Beside Monitor of Cerebral Metabolism in Premature Infants with Intraventricular

早产儿脑室内代谢的旁路监测

• 批准号: 9751359
• 负责人: Pei-Yi Lin
• 金额: $ 24.89万
• 依托单位: BOSTON CHILDREN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-07-14 至 2021-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9751359
• 关键词: 2 year old; Academy; Address; Adult; Age; Anatomy; Award; Beds; Biological Markers; Biomedical Technology; Blood Vessels; Blood flow; Boston; Brain Injuries; Brain imaging; Caring; Cerebrospinal Fluid; Cerebrovascular Circulation; Cerebrum; Childhood; Childhood Injury; Clinical; Clinical Trials; Clinical assessments; Communities; Complement; Complication; Depressed mood; Development; Devices; Diagnosis; Diagnostic; Diffuse; Drainage procedure; Early Diagnosis; Early treatment; Engineering; Ensure; Environment; Equipment; Evaluation; Exhibits; Extremely Low Birth Weight Infant; Faculty; Family; Funding; Gap Junctions; Goals; Grant; Growth; Health; Healthcare; Hemorrhage; Hospitals; Human; Hydrocephalus; Imaging technology; Impairment; Incidence; Infant; Infant Development; Interdisciplinary Study; Intervention; Intracranial Pressure; Intraventricular; Lead; Learning; Light; Live Birth; Magnetic Resonance Imaging; Measurement; Measures; Medical; Medical center; Medicine; Mentors; Mentorship; Metabolism; Methods; Modeling; Monitor; Near-Infrared Spectroscopy; Neonatal; Neonatal Brain Injury; Neonatal Intensive Care; Neonatal Intensive Care Units; Neonatology; Neurodevelopmental Impairment; Neurologic; Neurological outcome; Neuronal Injury; Neurons; New England; Newborn Infant; Optics; Outcome; Oxygen; Pathogenesis; Pathway interactions; Patients; Pediatric Hospitals; Perfusion; Perinatal Care; Phase; Population; Predictive Value; Premature Birth; Premature Infant; Prevention; Prevention strategy; Principal Investigator; Quality of life; Recovery; Regulation; Research; Research Personnel; Research Project Grants; Resolution; Resources; Risk; Science; Scientist; Severities; Site; Societies; Spectrum Analysis; Survival Rate; Techniques; Technology; Testing; Time; Toddler; Training; Treatment Effectiveness; Treatment outcome; Ultrasonography; United States; Universities; Weight; Woman; Work; base; brain abnormalities; brain health; career; cerebral hemodynamics; cerebrovascular; clinical application; cost; efficacy testing; experience; hemodynamics; improved; infancy; innovation; instrument; interest; intraventricular hemorrhage; member; metabolomics; mortality; multidisciplinary; neonatal brain; neonatal care; neonate; neurodevelopment; neuroimaging; non-invasive monitor; novel; outcome prediction; post intervention; postnatal period; premature; programs; public health relevance; response; routine imaging; skills; success; tenure track; tool; treatment response

 DESCRIPTION (provided by applicant): I am an experimental scientist with a particular interest in understanding the normal and abnormal brain to improve neurological outcomes and quality of life after neonatal brain injuries. My goal in seeking a K99/R00 Pathway to Independence Award is to obtain, through coursework and mentoring, the training in neonatology, pediatric neuroradiology and infant development to establish myself as an independent principal investigator in inter-disciplinary research in newborn medical science. This proposal is driven by my postdoctoral work within the Martinos Center and my identification of a new niche for advanced NIRS techniques in infants diagnosed with GM-IVH. For this project, I will investigate early post-natal cerebral metabolism in premature infants with germinal-matrix intraventricular hemorrhage (GM-IVH) and post-hemorrhagic hydrocephalus (PHH) and the relationship between cerebral metabolism in GMH-IVH and PHH with infants' developmental outcomes. My long-term career goal is to become a tenure-track faculty member at a research university or medical center and lead my own independent research group. Specifically I want to develop a tool to help doctors time their intervention and better select patients for clinical trials. My ultimate aim is to develop an FDA 510(k)- cleared