2016-08-012024-05-13https://scholars.lib.ntu.edu.tw/handle/123456789/646158摘要：過去文獻顯示西方國家早產兒實施早期介入能夠獲致短至中期認知療效並伴隨神經生理功能的改變，且多巴胺相關基因可能會影響環境介入對於兒童行為的療效，然而針對東方社會早產兒早期介入之療效、神經機轉以及基因與環境介入交互作用對於發展影響的探討則相當有限。本研究團隊於2012年針對臺灣極低出生體重早產兒設計了以家庭為中心之介入計畫(從住院到矯正年齡12 個月的兒童、父母及互動介入)，並且以多中心臨床實驗方式發現比常規介入計畫具短期較佳之發展預後。本研究擬提三年期計畫以持續追蹤以上250名極低出生體重早產兒(123名實驗組及127名控制組)之學齡前療效與其神經機轉，並探討多巴胺相關基因是否調控環境介入之於兒童發展的療效。早產兒將在三歲和四歲時接受生長、健康、神經發展(認知、語言、動作和行為)與神經生理評估(腦波與事件相關電位)，其家長同時接受壓力和生活品質評估；早產兒之前已經完成生物檢體收集，則將進行多巴胺相關基因的分析。本研究所獲得的療效結果將協助醫療和教育政策制定者訂定有利於臺灣早產兒的早期介入計畫，連續性神經發展與神經生理資料將有助於了解療效之神經生理機轉，亦可幫助釐清基因與環境介入交互作用對於兒童發展預後的影響。<br> Abstract: Accumulating data on early intervention for preterm infants in Western countries have demonstrated short- tomedium-term benefits on enhancing child cognitive outcome. However, rare studies have examined thelong-term effect of early intervention for preterm infants in Eastern society and explored its underlyingneural mechanism. Furthermore, recent evidence showed that the cumulative plasticity of dopamine-relatedgenes may interact with environmental intervention in influencing a child’s behavior. Whether the geneticmarkers interact with environmental intervention in shaping preterm infants’ developmental outcomesrequires investigation. To meet the contemporary concept of family centered care, we have developed afamily-centered intervention program (FCIP) for preterm infants with very low birth weight (VLBW, birthweight <1,500 g) in Taiwan and have found short-term developmental benefit with respect to a usual careprogram (UCP) via a multi-centered, randomized controlled trial. Therefore, this three-year project is aimedto extend our previous study to longitudinally examine the effectiveness of FCIP on child and parentoutcomes in VLBW preterm infants at preschool age, to investigate the neurophysiological mechanism foreffective intervention, and to evaluate if dopamine-related genes moderate intervention effect on childdevelopmental outcome. A total of 250 VLBW preterm children (FCIP: N=123; UCP: N=127) will beassessed their growth, health, neurobehavioral and neurophysiological functions at 3 and 4 years of age.Child neurobehavioral functions consisting of cognition, language, motor and behavior will be assessed usingthe Bayley Scales of Infant Development- 2nd edition and Bayley Scales of Infant and ToddlerDevelopment-3rd edition, Wechsler Pre-School and Primary Scales of Intelligence-4th Edition, MovementAssessment Battery for Children- 2nd Edition, Developmental Test of Visual-Motor Integration – 6th Edition,Children's Behavior Questionnaire Swanson, Nolan, and Pelham Questionnaire, IV, and Child BehaviorCheck List/4-18. Child neurophysiological functions will be assessed using electroencephalography andevent-related potentials in the resting state, auditory oddball, go/nogo and flanker tasks. Meanwhile, allparents will be assessed for stress using the Parenting Stress Index/Long Form and quality of life with theWorld Health Organization Quality of Life- Brief Taiwan Version. The long-term effect of early interventionfor preterm children from the neonatal period to preschool age will provide important information to helpmedical professionals and public policy makers to design effective intervention for Taiwanese pretermchildren who are at risk of developmental problems. The continuous neurophysiological and neurobehavioraldata are crucial for understanding the neurophysiological mechanisms underlying neurobehavioral changesfollowing intervention. Furthermore, the genetic susceptibility theory and the cumulative genetic plasticitytheory will be used to examine the relations of polymorphisms of dopamine-related genes with childdevelopment and their possible interactions with environmental intervention on child development. Overtwenty dopamine genetic markers that were identified in extensive research as being associated withplasticity for neurodevelopmental functions will be examined for their individual and synergistic influenceson developmental outcomes.療效基因早期介入神經發展機轉早產學齡前EffectivenessGenesInterventionMechanismNeurodevelopmentPrematurityPreschool Age