The period from 28 to 30 weeks gestation is one of significant neurological reorganization, initiating the beginning of fetal behavioral individually and maintenance of extrauterine survival. Infants born at this transitional stage, the fastest growing and largest segment of the PT infant (PT) population, later on exhibit unexpectedly significant brain dysfunction and remain at risk well into school age. Up to 52 percent of such infants present with deficits in psychomotor, cognitive, and attentional function, emotional vulnerability and substandard school performance, all thought to be due to a central deficit in processing complex information and attributable to association cortical frontal systems. It is postulated that such a central deficit may result from increased vulnerability of cerebral white matter during the last trimester of gestation, its phase of most rapid development. Persistent stress due to inappropriate sensory stimulation is thought to contribute to such alteration of early brain structure and function.
The aim of the proposed study is to identify specific adaptations of the PT brain in the last 12 weeks of gestation to the transient experience of the NICU environment in order to estimate the potential of such experience in remodeling neuroanatomical structure and neurodevelopmental function. A prospective randomized clinical trial will be conducted. Sixty medically healthy PTs born between 28 and 30 weeks will be randomly assigned to one of two treatment conditions, representing measurably different NICU experiences, standard care (SC) and developmental care (DC). They will be compared to 30 healthy full-term infants (FT). All 90 infants will be assessed at 42 w postconceptional age in three neurodevelopmental domains, neurobehavioral function (APIB; Prechtl), neuroelectrophysiological function (qEEG; FVER), and neuroanatomic structure (3D-MRI; DTI). Specific regions of interest investigated will be the early maturing occipital lobe and the later maturing frontal lobe and corpus callosum structures. It is hypothesized that PTs who receive DC will demonstrate regionally specific brain enhancement within domain compared to PTs who receive SC. Furthermore, such PTs will be more similar to FTs that PTs who receive SC. MANOVA will be employed by domain in order to test this hypothesis. Canonical correlations will be used to examine the relationships among and within the domains. It is anticipated that the proposed study will demonstrate for the first time the effect of experience on the remodeling of higher order neurofunctional and neuro structural processes, and will suggest and approach for later deficit amelioration, relevant to the largest segment of the PT population.

Agency
National Institute of Health (NIH)
Institute
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Type
Research Project (R01)
Project #
1R01HD038261-01
Application #
6027241
Study Section
Special Emphasis Panel (ZRG1-BBBP-6 (01))
Program Officer
Hanson, James W
Project Start
2000-03-01
Project End
2003-02-28
Budget Start
2000-03-01
Budget End
2001-02-28
Support Year
1
Fiscal Year
2000
Total Cost
$269,405
Indirect Cost
Name
Children's Hospital Boston
Department
Type
DUNS #
076593722
City
Boston
State
MA
Country
United States
Zip Code
02115
Duffy, Frank H; Shankardass, Aditi; McAnulty, Gloria B et al. (2013) The relationship of Asperger's syndrome to autism: a preliminary EEG coherence study. BMC Med 11:175
McAnulty, Gloria; Duffy, Frank H; Kosta, Sandra et al. (2012) School Age Effects of the Newborn Individualized Developmental Care and Assessment Program for Medically Low-Risk Preterm Infants: Preliminary Findings. J Clin Neonatol 1:184-194
Duffy, Frank H; Als, Heidelise (2012) A stable pattern of EEG spectral coherence distinguishes children with autism from neuro-typical controls - a large case control study. BMC Med 10:64
Als, Heidelise; McAnulty, Gloria B (2011) The Newborn Individualized Developmental Care and Assessment Program (NIDCAP) with Kangaroo Mother Care (KMC): Comprehensive Care for Preterm Infants. Curr Womens Health Rev 7:288-301
Als, H; Duffy, F H; McAnulty, G B et al. (2011) Is the Newborn Individualized Developmental Care and Assessment Program (NIDCAP) effective for preterm infants with intrauterine growth restriction? J Perinatol 31:130-6
McAnulty, Gloria B; Duffy, Frank H; Butler, Samantha C et al. (2010) Effects of the Newborn Individualized Developmental Care and Assessment Program (NIDCAP) at age 8 years: preliminary data. Clin Pediatr (Phila) 49:258-70
McAnulty, G; Duffy, F H; Butler, S et al. (2009) Individualized developmental care for a large sample of very preterm infants: health, neurobehaviour and neurophysiology. Acta Paediatr 98:1920-6
Mewes, Andrea U J; Huppi, Petra S; Als, Heidelise et al. (2006) Regional brain development in serial magnetic resonance imaging of low-risk preterm infants. Pediatrics 118:23-33
Als, Heidelise; Butler, Samantha; Kosta, Sandra et al. (2005) The Assessment of Preterm Infants' Behavior (APIB): furthering the understanding and measurement of neurodevelopmental competence in preterm and full-term infants. Ment Retard Dev Disabil Res Rev 11:94-102