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Hodel AS, Senich KL, Jokinen C, Sasson O, Morris AR, Thomas KM. Early executive function differences in infants born moderate-to-late preterm. Early Hum Dev 2017; 113:23-30. [PMID: 28711562 DOI: 10.1016/j.earlhumdev.2017.07.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 06/10/2017] [Accepted: 07/02/2017] [Indexed: 10/19/2022]
Abstract
Individuals who are born very preterm (<32weeks gestation) show differential development of prefrontal cortex structure, function, and dependent behaviors, including executive function (EF) skills, beginning during late infancy and extending into adulthood. Preschool-aged children born moderate-to-late preterm (PT; 32-36weeks gestation) show smaller discrepancies in EF development, but it is unclear whether these differences first emerge during the early childhood years, when EF is rapidly developing, or if they arise from alterations in complex cognitive skills measurable in late infancy. In the current study, we examined whether differences in complex attention, memory, and inhibition skills (precursor skills to EF) are altered in healthy infants born moderate-to-late PT at 9-months corrected age. Infants born PT demonstrated poorer memory at test following habituation than their full-term peers. Furthermore, lower gestational age at birth was associated with poorer performance on five of the six early EF tasks. Results indicate that even in the context of low medical and environmental risk, performance on the Bayley within the normal range, and no group-level differences in processing speed, infants born moderate-to-late PT show subtle alterations in cognitive skills presumed to be dependent on prefrontal cortex by 9-months of age, likely setting the stage for long-term differences in EF development.
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Affiliation(s)
- Amanda S Hodel
- Institute of Child Development, University of Minnesota, 51 East River Road, Minneapolis, MN 55455, USA.
| | - Kate L Senich
- Institute of Child Development, University of Minnesota, 51 East River Road, Minneapolis, MN 55455, USA
| | - Claire Jokinen
- Institute of Child Development, University of Minnesota, 51 East River Road, Minneapolis, MN 55455, USA
| | - Oren Sasson
- Institute of Child Development, University of Minnesota, 51 East River Road, Minneapolis, MN 55455, USA
| | - Alyssa R Morris
- Institute of Child Development, University of Minnesota, 51 East River Road, Minneapolis, MN 55455, USA
| | - Kathleen M Thomas
- Institute of Child Development, University of Minnesota, 51 East River Road, Minneapolis, MN 55455, USA
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Arthursson PMSH, Thompson DK, Spencer-Smith M, Chen J, Silk T, Doyle LW, Anderson PJ. Atypical neuronal activation during a spatial working memory task in 13-year-old very preterm children. Hum Brain Mapp 2017; 38:6172-6184. [PMID: 28940977 DOI: 10.1002/hbm.23820] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 08/22/2017] [Accepted: 09/10/2017] [Indexed: 11/07/2022] Open
Abstract
Children born very preterm (VP; <32 weeks' gestational age) are at risk for unfavorable outcomes in several cognitive domains, including spatial working memory (WM). The underlying neural basis of these cognitive impairments is poorly understood. We investigated differences in neuronal activation during spatial WM using a backward span (BS) task relative to a control (C) task in 45 VP children and 19 term-born controls aged 13 years. VP children showed significantly more activation in the bilateral superior frontal gyrus and significantly less activation in the left parahippocampal gyrus compared with controls. We further explored the distinct contributions of maintenance and manipulation processes of WM using forward span (FS)>C and BS > FS, respectively. There were no significant group differences in neuronal activation for FS > C. However, BS > FS revealed that VP children had significantly greater activation in the left middle frontal gyrus, in the left superior parietal gyrus and right cerebellar tonsil, and significantly less activation in the right precentral and postcentral gyrus and left insula compared with controls. Taken together these results suggest that VP children at 13 years of age show an atypical neuronal activation during spatial WM, specifically related to manipulation of spatial information in WM. It is unclear whether these findings reflect delayed maturation and/or recruitment of alternative neuronal networks as a result of neuroplasticity. Hum Brain Mapp 38:6172-6184, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Pia-Maria S H Arthursson
- Murdoch Childrens Research Institute, Parkville, Victoria, 3052, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Victoria, 3052, Australia
| | - Deanne K Thompson
- Murdoch Childrens Research Institute, Parkville, Victoria, 3052, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Victoria, 3052, Australia.,Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria, 3052, Australia
| | - Megan Spencer-Smith
- School of Psychological Sciences and Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Clayton, Victoria, 3800, Australia
| | - Jian Chen
- Murdoch Childrens Research Institute, Parkville, Victoria, 3052, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Victoria, 3052, Australia
| | - Tim Silk
- Murdoch Childrens Research Institute, Parkville, Victoria, 3052, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Victoria, 3052, Australia
| | - Lex W Doyle
- Murdoch Childrens Research Institute, Parkville, Victoria, 3052, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Victoria, 3052, Australia.,Department of Obstetrics and Gynaecology, The Royal Women's Hospital, University of Melbourne, Parkville, Victoria, 3010, Australia
| | - Peter J Anderson
- Murdoch Childrens Research Institute, Parkville, Victoria, 3052, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Victoria, 3052, Australia.,School of Psychological Sciences and Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Clayton, Victoria, 3800, Australia
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53
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Costa DS, Miranda DM, Burnett AC, Doyle LW, Cheong JLY, Anderson PJ. Executive Function and Academic Outcomes in Children Who Were Extremely Preterm. Pediatrics 2017; 140:peds.2017-0257. [PMID: 28853418 DOI: 10.1542/peds.2017-0257] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/13/2017] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Cognitive and behavioral impairments of children born extremely preterm (EP) (<28 weeks' gestation) and extremely low birth weight (ELBW) (<1000 g) may change with age. We assessed the individual stability of behavioral executive function (EF) from 8 to 18 years of age in children born EP or ELBW and their academic outcomes. METHODS Participants comprised 180 children born EP or ELBW from a large geographic cohort. We investigated the frequency of 4 developmental groups (persistent, remitting, late-onset, and typical development) on the basis of dichotomized scores (typical versus elevated) at ages 8 and 18 years in 2 indices (the Behavioral Regulation Index [BRI] and the Metacognition Index [MCI]) of the parental form of the Behavior Rating Inventory of Executive Function. Adolescent academic outcomes were measured by using the word reading, spelling, and math computation subtests of the Wide Range Achievement Test, Fourth Edition. RESULTS Most participants had a typical EF (BRI 61%, MCI 53%), followed by persistent (BRI 15%, MCI 16%), late-onset (BRI 12%, MCI 19%), or remitting (BRI 12%, MCI 13%) executive difficulties. Groups with executive impairments at age 18 years (persistent and late onset) had poorer academic outcomes than the typical and remitting groups. Shifting impairment categories between 8 and 18 years old was relevant to later academic outcomes. CONCLUSIONS Most children showed stable and age-appropriate EF, although persistent and transient difficulties were observed and related to uneven academic outcomes. Studying the origins and consequences of the developmental stability of EF may contribute to the development of interventions to decrease the adverse neurodevelopmental outcomes of preterm birth.
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Affiliation(s)
- Danielle S Costa
- Coordenação de Aperfeiçoamento de Pessoal de Nivel Superior, Ministry of Education of Brazil, Brasília, Brazil
| | - Débora M Miranda
- Department of Pediatrics, Federal University of Minas Gerais, Belo Horizonte, Brazil.,Conselho Nacional de Desenvolvimento Científico e Tecnológico, Ministry of Science, Technology, and Innovation of Brazil, Brasília, Brazil
| | - Alice C Burnett
- Neonatal Services, Royal Women's Hospital, Parkville, Victoria, Australia.,Clinical Sciences, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Lex W Doyle
- Neonatal Services, Royal Women's Hospital, Parkville, Victoria, Australia.,Clinical Sciences, Murdoch Childrens Research Institute, Parkville, Victoria, Australia.,Department of Obstetrics and Gynecology, and.,Department of Pediatrics, Melbourne Medical School, University of Melbourne, Parkville, Victoria, Australia; and
| | - Jeanie L Y Cheong
- Neonatal Services, Royal Women's Hospital, Parkville, Victoria, Australia.,Clinical Sciences, Murdoch Childrens Research Institute, Parkville, Victoria, Australia.,Department of Obstetrics and Gynecology, and
| | - Peter J Anderson
- Clinical Sciences, Murdoch Childrens Research Institute, Parkville, Victoria, Australia; .,Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
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Stinnett GR, Lin S, Korotcov AV, Korotcova L, Morton PD, Ramachandra SD, Pham A, Kumar S, Agematsu K, Zurakowski D, Wang PC, Jonas RA, Ishibashi N. Microstructural Alterations and Oligodendrocyte Dysmaturation in White Matter After Cardiopulmonary Bypass in a Juvenile Porcine Model. J Am Heart Assoc 2017; 6:JAHA.117.005997. [PMID: 28862938 PMCID: PMC5586442 DOI: 10.1161/jaha.117.005997] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background Newly developed white matter (WM) injury is common after cardiopulmonary bypass (CPB) in severe/complex congenital heart disease. Fractional anisotropy (FA) allows measurement of macroscopic organization of WM pathology but has rarely been applied after CPB. The aims of our animal study were to define CPB‐induced FA alterations and to determine correlations between these changes and cellular events after congenital heart disease surgery. Methods and Results Normal porcine WM development was first assessed between 3 and 7 weeks of age: 3‐week‐old piglets were randomly assigned to 1 of 3 CPB‐induced insults. FA was analyzed in 31 WM structures. WM oligodendrocytes, astrocytes, and microglia were assessed immunohistologically. Normal porcine WM development resembles human WM development in early infancy. We found region‐specific WM vulnerability to insults associated with CPB. FA changes after CPB were also insult dependent. Within various WM areas, WM within the frontal cortex was susceptible, suggesting that FA in the frontal cortex should be a biomarker for WM injury after CPB. FA increases occur parallel to cellular processes of WM maturation during normal development; however, they are altered following surgery. CPB‐induced oligodendrocyte dysmaturation, astrogliosis, and microglial expansion affect these changes. FA enabled capturing CPB‐induced cellular events 4 weeks postoperatively. Regions most resilient to CPB‐induced FA reduction were those that maintained mature oligodendrocytes. Conclusions Reducing alterations of oligodendrocyte development in the frontal cortex can be both a metric and a goal to improve neurodevelopmental impairment in the congenital heart disease population. Studies using this model can provide important data needed to better interpret human imaging studies.