device fo noninvasive monitoring of cerebral health at the bedside. I envision establishing a competitively funded lab and leading interdisciplinary research dedicated to developing and implementing innovative, noninvasive optical-based technologies in monitoring brain health. In particular, I am keen to establish biomarkers for infants to enable early diagnosis and management of various neonatal brain injuries. The biomarkers might shed light on the best ways to predict which infants would experience poor neurodevelopment. The biomarkers related to neonatal neuronal injury would impact every field of brain injury in children and adults. The proposal for this K99/R00 Pathway to Independence Award is the first step to identifying such biomarkers and providing me the opportunity to further expand the use of biomarkers. Twelve percent of live births in the United States are premature, resulting in the need to care for some 500,000 premature infants. The National Academies estimate premature births cost the US in excess of $26 billion every year. Germinal matrix-intraventricular hemorrhage (GM-IVH) is a major complication of prematurity, occurring in about 45% of extremely low birth weight infants (weight <1000 g), and all grades are associated with adverse long-term neurological impairment. Even as improved neonatal intensive care and technological advances have increased the survival rate of extremely premature infants, the high incidence of GM-IVH has remained unchanged over the past decade. This study will investigate the relationship between GM-IVH and cerebral blood flow and metabolism with the long-term goal of developing novel, easy-to-apply diagnostics for GM-IVH risk and progression. We propose innovative non-invasive Near Infrared Spectroscopy (FDNIRS-DCS) methods suitable for monitoring cerebral hemodynamics and metabolism of premature infants directly at the patient bedside. In earlier work, we have already demonstrated the feasibility and utility of performing cerebral metabolism measurements in the neonatal intensive care unit (NICU). Our central hypothesis is that NIRS measures of cerebral perfusion and oxygen metabolism can serve as additional objective criteria for assessing the impact of GM-IVH, the progression of PHH, and the effect of hydrocephalus treatment on cerebral CBF and CMRO2. This work will test the efficacy of NIRS-measured cerebral oxygen metabolism as a biomarker in neonatal neuronal health and perinatal care. My mentor's group at the Martinos Center at MGH is at a nexus of technology, research and clinical applications. This study will be at the Martinos center and sites within Newborn Medicine at Boston Children's Hospital (BCH), and Brigham and Women's Hospital (BWH). The Martinos Center is an ideal environment with a large multidisciplinary community of experts who develop and apply a wide range of innovative new imaging and biomedical technologies. The Optics Division has multiple human-use FDNIRS, CWNIRS and DCS instruments and has pledged the use of the equipment, resources and facilities needed to complete the aims of this proposal. We have long-standing relationships with neonatal intensive care units (NICUs) at BCH and BWH, as exhibited in our preliminary results. With 120 Level II and III neonatal intensive care beds, they are the largest such programs in New England and ideal for this study. I have formed a strong multi-disciplinary mentoring team in optical engineering (Dr. Franceschini), neonatal neuroimaging (Dr. Grant), neonatal hydrocephalus (Dr. Warf), neonatology (Dr. Inder) and infant neurodevelopment (Dr. Nelson). Each mentor provides critical expertise and experience to guide me to successful completion of this multidisciplinary project. In addition to the mentorship and research, I also plan for training through formal coursework in neonatology and infant development to complement my engineering background. The skills and experience garnered from completion of the proposed training and research objective will prepare me to become an independent investigator in the fields of neonatal brain imaging and development.

