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

描述（由申请人提供）：在美国出生的儿童中有13%到16%是早产的，其中近2%的婴儿体重不到1500克（不到四分之三磅）。在后一组患者中，近90%的幸存者存在神经功能缺陷：5-10%的患者存在脑瘫，约50%的患者存在认知、行为或注意力缺陷。2005年，出生后第一年的医疗费用平均为41,610美元，而足月婴儿的医疗费用为2830美元，每年的医院费用总额为74亿美元。磁共振成像越来越多地被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白质的损伤上，但最近的研究发现，大脑后部小脑的发育经常出现异常。小脑传统上被认为与运动张力和协调性有关，最近又被认为与认知功能有关。因此，早产不良后果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，并将这种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（脑室出血和脑白质损伤）联系起来。据推测，小脑周围脑室系统和蛛网膜下腔的出血使小脑无法接收覆盖小脑的组织发出的重要信号，而脑白质的损伤可能会干扰传递给小脑的信号，从而导致早产儿小脑损伤。确定致病因素可能使这些因素得以避免或更积极地治疗，最终减少小脑损伤并改善临床结果。

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.