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Affiliation(s)
- Gary R Stinnett
- Children's National Heart Institute, Children's National Health System, Washington, DC.,Center for Neuroscience Research, Children's National Health System, Washington, DC
| | - Stephen Lin
- Department of Radiology, Howard University, Washington, DC
| | - Alexandru V Korotcov
- Department of Radiology, Howard University, Washington, DC.,Center for Neuroscience and Regenerative Medicine, Uniformed Services University, Bethesda, MD
| | - Ludmila Korotcova
- Children's National Heart Institute, Children's National Health System, Washington, DC.,Center for Neuroscience Research, Children's National Health System, Washington, DC
| | - Paul D Morton
- Children's National Heart Institute, Children's National Health System, Washington, DC.,Center for Neuroscience Research, Children's National Health System, Washington, DC
| | - Shruti D Ramachandra
- Children's National Heart Institute, Children's National Health System, Washington, DC.,Center for Neuroscience Research, Children's National Health System, Washington, DC
| | - Angeline Pham
- George Washington University School of Medicine and Health Science, Washington, DC
| | - Sonali Kumar
- George Washington University School of Medicine and Health Science, Washington, DC
| | - Kota Agematsu
- Children's National Heart Institute, Children's National Health System, Washington, DC.,Center for Neuroscience Research, Children's National Health System, Washington, DC
| | - David Zurakowski
- Departments of Anesthesia and Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Paul C Wang
- Department of Radiology, Howard University, Washington, DC.,College of Science and Engineering, Fu Jen Catholic University, Taipei, Taiwan
| | - Richard A Jonas
- Children's National Heart Institute, Children's National Health System, Washington, DC .,Center for Neuroscience Research, Children's National Health System, Washington, DC.,George Washington University School of Medicine and Health Science, Washington, DC
| | - Nobuyuki Ishibashi
- Children's National Heart Institute, Children's National Health System, Washington, DC .,Center for Neuroscience Research, Children's National Health System, Washington, DC.,George Washington University School of Medicine and Health Science, Washington, DC
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55
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Vollmer B, Lundequist A, Mårtensson G, Nagy Z, Lagercrantz H, Smedler AC, Forssberg H. Correlation between white matter microstructure and executive functions suggests early developmental influence on long fibre tracts in preterm born adolescents. PLoS One 2017; 12:e0178893. [PMID: 28594884 PMCID: PMC5464584 DOI: 10.1371/journal.pone.0178893] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 05/19/2017] [Indexed: 12/04/2022] Open
Abstract
Main objectives Executive functions are frequently a weakness in children born preterm. We examined associations of executive functions and general cognitive abilities with brain structure in preterm born adolescents who were born with appropriate weight for gestational age and who have no radiological signs of preterm brain injury on neuroimaging. Methods The Stockholm Neonatal Project (SNP) is a longitudinal, population-based study of children born preterm (<36 weeks of gestation) with very low birth weight (<1501g) between 1988–1993. At age 18 years (mean 18 years, SD 2 weeks) 134 preterm born and 94 full term participants underwent psychological assessment (general intelligence, executive function measures). Of these, 71 preterm and 63 full term participants underwent Magnetic Resonance Imaging (MRI) at mean 15.2 years (range 12–18 years), including 3D T1-weighted images for volumetric analyses and Diffusion Tensor Imaging (DTI) for assessment of white matter microstructure. Group comparisons of regional grey and white matter volumes and fractional anisotropy (FA, as a measure of white matter microstructure) and, within each group, correlation analyses of cognitive measures with MRI metrics were carried out. Results Significant differences in grey and white matter regional volumes and widespread differences in FA were seen between the two groups. No significant correlations were found between cognitive measures and brain volumes in any group after correction for multiple comparisons. However, there were significant correlations between FA in projection fibres and long association fibres, linking frontal, temporal, parietal, and occipital lobes, and measures of executive function and general cognitive abilities in the preterm born adolescents, but not in the term born adolescents. Overall significance of the study In persons born preterm, in the absence of perinatal brain injury on visual inspection of MRI, widespread alterations in regional brain tissue volumes and microstructure are present in adolescence/young adulthood. Importantly, these alterations in WM tracts are correlated with measures of executive function and general cognitive abilities. Our findings suggest that disturbance of neural pathways, rather than changes in regional brain volumes, are involved in the impaired cognitive functions.
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Affiliation(s)
- Brigitte Vollmer
- Neuropaediatrics, Department of Women’s and Children’s Health, Karolinska Institutet, Astrid Lindgren Children’s Hospital, Stockholm, Sweden
- Clinical Neurosciences, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- * E-mail:
| | - Aiko Lundequist
- Neuropaediatrics, Department of Women’s and Children’s Health, Karolinska Institutet, Astrid Lindgren Children’s Hospital, Stockholm, Sweden
| | - Gustaf Mårtensson
- Neuropaediatrics, Department of Women’s and Children’s Health, Karolinska Institutet, Astrid Lindgren Children’s Hospital, Stockholm, Sweden
| | - Zoltan Nagy
- Department of Economics, University of Zürich, Zürich, Switzerland
| | - Hugo Lagercrantz
- Neonatal Research Unit, Department of Women’s and Children’s Health, Karolinska Institutet, Astrid Lindgren Children’s Hospital, Stockholm, Sweden
| | | | - Hans Forssberg
- Neuropaediatrics, Department of Women’s and Children’s Health, Karolinska Institutet, Astrid Lindgren Children’s Hospital, Stockholm, Sweden
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56
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Vohr BR. Follow-up of Extremely Preterm Infants; the Long and the Short of It. Pediatrics 2017; 139:peds.2017-0453. [PMID: 28814551 DOI: 10.1542/peds.2017-0453] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/07/2017] [Indexed: 11/24/2022] Open
Affiliation(s)
- Betty R Vohr
- Department of Pediatrics, Alpert Medical School, Brown University, Providence, Rhode Island; and Department of Pediatrics, Neonatal Follow-up Clinic, Women & Infants Hospital of Rhode Island, Providence, Rhode Island
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57
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Abstract
OBJECTIVES Children and adolescents who were born very preterm (≤32 weeks' gestation) are vulnerable to experiencing cognitive problems, including in executive function. However, it remains to be established whether cognitive deficits are evident in adulthood and whether these exert a significant effect on an individual's real-lifeachievement. METHODS Using a cross-sectional design, we tested a range of neurocognitive abilities, with a focus on executive function, in a sample of 122 very preterm individuals and 89 term-born controls born between 1979 and 1984. Associations between executive function and a range of achievement measures, indicative of a successful transition to adulthood, were examined. RESULTS Very preterm adults performed worse compared to controls on measures of intellectual ability and executive function with moderate to large effect sizes. They also demonstrated significantly lower achievement levels in terms of years spent in education, employment status, and on a measure of functioning in work and social domains. Results of regression analysis indicated a stronger positive association between executive function and real-life achievement in the very preterm group compared to controls. CONCLUSIONS Very preterm born adults demonstrate executive function impairments compared to full-term controls, and these are associated with lower achievement in several real-life domains. (JINS, 2017, 23, 381-389).
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58
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Ramani M, van Groen T, Kadish I, Ambalavanan N, McMahon LL. Vitamin A and retinoic acid combination attenuates neonatal hyperoxia-induced neurobehavioral impairment in adult mice. Neurobiol Learn Mem 2017; 141:209-216. [DOI: 10.1016/j.nlm.2017.04.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 03/16/2017] [Accepted: 04/26/2017] [Indexed: 01/10/2023]
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Réveillon M, Hüppi PS, Barisnikov K. Inhibition difficulties in preterm children: Developmental delay or persistent deficit? Child Neuropsychol 2017; 24:734-762. [DOI: 10.1080/09297049.2017.1294665] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Morgane Réveillon
- Child Clinical Neuropsychology Unit, Department of Psychology, University of Geneva, Switzerland
| | - Petra S. Hüppi
- Division of Development and Growth, Department of Pediatrics, University Hospital of Geneva, Switzerland
| | - Koviljka Barisnikov
- Child Clinical Neuropsychology Unit, Department of Psychology, University of Geneva, Switzerland
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60
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Perez-Roche T, Altemir I, Giménez G, Prieto E, González I, López Pisón J, Pueyo V. Face recognition impairment in small for gestational age and preterm children. RESEARCH IN DEVELOPMENTAL DISABILITIES 2017; 62:166-173. [PMID: 28171826 DOI: 10.1016/j.ridd.2017.01.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 01/21/2017] [Accepted: 01/22/2017] [Indexed: 06/06/2023]
Abstract
BACKGROUND Infants born prematurely or with low birth weight are at increased risk of visual perceptual impairment. Face recognition is a high-order visual ability important for social development, which has been rarely assessed in premature or low birth weight children. AIMS To evaluate the influence of prematurity and low birth weight on face recognition skills. METHODS Seventy-seven children were evaluated as part of a prospective cohort study. They were divided into premature and term birth cohorts. Children with a birth weight below the 10th centile were considered small for gestational age. All children underwent a full ophthalmologic assessment and evaluation of face recognition skills using the Facial Memory subtest from the Test of Memory and Learning. RESULTS Premature infants scored worse on immediate face recognition compared to term infants. However, after adjusting for birth weight, prematurity was not associated with worse outcomes. Independent of gestational age, outcomes of low birth weight children were worse than those of appropriate birth weight children, for immediate face recognition (odds ratio [OR], 5.14; 95% confidence interval [CI], 1.32-21.74) and for face memory (OR, 4.48; 95% CI, 1.14-16.95). CONCLUSIONS Being born small for gestational age is associated with suboptimal face recognition skills, even in children without major neurodevelopmental problems.
