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Current Research Studies
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- Developmental Care Study
- Does Early Experience Improve Preterm Neurodevelopment?
- Adolescents Born Preterm: Nurtured Beginnings
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Fetal growth restriction (FGR) increases the already substantial risk of prematurity for infants' survival, overall function and later learning competence. Of the 12% of prematurely born infants in the US each year, more than 5% failed to grow appropriately in the womb due to placental insufficiency. These infants present immediate significant challenges to Newborn Intensive Care Units (NICU); more than 70% will go on to develop learning disabilities and require special educational services. It is postulated that the NICU's stressful environment may exacerbate the FGR infant's low threshold of reactivity and jeopardize already compromised brain development. The proposed project will test the effectiveness of an in-NICU intervention for such infants. It will consist of efforts to individualize all care to the infant's thresholds of sensitivity and to thereby improve neural fiber tract development (MRI) and neurophysiologic functioning (EEG). This in turn is expected to result in better behavioral adaptations. Thirty FGR preterm infants will be randomized to either a Developmental Care (E) or Standard Care (C) group. All infants will be studied within 7 days of birth (baseline) and again at 2 weeks corrected age (2w CA) (outcome). The FGR-E group is expected to show better development at 2w CA in the 3 domains to be tested, neurobehavior, electrophysiology, and brain structure. Furthermore, the FGR infants will be compared to a sample of appropriate in growth for gestational age (AGA) preterm infants for whom comparable data are available at both age points from a previous study. The FGR and AGA C and E groups will be compared in order to identify sample specific aspects of the intervention effects. This might lead to better understanding of the intervention's interaction with sample specific risk factors. Results are expected to show brain-based effects of the intervention for the FGR infants, mediated by stress reduction. This is expected to bring them closer in functioning and brain structural development to their AGA peers. The study will be significant in understanding ways to reduce long-term functional morbidities in FGR infants, as well as in identifying opportunities for enhancing last trimester brain development.
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About fifty percent of prematurely born infants develop learning/behavior problems and school failure. The study will test the primary hypotheses, that preterm infants (PT) randomized to developmental care in the Newborn Intensive Care Unit (NICU) will be superior in cognitive performance at school age when compared to their peers, who did not receive the intervention. Fifty-two [26 control (C); 26 experimental (E)] infants born at a gestational age (GA) of 28-33 weeks (w) will be studied at 8 years (y) corrected age (CA). Three secondary hypotheses will be tested: The PT-E group will be superior to the PT-C, 1) in academic performance; 2) in long distance cortical connectivity of frontal and occipital brain systems (EEG coherence), and 3) in frontal cortical white matter volumes (MRI). Child physical and psychosocial functioning will be explored descriptively. The primary independent variable will be treatment group (PT-control, PT-experimental). Additionally tested will be GA, growth percentile (weight and head circumference) at birth, parent socioeconomic status, and parent cognitive function, all expected to influence outcome. The PT sample will be described by previously collected medical and demographic measures at birth, and by behavior and brain function at 2wCA and 9mCA. The study will provide, for the first time, evidence at school age of the effectiveness of a much needed, low cost, early behavioral intervention. The expected reduction in learning and school failure for the increasing numbers of preterm-born children in the nation's schools, would give the study and the intervention, significant national public health importance.
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The goal of this research project is to identify the effectiveness of earliest nurturing intervention in the newborn intensive care unit (NICU) in improving the health and neurodevelopmental functioning of adolescents born preterm and at high risk for later disabilities. According to the literature more than 50% of this population will be impaired in central mental control functions required for all learning and social adaptation, aside from frequent focal impairments of cerebral palsy and sensory deficits. Disadvantaged homes, poverty, and poor education worsens outcome. The proposed longitudinal randomized controlled trial will study in adolescence, 14-21 years corrected age (CA), 107 very early born (<28w gestation) infants, who were previously studied at 2 weeks and 9 months CA. The control group (n=51) received traditional NICU care, while the experimental group (n=56) received nurturing developmental care in the form of the Newborn Individualized Developmental Care and Assessment Program (NIDCAP). The primary adolescent outcome measures will be neuromedical wellbeing and mental function, with emphasis on mental control, academic achievement, and social-emotional adaptation. Secondary mediating measures will be parenting function, and the adolescents' educational experience. This is the first randomized controlled trial of the long-term effectiveness of earliest nurturing in-NICU intervention.
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To learn more about each of these ongoing research projects, please click on the links to the left.
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