Neonatal Neurobehavior and Outcomes in Very Preterm Infants

描述（由申请人提供）：出生后小于30周的婴儿（PMA）会经历与不成熟、缺氧损伤和炎症暴露相关的潜在破坏性脑损伤。这些婴儿患神经运动、认知和行为障碍的风险很高，并持续到成年。然而，对于大多数婴儿来说，在新生儿重症监护病房（NICU）期间，没有可靠的方法来区分哪些婴儿会继续发展为后期损伤，哪些不会。越来越多的证据表明，新生儿神经行为评估可以预测高危人群和早产儿的发育结果。本研究的总体目标是使用神经行为评估（NICU网络神经行为量表或NNNS）和医疗风险评分来确定哪些PMA <30周出生的婴儿发育受损的风险最大。识别风险最大的婴儿的能力解决了一个重大的公共卫生问题，并可能导致有针对性的干预措施，以减少或改善后来的缺陷，并更有效地分配有限的资源。我们计划在参与佛蒙特-牛津网络（VON）的7个地点的NICU期间对1060名PMA <30周的婴儿实施NNNS。这将使我们能够受益于VON基础设施和新生儿住院期间收集的医疗信息，包括结构性脑异常、感染和呼吸系统疾病。调整年龄23 +2个月时的神经发育随访将包括Bayley-III、儿童行为检查表、幼儿自闭症修改检查表和脑瘫患病率。我们的目的是确定：1)NNNS的异常是否会在23个月时识别出婴儿的损伤；2)累积医疗风险指数与PMA 36周（或PMA <30周的婴儿出院时）的NNNS评分之间的关系；3)出院后护理环境因素在解释医疗条件、NNNS评分和23个月预后之间的关系中的作用。

DESCRIPTION (provided by applicant): Infants born <30 wks postmenstrual age (PMA) experience the potentially devastating brain injuries associated with immaturity, hypoxic insults, and inflammatory exposures. These infants are at high risk for developing neuromotor, cognitive, and behavioral impairments that persist through adulthood. However, for the majority of infants, there is no reliable method during their stay in the Neonatal Intensive Care Unit (NICU) to distinguish infants who will go on to develop later impairments from those who will not. There is increasing evidence that neonatal neurobehavioral assessments may predict developmental outcome in at risk and preterm populations. The overarching goal of this study is to determine which infants born <30 wks PMA are at greatest risk for impaired development using a neurobehavioral assessment (the NICU Network Neurobehavioral Scale or NNNS) and a medical risk score. The ability to identify infants at greatest risk addresses a major public health problem and could lead to targeted interventions to reduce or ameliorate later deficits, and more effectively allocate limited resources. We plan to administer the NNNS to 1060 infants born <30 wks PMA during their NICU stay at 7 sites participating in the Vermont-Oxford Network (VON). This will enable us to benefit from the VON infrastructure and medical information collected during neonatal hospitalization, including structural brain abnormalities, infections, an respiratory illnesses. Neurodevelopmental follow-up at 23 +2 months adjusted age will include the Bayley-III, Child Behavior Checklist, Modified Checklist for Autism in Toddlers, and prevalence of cerebral palsy. Our Aims are to determine: 1) if abnormalities on the NNNS will identify infants with impairment at 23 months 2) the association between the cumulative medical risk index, and NNNS scores at 36 wks PMA (or at discharge from the NICU) in infants born <30 wks PMA and 3) the role of post-discharge caregiving environment factors in explaining associations between medical conditions, NNNS scores and 23 month outcomes.