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Affiliation(s)
- T Perez-Roche
- Instituto de Investigación Sanitaria de Aragón (ISS Aragón), Avenida San Juan Bosco 13, 50009 Zaragoza, Spain; Ophthalmology Department, Hospital Universitario Miguel Servet, Paseo Isabel la Católica 1-3, 50009 Zaragoza, Spain
| | - I Altemir
- Instituto de Investigación Sanitaria de Aragón (ISS Aragón), Avenida San Juan Bosco 13, 50009 Zaragoza, Spain; Optical Optometrist, Hospital Universitario Miguel Servet, Paseo Isabel la Católica 1-3, 50009 Zaragoza, Spain
| | - G Giménez
- Instituto de Investigación Sanitaria de Aragón (ISS Aragón), Avenida San Juan Bosco 13, 50009 Zaragoza, Spain; Optical Optometrist, Hospital Universitario Miguel Servet, Paseo Isabel la Católica 1-3, 50009 Zaragoza, Spain
| | - E Prieto
- Instituto de Investigación Sanitaria de Aragón (ISS Aragón), Avenida San Juan Bosco 13, 50009 Zaragoza, Spain; Ophthalmology Department, Hospital Universitario Miguel Servet, Paseo Isabel la Católica 1-3, 50009 Zaragoza, Spain
| | - I González
- Instituto de Investigación Sanitaria de Aragón (ISS Aragón), Avenida San Juan Bosco 13, 50009 Zaragoza, Spain; Ophthalmology Department, Hospital Universitario Miguel Servet, Paseo Isabel la Católica 1-3, 50009 Zaragoza, Spain
| | - J López Pisón
- Instituto de Investigación Sanitaria de Aragón (ISS Aragón), Avenida San Juan Bosco 13, 50009 Zaragoza, Spain; Child Neurology Unit, Hospital Universitario Miguel Servet, Paseo Isabel la Católica 1-3, 50009 Zaragoza, Spain
| | - V Pueyo
- Instituto de Investigación Sanitaria de Aragón (ISS Aragón), Avenida San Juan Bosco 13, 50009 Zaragoza, Spain; Ophthalmology Department, Hospital Universitario Miguel Servet, Paseo Isabel la Católica 1-3, 50009 Zaragoza, Spain.
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Weber P, Depoorter A, Hetzel P, Lemola S. Habituation as Parameter for Prediction of Mental Development in Healthy Preterm Infants: An Electrophysiological Pilot Study. J Child Neurol 2016; 31:1591-1597. [PMID: 27625014 DOI: 10.1177/0883073816665312] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 06/21/2016] [Accepted: 07/24/2016] [Indexed: 11/17/2022]
Abstract
The aim of this prospective pilot study was to evaluate the predictive value of discrimination and habituation, which was measured by mismatch negativity in 17 healthy very preterm (mean gestational age 27.4 weeks; range 25.0-31.3) and 16 term (mean gestational age 40.3 weeks; range 37.9-41.7) born infants at term equivalent age. Developmental outcome was measured by Bayley Scales of Infant Development-I in 13 preterm and 13 term-born children at a mean age of 21.7 months (±2.18) and 18.5 months (±1.9), respectively. No differences in amplitude and latency of the mismatch negativity were found between both groups at term equivalent age. Within the preterm group habituation capacity was positively correlated with the Mental Developmental Index (r = .654, P = .008) and Performance Developmental Index (r = .482, P = .048) at 21 months. Early learning capability, as measured by habituation, may be associated with a better prognosis for early mental development in healthy preterm infants.
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Affiliation(s)
- Peter Weber
- Division of Neuropediatrics & Developmental Medicine, University Children's Hospital, Basel, Switzerland
| | - Antoinette Depoorter
- Division of Neuropediatrics & Developmental Medicine, University Children's Hospital, Basel, Switzerland
| | - Patrick Hetzel
- Division of Neuropediatrics & Developmental Medicine, University Children's Hospital, Basel, Switzerland.,Division of Neonatology, University Children's Hospital, Basel, Switzerland
| | - Sakari Lemola
- Department of Psychology, University of Warwick, Conventry, UK
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Korpela S, Nyman A, Munck P, Ahtola A, Matomäki J, Korhonen T, Parkkola R, Haataja L. Working memory in very-low-birthweight children at the age of 11 years. Child Neuropsychol 2016; 24:338-353. [PMID: 27907284 DOI: 10.1080/09297049.2016.1260101] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The aim of this study is to investigate the working memory (WM) of very-low-birthweight (VLBW, ≤ 1500 g) children at the age of 11 years using Baddeley's WM model. A regional cohort of 95 VLBW children was assessed for the domains of the WM model (central executive [CE], visuospatial sketchpad [VS], and phonological loop [PL]) using subtests from the Working Memory Test Battery for Children (WMTB-C) and the Wechsler Intelligence Scale for Children - Fourth Edition (WISC-IV). VLBW children were categorized into three groups according to their degree of brain pathology (normal, minor, or major) in neonatal brain magnetic resonance imaging at the term age, and the WM performance was compared between groups to test norms. The structure of the WM model was studied by analyzing correlations among domains. Even VLBW children with normal cognitive development (general ability index ≥ 85) performed worse compared to the test norms (M = 100, SD = 15) on CE (M = 87.64, SD = 20.54, p < .001) and VS (M = 91.65, SD = 11.03, p < .001), but their performance on PL was above the norm (M = 110.79, SD = 13.79, p < .001). VLBW children with major brain pathology performed significantly worse on VS and PL compared to the other groups. The correlations among the WM domains of the VLBW children differ from earlier findings in normative populations. To conclude, the WM of the VLBW children in the study differ-especially in the CE and VS subtest scores-from the normative population irrespective of the degree of brain pathology and level of cognitive development.
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Affiliation(s)
- Satu Korpela
- a Department of Psychology , University of Turku , Finland.,b Helsinki University Hospital , Child Neurology , Finland
| | - Anna Nyman
- a Department of Psychology , University of Turku , Finland.,c Turku University Hospital , Child Neurology , Finland
| | - Petriina Munck
- a Department of Psychology , University of Turku , Finland.,c Turku University Hospital , Child Neurology , Finland
| | | | - Jaakko Matomäki
- d Clinical Research Center , Turku University Hospital , Finland
| | - Tapio Korhonen
- a Department of Psychology , University of Turku , Finland
| | - Riitta Parkkola
- e Department of Radiology, Turku PET Center , Turku University Hospital , Finland.,f Department of Medicine , University of Turku , Finland
| | - Leena Haataja
- b Helsinki University Hospital , Child Neurology , Finland.,g Department of Pediatric Neurology, Children's Hospital , University of Helsinki , Finland
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63
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Abstract
Executive function (EF) refers to the set of cognitive processes involved in the self-regulation of emotion and goal-directed behavior. These skills and the brain systems that support them develop throughout childhood and are frequently compromised in preterm children, even in those with broadly average global cognitive ability. Risks for deficits in EF in preterm children and attendant problems in learning and psychosocial functioning are higher in those with more extreme prematurity, neonatal complications, and related brain abnormalities. Associations of higher levels of EF with more supportive home and school environments suggest a potential for attenuating these risks, especially with early identification. Further research is needed to understand how deficits in EF evolve in preterm children, refine assessment methods, and develop interventions that either promote the development of EF in this population or help children to compensate for these weaknesses.
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Affiliation(s)
- H. Gerry Taylor
- Department of Pediatrics, Case Western Reserve University and Rainbow Babies & Children’s Hospital, University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Caron A.C. Clark
- Department of Education, University of Nebraska-Lincoln, Lincoln, NE, USA
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64
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Abstract
Infants born at extreme preterm gestation are at risk for both death and disability. Although rates of survival have improved for this population, and some evidence suggests a trend toward decreased neuromotor impairment over the past decades, a significant improvement in overall early neurodevelopmental outcome has not yet been realized. This review will examine the rates and types of neurodevelopmental impairment seen after extremely preterm birth, including neurosensory, motor, cognitive, and behavioral outcomes. We focus on early outcomes in the first 18-36 months of life, as the majority of large neonatal studies examining neurodevelopmental outcomes stop at this age. However, this early age is clearly just a first glimpse into lifetime outcomes; the neurodevelopmental effects of extreme prematurity may last through school age, adolescence, and beyond. Importantly, prematurity appears to be an independent risk factor for adverse development, but this population demonstrates considerable variability in the types and severity of impairments. Understanding both the nature and prevalence of neurodevelopmental impairment among extremely preterm infants is important because it can lead to targeted interventions that in turn may lead to improved outcomes.
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Affiliation(s)
- Elizabeth E Rogers
- Department of Pediatrics, UCSF Benioff Children's Hospital, University of California San Francisco, 550 4th St, 5th Floor, Box 0743, San Francisco, CA 94143.
| | - Susan R Hintz
- Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Lucile Packard Children's Hospital Stanford, Palo Alto, CA
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Abstract
There have been amazing changes in outcomes of preterm (PT) infants in the past decades. Whereas early studies reported only survival rates, Dr. Julius Hess published the first outcome study of PT infants in Chicago in 1953. Dr. Lubchenco then published the 10-year follow-up of premature infants born in 1947-1953 and identified a 68% handicap rate. As a result of these early studies, the importance of evaluating NICU graduates both for surveillance and as an outcome of trials was recognized. During the 1970s, there was a gradual expansion in the number of follow-up programs in the United States (US) with an increasing number of follow-up studies published. In the 1980s, the importance of multicenter clinical research networks was recognized and the NICHD Neonatal Research Network (NRN) was initiated in 1986. Follow-up protocols, definitions, and outcomes have evolved over the last 30 years and will be reviewed with a focus on NICHD NRN studies.
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Affiliation(s)
- Susan R Hintz
- Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, 750 Welch Rd, Suite 315, Palo Alto, CA 94304
| | - Jamie E Newman
- Public Health Research Division, RTI International, Research Triangle Park, NC
| | - Betty R Vohr
- Alpert Medical School of Brown University, Providence, RI; Department of Pediatrics Women & Infants Hospital of Rhode Island, Providence, RI.
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Tseng CEJ, Froudist-Walsh S, Brittain PJ, Karolis V, Caldinelli C, Kroll J, Counsell SJ, Williams SCR, Murray RM, Nosarti C. A multimodal imaging study of recognition memory in very preterm born adults. Hum Brain Mapp 2016; 38:644-655. [PMID: 27647705 PMCID: PMC5244672 DOI: 10.1002/hbm.23405] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 08/30/2016] [Accepted: 09/06/2016] [Indexed: 11/11/2022] Open
Abstract
Very preterm (<32 weeks of gestation) birth is associated with structural brain alterations and memory impairments throughout childhood and adolescence. Here, we used functional MRI (fMRI) to study the neuroanatomy of recognition memory in 49 very preterm‐born adults and 50 controls (mean age: 30 years) during completion of a task involving visual encoding and recognition of abstract pictures. T1‐weighted and diffusion‐weighted images were also collected. Bilateral hippocampal volumes were calculated and tractography of the fornix and cingulum was performed and assessed in terms of volume and hindrance modulated orientational anisotropy (HMOA). Online recognition memory task performance, assessed with A scores, was poorer in the very preterm compared with the control group. Analysis of fMRI data focused on differences in neural activity between the recognition and encoding trials. Very preterm born adults showed decreased activation in the right middle frontal gyrus and posterior cingulate cortex/precuneus and increased activation in the left inferior frontal gyrus and bilateral lateral occipital cortex (LOC) compared with controls. Hippocampi, fornix and cingulum volume was significantly smaller and fornix HMOA was lower in very preterm adults. Among all the structural and functional brain metrics that showed statistically significant group differences, LOC activation was the best predictor of online task performance (P = 0.020). In terms of association between brain function and structure, LOC activation was predicted by fornix HMOA in the preterm group only (P = 0.020). These results suggest that neuroanatomical alterations in very preterm born individuals may be underlying their poorer recognition memory performance. Hum Brain Mapp 38:644–655, 2017. © 2016 The Authors Human Brain Mapping Published by Wiley Periodicals, Inc.
