NIDCAP improves brain function and structure in preterm infants with severe intrauterine growth restriction

H Als, F H Duffy, G McAnulty, S C Butler, L Lightbody, S Kosta, N I Weisenfeld, R Robertson, R B Parad, S A Ringer, J G Blickman, D Zurakowski, S K Warfield, H Als, F H Duffy, G McAnulty, S C Butler, L Lightbody, S Kosta, N I Weisenfeld, R Robertson, R B Parad, S A Ringer, J G Blickman, D Zurakowski, S K Warfield

Abstract

Objective: The effect of NIDCAP (Newborn Individualized Developmental Care and Assessment Program) was examined on the neurobehavioral, electrophysiological and neurostructural development of preterm infants with severe intrauterine growth restriction (IUGR).

Study design: A total of 30 infants, 27-33 weeks gestation, were randomized to control (C; N=17) or NIDCAP/experimental (E; N=13) care. Baseline health and demographics were assessed at intake; electroencephalography (EEG) and magnetic resonance imaging (MRI) at 35 and 42 weeks postmenstrual age; and health, growth and neurobehavior at 42 weeks and 9 months corrected age (9 months).

Results: C and E infants were comparable in health and demographics at baseline. At follow-up, E infants were healthier, showed significantly improved brain development and better neurobehavior. Neurobehavior, EEG and MRI discriminated between C and E infants. Neurobehavior at 42 weeks correlated with EEG and MRI at 42 weeks and neurobehavior at 9 months.

Conclusion: NIDCAP significantly improved IUGR preterm infants' neurobehavior, electrophysiology and brain structure. Longer-term outcome assessment and larger samples are recommended.

Trial registration: ClinicalTrials.gov NCT00914108.

Figures

Figure 1
Figure 1
EEG coherence measures at 42 weeks postmenstrual age: C=17; E=13. Head images correspond to coherence factors, top view, scalp left to image left; index electrode and frequencies above head. Color regions: location, magnitude and sign (red=positive; blue=negative) of maximally loading coherence on factor. Color arrows: direction of statistical association/difference (from E-group perspective; red=increased; green=decreased).
Figure 2
Figure 2
MD in corticospinal tract (internal capsule) at 42 weeks postmenstrual age. Control infant on left, experimental infant on right. MD rendered onto trajectories of the corticospinal tract, and color-coded from red (low) to yellow (high). Brighter yellow: higher measure of MD; orange and red: lower measure of MD.

