DEXAMETHASONE STUDY

这个子项目是许多研究子项目中的一个 由NIH/NCRR资助的中心赠款提供的资源。子项目和 研究者（PI）可能从另一个NIH来源获得了主要资金， 因此可在其他CRISP条目中表示。所列机构为 研究中心，而研究中心不一定是研究者所在的机构。 在这个项目的第三年，我把我的重点从最初推动这个建议的动物模型转移到临床研究的重点。 有几个项目正在进行中，已接近完成。由于在临床实践中使用较短的疗程和较低剂量的糖皮质激素，我们改变了最初的目的，研究暴露于短期的地塞米松或氢化可的松在新生儿早期对LHPA轴的发展的影响。我们已经完成了对地塞米松与氢化可的松研究的行为和生理研究的分析，并准备提交手稿。一项旨在研究慢性母体压力对神经发育影响的临床研究的开发被搁置，而研究怀孕和创伤后应激障碍的小组准备提交一份提案。因此，我将重点转移到几项临床研究的开发上。每一项研究都与临床研究中心合作，我是每一项研究的主要研究者。这些措施包括：1）开发多学科颅面诊所，同时开发诊所参与者和父母的健康相关生活质量指标研究，2）开发和实施胎儿和新生儿姑息治疗计划，开发计划参与者的生活质量指标，3）评估早产儿和足月儿的全身运动，以研究脑瘫的早期预测，4）在极低出生体重儿中使用氦氧混合气和鼻CPAP预防呼吸衰竭，5）评价在III级NICU中实施纯母乳（母亲和供体母乳）对坏死性小肠结肠炎发病率的影响，6）比较极早产儿动脉导管液中氯化钠与醋酸钠的作用，以限制代谢性酸中毒的程度。

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. During year three of this project I moved my focus away from the animal model that initially drove this proposal to a clinical research focus. Several projects are ongoing, once near completion. Due to the use of shorter courses and lower doses of glucocorticoids in clinical practice, we altered the initial aims of the proposal to study the effects of exposure to a short course of either dexamethasone or hydrocortisone during the early neonatal period on development of the LHPA axis. We have completed analysis of behavioral and physiological studies of our dexamethasone vs. hydrocortisone study and are readying a manuscript for submission. Development of a clinical study to examine effects of chronic maternal stress on neurodevelopment is on hold while the group studying pregnancy and PTSD ready a proposal for submission. As a result I have moved my focus onto development of several clinical research studies. Each of these are in collaboration with the Clinical Research Center, and for each I am the principal investigator. These include 1) development of a multidisciplinary craniofacial clinic paralleling development of a study of health-related quality of life measures in clinic participants and parents, 2) development and implementation of a fetal and neonatal palliative care program with development of quality of life measures in program participants, 3) evaluation of generalized movements in preterm and term infants to study early prediction of cerebral palsy, 4) use of heliox with nasal CPAP in extremely low birth weight infants to prevent respiratory failure, 5) evaluation of implementation of a breast milk only practice (maternal and donor breast milk) on the incidence of necrotizing enterocolitis in a level III NICU and 6) comparison of sodium chloride versus sodium acetate in arterial catheter fluids in extremely premature infants to limit extent of metabolic acidosis.