Modeling Auditory Responses and Behavioral Outcomes in Preterm Infants

描述(由申请人提供)：了解听觉神经反应变异的原因对于有效诊断听力问题和在生命早期评估神经完整性至关重要。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进行了听力损失筛查，导致每年有超过6.5万名婴儿被转介进行进一步的诊断性听力测试。对婴儿的这些诊断测试的解释依赖于对来自外周和中枢听觉系统的测量的彻底了解。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。由于卫生保健标准的巨大变化，早产婴儿存活率的提高，以及允许评估听觉系统不同解剖水平的新的生理测试，更准确地描述听觉神经反应和相关的规范数据是必要的。这项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、反映外周和中央处理的生理测量，在不同和具有代表性的婴儿样本中构建听觉脑干反应随时间的模型。相关变量，如高危因素、早产、听力筛查结果、神经发育迟缓和语言技能将被用来解释生理指标的变异性。将对婴儿进行个体水平的跟踪，并纵向记录实验措施的反应。采用分层线性建模的统计方法对生理测试数据进行描述。第二个目标是用一种基于听觉和医学变量来预测神经发育和语言延迟可能性的方法来重新预测结果。在第三个目标中，我们将对语言增长进行建模，并描述其与听觉因素的关系。这项研究的预期结果是，对于听力和发育正常的婴儿、不同类别听力损失的婴儿、听力发育延迟的婴儿以及更具全局性、神经发育延迟的婴儿，现代、敏感的测量方法将有所不同。这项研究的结果将提高我们对各种听觉测量的科学和临床知识，并将听觉测量与语言和发育结果结合起来，影响到听力学、新生儿学、儿科、言语-语言病理学和早期干预等领域。这项拟议的研究将通过加快识别生命早期的行为延迟来改善公共健康，并更早地为父母和提供者提供更好的信息，以便他们能够做出更有效和更及时的康复决策。

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.