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: 8052886
• 负责人: TERRIE E INDER
• 金额: $ 31.97万
• 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 2013-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8052886
• 关键词: 2 year old; 6 year old; Address; Admission activity; Age; Anxiety; 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; Health; Hospitals; Image; Impaired cognition; Impairment; Incidence; Infant; Language Delays; Language Development; Learning Disabilities; Lesion; Longitudinal Studies; Magnetic Resonance; Magnetic Resonance Imaging; Measurement; Measures; Mental Depression; Mental Health; Microscopic; Motor; Nature; Neonatal; Neurobiology; Neurologic; Outcome; Parenting behavior; Perinatal; Population; Pregnancy; Premature Birth; Premature Infant; Prevalence; Problem behavior; Psychological Tests; Public Health; 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; Withdrawal; Woman; base; brain volume; cohort; comparison group; deafness; design; developmental disease; disability; early childhood; executive function; experience; follow-up; imaging modality; improved; insight; longitudinal course; longitudinal design; morphometry; neurobehavioral; neuromechanism; neuropsychological; novel; prenatal; relating to nervous system; response; skills; social; social skills; visual motor; 2 year old; 6 year old; Address; Admission activity; Age; Anxiety; 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; Health; Hospitals; Image; Impaired cognition; Impairment; Incidence; Infant; Language Delays; Language Development; Learning Disabilities; Lesion; Longitudinal Studies; Magnetic Resonance; Magnetic Resonance Imaging; Measurement; Measures; Mental Depression; Mental Health; Microscopic; Motor; Nature; Neonatal; Neurobiology; Neurologic; Outcome; Parenting behavior; Perinatal; Population; Pregnancy; Premature Birth; Premature Infant; Prevalence; Problem behavior; Psychological Tests; Public Health; 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; Withdrawal; Woman; base; brain volume; cohort; comparison group; deafness; design; developmental disease; disability; early childhood; executive function; experience; follow-up; imaging modality; improved; insight; longitudinal course; longitudinal design; 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，因为它的发生率越来越多，再加上随后的行为，神经和精神病挑战的经常出现。大约10-15％的非常早产儿（胎龄<30周）出现脑瘫，而30-60％的早产儿则患有认知障碍。这些障碍包括视觉运动问题，注意力困难，记忆力受损，语言掌握延迟，执行功能障碍，学习障碍，社交技能差，社交戒断，焦虑和抑郁症的率更高。此外，在早产群体中已经描述了发育障碍的患病率增加，例如注意力缺陷/多动障碍，自闭症和精神分裂症。对导致早产儿童障碍的机制有了更深入的了解，这是制定改善临床结局策略的重要步骤。我们有一个独特的，大的队列，包括229名早产儿（<30周妊娠或<1250g），我们为其开发了广泛的围产期数据库，并在期限等效的情况下获得了晚期磁共振（MR）图像。对这些数据的评估已导致对与早产相关的大脑病变性质的新见解。重要的是，在纵向神经心理学随访过程中，我们一直保持着与97％的该队列的联系。现在，该人群为与现代高级MR成像方法相关的神经行为障碍的机制提供了难得的机会。我们建议将最新的MR成像方法应用于6岁的该队列与神经心理学评估。 MR数据将使我们能够研究早产儿和年前婴儿的大脑从等效到儿童期的结构变化的演变。这些技术将包括基于表面的形态计量学（SBM），脑体积测量（体积计）和扩散张量成像（DTI）。 MR方法将提供宏观（体积和SBM）和显微镜（DTI）的大脑发育测量，以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有关，以研究MR测量与神经行为障碍的关系。纵向设计将使我们能够研究结构异常和童年的代偿性变化，以应对早期的脑损伤。这些数据可能会为神经恢复和改善早产儿的结局的策略提供新的了解。公共卫生相关性：这项研究旨在使用磁共振成像（MR）成像来提高我们对过早出生的婴儿所承受的脑损伤的理解，以及大脑随后如何在童年时期发展。使用先进的MR成像和心理测试的纵向设计将使我们能够研究结构异常和对童年时期的阳性自适应变化，以应对早期的脑损伤。这将有助于我们了解如何减少这些脆弱儿童后来面临的全球和特定残疾。