Preterm Fetal Growth Restriction and Developmental Care

早产胎儿生长受限和发育护理

• 批准号: 6915736
• 负责人: HEIDELISE ALS
• 金额: $ 47.87万
• 依托单位: BOSTON CHILDREN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2004
• 资助国家: 美国
• 起止时间: 2004-07-01 至 2007-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6915736
• 关键词: brain; clinical research; developmental neurobiology; electroencephalography; embryo /fetus; gestational age; growth /development; human subject; neurophysiology; premature infant human; prenatal growth disorder; prenatal stress

DESCRIPTION (provided by applicant): Fetal growth restriction (FGR) increases the already substantial risk of prematurity for infants' survival, overall function and later learning competence. Of the 12% of prematurely born infants in the US each year, more than 5% failed to grow appropriately in the womb due to placental insufficiency. These infants present immediate significant challenges to Newborn Intensive Care Units (NICU); more than 70% will go on to develop learning disabilities and require special educational services. It is postulated that the NICU's stressful environment may exacerbate the FGR infant's low threshold of reactivity and jeopardize already compromised brain development. The proposed project will test the effectiveness of an in-NICU intervention for such infants. It will consist of efforts to individualize all care to the infant's thresholds of sensitivity and to thereby improve neural fiber tract development (MRI) and neurophysiologic functioning (EEG). This in turn is expected to result in better behavioral adaptations. Thirty FGR preterm infants will be randomized to either a Developmental Care (E) or Standard Care (C) group. All infants will be studied within 7 days of birth (baseline) and again at 2 weeks corrected age (2w CA) (outcome). The FGR-E group is expected to show better development at 2w CA in the 3 domains to be tested, neurobehavior, electrophysiology, and brain structure. Furthermore, the FGR infants will be compared to a sample of appropriate in growth for gestational age (AGA) preterm infants for whom comparable data are available at both age points from a previous study. The FGR and AGA C and E groups will be compared in order to identify sample specific aspects of the intervention effects. This might lead to better understanding of the intervention's interaction with sample specific risk factors. The relationship and predictive success will be examined among background variables, intervention, and outcomes in the respective domains. Repeated measures multivariate analysis of variance by domain will be employed to assess sample, group and time effects as well as their interactions. Discriminate function analysis, canonical correlation, multiple regression as well as path analysis will be employed in order to model domain and across age relationships, and to predict intervention effectiveness. Results are expected to show brain-based effects of the intervention for the FGR infants, mediated by stress reduction. This is expected to bring them closer in functioning and brain structural development to their AGA peers. The study will be significant in understanding ways to reduce long-term functional morbidities in FGR infants, as well as in identifying opportunities for enhancing last trimester brain development.

描述（由申请人提供）：胎儿生长限制（FGR）增加了婴儿生存，整体功能和后来学习能力的早产风险。每年美国有12％的早产婴儿中，由于胎盘不足，有5％以上的婴儿在子宫中未能适当地生长。这些婴儿对新生儿重症监护病房（NICU）提出了立即的重大挑战；超过70％的人将继续发展学习障碍并需要特殊教育服务。据推测，NICU的压力环境可能会加剧FGR婴儿的反应性低阈值，并危害已经损害的大脑发育。拟议的项目将测试此类婴儿的NICU干预的有效性。它将努力将所有护理对婴儿的敏感性阈值进行个性化，从而改善神经纤维道发育（MRI）和神经生理功能（EEG）。反过来，这将导致更好的行为适应。 30名FGR早产儿将被随机分为发育护理（E）或标准护理（C）组。所有婴儿将在出生后的7天（基线）内进行研究，并在2周的校正年龄（2W CA）（结果）进行研究。预计FGR-E组将在要测试的3个结构域中显示2W CA的更好的发育，神经行为，电生理学和大脑结构。此外，将将FGR婴儿与适当的胎龄（AGA）早产儿的适当样本进行比较。将比较FGR和AGA C和E组，以确定干预效果的样本特定方面。这可能会更好地理解干预与样本特定风险因素的相互作用。关系和预测成功将在背景变量，干预和各个领域的结果之间进行研究。重复测量将采用域的多变量分析来评估样本，小组和时间效应及其相互作用。将采用区分功能分析，规范相关性，多重回归以及路径分析，以模拟域和跨年龄关系，并预测干预效率。预计结果将显示出通过减轻压力介导的FGR婴儿的干预措施的基于大脑的影响。预计这将使他们在功能和大脑结构发育方面更加接近他们的同伴。这项研究将在理解减少FGR婴儿长期功能性病的方法方面以及确定增强孕期脑发育的机会。