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.