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Affiliation(s)
- Chieh-En Jane Tseng
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| | - Seán Froudist-Walsh
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| | - Philip J Brittain
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| | - Vyacheslav Karolis
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| | - Chiara Caldinelli
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| | - Jasmin Kroll
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| | - Serena J Counsell
- Centre for the Developing Brain, Division of Imaging Sciences and Biomedical Engineering, King's College London, United Kingdom
| | - Steven C R Williams
- Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| | - Robin M Murray
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| | - Chiara Nosarti
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
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Zouikr I, Bartholomeusz MD, Hodgson DM. Early life programming of pain: focus on neuroimmune to endocrine communication. J Transl Med 2016; 14:123. [PMID: 27154463 PMCID: PMC4859995 DOI: 10.1186/s12967-016-0879-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Accepted: 04/27/2016] [Indexed: 01/21/2023] Open
Abstract
Chronic pain constitutes a challenge for the scientific community and a significant economic and social cost for modern societies. Given the failure of current drugs to effectively treat chronic pain, which are based on suppressing aberrant neuronal excitability, we propose in this review an integrated approach that views pain not solely originating from neuronal activation but also the result of a complex interaction between the nervous, immune, and endocrine systems. Pain assessment must also extend beyond measures of behavioural responses to noxious stimuli to a more developmentally informed assessment given the significant plasticity of the nociceptive system during the neonatal period. Finally integrating the concept of perinatal programming into the pain management field is a necessary step to develop and target interventions to reduce the suffering associated with chronic pain. We present clinical and animal findings from our laboratory (and others) demonstrating the importance of the microbial and relational environment in programming pain responsiveness later in life via action on hypothalamo-pituitary adrenal (HPA) axis activity, peripheral and central immune system, spinal and supraspinal mechanisms, and the autonomic nervous system.
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Affiliation(s)
- I Zouikr
- Laboratory of Neuroimmunology, School of Psychology, The University of Newcastle, Newcastle, NSW, Australia. .,Laboratory for Molecular Mechanisms of Thalamus Development, RIKEN BSI East Building 4F 409, 2-1 Hirosawa, Wako, Saitama, 351-0198, Japan.
| | - M D Bartholomeusz
- Laboratory of Neuroimmunology, School of Psychology, The University of Newcastle, Newcastle, NSW, Australia
| | - D M Hodgson
- Laboratory of Neuroimmunology, School of Psychology, The University of Newcastle, Newcastle, NSW, Australia
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Joseph RM, O’Shea TM, Allred EN, Heeren T, Hirtz D, Jara H, Leviton A, Kuban KC. Neurocognitive and Academic Outcomes at Age 10 Years of Extremely Preterm Newborns. Pediatrics 2016; 137:peds.2015-4343. [PMID: 27006473 PMCID: PMC4811321 DOI: 10.1542/peds.2015-4343] [Citation(s) in RCA: 99] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/15/2016] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Despite reductions in mortality and morbidity among children born extremely preterm, they remain at high risk of neurocognitive deficits, with up to 40% having significant cognitive deficits at school age. We assessed the rate of neurocognitive impairment in a contemporary US cohort of 873 children aged 10 years who were born <28 weeks' gestation. METHODS The families of 889 of 966 (92%) children enrolled from 2002 to 2004 at 14 sites in 5 states returned at age 10 years for a comprehensive assessment of IQ, language, attention, executive function, processing speed, visual perception, visual-motor function, and academic achievement. RESULTS A total of 873 children were assessed with well-validated tests of cognitive and academic function. Distributions of test scores were consistently and markedly shifted below normative expectation, with one-third to two-thirds of children performing >1 SD below age expectation. The most extreme downward shifts were on measures of executive control and processing speed. Multivariate analyses, adjusted for socioeconomic status, growth restriction, and other potential confounders, revealed that the risk of poor outcome was highest at the lowest gestational age across all 18 measures. CONCLUSIONS More than half of our extremely preterm cohort exhibited moderate or severe neurocognitive deficits at age 10 years, with the most extensive impairments found among those born at the lowest gestational age. Children born extremely preterm continue to be at significant risk of persistent impairments in neurocognitive function and academic achievement, underscoring the need for monitoring and remediating such outcomes beginning in early childhood.
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Affiliation(s)
| | - Thomas M. O’Shea
- Department of Pediatrics, University of North Carolina, Chapel Hill, North Carolina
| | - Elizabeth N. Allred
- Department of Neurology, Harvard Medical School, Boston, Massachusetts;,Neuroepidemiology Unit, Department of Neurology, Boston Children’s Hospital, Boston, Massachusetts
| | - Tim Heeren
- Department of Biostatistics, School of Public Health, Boston University, Boston, Massachusetts
| | - Deborah Hirtz
- National Institute of Neurologic Disorders and Stroke, Bethesda, Maryland; and
| | | | - Alan Leviton
- Department of Neurology, Harvard Medical School, Boston, Massachusetts;,Neuroepidemiology Unit, Department of Neurology, Boston Children’s Hospital, Boston, Massachusetts
| | - Karl C.K. Kuban
- Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
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Executive Functioning and Learning Skills of Adolescent Children Born at Fewer than 26 Weeks of Gestation. PLoS One 2016; 11:e0151819. [PMID: 26999522 PMCID: PMC4801389 DOI: 10.1371/journal.pone.0151819] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Accepted: 03/06/2016] [Indexed: 11/25/2022] Open
Abstract
Aims To assess the cognitive and behavioral aspects of executive functioning (EF) and learning skills in extremely preterm (EPT) children compared with term control children aged 10 to 15 years. Methods A total of 132 of 134 (98% of all eligible survivors) EPT children born at the 2 Swedish regional tertiary care centers from 1992 to 1998 (mean age = 12 years, mean birth weight = 718 g, and mean gestational age = 24.4 weeks) and 103 matched term controls were assessed. General intelligence was assessed using the Wechsler Intelligence Scale for Children (WISC-III-R), and cognitive aspects of EF were analyzed using EF-sensitive subscales of the WISC-III-R and Tower test of the Delis-Kaplan Executive Function Scale (D-KEFS). Behaviors related to EF and learning skills were assessed using the Five to Fifteen questionnaire, which is a validated parent and teacher instrument. Academic performance in school was assessed by teachers’ responses on Achenbach’s Teachers Report Form. Analyses performed included multivariate analyses of covariance (ANCOVA and MANCOVA) and logistic regression analyses. Results The EPT children displayed significant deficits in cognitive aspects of EF compared with the controls, exhibiting decreases on the order of 0.9 SD to 1.2 SD for tasks of verbal conceptual reasoning, verbal and non-verbal working memory, processing speed and planning ability (P <0.001 for all). After excluding the children with major neurosensory impairment (NSI) or a Full Scale intelligence quotient (FSIQ) of < 70, significant differences were observed on all tests. Compared with controls, parents and teachers of EPT children reported significantly more EF-related behavioral problems. MANCOVA of teacher-reported learning skills in children with FSIQ >70 and without major NSI revealed no interactions, but significant main effects were observed for the behavioral composite executive function score, group status (EPT vs control) and FSIQ, for which all effect sizes were medium to large. The corresponding findings of MANCOVA of the parent-reported learning skills were very similar. According to the teachers’ ratings, the EPT children were less well adjusted to the school environment. Conclusion EPT children born in the 1990s who received active perinatal care are at an increased risk of executive dysfunction, even after excluding children with significant neurodevelopmental disabilities. Even mild to moderate executive dysfunctions has a significant impact on learning skills. These findings suggest the need for timely interventions that address specific cognitive vulnerabilities and executive dysfunctions.
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Rimol LM, Bjuland KJ, Løhaugen GC, Martinussen M, Evensen KAI, Indredavik MS, Brubakk AM, Eikenes L, Håberg AK, Skranes J. Cortical trajectories during adolescence in preterm born teenagers with very low birthweight. Cortex 2016; 75:120-131. [DOI: 10.1016/j.cortex.2015.12.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 10/19/2015] [Accepted: 12/07/2015] [Indexed: 01/01/2023]
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González Stäger MA, Rodríguez Fernández A, Muñoz Valenzuela C, Ojeda Sáez A, San Martín Navarrete A. [Nutritional status of adolescents from a cohort of preterm children]. ACTA ACUST UNITED AC 2016; 87:268-73. [PMID: 26794475 DOI: 10.1016/j.rchipe.2015.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 09/25/2015] [Accepted: 11/30/2015] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Catch-up growth in preterm-born children occurs in the first months of life, but in some cases, growth recovery takes place in adolescence. The objective of this study was to study the growth and development of preterm-born adolescents from a cohort of preterm infants born between 1995 and 1996, who resided in the cities of Chillán and San Carlos in the Biobío Region, Chile. The results were then compared with term-born adolescents. SUBJECTS AND METHOD A sample of 91 children from the cohort was studied and compared with 91 term-born adolescents matched for gender, age, and attendance at the same educational institution. The nutritional status was assessed by BMI-for-age, height-for-age, body composition by skinfold, cardiovascular risk due to blood pressure, and waist circumference. RESULTS There was 23.0% and 24.1% overweight and obesity in preterm-born and term-born adolescents, respectively, with 25.5% of preterm-born and small for gestational age adolescents vs. 14.5% of those born adequate for gestational age were overweight. Lower height was observed in 16.5% and 5.5% of the preterm-born and term-born adolescents, respectively, and with a higher proportion of girls (P<.04). Preterm-born adolescents had a more fat mass than the controls, particularly in the suprailiac skinfold. No significant differences were found in blood pressure and waist circumference. CONCLUSIONS The results indicate that there is a group of preterm-born children who do not recover height during adolescence, especially girls.
