Perinatal Assessment of At-Risk Populations

高危人群的围产期评估

• 批准号: 8699897
• 负责人: William P. Fifer
• 金额: $ 8.56万
• 依托单位: NEW YORK STATE PSYCHIATRIC INSTITUTE DBA RESEARCH FOUNDATION FOR MENTAL HYGIENE, INC
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-09-01 至 2014-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8699897
• 关键词: Abdomen; Address; Affect; Age; Age-Months; Arousal; Arrhythmia; Autonomic nervous system; Birds; Blood Pressure; Budgets; Cardiac; Cities; Cohort Studies; Coupling; Devices; Distal; Electrocardiogram; Electroencephalography; Fetal Heart Rate; Fetal Movement; Fetus; Frequencies; Genetic Polymorphism; Goals; Grant; Heart Rate; Hospitals; Incidence; Individual; Infant; Investigation; Laboratories; Learning; Life; Measurement; Measures; Methodology; Mission; Monitor; Movement; National Institute of Child Health and Human Development; National Institute on Alcohol Abuse and Alcoholism; Neurodevelopmental Disorder; New York; Newborn Infant; Outcome; Pattern; Perfusion; Perinatal; Physiological; Pine Ridge Indian Reservation; Population; Populations at Risk; Positioning Attribute; Pregnancy; Premature Birth; Premature Infant; Prone Position; Publications; Regulation; Research; Research Personnel; Respiration; Risk; Risk Assessment; Risk Factors; Sampling; Sensory; Sleep; South Dakota; Sudden infant death syndrome; Supine Position; Techniques; Temperature; Testing; Time; Tissues; Variant; Venous; Vulnerable Populations; Work; developmental disease; driving force; experience; fetal; heart rate variability; high risk; indexing; innovation; multidisciplinary; new technology; northern plains; prenatal exposure; prenatal risk factor; programs; response; serotonin transporter; sleep position; sound; supine sleep; tool

The overall goals of our project remain unchanged from our original application: to carry out a program of research to develop non-invasive assessment tools, grounded in known physiological mechanisms, in infants at risk for SIDS and other developmental disorders. To continue this mission we have expanded our approach and our multidisciplinary team of perinatal researchers in order to develop new risk indices as early as possible in the life of the fetus and young infant. Over the next Ave years we will be assessing approximately 80 infants/year In the Northern Plains and 100 subjects/year in NYC from the late fetal through the early newborn period. In these studies we propose to incorporate more direct measures of CNS maturation during sleep, as well as more sophisticated analyses of autonomic nervous system regulation in both the fetus and infant in healthy and at-risk populations. Our physiological studies focus on testing both healthy term and at-risk, prematurely born infants in response to physiological challenges associated with changes in sleep state, prone vs supine sleep positions, and orthostatic tilt. These studies are conducted prior to and during the age range of greatest vulnerability for SIDS. In addition to our battery of existing measurements of respiration, heart rate, blood pressure, movement, EEG and temperature, we propose to incorporate new state of the art measures of venous return and tissue perfusion, as we believe these parameters will provide more direct information about the physiological forces that drive responses to alterations in tilt and sleep position. In addition, we will expand our use of fetal ECG monitoring to more comprehensively assess autonomic and cardiac function in the late term fetus. Specifically, with the Monica abdominal fECG device we will investigate maternal/fetal ECG interactions, the effect of uterine activity on fetal heart rate, incidence and variation in fetal arrhythmias, fetal movement and heart rate coupling, patterns of heart rate variability and fetal heart rate response to sound. This new technology will also allow access to-markers of perinatal autonomic function in both time and frequency domains, previously only accessible in the infant. We also propose to augment our autonomic challenges to include investigation of arousal and learning We have found an important cortical component to tilt and a strong relationship of cortical power and synchrony with postconceptional age and later outcome. We have also developed analytic toots that can quantify arousal, i.e., cortical activation, in response to sensory stimulation and while learning during Sleep. We propose to extend our investigations of cortical and cerebellar markers of reactivity and learning during sleep in both healthy and high risk premature infants prior to discharge from the hospital and at one month of age. We predict that altered patterns of electrocortical synchrony will be associated with adverse prenatal exposures, both in premature infants and in the high risk sample from the Northern Plains. In these populations we will continue to measure local and distal coherence, as well as high frequency spectral power, parameters we have shown to be altered during tilts and which are affected by sleep positions. The additional EEG measures will provide more comprehensive estimates of individual physiological trajectories following adverse exposures. Consistent with our initial proposal we will export new comprehensive assessment techniques developed in our Columbia laboratories to assess a vulnerable population (Native Amencans in the Northern Plains). This work, which in past years was conducted on the Pine Ridge Indian Reservation in South Dakota, was curtailed due to budget cuts in our last application. However, we now plan to merge our efforts with those of another NICHD/NIAAA study being conducted by the PASS network in Rapid City, S.D: In these studies, we will measure EEG and autonomic activity as a function of prenatal risk factors In one month old Infants during sleep in both prone and supine positions and in response to a tilt challenge. In summary, our primary hypotheses focus on testing how known risk factors for SIDS premature birth, sleep position, prenatal exposures) alter physiological function in the fetus and infant Our long-term objectives are to elucidate physiologic mechanisms that underlie SIDS and to develop, age-appropriate, non-invasive tests that will identify infants who are at the greatest risk. These primary hypotheses and goals remain as stated in our original application.

