PRETERM TRANSFUSIONS: BRAIN FUNCTION/STRUCTURE OUTCOMES

该子项目是利用NIH/NCRR资助的中心赠款提供的资源的许多研究子项目之一。子项目和研究者（PI）可能从另一个NIH来源获得了主要资金，因此可以在其他CRISP条目中表示。所列机构为中心，不一定是研究者所在机构。红细胞（RBC）输血管理包括什么是最佳标准，以确定何时输血应该发生在早产极低出生体重（VLBW）婴儿的关键问题。对于是否更严格或更宽松的标准将最好地服务于这些婴儿的长期结果存在争议。特别是，极低出生体重婴儿的大脑特别容易受到缺血和低氧血症的影响，因此自由输血与限制性输血的问题在对发育中的大脑的短期和长期影响方面特别重要。目前的提案计划通过进行长期的结果评估来解决这个问题，检查大脑结构的差异（使用MRI）和功能（使用认知，运动和行为测试）在三组12岁的儿童中：两组早产儿在出生时被随机分配到婴儿期红细胞输注的限制性或自由性标准，以及健康足月儿的对照组。两个早产儿组输血后的评估表明，限制性输血组发生脑室内出血，脑室周围白质软化，或两者的发生率更高，如超声所见。这些发现表明，自由输血的做法实际上可能是“神经保护”。这些婴儿现在接近12岁，并提供了一个很好的机会，长期评估，考虑到能够解决这个问题，更详细地使用最先进的定量成像方法和仔细的功能评估。通过确定可能直接影响早产儿大脑结构和功能结果的因素，这项研究有可能显著改善这一结果。

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Red Blood Cell (RBC) transfusion management includes the crucial issue of what are the optimal criteria to determine when transfusion should occur in preterm very-low-birth-weight (VLBW) infants. There is controversy regarding whether more restrictive or more liberal criteria would best serve the long-term outcomes of these infants. In particular, the brain of VLBW infants are especially susceptible to ischemia and hypoxemia, thus the issue of liberal versus restrictive transfusion is particularly important in regard to short and long-term effects on the developing brain. The current proposal plans to address this issue by conducting a long-term outcome evaluation, examining differences in brain structure (using MRI) and function (using cognitive, motor, and behavioral tests) in three groups of 12 year old children: two preterm groups who, at birth, had been randomly assigned to either restrictive or liberal criteria for RBC transfusion during infancy, and a control group of healthy full-term children. Evaluation of the two preterm groups after the transfusion protocol indicated that the restrictive transfusion group suffered a greater incidence of intraventricular hemorrhage, periventricular leukomalacia, or both as seen on ultrasound. These findings suggested that liberal transfusion practices may in fact be "neuroprotective". These infants are now approaching 12 years of age and present an excellent opportunity for long-term assessment, given the ability to address this issue in far greater detail by using the state of the art quantitative imaging methodology and careful functional assessment. By identifying factors that may have a direct influence on the outcome of brain structure and function in children born prematurely, this study has the potential for significantly improving that outcome.