DTI, MRSI, and Volumetry of Cerebellar Injury in Preterm Neonates

在美国出生的儿童中，有13%至16%是早产儿，其中近2%的体重低于1500克（不到四分之三磅）。在后一组中，在近90%的幸存者中观察到神经功能缺损：大脑性瘫痪在5-10%中发现，认知，行为或注意力缺陷在约50%中发现。2005年，新生儿第一年的平均医疗费用为41，610美元，而足月婴儿的医疗费用为2，830美元，每年的医院费用总额为74亿美元。磁共振成像正越来越多地用于观察这些婴儿的大脑，以了解为什么这么多婴儿有这些发育异常。大多数研究都集中在大脑半球的白色物质的损伤上，但最近的研究发现，小脑（大脑的更后部）的发育经常异常。小脑传统上与运动张力和协调有关，最近又与认知功能有关。因此，早产儿不良结局的一个组成部分可能与小脑发育异常有关。本研究建议使用最先进的磁共振技术来评估早产新生儿发育过程中小脑的代谢和微观结构，并将该发育与婴儿其他器官系统的潜在可治疗疾病以及早产新生儿大脑的两种常见疾病（脑室出血和脑白色物质损伤）相关联。据推测，出血进入脑室系统和小脑周围的蛛网膜下腔会阻止小脑从覆盖它的组织接收重要信号，而大脑白色物质的损伤可能会干扰发送到小脑的信号，从而导致早产儿大脑的小脑损伤。识别致病因素可能会使这些因素被避免或更积极地治疗，最终导致小脑损伤减少和临床结果改善。 公共卫生相关性：早产儿的脑损伤极大地增加了生命第一年的医疗保健费用。此外，不良的神经发育结果导致不良的学校表现，行为表现导致儿童期后受影响患者的生产力下降。这项研究旨在确定原因，并以这种方式减少这些伤害的发生率。

DESCRIPTION (provided by applicant): Between 13 and 16% of children born in the United States are born prematurely, with nearly 2% of these weighing less than 1500 g (less than three-quarters of a pound). In this latter group, neurological deficits are observed in nearly 90% of those who survive: cerebral palsy is found in 5-10% and deficits in cognition, behavior, or attention is found in about 50%. In 2005, medical costs during the first year of life averaged $41,610, compared to $2830 for a full term baby, for total annual hospital charges of $7.4 billion. Magnetic resonance imaging is being used increasingly to look at the brains of these babies in order to understand why so many have these developmental abnormalities. Most studies have focused upon injury to the white matter of the cerebral hemispheres, but recent studies have discovered frequent abnormalities of development of the cerebellum, a more posterior part of the brain. The cerebellum has traditionally been associated with motor tone and coordination, and more recently has been implicated in cognitive function. As a result, a component of the adverse outcome from prematurity may relate to abnormal cerebellar development. This study proposes to use state-of-the-art magnetic resonance techniques to assess the metabolism and microstructure of the cerebellum during development in prematurely born neonates and to correlate that development with potentially treatable conditions in other organ systems of the baby and with two common conditions of the brain in prematurely born neonates: hemorrhage into the cerebral ventricles, and injury of the cerebral white matter. It is postulated that hemorrhage into the ventricular system and subarachnoid spaces around the cerebellum prevents the cerebellum from receiving important signals from the tissues that cover it, while injury to the cerebral white matter might interfere with signals sent to the cerebellum, thus contributing to cerebellar injury of the premature brain. Identification of the causative factors might allow those factors to be avoided or treated more aggressively, ultimately resulting in less cerebellar damage and improved clinical outcome. PUBLIC HEALTH RELEVANCE: Brain injuries in prematurely born babies enormously increase the costs of health care during the first year of life. In addition, the poor neurodevelopmental outcome that results in poor school performance, and behavioral performance that results in decreased productivity of affected patients after childhood. This study aims to identify causes and, in that way, reduce the incidence of these injuries.