Neuroimaging measures of brain function in preterm neonates

早产在加拿大很常见，大约每20个新生儿中就有1个需要长期留在重症监护室。现代技术和护理方面的改进提高了早产儿的存活率，但照顾早产儿的医务人员和父母仍然非常担心，至少有一半的早产儿会有严重的残疾，更多的早产儿在学校会有问题。我们现在的重点是试图更好地了解早产儿作为新生儿所面临的严重问题，以及它们如何影响身体器官，特别是大脑。早产儿最常见的问题是动脉导管未闭（PDA）。这条血管在胎儿生命中是必不可少的，是胎盘血液到达婴儿身体的途径。当出生后PDA不能关闭时，它会导致过多的血液流入肺部，同时从大脑和其他重要器官转移所需的血液。后果很严重，包括肺、心脏、肠道和大脑损伤。目前对PDA的治疗要么是药物治疗，要么是手术治疗，要么两者兼而有之。治疗本身也可能导致大脑循环的血流量改变，这可能对婴儿产生不利影响，并与长期的发育和认知问题有关。在心脏手术前后评估患有PDA的婴儿的大脑及其功能，并确定这种治疗对大脑的影响是至关重要的。目前的建议解决了这一重要的临床需求。一个多学科专家团队将开发工具来测量大脑中的血流和活动，并将这些与四个月大时心脏功能和大脑结构的综合评估联系起来。这将使我们能够更好地了解早产儿脑损伤的原因，并针对那些风险最大的人进行针对性治疗。

Premature births are common in Canada with about 1 in every 20 births requiring a protracted stay in intensive care. Modern technology and improvements in care have resulted in excellent survival rates but medical staff who care for premature infants and parents remain very concerned that at least half of them will have significant disabilities and many more will have problems at school. Our focus now is to try to better understand the acute problems that premature infants face as newborns, and how they may impact on the organs of the body, particularly the brain. An extremely common problem for premature infants is the patent ductus arteriosus (PDA). This blood vessel is essential during fetal life and is the route through which placental blood reaches the baby's body. When the PDA fails to close after birth, it causes too much blood to flow into the lungs and at the same time diverts needed blood flow away from the brain and other vital organs. The consequences are serious and include lung, heart, bowel and brain damage. The current treatment for a PDA is either medication, surgery or both. The treatments themselves may also cause changes in blood flow to the brain circulation which could adversely affect the baby and be associated with the long term developmental and cognitive problems. It is critical to assess the brain and its function in babies with PDA both before and after heart surgery and determine how the brain is affected by this treatment. The present proposal addresses this important clinical need. A multidisciplinary team of experts will develop tools to measure blood flow and activity in the brain and link these with comprehensive assessments of heart function and brain structure at four months of age. This will allow us to better understand the causes of brain injury in preterm infants and to focus targeted therapies for those most at risk.