我们项目的总体目标与我们最初的申请保持不变：开展一项研究计划，以开发基于已知生理机制的非侵入性评估工具，用于有SIDS和其他发育障碍风险的婴儿。为了继续这一使命，我们扩大了我们的方法和我们的围产期研究人员的多学科团队，以便在胎儿和幼儿的生命中尽早开发新的风险指数。在接下来的Ave年中，我们将评估北方平原地区每年约80例婴儿和纽约市每年约100例受试者，从胎儿晚期到新生儿早期。在这些研究中，我们建议纳入更直接的措施，中枢神经系统的成熟在睡眠中，以及更复杂的分析自主神经系统的调节在胎儿和婴儿在健康和高危人群。 我们的生理学研究专注于测试健康足月儿和高危早产儿，以应对与睡眠状态变化、俯卧与仰卧睡眠姿势以及直立倾斜相关的生理挑战。这些研究是在小岛屿发展中国家最脆弱的年龄段之前和期间进行的。除了我们现有的呼吸，心率，血压，运动，EEG和温度的测量电池，我们建议纳入静脉回流和组织灌注的新的最先进的措施，因为我们相信这些参数将提供更直接的信息，驱动响应倾斜和睡眠姿势的改变的生理力量。 此外，我们将扩大胎儿心电图监测的使用范围，以更全面地评估晚期胎儿的自主神经和心脏功能。具体而言，我们将使用Monica腹部fECG设备研究母体/胎儿ECG相互作用、子宫活动对胎儿心率的影响、胎儿心律失常的发生率和变化、胎动和心率耦合、心率变异性模式和胎儿心率对声音的反应。这项新技术还将允许在时域和频域中获得围产期自主神经功能的标记物，以前只能在婴儿中获得。 我们还建议增加我们的自主挑战，包括唤醒和学习的调查 我们已经发现了一个重要的皮质成分倾斜和皮质功率和同步性与孕后年龄和后来的结果有很强的关系。我们还开发了可以量化唤醒的分析工具，即，皮层激活，对感觉刺激作出反应，并在睡眠期间学习。我们建议在健康和高危早产儿出院前和一个月大时，扩大我们对睡眠期间反应性和学习的皮质和小脑标志物的调查。我们预测，无论是早产儿还是来自北方平原的高危样本，皮层电同步模式的改变都与产前不良暴露相关。在这些人群中，我们将继续测量局部和远端相干性，以及高频频谱功率，我们已经证明在倾斜过程中会改变的参数，这些参数会受到睡眠姿势的影响。额外的EEG测量将提供不良暴露后个人生理轨迹的更全面估计。 与我们最初的建议一致，我们将出口我们哥伦比亚实验室开发的新的综合评估技术，以评估弱势群体（北方平原的土著阿门坎人）。这项工作，这在过去几年中进行的松树岭印第安人保留地在南达科他州，被削减，由于预算削减，在我们的最后一次申请。然而，我们现在计划将我们的努力与另一项由PASS网络在南达科他州拉皮德城进行的NICHD/NIAAA研究相结合：在这些研究中，我们将测量EEG和自主神经活动作为产前风险因素的函数。 总之，我们的主要假设集中于测试已知的SIDS风险因素（早产、睡眠姿势、产前暴露）如何改变胎儿和婴儿的生理功能。我们的长期目标是阐明SIDS的生理机制，并开发适合年龄的非侵入性测试，以识别风险最大的婴儿。这些主要假设和目标仍如我们的原始申请中所述。