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Affiliation(s)
- M Angélica González Stäger
- Nutricionista, Departamento de Nutrición y Salud Pública, Facultad Ciencias de la Salud y de los Alimentos, Universidad del Bío-Bío, Chillán, Chile.
| | - Alejandra Rodríguez Fernández
- Biólogo Marino, Departamento de Nutrición y Salud Pública, Facultad Ciencias de la Salud y de los Alimentos, Universidad del Bío-Bío, Chillán, Chile
| | - Carolina Muñoz Valenzuela
- Escuela de Nutrición Dietética, Facultad Ciencias de la Salud y de los Alimentos, Universidad del Bío-Bío, Chillán, Chile
| | - Alejandra Ojeda Sáez
- Escuela de Nutrición Dietética, Facultad Ciencias de la Salud y de los Alimentos, Universidad del Bío-Bío, Chillán, Chile
| | - Ana San Martín Navarrete
- Escuela de Nutrición Dietética, Facultad Ciencias de la Salud y de los Alimentos, Universidad del Bío-Bío, Chillán, Chile
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Gaudet CM, Lim YP, Stonestreet BS, Threlkeld SW. Effects of age, experience and inter-alpha inhibitor proteins on working memory and neuronal plasticity after neonatal hypoxia-ischemia. Behav Brain Res 2016; 302:88-99. [PMID: 26778784 DOI: 10.1016/j.bbr.2016.01.016] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 12/23/2015] [Accepted: 01/05/2016] [Indexed: 01/15/2023]
Abstract
Neonatal cerebral hypoxia-ischemia (HI) commonly results in cognitive and sensory impairments. Early behavioral experience has been suggested to improve cognitive and sensory outcomes in children and animal models with perinatal neuropathology. In parallel, we previously showed that treatment with immunomodulator Inter-alpha Inhibitor Proteins (IAIPs) improves cellular and behavioral outcomes in neonatal HI injured rats. The purpose of the current study was to evaluate the influences of early experience and typical maturation in combination with IAIPs treatment on spatial working and reference memory after neonatal HI injury. A second aim was to determine the effects of these variables on hippocampal CA1 neuronal morphology. Subjects were divided into two groups that differed with respect to the time when exposed to eight arm radial water maze testing: Group one was tested as juveniles (early experience, Postnatal day (P) 36-61) and adults (P88-113), and Group two was tested in adulthood only (P88-113; without early experience). Three treatment conditions were included in each experience group (HI+Vehicle, HI+IAIPs, and Sham subjects). Incorrect arm entries (errors) were compared between treatment and experience groups across three error types (reference memory (RM), working memory incorrect (WMI), working memory correct (WMC)). Early experience led to improved working memory performance regardless of treatment. Combining IAIPs intervention with early experience provided a long-term behavioral advantage on the WMI component of the task in HI animals. Anatomically, early experience led to a decrease in the average number of basal dendrites per CA1 pyramidal neuron for IAIP treated subjects and a significant reduction in basal dendritic length in control subjects, highlighting the importance of pruning in typical early life learning. Our results support the hypothesis that early behavioral experience combined with IAIPs improve outcome on a relativity demanding cognitive task, beyond that of a single intervention strategy, and appears to facilitate neuronal plasticity following neonatal brain injury.
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Affiliation(s)
- Cynthia M Gaudet
- Department of Biology, Rhode Island College, 600 Mount Pleasant Ave., Providence, RI 02904, USA
| | - Yow-Pin Lim
- ProThera Biologics, Inc., 349 Eddy Street, Providence, RI 02903, USA
| | - Barbara S Stonestreet
- Department of Pediatrics, The Alpert Medical School of Brown University, Women & Infants Hospital of Rhode Island, 101 Dudley Street, Providence, RI 02905, USA
| | - Steven W Threlkeld
- Department of Psychology, Rhode Island College, 600 Mount Pleasant Ave. Providence, RI 02904, USA.
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Wehrle FM, Kaufmann L, Benz LD, Huber R, O'Gorman RL, Latal B, Hagmann CF. Very preterm adolescents show impaired performance with increasing demands in executive function tasks. Early Hum Dev 2016; 92:37-43. [PMID: 26651084 DOI: 10.1016/j.earlhumdev.2015.10.021] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 09/29/2015] [Accepted: 10/26/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Very preterm birth is often associated with executive function deficits later in life. The transition to adolescence increases personal autonomy, independence and, in parallel, the demands placed on executive functions at home and in school. AIM To assess the impact of increasing demands on executive function performance in very preterm children and adolescents with normal intellectual and motor functions. METHODS Forty-one very preterm children and adolescents with normal intellectual and motor functions and 43 healthy term-born peers were assessed at a mean age of 13.0 years (SD: 1.9; range: 10.0-16.9). A comprehensive battery of performance-based executive function measures with different demand levels as well as a parent-rating questionnaire evaluating executive functions relevant for everyday life was applied. Standardized mean differences between groups of d ≥ .41 were regarded as clinically relevant. RESULTS No group differences were found at the lowest demand levels of working memory (d=.09), planning (d=-.01), cognitive flexibility (d=-.21) and verbal fluency (d=-.14) tasks, but very preterm participants scored significantly below their term-born peers in the most demanding levels (d=-.50, -.59, -.43 and -.55, respectively). These differences were clinically relevant. Executive functions relevant for everyday life were strongly impaired in very preterm participants, e.g., global executive composite (d=-.66). CONCLUSION Very preterm children and adolescents with normal intellectual and motor functions are at high risk for executive function deficits that may only become apparent with increasing demands, potentially leading to academic and other deficits.
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Affiliation(s)
- Flavia M Wehrle
- Department of Neonatology, University Hospital Zurich, Switzerland; Child Development Center, University Children's Hospital Zurich, Switzerland; University of Zurich, Switzerland
| | - Liane Kaufmann
- General Hospital, Department of Psychiatry and Psychotherapy A, Hall in Tyrol, Austria
| | - Laura D Benz
- Faculty of Medicine, University of Zurich, Switzerland
| | - Reto Huber
- Child Development Center, University Children's Hospital Zurich, Switzerland; Children's Research Center, University Children's Hospital Zurich, Switzerland; University Clinics for Child and Adolescent Psychiatry, Zurich, Switzerland
| | - Ruth L O'Gorman
- Children's Research Center, University Children's Hospital Zurich, Switzerland; Center for MR Research, University Children's Hospital Zurich, Switzerland; Zurich Center for Integrative Human Physiology, University of Zurich, Switzerland
| | - Beatrice Latal
- Child Development Center, University Children's Hospital Zurich, Switzerland; Children's Research Center, University Children's Hospital Zurich, Switzerland
| | - Cornelia F Hagmann
- Department of Neonatology, University Hospital Zurich, Switzerland; Child Development Center, University Children's Hospital Zurich, Switzerland.
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Daamen M, Bäuml JG, Scheef L, Meng C, Jurcoane A, Jaekel J, Sorg C, Busch B, Baumann N, Bartmann P, Wolke D, Wohlschläger A, Boecker H. Neural correlates of executive attention in adults born very preterm. NEUROIMAGE-CLINICAL 2015; 9:581-91. [PMID: 26640769 PMCID: PMC4633838 DOI: 10.1016/j.nicl.2015.09.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Revised: 08/31/2015] [Accepted: 09/07/2015] [Indexed: 01/16/2023]
Abstract
Very preterm birth is associated with an increased prevalence of attention problems and may especially impair executive attention, i.e., top-down control of attentional selection in situations where distracting information interferes with the processing of task-relevant stimuli. While there are initial findings linking structural brain alterations in preterm-born individuals with attention problems, the functional basis of these problems are not well understood. The present study used an fMRI adaptation of the Attentional Network Test to examine the neural correlates of executive attention in a large sample of N = 86 adults born very preterm and/or with very low birth weight (VP/VLBW), and N = 100 term-born controls. Executive attention was measured by comparing task behavior and brain activations associated with the processing of incongruent vs. congruent arrow flanker stimuli. Consistent with subtle impairments of executive attention, the VP/VLBW group showed lower accuracy and a tendency for increased response times during the processing of incongruent stimuli. Both groups showed similar activation patters, especially within expected fronto-cingulo-parietal areas, but no significant between-group differences. Our results argue for a maintained attention-relevant network organization in high-functioning preterm born adults in spite of subtle deficits in executive attention. Gestational age and neonatal treatment variables showed associations with task behavior, and brain activation in the dorsal ACC and lateral occipital areas, suggesting that the degree of prematurity (and related neonatal complications) has subtle modulatory influences on executive attention processing. fMRI study examines neural correlates of executive attention in preterm-born adults. Preterm-born adults show subtle behavioral deficits. Preterm-born adults show maintained organization of attention-related networks. Modulatory effects of gestational age and neonatal treatment variables are observed.
