Intraventricular hemorrhage (IVH) occurs in approximately 40% of infants born weighing less than 1000 grams and is associated with a 40% increase in the risk of life-long neurodevelopment disability. African-descent infants face at least double the risk of IVH when compared to their European-descent counterparts. While progress has been made in reducing the overall risk of IVH, it remains a common, and potentially devastating complication of prematurity, particularly for African-descent infants. Hampering the development of new neuroprotective strategies is an incomplete and inconsistent understanding of the risk factors for IVH. In this application, we introduce a focused investigation into the prenatal, perinatal and postnatal factors which contribute to a neonate?s ?physiologic phenotype.? Our preliminary data suggest that African-descent infants are over-represented in the immature physiologic phenotype group and that this confers an increased risk of IVH. The results of this study will provide a rigorously developed platform for future investigation of targeted interventions for reduction of IVH in this patient population. The research training program outlined in this proposal provides for a robust education in health outcomes disparities, bioinformatics, risk prediction modeling, and the ethical conduct of research through formal and informal coursework. This comprehensive plan will form a firm educational foundation for the design and execution of high-quality research and map directly to the goals of the research plan.
Although it is known that all preterm infants are vulnerable to catastrophic bleeding in the brain, African-descent infants have at least twice the risk of European-descent infants, a significant disparity for which there currently is no explanation. In this study, we propose a novel method for measuring how well the brain is able to dampen fluctuations in blood pressure by using non-invasive bedside monitor. In particular, we will examine how the degree of prematurity and the race of the infant affects the function of this system. If successful, this approach will form a standard platform for monitoring the preterm brain and will aid in developing new strategies to reduce the risk of brain bleeding in this high-risk population.
