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

基本信息

批准号：
7502616
负责人：
WALDEMAR A. CARLO FONT
金额：
$ 42.82万
依托单位：
UNIVERSITY OF ALABAMA AT BIRMINGHAM
依托单位国家：
美国
项目类别：
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/7502616
关键词：
Address Age-Months Area Asphyxia Birth Caring Cerebral Palsy Child Clinic Clinical Cognitive Collaborations Communities Counseling Country Data Developed Countries Developing Countries Development Early Intervention Early intervention trials Economics Effectiveness of Interventions Environment Evaluation Exercise Family Characteristics Fostering Funding Goals Grant Health Health Care Visit Health system Healthcare Home environment Home visitation House Call Impaired cognition India Infant Infant Development Interdisciplinary Study Intervention Logistics Mental Retardation Mentors Meta-Analysis Methods Modeling Morbidity - disease rate Mothers Motor National Institute of Child Health and Human Development Neonatal Mortality Neurodevelopmental Disorder Neurodevelopmental Impairment Neurologic Numbers Outcome Pakistan Parents Pediatrics Perinatal Phase Population Pregnant Women Psyche structure Randomized Randomized Controlled Clinical Trials Randomized Controlled Trials Rate Recruitment Activity Research Research Infrastructure Research Personnel Research Support Resources Resuscitation Risk Scientist Senior Scientist Services Social Development Socioeconomic Status Special Education Standards of Weights and Measures Survivors System Testing Training and Education United States Universities Visit Week Woman Work Zambia base brain research comparison group cost cost effective design disability improved indexing innovation interdisciplinary collaboration intervention program mental development multidisciplinary neonatal morbidity neurodevelopment prevent programs skills social socioeconomics therapy development

项目摘要

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）：出生窒息是发展中国家新生儿死亡和发病的主要原因。出生窒息的幸存者出现智力低下、脑瘫和其他神经发育障碍的比例很高。对照试验和荟萃分析得出结论，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。这些计划是美国立法授权的，也是发达国家的护理标准。然而，早期干预计划在发展中国家很少适用，因此对于全世界大多数高危婴儿来说也是如此。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，家庭早期干预计划可以改善出生窒息幸存者的神经发育结果（心理发育指数），但尚无确凿的证据。作为 R21 资助的规划拨款的一部分获得的试点数据记录了出生窒息后遗症的高发生率以及早期干预计划的可行性。当前的应用程序旨在识别有神经发育障碍风险的婴儿，并利用美国、赞比亚、印度和巴基斯坦研究人员之间建立的多学科合作来评估发展中国家的创新早期干预计划，这些研究人员目前是 NICHD 全球网络的一部分第一次呼吸多中心集群随机复苏试验早期阶段的妇女和儿童研究。一项早期干预的随机对照试验将对出生后第一周内神经系统检查异常发现的出生窒息婴儿和正常对照组进行。以家庭为基础、由家长提供的早期干预将通过两种实施模式进行测试：资源密集型和资源有限型。如果在发展中国家证明有效，家庭早期干预计划有可能以低于更昂贵的特殊教育服务的成本提高全世界许多高危婴儿的认知能力。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，以预防或减少出生窒息和儿童神经发育障碍的其他重要原因引起的神经发育后遗症。