Modeling Auditory Responses and Behavioral Outcomes in Preterm Infants

描述（由申请人提供）：了解听神经反应变异的原因对于听力问题的有效诊断和生命早期神经完整性的评估至关重要。自2000年《儿童健康法》（公法106-310）通过以来，美国大多数新生儿都接受了听力损失筛查，导致每年有超过65,000名婴儿被转介进行进一步的听力诊断测试。对这些婴儿诊断测试的解释依赖于对外周和中枢听觉系统测量的透彻理解。目前的标准是基于近30年前从选定的婴儿群体中收集的横断面研究。由于医疗保健标准的巨大变化，早产婴儿存活率的提高，以及新的生理测试允许评估听觉系统的不同解剖水平，因此需要更准确地描述听觉神经反应和相关的规范数据。拟议的研究有三个具体目标。在第一个目标中，我们将基于客观的、反映外周和中枢处理的生理测量，在不同的、有代表性的婴儿样本中构建听觉脑干随时间的反应模型。高危因素、早产、听力筛查结果、神经发育迟缓和语言技能等相关变量将用于解释生理指标的可变性。婴儿将在个体层面上被跟踪，并在实验测量中纵向记录他们的反应。采用层次线性建模的统计方法对生理试验数据进行描述。第二个目标是根据听觉和医学变量来预测神经发育和语言延迟的可能性。在第三个目标中，我们将建立语言增长模型，并描述其与听觉因素的关系轨迹。本研究的一个预期结果是，对于听力和发育正常的婴儿、不同类别的听力损失的婴儿、听觉发育迟缓的婴儿和更全面的神经发育迟缓的婴儿，现代的、敏感的措施将有所不同。本研究结果将提高我们对各种听觉测量的科学和临床认识，并将听觉测量与语言和发育结果相结合，影响听力学、新生儿、儿科、言语语言病理学和早期干预等领域。拟议的研究将通过加速对生命早期行为迟缓的识别，以及向父母和提供者提供更早的改进信息，从而改善公众健康，以便他们能够做出更有效和及时的康复决定。

DESCRIPTION (provided by applicant): Understanding the causes of variability in auditory neural responses is critical for effective diagnosis of hearing problems and evaluation of neural integrity early in life. Since the Children's Health Act of 2000 (Public Law 106-310) was adopted, most newborns in the US are screened for hearing loss, resulting in more than 65,000 infants being referred every year for further diagnostic auditory testing. Interpretation of these diagnostic tests in infants relies on a thorough understanding of measures from the peripheral and central auditory system. Current norms are based on cross-sectional studies collected from select groups of infants almost 3 decades ago. Because of dramatic changes in health care standards, increased survival rates of infants born prematurely, and new physiological tests that allow evaluation of different anatomical levels of the auditory system, more accurate descriptions of auditory neural responses and relevant normative data are necessary. The proposed research has three specific aims. In the first aim, we will construct models of auditory brainstem responses over time in a diverse and representative infant sample based on objective, physiological measurements reflecting peripheral and central processing. Relevant variables such as high risk factors, prematurity of birth, hearing screening outcome, neurodevelopmental delay and language skills will be used to explain variability in the physiological measures. Infants will be followed on an individual level, with responses recorded longitudinally on experimental measures. The statistical method of hierarchical linear modeling will be used to describe the physiological test data. The second aim is to recast the results in a way that predicts the likelihood of neurodevelopmental and language delay based on auditory and medical variables. In the third aim, we will model language growth and describe its trajectory in relationship to auditory factors. An expected outcome of this study is that modern, sensitive measures will be different for infants with normal hearing and development, infants with different categories of hearing loss, infants with delayed auditory development and infants with more global, neurodevelopmental delays. The results from this study will improve our scientific and clinical knowledge of various auditory measures and couple the auditory measures to language and developmental outcomes, influencing the fields of audiology, neonatology, pediatrics, speech-language pathology and early intervention. The proposed research will improve the public health by accelerating the identification of behavioral delays early in life as well as supplying parents and providers with improved information earlier so that they can make more efficient and timely rehabilitation decisions.