Infants born preterm continue to be a national public health concern due to their rising numbers and risk for long term disability. The purpose of this project is to determine the level of motor learning and coordination impairment in preterm infants at high risk for functional disabilities (Aims 1 and 2), and relate these behavioral impairments to their neurological impairment as assessed by cranial ultrasound, quantitative brain MRI and follow-up clinical examinations (Aim 3). The project focuses on preterm infants born at very low weight (1000-1500 grams, VLBW) and extremely low weight (<1000grams, ELBW) as up to 50% of these infants will display one or more major neurodevelopmental impairments such as those associated with cerebral palsy and developmental coordination disorder. Perinatal brain injuries underlie these impairments and are readily detected by advancing imaging technology of cranial ultrasound (CUS) and magnetic resonance imaging (MRI). In adult neurological populations, such brain imaging is routinely linked to motor learning and coordination assessments. The resulting brain-motor behavior relationships inform basic science and advance adult neurorehabilitation. Pediatric clinicians lack motor learning and coordination assessments for very young infants. As a result, extremely little is known about the brain-motor behavior relationships in infant populations. More importantly, clinicians and families are often forced to wait into the 2nd year before persistent delays in gross motor milestones confirm the functional results of brain impairments noted in infancy. In a recent series of studies, we used the Eye Blink Conditioning paradigm and the Mobile paradigm, two well established learning paradigms from developmental science, to study motor learning and coordination impairments in both full-term healthy infants and VLBW preterm infants (Heathcock et al 2004, 2005;Herbert et al., 2004). In this proposal, we directly extend our previous work to test specific hypotheses regarding motor learning and coordination in both VLBW and the even higher risk ELBW preterm infants at 3 and 6 months of age (Aim 1 and 2). We will also relate this to CUS at birth, MRI at 6 months and clinical examinations every 3rd month from 3 to 24 months of age. Imaging will focus on common neurological diagnoses in preterm infants such as PVL and IVH, as well as changes in motor learning and coordination-related areas (cerebellum, basal ganglia, hippocampus, frontal and parietal gray and white matter), many of which are commonly reported as impaired in high risk preterm infants. These results will provide the foundation whereby standardized assessments for the very young infant may be developed and linked with specific neurological injury. Such standards enable pediatric clinicians to better understand the complex relationship between neurological injury and functional impairment in the first months of life.
