Neurobehavioral Impairments in Preterm Children - A Longitudinal MR Study

描述（由申请人提供）：早产是一个主要的公共卫生问题，因为其发病率不断上升，并且幸存婴儿随后经常面临行为、神经和精神方面的挑战。大约10-15%的极早产儿（出生时胎龄< 30周）会发生脑瘫，30 - 60%的极早产儿会出现认知障碍。这些障碍包括视觉运动问题、注意力困难、记忆受损、语言习得延迟、执行功能障碍、学习障碍、社交技能差、社交退缩、焦虑和抑郁的高发率。此外，在早产儿中，发育障碍如注意力缺陷/多动障碍、自闭症和精神分裂症的患病率有所增加。更好地了解导致早产儿神经行为障碍的机制是制定改善临床结果策略的重要一步。我们有一个独特的，大型队列229早产儿（<30周妊娠或<1250g），我们已经开发了广泛的围产期数据库，并获得了先进的磁共振（MR）图像在足月等效。对这些数据的评估导致了对与早产相关的大脑病变性质的新见解。重要的是，在纵向神经心理学随访过程中，我们与97%的患者保持了持续的联系。这一人群现在提供了一个难得的机会来纵向评估与现代先进的MR成像方法相关的神经行为损伤机制。我们建议将最先进的磁共振成像方法应用于6岁的这一队列，并结合神经心理学评估。核磁共振数据将使我们能够研究早产儿和足月新生儿从足月到儿童时期大脑结构变化的演变。这些技术将包括基于表面的形态测量（SBM）、脑容量测量（volumetry）和扩散张量成像（DTI）。MR方法将提供宏观（体积和SBM）和微观（DTI）的大脑发育测量，解决大脑结构和成熟的不同方面。这些将与纵向社会和神经心理学评估相关，以调查MR测量与神经行为障碍的关系。纵向设计将允许我们研究结构异常和代偿性变化在儿童早期脑损伤的反应。这些数据可能会为早产儿的神经恢复和改善预后的策略提供新的理解。公共卫生相关性：本研究旨在利用磁共振（MR）成像来提高我们对早产儿脑损伤的理解，以及大脑随后在儿童时期的发育情况。纵向设计，使用先进的磁共振成像和心理测试，将使我们能够研究结构异常和儿童早期脑损伤的积极适应性变化。这将有助于我们了解如何减少这些弱势儿童今后面临的全球和具体残疾。

DESCRIPTION (provided by applicant): Preterm birth is a major public-health issue because of its increasing incidence combined with the frequent occurrence of subsequent behavioral, neurological, and psychiatric challenges faced by surviving infants. Approximately 10-15% of very preterm children (born < 30 weeks gestational age) develop cerebral palsy, and 30 - 60% of very preterm children experience cognitive impairments. These impairments include visual-motor problems, attentional difficulties, impaired memory, delayed acquisition of language, executive dysfunction, learning disabilities, poor social skills, and higher rates of social withdrawal, anxiety and depression. In addition, an increased prevalence of developmental disorders such as attention deficit/hyperactivity disorder, autism and schizophrenia, has been described in the preterm population. A greater understanding of the mechanisms leading to neurobehavioral impairments in preterm children is an important step in developing strategies for improving clinical outcomes. We have a unique, large cohort of 229 preterm infants (<30 weeks gestation or <1250g) for whom we have developed an extensive perinatal database and obtained advanced magnetic resonance (MR) images at term equivalent. Evaluation of these data has led to novel insights into the nature of the cerebral lesion associated with preterm birth. Importantly, we have maintained ongoing contact with 97% of this cohort during the course of longitudinal neuropsychological follow up. This population now offers a rare opportunity for longitudinal evaluation of the mechanisms of neurobehavioral impairment in association with modern, advanced MR imaging methods. We propose to apply state-of-the-art MR imaging methods to this cohort at 6 years of age in conjunction with neuropsychological evaluation. The MR data will allow us to study the evolution of structural changes in the brain from term equivalent into childhood in both the preterm and term born infants. The techniques will include surface based morphometry (SBM), brain volume measurements (volumetry), and diffusion tensor imaging (DTI). The MR approaches will provide both macroscopic (volumes and SBM) and microscopic (DTI) measures of cerebral development that address different aspects of brain structure and maturation. These will be related to the longitudinal social and neuropsychological evaluations to investigate the relationship of MR measures to neurobehavioral impairments. The longitudinal design will allow us to study both structural abnormalities and compensatory changes over childhood in response to early brain injury. These data will likely provide new understanding of neural recovery and strategies for improving outcomes in preterm infants. PUBLIC HEALTH RELEVANCE: This study is designed to use magnetic resonance (MR) imaging to improve our understanding of the brain injury sustained by prematurely-born infants and how the brain subsequently develops over childhood. The longitudinal design, using both advanced MR imaging and psychological testing, will allow us to study both structural abnormalities and positive adaptive changes over childhood in response to early brain injury. This will assist us in understanding how to reduce the global and specific disabilities that these vulnerable children later face.