This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Despite advances in neuroimaging techniques that visualize central nervous system (CNS) injury, it is impossible to predict individual outcome for preterm infants discharged from a Neonatal Intensive Care Unit (NICU). Neuroimaging cannot replace clinical skills needed to assess the rate and quality of a child's development in order to diagnose disability (at the earliest, 1-2 years). Some infants with signs of severe CNS injury function well, while some disabled children have normal neuroimaging studies. Prospectively, perinatal risk factors merely allow selection of infants at risk for neurodevelopmental disability. Definitive diagnosis requires examination and use of child-based measures of cognition, language, motor abilities and adaptive function. We have extended our previous work on motor and language milestones as predictors of preterm outcome by designing a measure of CNS function at the earliest possible extrauterine age. We perform serial neurodevelopmental examinations on preterm infants in a NICU and score them by quantifying both degree of abnormality (Abnormality Score) and rate of neuromaturation (Maturity Score). Because they require expertise but no expensive technology, they can be used wherever trained clinicians encounter preterm infants. Our measures of early CNS function can be used to evaluate how preterm development is influenced by CNS injury, illness and recovery. They have the exciting potential to provide insight into causes of and responses to CNS injury in preterm infants. This project proposes to 1) standardize quantifiable norms for development of CNS function prior to term, 2) evaluate the efficacy of these measures in determining delay and predicting neurodevelopmental disability and functional outcome at 18 months from due date, and 3) determine how these measures are modified by prenatal (IUGR), perinatal (intraventricular hemorrhage) and neonatal (CLD) illness. This endeavor contributes substantially to a systematic approach to clinical assessments that can be used to better target and measure efficacy and effectiveness of interventions for preterm infants. As preventive and treatment strategies for CNS injury emerge, these measures of early CNS function can improve safety and help evaluate efficacy in randomized controlled clinical trials in preterm infants by providing earlier feedback, when the infants are in the NICU. In these ways, developing a measurement tool of early CNS function will improve preterm outcomes and optimize the use of health and neurodevelopmental resources for preterm infants.
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