The microbiome as a potential mediator of socio-economic disparities in preterm infant neurodevelopmental trajectories from NICU discharge to school age

项目摘要/摘要 新生儿重症监护病房(NICU)护理的目标不仅是早产儿的存活，而且要完好无损 这些脆弱的患者的神经发育。影响神经发育的因素很多。身份识别 在某个时间点可以修改的因素，足够早地改善个人的发展轨迹 需要婴儿。而具有一定发展潜力的早产儿则从NICU出院 根据他们的胎龄和临床病程，家庭环境的社会经济地位(SES)可以 显著改变了发展轨迹。贫困会增加神经发育恶化的风险， 造成了巨大的健康差距。贫困是如何改变神经发育的，目前尚不清楚。 微生物群受到环境的影响，进而影响大脑的发育。我们假设 微生物组是SES和环境对神经发育影响的生物效应器。这 提案将重点关注微生物群暴露在重大环境中的两个关键时间点 改变-在NICU生活的前2周和在家庭环境中生活的6-12个月。纵向 临床数据、患者微生物样本、环境数据和SES数据将在已建立的 来自美国五家机构的早产儿队列已经在调查肠道 早产儿的微生物群。将进行神经发育检查以评估功能结果。 准备好上学了。这项提案的目标是证明微生物群的发育影响 神经发育。此外，我们将确定与SES相关的环境因素，这些因素会影响 微生物组，从而影响神经发育结果。该建议的优点包括以下方面的独特专业知识 新生儿护理、神经发育、微生物组分析等领域的跨学科研究团队， 生物信息学、经济学和家庭环境的环境特征分析。进阶 测序技术、环境因素的空间分析(地质图)和经济建模将 用于研究SES、环境、微生物组和神经发育之间的关系 结果，以确定一个时间点和可能的环境或微生物组改造，以改善结果。 除了增加社交策略、扩展有效的学习模式和缓解老年人的医疗需求之外 风险婴儿，了解和促进微生物组的转变可能会导致对 健康差距，并使干预措施能够以创新的方式改变婴儿的神经发育轨迹。

Project Summary/Abstract The goal of neonatal intensive care unit (NICU) care is not just survival of preterm infants, but also intact neurodevelopment for these vulnerable patients. Many factors affect neurodevelopment. Identification of factors that are modifiable at a time point early enough to improve the developmental trajectory of an individual infant is needed. While preterm infants are discharged from the NICU with a certain developmental potential based on their gestational age and clinical course, socioeconomic status (SES) of the home environment can significantly alter the developmental trajectory. Poverty increases risk for neurodevelopmental deterioration, resulting in significant health disparities. The means by which poverty alters neurodevelopment are unknown. The microbiome is influenced by environment and in turn influences brain development. We hypothesize that that the microbiome is a biologic effector of the influence of SES and environment on neurodevelopment. This proposal will focus on two key time points at which the microbiome is exposed to significant environmental alteration – first 2 weeks of life in the NICU and 6-12 months of life in the home environment. Longitudinal clinical data, patient microbial samples, environmental data, and SES data will be collected on established cohorts of preterm infants from five institutions across the United States already investigating the intestinal microbiome of preterm infants. Neurodevelopmental exams will be performed to assess the functional outcome of school readiness. The goal of this proposal is to demonstrate that microbiome development influences neurodevelopment. Furthermore we will identify environmental factors associated with SES that influence the microbiome and thus neurodevelopmental outcomes. Strengths of this proposal include distinctive expertise of the interdisciplinary investigative team in neonatal care, neurodevelopment, microbiome analysis, bioinformatics, economics, and analysis of environmental features of the home environment. Advanced sequencing techniques, spatial analysis of environmental factors (geomapping), and economic modeling will be used to investigate the relationships among SES, environment, microbiome, and neurodevelopmental outcome to identify a time point and possible environmental or microbiome modification to improve outcomes. Beyond increasing social strategies, expanding effective learning models, and mitigating medical needs of at risk infants, understanding and promoting shifts in the microbiome could lead to improved understanding of health disparities and enable interventions to alter infant neurodevelopmental-trajectories in innovative ways.