Preterm Transfusions: Brain Function/Structure Outcomes

早产输血：脑功能/结构结果

基本信息

批准号：
7476431
负责人：
LYNN C. RICHMAN
金额：
$ 34.9万
依托单位：
UNIVERSITY OF IOWA
依托单位国家：
美国
项目类别：
财政年份：
2007
资助国家：
美国
起止时间：
2007-07-01 至 2011-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7476431
关键词：
13 year old Academic achievement Address Adult Adverse effects Affect Age Anemia Anisotropy Anxiety Apnea Arts Attention Attention deficit hyperactivity disorder Basal Ganglia Behavior Behavior assessment Behavioral Behavioral inhibition Birth Brain Brain Hypoxia-Ischemia Brain hemorrhage Brain imaging Brain region Cell Nucleus Cerebellum Cerebrum Child Child Development Chronic lung disease Cleft Palate Clinical Management Clinical Trials Cognition Cognitive Cognitive deficits Control Groups Corpus striatum structure Development Dopamine Dysphasia Equilibrium Erythrocyte Transfusion Erythrocytes Evaluation Event Follow-Up Studies Frequencies Funding Gait Goals Guidelines Hematocrit procedure Hemoglobin Hippocampus (Brain)Hyperactive behavior Hypoxia Image Analysis Incidence Infant Intelligence Iron Ischemia Label Language Lead Light Literature Long-Term Effects Magnetic Resonance Imaging Measures Memory Memory impairment Mental Retardation Metabolism Motor Motor Cortex Movement Names Neurocognitive Neurologic Neuropsychological Tests Numbers Outcome Oxygen Patients Performance Periventricular Leukomalacia Prefrontal Cortex Premature Infant Prematurity of fetus Principal Investigator Protocols documentation Randomized Range Reading Recruitment Activity Research Research Personnel Resolution Rest Risk Risk Factors Safety Schools Score Short-Term Memory Social Behavior Social isolation Structure Techniques Transfusion Ventilator Very Low Birth Weight Infant Visuospatial Weight Gain Work base concept day executive function follow-up frontal lobe improved infancy interdisciplinary approach interest long term memory neurodevelopment neuroimaging neuropsychological peer programs putamen self esteem skills success trial comparing white matter

项目摘要

The primary goal of Project #2 is to evaluate the long-term outcomes in brain function/structure of two groups of VLBW infants (<1300 g) with anemia of prematurity, who were randomly assigned to either a restrictive or liberal RBC transfusion protocol as part of a previous PPG project. Our aim is to determine whether different RBC transfusion guidelines result in different long-term (at age 13) neurodevelopmental outcomes. Our general hypotheses are: 1) Preterm groups will show structural abnormalities of frontal, prefrontal, hippocampal, cerebellar and white matter brain regions, with the restricted transfusion group showing greater abnormalities. 2) Neuropsychological deficits will be identified in both preterm groups in functions governed by fronto-striatal circuits such as rapid naming, verbal fluency, working memory, fine-motor dexterity, and attention. 3) There will be a relationship between documented brain abnormalities and cognitive deficits. We will accomplish our goal by comparing these two groups at age 13, as well as a matched healthy term control group, on neuropsychological functions and brain structure (MRI). The hypotheses of Project #2 are based on the concept that more restrictive transfusion criteria may decrease the oxygen available to the developing brain and could result in more apnea and hypoxia or create iron depletion, either of which could result in impaired neurodevelopment. The specific neuropsychological functions and brain structures that will be addressed in this study have been selected as those most likely to be impaired by limited brain oxygen delivery or brain iron depletion, either of which could be due to restrictive transfusion criteria or to poorly understood adverse effects of multiple transfusions. This project allows the evaluation of strategies for transfusion management of anemia, which is central to the overall PPG theme. Our specific hypotheses are that more restrictive criteria for transfusion will lead to greater structural abnormalities in specific regions of the brain including frontal-prefrontal cortex, basal ganglia, and hippocampus and cerebellum. These abnormalities will affect functions such as rapid naming, verbal fluency, memory, fine- and gross-motor dexterity, attention and executive functions. More restrictive criteria will also lead to greater behavioral inhibition due to frontalstriatal deficits; but will not lead to differences in more general functions such as language, visual-spatial skills, long-term memory, intelligence, and academic achievement. The study proposed is timely because all of the children will be 13 years old during this study period, allowing examination of long-term effects of the transfusion practices. It is also timely in light of the continuing controversy regarding the most appropriate RBC transfusion guidelines to be used to treat anemia of prematurity. The long-term neuropsychological and brain imaging follow-up of premature anemic infants receiving different transfusion management criteria has never before been examined. This study will provide important findings related to potential adverse effects of transfusion practices on neurodevelopment.

项目＃2的主要目标是评估两个大脑功能/结构的长期结果与早产性贫血的VLBW婴儿（<1300 g），他们被随机分配给任何一个作为先前PPG项目的一部分，限制性或自由RBC输血协议。我们的目的是确定不同的RBC输血指南是否导致不同的长期（13岁）神经发育结果。我们的一般假设是：1）早产组将显示结构性额叶，前额叶，海马，小脑和白质大脑区域的异常，限制输血组显示出更大的异常。 2）神经心理缺陷将是在两个早产组中都在额叶纹状体电路（例如快速命名）的功能中确定言语流利，工作记忆，精力敏捷性和注意力。 3）将会有关系在有记录的大脑异常和认知缺陷之间。我们将通过比较13岁时的这两组以及匹配的健康期限对照组神经心理学功能和大脑结构（MRI）。项目2的假设是基于更限制的输血标准可能会减少发育中可用的氧气的概念大脑，可能导致更多的呼吸暂停和缺氧或产生铁耗竭，这两种可能导致在神经发育受损中。特定的神经心理学功能和大脑结构在这项研究中被选择是因为大脑最有可能受到损害氧递送或脑铁的耗竭，这两种可能是由于限制性输血标准或多次输血的不良影响了解不足。该项目允许评估贫血的输血管理策略，这对于整体PPG主题至关重要。我们的具体的假设是，输血的更严格的标准将导致更大的结构大脑特定区域的异常，包括额叶额叶皮层，基底神经节和海马和小脑。这些异常会影响诸如快速命名，口头的功能流利的记忆力，精细和总体运动敏捷性，注意力和执行功能。更加限制标准还将导致额叶缺陷引起的行为抑制更大。但不会导致语言，视觉空间技能，长期记忆等更通用功能的差异，情报和学术成就。提出的研究是及时的，因为所有孩子都会在本研究期间，年龄为13岁，允许检查输血的长期影响实践。鉴于关于最合适的RBC的持续争议，这也及时输血指南用于治疗早产贫血。长期神经心理学和收到不同输血管理标准的早产婴儿的大脑成像随访从未检查过。这项研究将提供与潜在不利有关的重要发现输血实践对神经发育的影响。