References

    1. Als H, Duffy F, McAnulty GB, Rivkin MJ, Vajapeyam S, Mulkern RV, et al. Early experience alters brain function and structure. Pediatrics. 2004;113 (4:846–857.
    1. Peters K, Rosychuk R, Hendson L, Cote J, McPherson C, Tyebkhan J. Improvement of short- and long-term outcomes for very low birth weight infants: The Edmonton NIDCAP trial. Pediatrics. 2009;124:1009–1020.
    1. Heron M, Sutton P, Xu J, Ventura S, Strobino D, Guyer B. Annual summary of vital statistics: 2007. Pediatrics. 2010;125:4–15.
    1. Committee on Understanding Premature Birth and Assuring Healthy Outcomes Preterm birth: Causes, Consequences, and Prevention The National Academies Press: Washington, DC; 2007. p31
    1. Sizonenko SV, Borradori-Tolsa C, Hüppi PS. [Intrauterine growth restriction: impact on brain development and function] Rev Med Suisse. 2008;4 (146:509–514.
    1. Als H.Program Guide—Newborn Individualized Developmental Care and Assessment Program (NIDCAP): An Education and Training Program for Health Care Professionals Copyright, NIDCAP Federation International: Boston; 1986. rev 2009.
    1. Als H, Duffy FH, McAnulty GB, Fischer CB, Kosta S, Butler SC, et al. Is the Newborn Individualized Developmental Care and Assessment Program (NIDCAP) effective for preterm infants with intrauterine growth restriction. J Perinatol. 2011;31 (2:130–136.
    1. Ballard JL, Khoury JC, Wedig K, Wang L, Eilers-Walsman BL, Lipp R. New Ballard score, expanded to include extremely premature infants. J Pediatr. 1991;119:417–423.
    1. Gairdner D, Pearson J. A growth chart for premature and other infants. Arch Dis Child. 1971;46:783–787.
    1. Als H, Buehler D, Kerr D, Feinberg E, Gilkerson L.Profile of the Nursery Environment and of Care Components. Template Manual, Part I Children's Hospital: Boston; 1990, 1995. Rev. 1997.
    1. Littman B, Parmelee AH.Manual for Pediatric ComplicationsInfant Studies Project, Department of Pediatrics, School of Medicine, ed:University of California: Los Angeles; 1974
    1. Duffy FH, Als H, McAnulty GB. Infant EEG spectral coherence data during quiet sleep: Unrestricted Principal Components Analysis - Relation of factors to gestational age, medical risk, and neurobehavioral status. Clin Electroencephalogr. 2003;34 (2:54–69.
    1. Mewes A, Huppi P, Als H, Rybicki F, Inder T, McAnulty G, et al. Regional brain development in serial magnetic resonance imaging of low-risk preterm infants. Pediatrics. 2006;118 (1:23–33.
    1. Basser PJ, Pierpaoli C. Microstructural and physiological features of tissues elucidated by quantitative-diffusion tensor MRI. J Magn Reson B. 1996;11:209–219.
    1. Als H, Lester BM, Tronick EZ, Brazelton TB. Theory and Research in Behavioral Pediatrics. Plenum Press: New York; 1982. Manual for the assessment of preterm infants' behavior (APIB) pp. 65–132.
    1. Prechtl HFR.The Neurological Examination of the Full-term Infant: A manual for clinical use2nd edn.Lippincott: Philadelphia; 1977
    1. Buehler DM, Als H, Duffy FH, McAnulty GB, Liederman J. Effectiveness of individualized developmental care for low-risk preterm infants: Behavioral and electrophysiological evidence. Pediatrics. 1995;96:923–932.
    1. Bayley N.Bayley Scales of Infant Development2nd edn.The Psychological Corporation: San Antonio; 1993
    1. Richardson D, Corcoran J, Escobar G, Lee S.Canadian-NICU-Network, Kaiser-Permanente-Network, et al.SNAP-II and SNAPPE-II: Simplified newborn illness severity and mortality risk scores J Pediatr 200113892–100.
    1. Gray CM, Engel AK, König P, Singer W. Synchronization of oscillatory neuronal responses in cat striate cortex: Temporal properties. Visual Neurosci. 1992;8:337–347.
    1. Littman B, Parmelee AH.Manual for Obstetric ComplicationsInfant Studies Project, Department of Pediatrics, School of Medicine, ed:University of California: Los Angeles; 1974
    1. Hollingshead AB. Four Factor Index of Social Status. Working Paper: Yale University: New Haven; 1975.
    1. Fair DA, Cohen AL, Power JD, Dosenbach NU, Church JA, Miezin FM, et al. Functional brain networks develop from a ‘local to distributed' organization. PLoS Comput Biol. 2009;5 (5:e1000381.
    1. Hüppi PS, Warfield S, Kikinis R, Barnes PD, Zientara GP, Jolesz FA, et al. Quantitative magnetic resonance imaging of brain development in premature and mature newborns. Ann Neurol. 1998;43:224–235.
    1. Dubois J, Benders M, Borradori-Tolsa C, Cachia A, Lazeyras F, Ha-Vinh Leuchter R, et al. Primary cortical folding in the human newborn: An early marker of later functional development. Brain. 2008;131 (8:2028–2041.
    1. Volpe J. Brain injury in premature infants: A complex amalgam of destructive and developmental disturbances. Lancet Neurol. 2009;8:110–124.
    1. Krishnan ML, Dyet LE, Boardman JP, Kapellou O, Allsop JM, Cowan F, et al. Relationship between white matter apparent diffusion coefficients in preterm infants at term-equivalent age and developmental outcome at 2 years. Pediatrics. 2007;120 (3:e604–e6e9.
    1. Barnea A, Nottebohm F. Seasonal recruitment of hippocampal neurons in adult free-ranging black-capped chickadees. Proc Natl Acad Sci USA. 1994;91:11217–11221.
    1. van Praag H, Kempermann G, Gage F. Neural consequences of environmental enrichment. Nat Rev Neurosci. 2000;1:191–198.
    1. Leggio MG, Mandolesi L, Federico F, Spirito F, Ricci B, Gelfo F, et al. Environmental enrichment promotes improved spatial abilities and enhanced dendritic growth in the rat. Behav Brain Res. 2005;163:78–90.
    1. Westrup B, Böhm B, Lagercrantz H, Stjernqvist K. Preschool outcome in children born very prematurely and cared for according to the Newborn Individualized Developmental Care and Assessment Program (NIDCAP) Acta Paediatrica. 2004;93 (4:498–507.
    1. McAnulty G, Duffy F, Butler S, Bernstein J, Zurakowski D, Als H. Effects of the Newborn Individualized Developmental Care and Assessment Program (NIDCAP) at age 8 years: Preliminary data. Clin Pediatr. 2010;49 (3:258–270.
    1. Milgrom J, Newnham C, Anderson PJ, Doyle LW, Gemmill AW, Lee K, et al. Early sensitivity training for parents of preterm infants: impact on the developing brain. Pediatr Res. 2010;67 (3:330–335.
    1. Meany MJ, Aitken DH, van Berkel C, Bhatnagar S, Sapolsky RM. Effect of neonatal handling on age-related impairments associated with the hippocampus. Science. 1988;239:766–768.
    1. Anand KJS, Scalzo FM. Can adverse neonatal experiences alter brain development and subsequent behavior. Biol Neonate. 2000;77:69–82.
    1. Kolber B, Boyle M, Wieczorek L, Kelley C, Onwuzurike C, Nettles S, et al. Transient early-life forebrain corticotropin-releasing hormone elevation causes long-lasting anxiogenic and despair-like changes in mice. J Neurosci. 2010;30 (7:2571–2581.
    1. Limperopoulos C, Gauvreau K, O'Leary H, Moore M, Bassan H, Eichenwald E, et al. Cerebral hemodynamic changes during intensive care of preterm infants. Pediatrics. 2008;122:e1006–e1013.

Source: PubMed

赞助者和合作者

医疗条件

药物干预

3
订阅