Fetal Brain MRI as a Predictor of Late Neurodevelopmental Outcome in Congenital Heart Disease

胎儿脑 MRI 作为先天性心脏病晚期神经发育结果的预测因子

基本信息

批准号：
10364835
负责人：
Caitlin Rollins
金额：
$ 46.45万
依托单位：
BOSTON CHILDREN'S HOSPITAL
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-01-01 至 2026-12-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10364835
关键词：
2 year old 7 year old Adolescence Adult Advanced Development Affect Anatomy Area Attention Birth Brain Brain Hypoxia-Ischemia Cardiac Cell Compartmentation Cells Cerebrum Child Childhood Congenital Abnormality Data Data Set Development Employment Executive Dysfunction Fetus Foundations Genetic Genetic Status Health High Prevalence Impairment Intervention Knowledge Live Birth Location Magnetic Resonance Imaging Measures Medical Mental Health Modeling Morbidity - disease rate Nature Neurobiology Neurodevelopmental Disability Neurodevelopmental Impairment Neurons Oligodendroglia Operative Surgical Procedures Outcome Outcome Measure Pathology Pathway interactions Patients Perinatal Population Predictive Value Process Property Quality of life Recording of previous events School-Age Population Services Severities Socioeconomic Status Special Education Structural Congenital Anomalies Structural defect Structure Surface Survivors System Techniques Therapeutic Thick Variant brain abnormalities brain magnetic resonance imaging brain volume clinical care clinical development clinical risk cognitive function cohort congenital heart disorder disability executive function experience fetal in utero indexing individual patient innovation myelination neonate nerve stem cell neurodevelopment neuroimaging personalized medicine postnatal prenatal primary outcome processing speed risk stratification secondary outcome skills social cognition therapy design tool white matter

项目摘要

PROJECT SUMMARY/ABSTRACT Congenital heart disease is the most common birth defect, affecting 0.5-2% of all live births. As medical and surgical advances have dramatically increased survival, the burgeoning population of children and adults with congenital heart disease has exposed a high prevalence of neurodevelopmental disabilities in survivors. By adolescence, more than 2 out of every 3 children with critical congenital heart disease experience deficits requiring developmental/special education services. As these children reach adulthood, their disabilities may limit educational opportunities, employment, and quality of life. Abnormal fetal brain development may contribute to neurodevelopmental disability in patients with congenital heart disease. Neonates with congenital heart disease have abnormal brain structure before surgery. Neurobiological processes that lay the foundation for long-term structural brain organization begin in utero. Components of fetal brain critical for this process, in particular neural progenitor cells, premyelinating oligodendrocytes, and subplate neurons, are sensitive to hypoxia-ischemia, rendering this system vulnerable to prenatal circulatory disturbances. The impact of abnormal fetal brain development on long-term brain structure and function in congenital heart disease is unknown. To date, there are no congenital heart disease cohorts that have been studied in both the fetal period and later in childhood when these deficits are typically detected. This proposal will leverage an existing fetal MRI cohort, including children both with and without congenital heart disease, to acquire long-term neuroimaging and neurodevelopmental data at 7 years of age, thereby determining the fetal contribution to long-term outcome. Specifically, the proposed study will investigate 1) the association between fetal brain structure and school-age structural brain connectivity; 2) the relationship between fetal brain structure and school-age neurodevelopmental functioning; and 3) the potential for a clinical risk stratification tool harnessing measures available in utero to predict school-age neurodevelopmental outcome. The overarching hypothesis is that abnormal fetal brain structure is associated with long-term differences in structural brain connectivity and neurodevelopmental functioning in congenital heart disease. This project will support the development of clinical risk stratification and advance the development of interventions designed to protect the brain in children with congenital heart disease.

项目概要/摘要先天性心脏病是最常见的出生缺陷，影响所有活产儿的 0.5-2%。作为医疗和外科手术的进步极大地提高了生存率，患有此病的儿童和成人人数不断增加先天性心脏病暴露了幸存者神经发育障碍的高患病率。经过青春期时，每 3 个患有严重先天性心脏病的儿童中就有超过 2 个患有缺陷需要发展/特殊教育服务。当这些儿童成年后，他们的残疾可能会限制教育机会、就业和生活质量。胎儿大脑发育异常可能导致先天性脑病患者的神经发育障碍心脏病。先天性心脏病新生儿在手术前脑部结构存在异常。为大脑长期结构组织奠定基础的神经生物学过程始于子宫内。胎儿大脑的组成部分对此过程至关重要，特别是神经祖细胞、髓鞘形成前细胞少突胶质细胞和亚板神经元对缺氧缺血敏感，使得该系统容易受到产前循环障碍。胎儿大脑发育异常对长期大脑结构的影响在先天性心脏病中的作用尚不清楚。迄今为止，还没有先天性心脏病队列已经在胎儿期和儿童后期进行了研究，这些缺陷通常是在婴儿期和儿童期被发现的。该提案将利用现有的胎儿 MRI 队列，包括患有和不患有先天性疾病的儿童心脏病，在 7 岁时获取长期神经影像和神经发育数据，从而确定胎儿对长期结局的贡献。具体来说，拟议的研究将调查 1) 胎儿大脑结构与学龄大脑结构连接之间的关联； 2）关系胎儿大脑结构与学龄神经发育功能之间的关系； 3) 临床应用的潜力风险分层工具利用子宫内可用的措施来预测学龄神经发育结果。最重要的假设是胎儿大脑结构异常与长期先天性心脏病中大脑结构连接和神经发育功能的差异。该项目将支持临床风险分层的发展并推动临床风险分层的发展旨在保护先天性心脏病儿童大脑的干预措施。