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Key Words
- ACC, anterior cingulate cortex
- ANT, Attentional Network Test
- Anterior cingulate
- Attentional Network Test
- BLS, Bavarian Longitudinal Study
- BW, birth weight
- CSF, cerebrospinal fluid
- DLPFC, dorsolateral prefrontal cortex
- DNTI, duration of neonatal intensive treatment
- EHI, Edinburgh Handedness Inventory
- ELBW, extremely low birth weight
- EP, extremely preterm
- Executive attention
- FWE, familywise error
- GA, gestational age
- GM, gray matter
- Gestational age
- ICV, intracranial volume
- INTI, intensity of neonatal intensive treatment
- IVH, intraventricular hemorrhage
- PFC, prefrontal cortex
- Preterm birth
- VLBW, very low birth weight
- VP, very preterm
- WM, white matter
- fMRI, functional magnetic resonance imaging
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Affiliation(s)
- Marcel Daamen
- Department of Radiology, University Hospital Bonn, Sigmund Freud-Str. 25, 53105 Bonn, Germany ; Department of Neonatology, University Hospital Bonn, Sigmund Freud-Str. 25, 53105 Bonn, Germany
| | - Josef G Bäuml
- Department of Neuroradiology, Klinikum Rechts der Isar, Technische Universität München, Ismaninger str. 22, 81664 Munich, Germany ; TUM-Neuroimaging Center of Klinikum rechts der Isar, Technische Universität München, Ismaninger str. 22, Munich 81664, Germany
| | - Lukas Scheef
- Department of Radiology, University Hospital Bonn, Sigmund Freud-Str. 25, 53105 Bonn, Germany
| | - Chun Meng
- Department of Neuroradiology, Klinikum Rechts der Isar, Technische Universität München, Ismaninger str. 22, 81664 Munich, Germany ; TUM-Neuroimaging Center of Klinikum rechts der Isar, Technische Universität München, Ismaninger str. 22, Munich 81664, Germany ; Graduate School of Systemic Neurosciences GSN, Ludwig Maximilians Universität, Biocenter, Department Biology II Neurobiology, Großhaderner Str. 2, D-82152 Planegg-Martinsried, Germany
| | - Alina Jurcoane
- Department of Radiology, University Hospital Bonn, Sigmund Freud-Str. 25, 53105 Bonn, Germany ; Department of Neonatology, University Hospital Bonn, Sigmund Freud-Str. 25, 53105 Bonn, Germany
| | - Julia Jaekel
- Department of Developmental Psychology, Ruhr-University Bochum, Universitätsstraße 150, Bochum 44801, Germany ; Department of Psychology, University of Warwick, University Road, Coventry CV4 7AL, UK
| | - Christian Sorg
- Department of Neuroradiology, Klinikum Rechts der Isar, Technische Universität München, Ismaninger str. 22, 81664 Munich, Germany ; Department of Psychiatry, Klinikum Rechts der Isar, Technische Universität München, Ismaninger str. 22, Munich 81664, Germany ; TUM-Neuroimaging Center of Klinikum rechts der Isar, Technische Universität München, Ismaninger str. 22, Munich 81664, Germany
| | - Barbara Busch
- Department of Neonatology, University Hospital Bonn, Sigmund Freud-Str. 25, 53105 Bonn, Germany
| | - Nicole Baumann
- Department of Psychology, University of Warwick, University Road, Coventry CV4 7AL, UK
| | - Peter Bartmann
- Department of Radiology, University Hospital Bonn, Sigmund Freud-Str. 25, 53105 Bonn, Germany
| | - Dieter Wolke
- Department of Psychology, University of Warwick, University Road, Coventry CV4 7AL, UK ; Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
| | - Afra Wohlschläger
- Department of Neuroradiology, Klinikum Rechts der Isar, Technische Universität München, Ismaninger str. 22, 81664 Munich, Germany ; TUM-Neuroimaging Center of Klinikum rechts der Isar, Technische Universität München, Ismaninger str. 22, Munich 81664, Germany ; Graduate School of Systemic Neurosciences GSN, Ludwig Maximilians Universität, Biocenter, Department Biology II Neurobiology, Großhaderner Str. 2, D-82152 Planegg-Martinsried, Germany
| | - Henning Boecker
- Department of Radiology, University Hospital Bonn, Sigmund Freud-Str. 25, 53105 Bonn, Germany
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Sayeur MS, Vannasing P, Tremblay E, Lepore F, McKerral M, Lassonde M, Gallagher A. Visual Development and Neuropsychological Profile in Preterm Children from 6 Months to School Age. J Child Neurol 2015; 30:1159-73. [PMID: 25414236 DOI: 10.1177/0883073814555188] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 09/19/2014] [Indexed: 11/15/2022]
Abstract
The aim of this semilongitudinal study was to investigate the development of central visual pathways in children born preterm but without major neurologic impairments and to establish their cognitive and behavioral profile at school age. Ten children born preterm were assessed at 6 months and at school age, using visual evoked potentials at both time points and cognitive and behavioral tests at school age. We also tested 10 age-matched children born full-term. At 6 months' corrected age, we found no significant differences between preterm and full-term groups for either amplitude or latency of N1 and P1 components. At school age, the preterm group manifested significantly higher N1 amplitudes and tended to show higher P1 amplitudes than the full-term group. We found no significant differences in cognitive and behavioral measures at school age. These results suggest that preterm birth affects visual pathways development, yet the children born preterm did not manifest cognitive problems.
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Affiliation(s)
- Mélissa Sue Sayeur
- Research Centre in Neuropsychology and Cognition, University of Montreal, Quebec, Canada Department of Psychology, University of Montreal, Quebec, Canada Research Centre, Sainte-Justine Hospital, Montreal, Quebec, Canada
| | | | - Emmanuel Tremblay
- Research Centre in Neuropsychology and Cognition, University of Montreal, Quebec, Canada Department of Psychology, University of Montreal, Quebec, Canada Research Centre, Sainte-Justine Hospital, Montreal, Quebec, Canada
| | - Franco Lepore
- Research Centre in Neuropsychology and Cognition, University of Montreal, Quebec, Canada Department of Psychology, University of Montreal, Quebec, Canada Research Centre, Sainte-Justine Hospital, Montreal, Quebec, Canada
| | - Michelle McKerral
- Research Centre in Neuropsychology and Cognition, University of Montreal, Quebec, Canada Department of Psychology, University of Montreal, Quebec, Canada
| | - Maryse Lassonde
- Research Centre in Neuropsychology and Cognition, University of Montreal, Quebec, Canada Department of Psychology, University of Montreal, Quebec, Canada Research Centre, Sainte-Justine Hospital, Montreal, Quebec, Canada
| | - Anne Gallagher
- Research Centre in Neuropsychology and Cognition, University of Montreal, Quebec, Canada Department of Psychology, University of Montreal, Quebec, Canada Research Centre, Sainte-Justine Hospital, Montreal, Quebec, Canada
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Glass HC, Costarino AT, Stayer SA, Brett CM, Cladis F, Davis PJ. Outcomes for extremely premature infants. Anesth Analg 2015; 120:1337-51. [PMID: 25988638 PMCID: PMC4438860 DOI: 10.1213/ane.0000000000000705] [Citation(s) in RCA: 424] [Impact Index Per Article: 47.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Premature birth is a significant cause of infant and child morbidity and mortality. In the United States, the premature birth rate, which had steadily increased during the 1990s and early 2000s, has decreased annually for 7 years and is now approximately 11.39%. Human viability, defined as gestational age at which the chance of survival is 50%, is currently approximately 23 to 24 weeks in developed countries. Infant girls, on average, have better outcomes than infant boys. A relatively uncomplicated course in the intensive care nursery for an extremely premature infant results in a discharge date close to the prenatal estimated date of confinement. Despite technological advances and efforts of child health experts during the last generation, the extremely premature infant (less than 28 weeks gestation) and extremely low birth weight infant (<1000 g) remain at high risk for death and disability with 30% to 50% mortality and, in survivors, at least 20% to 50% risk of morbidity. The introduction of continuous positive airway pressure, mechanical ventilation, and exogenous surfactant increased survival and spurred the development of neonatal intensive care in the 1970s through the early 1990s. Routine administration of antenatal steroids during premature labor improved neonatal mortality and morbidity in the late 1990s. The recognition that chronic postnatal administration of steroids to infants should be avoided may have improved outcomes in the early 2000s. Evidence from recent trials attempting to define the appropriate target for oxygen saturation in preterm infants suggests arterial oxygen saturation between 91% and 95% (compared with 85%-89%) avoids excess mortality; however, final analyses of data from these trials have not been published, so definitive recommendations are still pending. The development of neonatal neurocritical intensive care units may improve neurocognitive outcomes in this high-risk group. Long-term follow-up to detect and address developmental, learning, behavioral, and social problems is critical for children born at these early gestational ages.The striking similarities in response to extreme prematurity in the lung and brain imply that agents and techniques that benefit one organ are likely to also benefit the other. Finally, because therapy and supportive care continue to change, the outcomes of extremely low birth weight infants are ever evolving. Efforts to minimize injury, preserve growth, and identify interventions focused on antioxidant and anti-inflammatory pathways are now being evaluated. Thus, treating and preventing long-term deficits must be developed in the context of a "moving target."
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Affiliation(s)
- Hannah C Glass
- From the *Department of Neurology and Pediatrics, UCSF Benioff Children's Hospital, San Francisco, California; †Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania; ‡Department of Pediatric Anesthesiology, The Alfred I. duPont Hospital for Children, Wilmington, Delaware; §Baylor College of Medicine, Texas Children's Hospital, Houston, Texas; ∥Department of Anesthesiology and Perioperative Care, University of California, San Francisco, San Francisco, California; and ¶Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Kovachy VN, Adams JN, Tamaresis JS, Feldman HM. Reading abilities in school-aged preterm children: a review and meta-analysis. Dev Med Child Neurol 2015; 57:410-9. [PMID: 25516105 PMCID: PMC4397135 DOI: 10.1111/dmcn.12652] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/16/2014] [Indexed: 12/19/2022]
Abstract
AIM Children born preterm (at ≤32wks) are at risk of developing deficits in reading ability. This meta-analysis aims to determine whether or not school-aged preterm children perform worse than those born at term in single-word reading (decoding) and reading comprehension. METHOD Electronic databases were searched for studies published between 2000 and 2013, which assessed decoding or reading comprehension performance in English-speaking preterm and term-born children aged between 6 years and 13 years, and born after 1990. Standardized mean differences in decoding and reading comprehension scores were calculated. RESULTS Nine studies were suitable for analysis of decoding, and five for analysis of reading comprehension. Random-effects meta-analyses showed that children born preterm had significantly lower scores (reported as Cohen's d values [d] with 95% confidence intervals [CIs]) than those born at term for decoding (d=-0.42, 95% CI -0.57 to -0.27, p<0.001) and reading comprehension (d=-0.57, 95% CI -0.68 to -0.46, p<0.001). Meta-regressions showed that lower gestational age was associated with larger differences in decoding (Q[1]=5.92, p=0.02) and reading comprehension (Q[1]=4.69, p=0.03) between preterm and term groups. Differences between groups increased with age for reading comprehension (Q[1]=5.10, p=0.02) and, although not significant, there was also a trend for increased group differences for decoding (Q[1]=3.44, p=0.06). INTERPRETATION Preterm children perform worse than peers born at term on decoding and reading comprehension. These findings suggest that preterm children should receive more ongoing monitoring for reading difficulties throughout their education.
