Brain Research to Ameliorate Impaired Neurodevelopment-Home-based Intervention

改善神经发育受损的大脑研究——家庭干预

• 批准号: 7098573
• 负责人: WALDEMAR A. CARLO FONT
• 金额: $ 45万
• 依托单位: UNIVERSITY OF ALABAMA AT BIRMINGHAM
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-09-29 至 2011-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7098573
• 关键词: Africa; India; behavior test; clinical research; clinical trials; developmental neurobiology; disease /disorder proneness /risk; early /brief intervention /therapy; growth /development; home health care; human therapy evaluation; infant human (0-1 year); international cooperation; longitudinal human study; respiratory distress syndrome of newborn; southeast Asia

DESCRIPTION (provided by applicant): Birth asphyxia is a leading cause of neonatal mortality and morbidity in developing countries. Survivors of birth asphyxia have high rates of mental retardation, cerebral palsy, and other neurodevelopmental disorders. Controlled trials and meta-analyses conclude that early intervention programs prevent or minimize cognitive impairment in many high-risk infants. These programs are legislatively mandated in the United States and are the standard of care in developed nations. However, early intervention programs are rarely available in developing countries and thus, to most at-risk infants worldwide. Preliminary evidence from a small randomized controlled trial conducted in a developing country suggests that a program of home-based early intervention improves neurodevelopmental outcome (Mental Developmental Index) in survivors of birth asphyxia but conclusive evidence is not available. Pilot data obtained as part of a planing grant funded by an R21 documented the high prevelence of sequelae for birth asphyxia and feasibility of an early intervention program. The current application aims to identify infants at risk for neurodevelopmental disorders and to evaluate an innovative early intervention program in developing countries utilizing established multidisciplinary collaborations between researchers in the US, Zambia, India, and Pakistan who currently work as part of the NICHD Global Network for Women's and Children's Research on an early phase of the FIRST BREATH multicenter cluster randomized trial on resuscitation. A randomized controlled trial of early intervention will be performed in infants with birth asphyxia identified by abnormal neurological exam during the first week after birth and in normal a comparison group. A home-based, parent-provided, early intervention will be tested in two delivery modes: resource-intensive and resource-limited. If proven effective in developing countries, a home-based early intervention program has the potential of improving cognitive capacity in many at-risk infants worldwide at a cost lower than more expensive special education services. The long term goal of this proposal is to broaden research collaborations and to build sustainable capacity for research to prevent or reduce neurodevelopmental sequelae resulting from birth asphyxia and other important causes of neurodevelopmental impairment in children.

描述（由申请人提供）：窒息出生是发展中国家新生儿死亡率和发病率的主要原因。出生窒息的幸存者的智力低下，脑瘫和其他神经发育障碍率很高。对照试验和荟萃分析得出的结论是，早期干预计划可以预防或最大程度地减少许多高危婴儿的认知障碍。这些计划是在美国授权的，是发达国家的护理标准。但是，在发展中国家，对于全世界大多数高危婴儿，早期干预计划很少可以使用。在发展中国家进行的一项小型随机对照试验的初步证据表明，基于家庭的早期干预计划改善了出生窒息幸存者的神经发育结果（心理发育指数），但没有结论性证据。作为R21资助的计划赠款的一部分获得的试点数据，记录了后遗症的高度窒息和早期干预计划的可行性。当前的申请旨在确定有神经发育障碍风险的婴儿，并评估发展中国家的创新性早期干预计划，利用美国，赞比亚，印度和巴基斯坦研究人员之间建立的多学科合作，该研究人员目前是NICHD全球网络对妇女和儿童对第一阶段的NICHD全球网络的一部分。早期干预的随机对照试验将在出生后的第一周和正常的比较组中通过异常神经学检查确定的出生窒息的婴儿进行。基于家庭的，提供的早期干预措施将以两种交付方式进行测试：资源密集型和资源有限的。如果被证明在发展中国家有效，则一项基于家庭的早期干预计划具有提高全球许多高风险婴儿的认知能力，其成本低于昂贵的特殊教育服务。该提案的长期目标是扩大研究合作，并建立可持续的研究能力，以预防或减少因窒息出生而导致的神经发育后遗症和儿童神经发育障碍的其他重要原因。