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

风险

• 批准号: 7695009
• 负责人: Mary C Sullivan
• 金额: $ 13.75万
• 依托单位: UNIVERSITY OF RHODE ISLAND
• 依托单位国家: 美国
• 财政年份: 1994
• 资助国家: 美国
• 起止时间: 1994-09-25 至 2013-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7695009
• 关键词: Achievement; Adolescent; Adult; Affect; Age; Attention; Biological Markers; Birth; Birth Weight; Blood Chemical Analysis; Cardiopulmonary; Cardiovascular Physiology; Caring; Charge; Child; Circadian Rhythms; Clinical; Cognitive deficits; Competence; Complex; Control Groups; Data; Databases; Development; Disease; Early identification; Economic Burden; Education; Emotional; Environment; Environmental Risk Factor; Etiology; Evidence based intervention; Exercise; Family; Financial cost; Functional disorder; Funding; Gestational Age; Goals; Growth; Health; Healthcare; Healthy People 2010; Heterogeneity; Home environment; Hospitals; Hydrocortisone; Impairment; Incidence; Infant; Institute of Medicine (U.S.); Intelligence; Intervention; Interview; Knowledge; Laboratories; Learning Disabilities; Longevity; Longitudinal Studies; Maps; Mediating; Medical; Medical History; Mental Health; Metabolic; Modeling; Monitor; Morbidity - disease rate; Neurobiology; Neurologic; Onset of illness; Outcome; Outcome Study; Performance; Perinatal; Positioning Attribute; Premature Birth; Premature Infant; Prevention; Problem behavior; Process; Public Health; Pulmonary function tests; Questionnaires; Recommendation; Recovery; Reporting; Research; Research Design; Risk; Salivary; Sampling; Science; Services; Stress; Subgroup; Survivors; System; Testing; Time; Toddler; Translational Research; United States; Visit; Work; base; comparison group; cost; design; disability; emerging adult; executive function; experience; follow-up; hypothalamic-pituitary-adrenal axis; indexing; infant animal; innovation; longitudinal design; meetings; neuropsychological; postnatal; premature; prospective; psychologic; public health relevance; resilience; response; social; theories; young adult

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.

描述（由申请人提供）：每年有超过50万名婴儿早产，50- 70%的婴儿后来有需要专门服务的障碍。2005年，美国与早产相关的费用至少为262亿美元。医学研究所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），并监测他们的疾病发作。在这一竞争性更新中，我们回应了这一建议，并提出了第八项研究，在23岁时，对213名婴儿进行了独特的样本，按早产和围产期发病率进行分组，并设一个足月对照组。我们保留了92%的出生样本和97%的12岁样本。我们现在建议研究早产，病史和环境对成年早期成就和缺陷的影响。根据发育起源理论，我们将研究早产对健康状况不佳和早期疾病发作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。具体目标是：（1）确定早产和风险和保护过程对23岁时健康，功能表现，情绪智力，执行功能和工作能力的成年结果的影响;（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展轨迹，并估计累积风险和保护过程的影响;（3）检查HPA功能与早产的关系及其对23岁时心血管功能、功能表现、情绪智力、执行功能和工作能力的成年结果的影响。将在家庭访视和实验室访视期间使用标准化问卷、访谈和基于客观表现的评估收集数据。生物标志物是综合的，包括血液化学，肺功能测试，心肺反应的运动和代谢功能，和HPA功能唾液皮质醇。我们的分析方法将使用混合模型，以确定协变量是否随时间预测结局，关系是否随时间变化，以及受试者内结局变化是否通过协变量变化预测。考虑到科学的现状，这种前瞻性的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早产儿的恢复程度和成年期疾病的发作。当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被理解时，我们将能够更好地理解长期结果的病因，以确定预防干预的时机和内容。本项目旨在实现这一目标。制定预防科学需要关注婴儿与其不同时期环境之间的复杂互动。因此，该项目与“2010年健康人”、移徙组织和国家康复研究所的倡议密切配合。公共卫生关系：每年有超过525，000名婴儿早产，50%-70%的婴儿后来有需要专门服务的障碍。2005年，美国与早产相关的成本至少为262亿美元，随着更多早产儿的存活，预计还会上升。了解从早产到成年的轨迹，以及影响他们的过程，将使专业人员能够早期识别那些有风险的人，以更准确地确定干预的时间和内容。