PRETERM TRANSFUSIONS: BRAIN FUNCTION/STRUCTURE OUTCOMES

这个子项目是许多研究子项目中利用 资源由NIH/NCRR资助的中心拨款提供。子项目和 调查员(PI)可能从NIH的另一个来源获得了主要资金， 并因此可以在其他清晰的条目中表示。列出的机构是 该中心不一定是调查人员的机构。 红细胞(RBC)输血管理包括决定早产极低出生体重(VLBW)婴儿何时输血的最佳标准是什么这一关键问题。对于更严格的标准还是更宽松的标准对这些婴儿的长期结局最好，存在争议。特别是，极低出生体重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对于发育中的大脑的短期和长期影响尤为重要。目前的提案计划通过进行长期结果评估来解决这个问题，检查三组12岁儿童在大脑结构(使用MRI)和功能(使用认知、运动和行为测试)方面的差异：两组早产儿在出生时被随机分配到婴儿时期的限制性或自由性红细胞输注标准，以及一组健康的足月儿童。两组早产儿在输血方案后的评估表明，限制性输血组的脑室内出血和/或脑室周围白质软化的发生率较高，如超声所见。这些发现表明，自由输血做法实际上可能具有“神经保护”作用。这些婴儿现在接近12岁，提供了一个进行长期评估的绝佳机会，因为他们有能力通过使用最先进的定量成像方法和仔细的功能评估来更详细地解决这个问题。通过确定可能对早产儿大脑结构和功能的结果有直接影响的因素，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.