的时间和内容。

DESCRIPTION (provided by applicant): More than 500,000 infants are born prematurely annually and 50-70 percent have later impairments requiring specialized services. Costs associated with preterm birth in the U.S. were at least $26.2 billion in 2005. A recent Institute of Medicine report recommends long term outcome studies into young adulthood for preterm infants to determine the extent of recovery, if any, and to monitor them for the onset of disease. In this competing renewal, we respond to this recommendation and propose an eighth study at age 23 of a unique sample of 213 infants grouped by prematurity and perinatal morbidity with a full term control group. We have retained 92 percent of the sample since birth and 97 percent since age 12. We now propose to examine the impact of prematurity, medical history and environments on achievements and deficits during young adulthood. Raised by the Developmental Origins Theory, we will investigate whether the impact of prematurity on poor health and early disease onset could be explained by alteration in hypothalamic-pituitary-adrenal axis (HPA) function. The specific aims are to: (1) Determine effects of prematurity and risk and protective processes on adult outcomes of health, functional performance, emotional intelligence, executive function, and work competence at age 23; (2) Determine the developmental trajectories for growth, neurological morbidities, and psychological problems from birth to age 23 and estimate the effects of cumulative risk and protective processes; (3) Examine the relationship of HPA function and prematurity and its impact on adult outcomes of cardiovascular function, functional performance, emotional intelligence, executive function, and work competence at age 23. Data will to be collected during home and laboratory visits using standardized questionnaires, interviews and objective performance based assessments. Biomarkers are integrated and include blood chemistry, pulmonary function testing, cardiopulmonary response to exercise and metabolic functioning, and HPA function by salivary cortisol. Our analysis approach will use mixed models which enable determination of whether the covariates predict outcome across time, if the relationship changes over time, and if within-subject changes in outcome are predicted by changes in a covariate. Given the state of the science, this prospective, 5-group longitudinal design will establish the extent of recovery from prematurity and the onset of disease during adulthood within a developmental framework characterized by risk and protection processes. When developmental trajectories from premature birth through early adulthood and factors that influence and impede them are understood, we will be better able to understand the etiology of long term outcomes to pinpoint the timing and content of preventative interventions. This project is designed to fulfill this goal. Formulating a science of prevention requires attention to complex interactions between infants and their contexts across periods of time. Thus, the project is closely aligned with the initiatives of Healthy People 2010, the IOM, and NINR. PUBLIC HEALTH RELEVANCE: More than 525,000 infants are born prematurely annually and 50 percent-70 percent have later impairments requiring specialized services. Costs associated with preterm birth in the United States were at least $26.2 billion in 2005 and expected to rise as more preterm infants survive. Understanding trajectories from premature birth through adulthood, and the processes that affect them, will enable professionals to make early identification of those at risk to more accurately pinpoint the timing and content of intervention.