Perinatal asphyxia is a leading cause of neonatal mortality and morbidity in developing countries. Survivors of perinatal asphyxia have high rates of mental retardation, cerebral palsy, and other neurodevelopmental disorders. Controlled trials and meta-analyses conclude that early intervention programs prevent or minimize cognitive impairment in high-risk infants. These programs are legislatively mandated in the United States and are the standard of care in developed nations. However, early intervention programs are rarely available in developing countries and to most at-risk infants worldwide. Preliminary evidence from a small, randomized controlled trial conducted in a developing country suggests that a program of home-based early intervention improves neurodevelopmental outcome (Mental Developmental Index) in survivors of perinatal asphyxia but conclusive evidence is not available. This proposal, the Brain Research to Ameliorate Impaired Neurodevelopment (BRAIN) Planning Grant for the Developing World, aims to identify infants at risk for neurodevelopmental disorders and to evaluate the feasibility of implementing an innovative intervention trial in a developing nation. Utilizing established collaborations between researchers at the University of Alabama at Birmingham, University of Zambia, University Teaching Hospital in Zambia, and the Lusaka Urban District Health Management Team in Lusaka, Zambia, pilot studies will be performed to determine the incidence and types of neurodevelopmental impairments following perinatal asphyxia. Additionally, the Partners for Learning curriculum (or similar curriculum) will be adapted to the Zambian population. Two research nurses will be certified with the Partners for Learning curriculum to become trainer-of-trainers so they can instruct the parents. A Zambian clinician will receive training and certification as a psychometric trainer-of-trainers. Pilot studies will be performed to validate the adapted curriculum and to implement a home-based parent-provided intervention. This proposal is intended to generate the preliminary data for the implementation of a large, randomized controlled trial of an innovative, cost effective, home-based, early intervention trial in infants who survive following perinatal asphyxia. The long-term goal of this proposal is to broaden research collaborations and to build sustainable capacity to prevent or reduce neurodevelopmental sequelae resulting from perinatal asphyxia and other important causes of neurodevelopmental impairment in children. If proven effective in developing countries, a home-based early intervention program has the potential of improving cognitive capacity in many at-risk infants worldwide at a cost lower than more expensive special education services.
