NEURODEVELOPMENT AND EXPERIENCE: BEHAVIOR, QEEG AND MRI

怀孕28至30周是一个重要的时期， 神经重组，启动胎儿行为的开始， 和维持子宫外存活。婴儿出生于此 过渡阶段，PT婴儿中增长最快和最大的部分 (PT)后来意外地表现出严重的脑功能障碍 并在学龄前一直处于危险之中。高达52%的婴儿 存在精神、认知和注意力功能缺陷， 情感脆弱和不合格的学校表现，都被认为是 由于在处理复杂信息方面的核心缺陷， 联合皮质额叶系统。据推测，这样的中央 脑白色物质的脆弱性增加， 妊娠期的最后三个月，也是发育最快的阶段。 由于不适当的感官刺激造成的持续压力被认为是 这些都是导致早期大脑结构和功能改变的原因。的目的 拟议的研究是为了确定PT大脑的具体适应， 妊娠最后12周到NICU环境的短暂经历 为了评估这种经验在重塑中的潜力， 神经解剖结构和神经发育功能。一项前瞻性 将进行随机临床试验。60名医学健康的PT出生 28 - 30周的受试者将被随机分配至两种治疗之一 条件，代表可测量的不同NICU经验，标准护理 (SC)发展关怀（DC）他们将与30名健康的足月妊娠妇女进行比较， 婴儿（FT）。所有90名婴儿将在孕后42周进行评估， 三个神经发育领域，神经行为功能（APIB; Prechtl）， 神经电生理功能（qEEG; FVER）和神经解剖结构 （3D-MRI; DTI）。调查的具体区域将是早期的 成熟枕叶和晚熟额叶及胼胝体 结构.假设接受DC的PT将证明 与接受治疗的PT相比，区域内区域特异性脑增强 此外，这些PT将比接受SC的PT更类似于FT。 将按领域采用MANOVA来检验这一假设。Canonical 相关性将被用来检查之间的关系和内部 域.预计拟议的研究将证明 第一次经验对高阶重塑的影响 神经功能和神经结构过程，并将建议和方法 对于后期赤字改善，与PT的最大部分相关 人口

The period from 28 to 30 weeks gestation is one of significant neurological reorganization, initiating the beginning of fetal behavioral individually and maintenance of extrauterine survival. Infants born at this transitional stage, the fastest growing and largest segment of the PT infant (PT) population, later on exhibit unexpectedly significant brain dysfunction and remain at risk well into school age. Up to 52 percent of such infants present with deficits in psychomotor, cognitive, and attentional function, emotional vulnerability and substandard school performance, all thought to be due to a central deficit in processing complex information and attributable to association cortical frontal systems. It is postulated that such a central deficit may result from increased vulnerability of cerebral white matter during the last trimester of gestation, its phase of most rapid development. Persistent stress due to inappropriate sensory stimulation is thought to contribute to such alteration of early brain structure and function. The aim of the proposed study is to identify specific adaptations of the PT brain in the last 12 weeks of gestation to the transient experience of the NICU environment in order to estimate the potential of such experience in remodeling neuroanatomical structure and neurodevelopmental function. A prospective randomized clinical trial will be conducted. Sixty medically healthy PTs born between 28 and 30 weeks will be randomly assigned to one of two treatment conditions, representing measurably different NICU experiences, standard care (SC) and developmental care (DC). They will be compared to 30 healthy full-term infants (FT). All 90 infants will be assessed at 42 w postconceptional age in three neurodevelopmental domains, neurobehavioral function (APIB; Prechtl), neuroelectrophysiological function (qEEG; FVER), and neuroanatomic structure (3D-MRI; DTI). Specific regions of interest investigated will be the early maturing occipital lobe and the later maturing frontal lobe and corpus callosum structures. It is hypothesized that PTs who receive DC will demonstrate regionally specific brain enhancement within domain compared to PTs who receive SC. Furthermore, such PTs will be more similar to FTs that PTs who receive SC. MANOVA will be employed by domain in order to test this hypothesis. Canonical correlations will be used to examine the relationships among and within the domains. It is anticipated that the proposed study will demonstrate for the first time the effect of experience on the remodeling of higher order neurofunctional and neuro structural processes, and will suggest and approach for later deficit amelioration, relevant to the largest segment of the PT population.