 描述（由适用提供）：我是一名实验科学家，对了解正常和异常大脑的兴趣特别感兴趣，以改善新生儿脑损伤后的神经系统结局和生活质量。我寻求K99/R00独立奖的目标是通过课程和心理，在新生儿医学科学领域的新生儿神经放射学和婴儿发展中获得新生儿学，小儿神经放射学和婴儿发展的培训。该提案是由我在马提尼斯中心（Martinos Center）内的博士后工作以及我对被诊断为GM-IVH的婴儿的高级NIRS技术的识别的确定。对于这个项目，我将研究产后早期的脑脑脑内代谢，脑室内出血（GM-IVH）和毛发后脑电图（PHH）（pHH）以及GMH-IVH和PHH与Adperant a Devervationant的发展。我的长期职业目标是成为研究大学或医学中心的终身教师，并领导我自己的独立研究小组。具体而言，我想开发一种工具，以帮助医生计时他们的干预时间，并更好地选择患者进行临床试验。我的最终目的是开发FDA 510（k） - 清除的设备，用于对床边大脑健康的无创监测。我设想建立一项有竞争力的实验室和领先的跨学科研究，致力于开发和实施创新的，无创的基于光学的基于光学的技术，以监测大脑健康。特别是，我渴望为婴儿建立生物标志物，以使各种新生儿脑损伤的早期诊断和管理。生物标志物可能会阐明预测哪些婴儿会经历不良神经发育的最佳方法。与新生儿神经元损伤有关的生物标志物将影响儿童和成人的每个领域。这项K99/R00独立奖的提案是确定此类生物标志物并为我提供进一步扩大生物标志物使用的机会的第一步。在美国，有十二％的活产物为时过早，导致需要照顾大约500,000个早产儿。美国国家科学院估计，每年的早产时间超过260亿美元。生发基质内脑出血（GM-IVH）是早产的主要并发症，发生在大约45％的极低的出生体重婴儿（体重<1000 g）中，并且所有等级都与不良的长期神经系统障碍有关。即使改善的新生儿重症监护和技术进步提高了极早婴儿的生存率，在过去的十年中，GM-IVH的高发病率一直保持不变。这项研究将研究GM-IVH与脑血流和代谢之间的关系，其长期目标是为GM-IVH风险和进展而开发新颖的，易于应用的诊断。我们提出了创新的非侵入性近红外光谱（FDNIRS-DCS）方法，适用于直接在患者床边监测过早婴儿的脑血液动力学和代谢。在较早的工作中，我们已经证明了在新生儿重症监护病房（NICU）中执行脑代谢测量的可行性和实用性。我们的中心假设是，脑灌注和氧代谢的NIRS测量可以作为评估GM-IVH，PHH进展以及脑积水治疗对脑CBF和CMRO2的影响的其他客观标准。这项工作将测试NIRS测量的脑氧代谢作为新生儿神经元健康和围产期护理中的生物标志物的功效。我在MGH马蒂诺斯中心的导师小组是技术，研究和临床应用的联系。这项研究将在波士顿儿童医院（BCH）以及杨百翰和妇女医院（BWH）的马提尼斯中心和新生儿医学中的现场。马蒂诺斯中心（Martinos Center）是一个理想的环境，拥有大型的跨学科专家社区，他们开发和应用各种创新的新成像和生物医学技术。光学部有多个人使用的FDNIR，CWNIRS和DCS仪器，并迫切使用了完成该提案目标所需的设备，资源和设施。我们与BCH和BWH的新生儿重症监护病房（NICUS）有着长期的关系，在我们的120级II和III新生儿重症监护床中曝光，它们是新英格兰最大的此类计划，是这项研究的理想选择。我在光学工程（Franceschini博士），新生儿神经影像学（Grant博士），新生儿脑电图（WARF博士），新生儿学（INDER博士）和婴儿神经发育转发（尼尔森博士）中组建了一个强大的多学科指导团队。每种心理都提供重要的专业知识和经验，以指导我成功完成这个多学科项目。除了心态和研究外，我还计划通过新生儿学和婴儿发展的正式课程进行培训，以完成我的工程背景。从拟议的培训和研究目标完成后，获得的技能和经验将使我成为新生儿脑成像和开发领域的独立研究者。