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Affiliation(s)
- Vanessa N Kovachy
- Department of Pediatrics, Stanford School of Medicine, Palo Alto, CA, USA
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78
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Burnett AC, Scratch SE, Lee KJ, Cheong J, Searle K, Hutchinson E, De Luca C, Davey MA, Roberts G, Doyle LW, Anderson PJ. Executive function in adolescents born <1000 g or <28 weeks: a prospective cohort study. Pediatrics 2015; 135:e826-34. [PMID: 25802342 DOI: 10.1542/peds.2014-3188] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/20/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Extremely preterm (EP; <28 weeks) birth and extremely low birth weight (ELBW; <1000 g) are risk factors for poor cognitive outcomes, including in executive function (EF; higher-order cognitive skills necessary for goal-directed, adaptive functioning and important for academic and behavioral-emotional outcomes). We aimed to (1) extend the limited data on EF in EP/ELBW survivors in adolescence compared with normal birth weight controls, and (2) determine changes in EF between ages 8 and 17 years in both groups. METHODS Two hundred twenty-eight EP/ELBW and 166 control adolescents (mean age, 17 years) from a prospective geographical cohort were assessed with multiple EF tasks, and parent- and self-ratings of behavioral EF. The Rey Complex Figure and Behavior Rating Inventory of Executive Function parent report were also administered at age 8 years, enabling examination of change in scores between childhood and adolescence. RESULTS EP/ELBW adolescents performed more poorly than controls in verbal processing speed, attentional control, cognitive flexibility, and goal-setting (effect sizes, -0.7 to -0.2 SD), but not psychomotor reaction time. Group differences were of similar magnitude across tasks. From childhood to late adolescence, EP/ELBW children improved their accuracy of the Rey Complex Figure copy more than controls. According to parents, executive behaviors were largely stable over time in both groups. CONCLUSIONS Adolescents born EP/ELBW have poorer EF skills across multiple domains than controls. From childhood to late adolescence, different aspects of EF improved, but others did not, underscoring the need for multidomain, longitudinal assessments in this high-risk population.
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Affiliation(s)
- Alice C Burnett
- Premature Infant Follow-Up Programme and Victorian Infant Brain Studies and
| | | | - Katherine J Lee
- Victorian Infant Brain Studies and Departments of Paediatrics
| | - Jeanie Cheong
- Victorian Infant Brain Studies and Neonatal Services, Royal Women's Hospital, Parkville, Victoria, Australia; Obstetrics and Gynaecology, and
| | - Karissa Searle
- Psychiatry, University of Melbourne, Parkville, Victoria, Australia
| | | | | | - Mary-Ann Davey
- Judith Lumley Centre, LaTrobe University, Melbourne, Victoria, Australia
| | - Gehan Roberts
- Departments of Paediatrics, Centre for Community Child Health, Royal Children's Hospital, Victoria, Australia; and Population Health, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Lex W Doyle
- Premature Infant Follow-Up Programme and Victorian Infant Brain Studies and Departments of Paediatrics, Obstetrics and Gynaecology, and
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Smith AL, Alexander M, Chrobak JJ, Rosenkrantz TS, Fitch RH. Dissociation in the Effects of Induced Neonatal Hypoxia-Ischemia on Rapid Auditory Processing and Spatial Working Memory in Male Rats. Dev Neurosci 2015; 37:440-52. [PMID: 25791036 DOI: 10.1159/000375487] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 01/26/2015] [Indexed: 12/25/2022] Open
Abstract
Infants born prematurely are at risk for cardiovascular events causing hypoxia-ischemia (HI; reduced blood and oxygen to the brain). HI in turn can cause neuropathology, though patterns of damage are sometimes diffuse and often highly variable (with clinical heterogeneity further magnified by rapid development). As a result, though HI injury is associated with long-term behavioral and cognitive impairments in general, pathology indices for specific infants can provide only limited insight into individual prognosis. The current paper addresses this important clinical issue using a rat model that simulates unilateral HI in a late preterm infant coupled with long-term behavioral evaluation in two processing domains - auditory discrimination and spatial learning/memory. We examined the following: (1) whether deficits on one task would predict deficits on the other (suggesting that subjects with more severe injury perform worse across all cognitive domains) or (2) whether domain-specific outcomes among HI-injured subjects would be uncorrelated (suggesting differential damage to orthogonal neural systems). All animals (sham and HI) received initial auditory testing and were assigned to additional auditory testing (group A) or spatial maze testing (group B). This allowed within-task (group A) and between-task (group B) correlation. Anatomic measures of cortical, hippocampal and ventricular volume (indexing HI damage) were also obtained and correlated against behavioral measures. Results showed that auditory discrimination in the juvenile period was not correlated with spatial working memory in adulthood (group B) in either sham or HI rats. Conversely, early auditory processing performance for group A HI animals significantly predicted auditory deficits in adulthood (p = 0.05; no correlation in shams). Anatomic data also revealed significant relationships between the volumes of different brain areas within both HI and shams, but anatomic measures did not correlate with any behavioral measure in the HI group (though we saw a hippocampal/spatial correlation in shams, in the expected direction). Overall, current data provide an impetus to enhance tools for characterizing individual HI-related pathology in neonates, which could provide more accurate individual prognoses within specific cognitive/behavioral domains and thus improved patient-specific early interventions.
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Affiliation(s)
- Amanda L Smith
- Department of Psychology, Behavioral Neuroscience Division, University of Connecticut, Storrs, Conn., USA
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80
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Lundequist A, Böhm B, Lagercrantz H, Forssberg H, Smedler A. Cognitive outcome varies in adolescents born preterm, depending on gestational age, intrauterine growth and neonatal complications. Acta Paediatr 2015; 104:292-9. [PMID: 25394225 PMCID: PMC4657491 DOI: 10.1111/apa.12864] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 10/20/2014] [Accepted: 11/10/2014] [Indexed: 11/30/2022]
Abstract
Aim The aim of this study was to investigate long-term cognitive outcome in a cohort of 18-year-olds born preterm and previously assessed at the age of 5.5. Methods We tested 134 adolescents born preterm with a very low birthweight of <1500 g and 94 term-born controls with a comprehensive cognitive battery at 18 years of age. The cohort was subdivided into 73 extremely preterm, 42 very preterm and 19 moderately preterm infants with gestational ages of 23–27, 28–31 and 32–36 weeks, respectively. The moderately preterm group was dominated by adolescents born small for gestational age. Results Very preterm adolescents performed on a par with term-born controls. In contrast, extremely preterm adolescents displayed inferior results on all cognitive tests, more so if they had suffered neonatal complications. Moderately preterm adolescents scored lower than very preterm and full-term born adolescents, particularly on complex cognitive tasks. Conclusion Adolescents born at 28 weeks of gestation or later, with appropriate birthweight and no perinatal complications, functioned like term-born peers at 18 years of age. Extremely preterm birth per se posed a risk for long-term cognitive deficits, particularly executive deficits. Adolescents born moderately preterm but small for gestational age were at risk of general cognitive deficits.
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Affiliation(s)
- Aiko Lundequist
- Department of Psychology Stockholm University Stockholm Sweden
- Department of Women's and Children's Health Karolinska Institutet Stockholm Sweden
| | - Birgitta Böhm
- Department of Women's and Children's Health Karolinska Institutet Stockholm Sweden
| | - Hugo Lagercrantz
- Department of Women's and Children's Health Karolinska Institutet Stockholm Sweden
| | - Hans Forssberg
- Department of Women's and Children's Health Karolinska Institutet Stockholm Sweden
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81
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Hackman DA, Gallop R, Evans GW, Farah MJ. Socioeconomic status and executive function: developmental trajectories and mediation. Dev Sci 2015; 18:686-702. [PMID: 25659838 DOI: 10.1111/desc.12246] [Citation(s) in RCA: 306] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2013] [Accepted: 07/31/2014] [Indexed: 11/29/2022]
Abstract
Childhood socioeconomic status (SES) predicts executive function (EF), but fundamental aspects of this relation remain unknown: the developmental course of the SES disparity, its continued sensitivity to SES changes during that course, and the features of childhood experience responsible for the SES-EF relation. Regarding course, early disparities would be expected to grow during development if caused by accumulating stressors at a given constant level of SES. Alternatively, they would narrow if schooling partly compensates for the effects of earlier deprivation, allowing lower-SES children to 'catch up'. The potential for later childhood SES change to affect EF is also unknown. Regarding mediating factors, previous analyses produced mixed answers, possibly due to correlation amongst candidate mediators. We address these issues with measures of SES, working memory and planning, along with multiple candidate mediators, from the NICHD Study of Early Childcare (n = 1009). Early family income-to-needs and maternal education predicted planning by first grade, and income-to-needs predicted working memory performance at 54 months. Effects of early SES remained consistent through middle childhood, indicating that the relation between early indicators of SES and EF emerges in childhood and persists without narrowing or widening across early and middle childhood. Changes in family income-to-needs were associated with significant changes in planning and trend-level changes in working memory. Mediation analyses supported the role of early childhood home characteristics in explaining the association between SES and EF, while early childhood maternal sensitivity was specifically implicated in the association between maternal education and planning. Early emerging and persistent SES-related differences in EF, partially explained by characteristics of the home and family environment, are thus a potential source of socioeconomic disparities in achievement and health across development.
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Affiliation(s)
- Daniel A Hackman
- Center for Cognitive Neuroscience, Center for Neuroscience and Society, Department of Psychology, University of Pennsylvania, USA
| | - Robert Gallop
- Department of Mathematics and Applied Statistics, West Chester University, USA
| | - Gary W Evans
- Departments of Design and Environmental Analysis and Human Development, Bronfenbrenner Center for Translational Research, Cornell University, USA
| | - Martha J Farah
- Center for Cognitive Neuroscience, Center for Neuroscience and Society, Department of Psychology, University of Pennsylvania, USA
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The effect of the Infant Health and Development Program on special education use at school age. J Pediatr 2015; 166:457-62.e1. [PMID: 25449222 DOI: 10.1016/j.jpeds.2014.09.066] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 08/19/2014] [Accepted: 09/30/2014] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To evaluate the effect of an intensive early intervention on special service use at school-age. STUDY DESIGN The Infant Health and Development Program was a randomized controlled trial of an intervention for low birth weight (<2500 g) infants ages 0-3 years. We used multivariate logistic regression to test the association between intervention and risk of special education, remedial reading and math, and speech therapy at age 8 years. We also compared rates of service use between study arms among those with learning disabilities (LDs). RESULTS There were 875 complete cases at 8-year follow-up. There were no statistically significant differences between groups in risk of special education (risk ratio [RR] 0.86, 95% CI 0.64-1.15), remedial reading (RR 0.88, 95% CI 0.68-1.14), remedial math (RR 0.92, 95% CI 0.63-1.34), or speech therapy (RR 0.87, 95% CI 0.62-1.23). The treatment arms did not differ in rates of LDs, and service use for those with LDs was low and unaffected by study group. CONCLUSIONS Early gains in IQ from infant interventions may not protect children as they face the educational demands of grade school. Only a fraction of those having a LD were receiving school-based support services, indicating a high level of unmet need among low birth weight children with disabilities.
