Neurobehavioral Impairments in Preterm Children - A Longitudinal MR Study

早产儿的神经行为损伤——一项纵向 MR 研究

• 批准号: 7447715
• 负责人: TERRIE E INDER
• 金额: $ 48.06万
• 依托单位: WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-07-01 至 2012-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7447715
• 关键词: Address; Admission activity; Age; Age-Years; Anxiety; Arts; Atlases; Attention; Attention deficit hyperactivity disorder; Australia; Autistic Disorder; Behavioral; Biological Markers; Birth; Blindness; Brain; Brain Injuries; Caring; Cerebral Palsy; Cerebrum; Characteristics; Child; Childhood; Clinical; Cognition; Communities; Control Groups; Data; Data Analyses; Databases; Delayed Memory; Development; Diffusion Magnetic Resonance Imaging; Emotional; Environmental Risk Factor; Evaluation; Evolution; Face; Family; Financial compensation; Functional disorder; Gestational Age; Growth; Hospitals; Image; Impaired cognition; Impairment; Incidence; Infant; Language; Language Development; Learning Disabilities; Lesion; Longitudinal Studies; Magnetic Resonance; Magnetic Resonance Imaging; Measurement; Measures; Mental Depression; Mental Health; Methods; Microscopic; Motor; Nature; Neonatal; Neurobiology; Neurologic; Outcome; Parenting behavior; Perinatal; Population; Pregnancy; Premature Birth; Premature Infant; Prevalence; Problem behavior; Psychological Tests; Public Health; Range; Rate; Readiness; Recovery; Recruitment Activity; Risk Factors; Schizophrenia; School-Age Population; Schools; Sensitivity and Specificity; Social support; Structure; Surface; Survival Rate; Techniques; Underachievement; Universities; Variant; Visual; Visual Perception; Washington; Week; Withdrawal; Woman; base; brain volume; cohort; comparison group; deafness; design; developmental disease; disability; early childhood; executive function; experience; follow-up; improved; insight; morphometry; neurobehavioral; neuromechanism; neuropsychological; novel; prenatal; relating to nervous system; response; skills; social; social skills; visual motor

DESCRIPTION (provided by applicant): Preterm birth is a major public-health issue because of its increasing incidence combined with the frequent occurrence of subsequent behavioral, neurological, and psychiatric challenges faced by surviving infants. Approximately 10-15% of very preterm children (born < 30 weeks gestational age) develop cerebral palsy, and 30 - 60% of very preterm children experience cognitive impairments. These impairments include visual-motor problems, attentional difficulties, impaired memory, delayed acquisition of language, executive dysfunction, learning disabilities, poor social skills, and higher rates of social withdrawal, anxiety and depression. In addition, an increased prevalence of developmental disorders such as attention deficit/hyperactivity disorder, autism and schizophrenia, has been described in the preterm population. A greater understanding of the mechanisms leading to neurobehavioral impairments in preterm children is an important step in developing strategies for improving clinical outcomes. We have a unique, large cohort of 229 preterm infants (<30 weeks gestation or <1250g) for whom we have developed an extensive perinatal database and obtained advanced magnetic resonance (MR) images at term equivalent. Evaluation of these data has led to novel insights into the nature of the cerebral lesion associated with preterm birth. Importantly, we have maintained ongoing contact with 97% of this cohort during the course of longitudinal neuropsychological follow up. This population now offers a rare opportunity for longitudinal evaluation of the mechanisms of neurobehavioral impairment in association with modern, advanced MR imaging methods. We propose to apply state-of-the-art MR imaging methods to this cohort at 6 years of age in conjunction with neuropsychological evaluation. The MR data will allow us to study the evolution of structural changes in the brain from term equivalent into childhood in both the preterm and term born infants. The techniques will include surface based morphometry (SBM), brain volume measurements (volumetry), and diffusion tensor imaging (DTI). The MR approaches will provide both macroscopic (volumes and SBM) and microscopic (DTI) measures of cerebral development that address different aspects of brain structure and maturation. These will be related to the longitudinal social and neuropsychological evaluations to investigate the relationship of MR measures to neurobehavioral impairments. The longitudinal design will allow us to study both structural abnormalities and compensatory changes over childhood in response to early brain injury. These data will likely provide new understanding of neural recovery and strategies for improving outcomes in preterm infants. PUBLIC HEALTH RELEVANCE: This study is designed to use magnetic resonance (MR) imaging to improve our understanding of the brain injury sustained by prematurely-born infants and how the brain subsequently develops over childhood. The longitudinal design, using both advanced MR imaging and psychological testing, will allow us to study both structural abnormalities and positive adaptive changes over childhood in response to early brain injury. This will assist us in understanding how to reduce the global and specific disabilities that these vulnerable children later face.

描述（由申请人提供）：早产是一个主要的公共卫生问题，因为其发病率不断增加，而且幸存婴儿随后经常面临行为、神经和精神方面的挑战。大约 10-15% 的极早产儿（出生胎龄 < 30 周）会出现脑瘫，30-60% 的极早产儿会出现认知障碍。这些障碍包括视觉运动问题、注意力困难、记忆力受损、语言习得延迟、执行功能障碍、学习障碍、社交技能差以及社交退缩、焦虑和抑郁的发生率较高。此外，早产儿人群中注意力缺陷/多动症、自闭症和精神分裂症等发育障碍的患病率有所增加。更好地了解导致早产儿神经行为损伤的机制是制定改善临床结果策略的重要一步。我们拥有一个独特的大型队列，由 229 名早产儿（妊娠 <30 周或 <1250g）组成，我们为他们开发了广泛的围产期数据库，并获得了足月的先进磁共振 (MR) 图像。对这些数据的评估使人们对与早产相关的脑损伤的性质有了新的见解。重要的是，在纵向神经心理学随访过程中，我们与该队列中 97% 的人保持持续接触。该人群现在为结合现代、先进的 MR 成像方法纵向评估神经行为损伤机制提供了难得的机会。我们建议将最先进的 MR 成像方法结合神经心理学评估应用于该 6 岁队列。磁共振数据将使我们能够研究早产儿和足月儿从足月到童年时期大脑结构变化的演变。这些技术将包括基于表面的形态测量（SBM）、脑体积测量（体积测定）和扩散张量成像（DTI）。 MR 方法将提供大脑发育的宏观（体积和 SBM）和微观（DTI）测量，解决大脑结构和成熟的不同方面。这些将与纵向社会和神经心理学评估相关，以研究 MR 测量与神经行为损伤的关系。纵向设计将使我们能够研究儿童时期针对早期脑损伤的结构异常和代偿性变化。这些数据可能会提供对神经恢复的新认识以及改善早产儿结局的策略。公共健康相关性：本研究旨在利用磁共振 (MR) 成像来提高我们对早产儿脑损伤以及大脑在童年时期如何发育的了解。纵向设计使用先进的磁共振成像和心理测试，使我们能够研究儿童时期针对早期脑损伤的结构异常和积极的适应性变化。这将有助于我们了解如何减少这些弱势儿童日后面临的总体和特定残疾。