Inflammatory Mediators of Stress Exposure and Neurodevelopment in Very Preterm Infants

项目总结/摘要 早产儿（月经后28-31周（PMA））的风险增加， 早产和新生儿重症监护室住院时间延长导致神经发育不良 （新生儿重症监护病房）。极早产儿的认知、运动、行为和社会情感功能较差， 对足月出生的健康婴儿，这可能会持续到儿童晚期和成年早期。早产儿暴露于 许多经验性（例如疼痛的过程）、环境性（例如感觉刺激）和生理性（例如脓毒症， 严重疾病）的压力源，这可能会影响他们的长期神经发育。研究人员 已经提出了一个直接的因果通路，将炎症与脑损伤和早产儿神经发育受损联系起来。 婴儿。确定连接压力和神经发育的潜在可改变的介质对于改善 早产儿的长期预后。本研究的目的是评估压力与 暴露、炎症和极早产儿神经发育。本研究将实现以下具体目标： 目的：（1）探讨极早产儿应激暴露、炎症反应与神经发育的关系 婴儿，（2）确定压力暴露对炎症和抗炎细胞因子每周变化的影响 从一周龄到35周龄PMA，和（3）检查NICU压力的公布量表之间的相关性 暴露和慢性应激反应测量的头发皮质醇浓度非常早产儿。累积和 将使用新生儿压力源量表（NISS）计算每周压力暴露评分。炎症将是 用一组促炎和抗炎细胞因子测量，通过多重测定定量。 将使用早产儿神经行为评估（NAPI）评估神经发育。研究 包括一个探索性的目标，以衡量NISS分数和头发皮质醇浓度之间的相关性，一个创新的 住院早产儿慢性应激反应的测量方法。本研究与 国家护理研究所的使命，以促进终身健康，是一个重要的步骤， 制定有针对性的干预措施，以优化早产儿的神经发育结果。培训计划 将为申请人提供许多正式和非正式的专业发展机会，同时允许 申请人建立一个坚实的基础，为成功的职业生涯作为一个独立的研究人员。这项研究建立在 申请人作为NICU护士和研究助理的经验，并将她的生物学，护理学和 分子生物学实验室技术

PROJECT SUMMARY/ABSTRACT Infants born very preterm (28-31 weeks post-menstrual age (PMA)) are at an increased risk for impaired neurodevelopment as a result of their preterm birth and extended hospitalization in the neonatal intensive care unit (NICU). Very preterm infants experience poorer cognitive, motor, behavioral, and socioemotional functioning compared to healthy infants born at term, which may persist into late childhood and early adulthood. Preterm infants are exposed to numerous experiential (e.g. painful procedures), environmental (e.g. sensory stimulation), and physiologic (e.g. sepsis, critical illness) stressors during their hospitalization which may affect their long-term neurodevelopment. Researchers have suggested a direct causal pathway linking inflammation with brain injury and impaired neurodevelopment in preterm infants. Determining the potentially modifiable mediators linking stress and neurodevelopment is paramount to improve the long-term outcomes of very preterm infants. The purpose of this study is to evaluate the relationships among stress exposure, inflammation, and neurodevelopment in very preterm infants. This study will accomplish the following specific aims: (1) determine the relationships among stress exposure, inflammation, and neurodevelopment in very preterm infants, (2) determine the effect of stress exposure on weekly changes in inflammatory and anti-inflammatory cytokines from one week of age until 35 weeks PMA, and (3) examine the correlation between a published scale of NICU stress exposure and chronic stress response measured by hair cortisol concentration in very preterm infants. Cumulative and weekly stress exposure scores will be calculated using the Neonatal Infant Stressor Scale (NISS). Inflammation will be measured with a panel of pro-inflammatory and anti-inflammatory cytokines, quantified by multi-plex assay. Neurodevelopment will be assessed using the Neurobehavioral Assessment of the Preterm Infant (NAPI). The study includes an exploratory aim to measure the correlation between NISS scores and hair cortisol concentration, an innovative approach to the measurement of a chronic stress response in hospitalized preterm infants. This study aligns with the National Institute of Nursing Research’s mission to promote life-long wellness and is an important step in the development of targeted interventions to optimize neurodevelopmental outcomes for preterm infants. The training plan will provide the applicant with numerous formal and informal opportunities for professional development while allowing the applicant to build a solid foundation for a successful career as an independent researcher. This study builds on the applicant’s experiences as a NICU nurse and research assistant and integrates her knowledge of biology, nursing, and molecular biology lab techniques.