Assessment of metabolic bone disease of prematurity using an acoustic method

声学方法评估早产儿代谢性骨病

• 批准号: 10005122
• 负责人: Azra Alizad
• 金额: $ 20.99万
• 依托单位: MAYO CLINIC ROCHESTER
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-01 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10005122
• 关键词: Acoustics; Adult; Affect; Alkaline Phosphatase; Assessment tool; Biochemical; Biomedical Engineering; Bone Diseases; Bone structure; Calcium; Characteristics; Clinic; Clinical; Clinical Research; Data; Decision Making; Densitometry; Detection; Development; Devices; Diagnostic radiologic examination; Environment; Equipment; Evaluation; Fatty acid glycerol esters; Fracture; Frequencies; Generations; Goals; Health; Infant; Intervention; Investigation; Ionizing radiation; Lead; Life; Longitudinal Studies; Low Birth Weight Infant; Measurement; Measures; Mechanics; Metabolic Bone Diseases; Methods; Minerals; Monitor; Nature; Neonatal; Operating System; Osteopenia; Osteoporosis; Outcome; Pathologic; Patient-Focused Outcomes; Patients; Pediatrics; Phosphorus; Physiologic calcification; Pilot Projects; Population; Premature Infant; Property; Quantitative Evaluations; Radiation; Research; Rickets; Risk; Roentgen Rays; Serum; Signal Transduction; Skeletal system; Skeleton; Speed; Structure; Subcutaneous Tissue; Systems Analysis; Systems Development; Techniques; Technology; Testing; Time; Treatment Efficacy; Ultrasonics; Ultrasonography; absorption; base; bone; bone health; cost; design; experience; health assessment; improved; in vivo; infancy; infant nutrition; innovation; inorganic phosphate; limb bone; long bone; mineralization; multidisciplinary; novel; nutrition; patient population; portability; premature; preterm newborn; quantitative ultrasound; rib bone structure; risk minimization; screening; skeletal; soft tissue; sound; statistics; subcutaneous; tibia; time use; treatment response

Metabolic bone disease in preterm newborn or osteopenia of prematurity (OP), or neonatal rickets or rickets of prematurity, are terms used to describe a common and significant problem that refers to hypo-mineralized skeleton of premature infants that is hallmarked by radiographic evidence of decreased bone mineralization and often leads to fractures of long bone and ribs. In an effort to maximize bone mineralization and minimize OP, clinicians use biochemical measurements of serum calcium, inorganic phosphorus, and alkaline phosphatase to make decisions for optimizing infant nutrition, but are limited to radiographic evidence over time to monitor this progress. Currently, no screening test has been shown to provide both sensitive and specific evidence of developing OP over the first several weeks of life in the premature infants. Such information would greatly facilitate clinicians’ efforts to optimize nutrition for preterm infants in an effort to minimize the risk of OP. Current bone assessment tools include plain radiography, dual-energy X-ray absorption (DXA), and quantitative ultrasonography (QUS). Due to the use of ionizing radiation and bulky equipment, the first two methods are not suitable for infants and especially for the low-birth-weight pre-term neonates, a group at particular risk of mineral compromise. QUS is designed to measure the speed of sound in large extremity bones by transmitting a single-frequency ultrasound. Adaptation of this device to infants and especially premature infants is very poor. The most important shortcoming of conventional QUS for evaluation of infant bone is that the results are greatly affected by subcutaneous tissues, particularly by the subcutaneous fat layer. Another shortcoming of the current QUS technology is that the system operates on a single- frequency basis. Based on our investigations, to be described later in this application, acquiring ultrasound data in a wide range of frequencies, especially in the kilo-Hertz range, can provide valuable information about the mechanical structure of bone and may lead to improved bone assessment. The goal of the proposed project is to develop a new ultrasound based technology, called vibro-acoustic analysis (VAA), which is based on a fundamentally new mechanism that allows evaluation of infant bone properties in a wide frequency range without the interference from subcutaneous tissues. In Aim 1, optimization of the VAA method for quantitative assessment, we will optimize and validate the technique for in vivo study. In Aim 2, we will determine the efficacy of the VAA method for quantitative assessment of tibia bone in a pilot study.The proposed technique will be tested on term and preterm infants to detect and monitor the treatment in a longitudinal study. The technology to be developed in this project may provide clinicians with valuable information to monitor and treat developing OP at a stage where radiographic evidence is not yet apparent. Additionally, quantitative measurements over time using improved VAA technology may facilitate assessments of treatment efficacy, thus further guiding clinical interventions with the strong potential for improved patient outcomes.

早产儿代谢性骨病或早产儿骨质减少（OP），或新生儿佝偻病或佝偻病 早产是用来描述矿化不足的常见且重大问题的术语 早产儿的骨骼，其特征是骨矿化减少的放射学证据 并经常导致长骨和肋骨骨折。为了最大限度地提高骨矿化程度并最大限度地减少 OP，临床医生使用血清钙、无机磷和碱性的生化测量 磷酸酶来做出优化婴儿营养的决策，但仅限于放射学证据 是时候监控这一进展了。目前，还没有证据表明筛选测试能够同时提供敏感和 早产儿出生后最初几周内发生 OP 的具体证据。这样的 信息将极大地促进临床医生优化早产儿营养的努力 最大限度地降低 OP 的风险。目前的骨骼评估工具包括平片、双能 X 射线 吸收（DXA）和定量超声检查（QUS）。由于使用电离辐射且体积庞大 设备，前两种方法不适合婴儿，特别是低出生体重的早产儿 新生儿是矿物质受损风险特别高的群体。 QUS 旨在测量声速 通过传输单频超声波来治疗大的四肢骨骼。该设备适用于婴儿和 尤其是早产儿非常可怜。传统QUS评估的最大缺点 婴儿骨骼的特点是结果受皮下组织影响很大，特别是皮下组织 脂肪层。当前QUS技术的另一个缺点是该系统在单芯片上运行 频率基础。根据我们的调查，本申请稍后将进行描述，获取超声波 各种频率的数据，特别是千赫兹范围的数据，可以提供有关以下方面的有价值的信息： 骨骼的机械结构，可能会改善骨骼评估。拟议的目标 该项目旨在开发一种新的基于超声波的技术，称为振动声学分析（VAA），该技术基于 一种全新的机制，可以在很宽的频率范围内评估婴儿骨骼特性 不受皮下组织的干扰。在目标 1 中，优化 VAA 方法进行定量 评估后，我们将优化和验证体内研究的技术。在目标 2 中，我们将确定 初步研究中 VAA 方法对胫骨骨定量评估的有效性。所提出的技术 将在足月儿和早产儿身上进行测试，以检测和监测纵向研究中的治疗情况。这 该项目将开发的技术可以为临床医生提供有价值的信息来监测和治疗 在放射学证据尚不明显的阶段开发 OP。此外，定量 使用改进的 VAA 技术进行随时间的测量可能有助于评估治疗效果， 从而进一步指导具有改善患者预后的巨大潜力的临床干预措施。