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Gough A, Linden MA, Spence D, Halliday HL, Patterson CC, McGarvey L. Executive functioning deficits in young adult survivors of bronchopulmonary dysplasia. Disabil Rehabil 2014; 37:1940-5. [DOI: 10.3109/09638288.2014.991451] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Kalpakidou AK, Allin MPG, Walshe M, Giampietro V, McGuire PK, Rifkin L, Murray RM, Nosarti C. Functional neuroanatomy of executive function after neonatal brain injury in adults who were born very preterm. PLoS One 2014; 9:e113975. [PMID: 25438043 PMCID: PMC4250191 DOI: 10.1371/journal.pone.0113975] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 11/01/2014] [Indexed: 02/01/2023] Open
Abstract
Individuals who were born very preterm (VPT; <33 gestational weeks) are at risk of experiencing deficits in tasks involving executive function in childhood and beyond. In addition, the type and severity of neonatal brain injury associated with very preterm birth may exert differential effects on executive functioning by altering its neuroanatomical substrates. Here we addressed this question by investigating with functional magnetic resonance imaging (fMRI) the haemodynamic response during executive-type processing using a phonological verbal fluency and a working memory task in VPT-born young adults who had experienced differing degrees of neonatal brain injury. 12 VPT individuals with a history of periventricular haemorrhage and ventricular dilatation (PVH+VD), 17 VPT individuals with a history of uncomplicated periventricular haemorrhage (UPVH), 13 VPT individuals with no history of neonatal brain injury and 17 controls received an MRI scan whilst completing a verbal fluency task with two cognitive loads (‘easy’ and ‘hard’ letters). Two groups of VPT individuals (PVH+VD; n = 10, UPVH; n = 8) performed an n-back task with three cognitive loads (1-, 2-, 3-back). Results demonstrated that VPT individuals displayed hyperactivation in frontal, temporal, and parietal cortices and in caudate nucleus, insula and thalamus compared to controls, as demands of the verbal fluency task increased, regardless of type of neonatal brain injury. On the other hand, during the n-back task and as working memory load increased, the PVH+VD group showed less engagement of the frontal cortex than the UPVH group. In conclusion, this study suggests that the functional neuroanatomy of different executive-type processes is altered following VPT birth and that neural activation associated with specific aspects of executive function (i.e., working memory) may be particularly sensitive to the extent of neonatal brain injury.
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Affiliation(s)
- Anastasia K. Kalpakidou
- Department of Psychosis Studies, Institute of Psychiatry, King's Health Partners, King's College London, London, United Kingdom
- * E-mail:
| | - Matthew P. G. Allin
- Department of Psychosis Studies, Institute of Psychiatry, King's Health Partners, King's College London, London, United Kingdom
| | - Muriel Walshe
- Department of Psychosis Studies, Institute of Psychiatry, King's Health Partners, King's College London, London, United Kingdom
| | - Vincent Giampietro
- Department of Neuroimaging, Institute of Psychiatry, King's Health Partners, King's College London, London, United Kingdom
| | - Philip K. McGuire
- Department of Psychosis Studies, Institute of Psychiatry, King's Health Partners, King's College London, London, United Kingdom
| | - Larry Rifkin
- Department of Psychosis Studies, Institute of Psychiatry, King's Health Partners, King's College London, London, United Kingdom
| | - Robin M. Murray
- Department of Psychosis Studies, Institute of Psychiatry, King's Health Partners, King's College London, London, United Kingdom
| | - Chiara Nosarti
- Department of Psychosis Studies, Institute of Psychiatry, King's Health Partners, King's College London, London, United Kingdom
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Vohr BR, Allan W, Katz KH, Schneider K, Tucker R, Ment LR. Adolescents born prematurely with isolated grade 2 haemorrhage in the early 1990s face increased risks of learning challenges. Acta Paediatr 2014; 103:1066-71. [PMID: 24976311 DOI: 10.1111/apa.12728] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 05/20/2014] [Accepted: 06/24/2014] [Indexed: 11/29/2022]
Abstract
AIM To compare the impact of low-grade haemorrhage on neurocognitive function in 16-year-old adolescents born preterm, by grade of intraventricular haemorrhage, and term controls. METHODS We evaluated 338 preterm adolescents (birth weight 600-1250 g) for intelligence, executive function and memory tasks. Eleven had grade 3-4 haemorrhage, 44 had grade 2, 31 had grade 1, and 251 had no haemorrhage. Group comparisons were made with 102 term age-matched controls, and regression models used to identify the risk that low-grade haemorrhage posed for cognitive, executive function and memory deficits. RESULTS Preterm adolescents with grade 2 haemorrhage had higher deficit rates of verbal intelligence, receptive vocabulary, phonemic fluency, cognitive flexibility and phonological fluency than preterm adolescents with grade 1 or no haemorrhage, compared with term controls. After excluding preterm adolescents with both grade 2 haemorrhage and cystic periventricular leukomalacia, those with isolated grade 2 haemorrhage remained at greater risk of cognitive and executive function deficits than term controls and of cognitive deficits than preterm adolescents with no haemorrhage. CONCLUSION Our findings suggest that preterm adolescents born in the early 1990s with isolated grade 2 haemorrhage are at increased risk of learning challenges, including cognitive and executive function deficits.
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Affiliation(s)
- Betty R. Vohr
- Pediatrics; Alpert Medical School of Brown University; Providence RI USA
- Women and Infants Hospital; Providence RI USA
| | - Walter Allan
- Pediatrics; Maine Medical Center; Portland ME USA
| | - Karol H. Katz
- Epidemiology and Public Health; Yale University School of Medicine; New Haven CT USA
| | - Karen Schneider
- Pediatrics; Yale University School of Medicine; New Haven CT USA
| | | | - Laura R. Ment
- Pediatrics; Yale University School of Medicine; New Haven CT USA
- Neurology; Yale University School of Medicine; New Haven CT USA
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86
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Stålnacke J, Lundequist A, Böhm B, Forssberg H, Smedler AC. Individual cognitive patterns and developmental trajectories after preterm birth. Child Neuropsychol 2014; 21:648-67. [PMID: 25265400 DOI: 10.1080/09297049.2014.958071] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Cognitive outcome after preterm birth is heterogeneous, and group level analyses may disguise individual variability in development. Using a person-oriented approach, this study investigated individual cognitive patterns and developmental trajectories from preschool age to late adolescence. As part of a prospective longitudinal study, 118 adolescents born preterm, with a birth weight < 1,500 g, participated in neuropsychological assessments at age 5½ years and at 18 years. At each age, four cognitive indices, two tapping general ability and two tapping executive functions, were formed to reflect each individual's cognitive profile. Cluster analyses were performed at each age separately, and individual movements between clusters across time were investigated. At both 5½ and 18 years, six distinct, and similar, cognitive patterns were identified. Executive functions were a weakness for some but not all subgroups, and verbal ability was a strength primarily among those whose overall performance fell within the normal range. Overall, cognitive ability at 5½ years was highly predictive of ability at age 18. Those who performed at low levels at 5½ years did not catch up but rather deteriorated in relative performance. Over half of the individuals who performed above the norm at 5½ years improved their relative performance by age 18. Among those performing around the norm at 5½ years, half improved their relative performance over time, whereas the other half faced increased problems, indicating a need for further developmental monitoring. Perinatal factors were not conclusively related to outcome, stressing the need for cognitive follow-up assessment of the preterm-born child before school entry.
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87
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Quesada AA, Tristão RM, Pratesi R, Wolf OT. Hyper-responsiveness to acute stress, emotional problems and poorer memory in former preterm children. Stress 2014; 17:389-99. [PMID: 25089937 DOI: 10.3109/10253890.2014.949667] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The prevalence of preterm birth (PTB) is high worldwide, especially in developing countries like Brazil. PTB is marked by a stressful environment in intra- as well as extrauterine life, which can affect neurodevelopment and hormonal and physiological systems and lead to long-term negative outcomes. Nevertheless, little is known about PTB and related outcomes later on in childhood. Thus, the goals of the current study were threefold: (1) comparing cortisol and alpha-amylase (sAA) profiles, including cortisol awakening response (CAR), between preterm and full-term children; (2) evaluating whether preterm children are more responsive to acute stress and (3) assessing their memory skills and emotional and behavioral profiles. Basal cortisol and sAA profiles, including CAR of 30 preterm children, aged 6 to 10 years, were evaluated. Further, we assessed memory functions using the Wide Range Assessment of Memory and Learning, and we screened behavior/emotion using the Strengths and Difficulties Questionnaire. The results of preterm children were compared to an age- and sex-matched control group. One week later, participants were exposed to a standardized laboratory stressor [Trier Social Stress Test for Children (TSST-C)], in which cortisol and sAA were measured at baseline, 1, 10 and 25 min after stressor exposure. Preterm children had higher cortisol concentrations at awakening, a flattened CAR and an exaggerated response to TSST-C compared to full-term children. These alterations were more pronounced in girls. In addition, preterm children were characterized by more emotional problems and poorer memory performance. Our findings illustrate the long-lasting and in part sex-dependent effects of PTB on the hypothalamic-pituitary-adrenal (HPA) axis, internalizing behavior and memory. The findings are in line with the idea that early adversity alters the set-point of the HPA axis, thereby creating a more vulnerable phenotype.
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Affiliation(s)
- Andrea A Quesada
- Department of Cognitive Psychology, Institute of Cognitive Neuroscience, Ruhr-University Bochum , Bochum , Germany
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Borradori Tolsa C, Barisnikov K, Lejeune F, Hüppi P. [Development of executive functions in preterm children]. Arch Pediatr 2014; 21:1035-40. [PMID: 25089045 DOI: 10.1016/j.arcped.2014.06.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 06/18/2014] [Indexed: 11/17/2022]
Abstract
The rate of children born prematurely has increased considerably in the last few decades, and their developmental outcome remains of great concern. The literature on the impact of prematurity has reported a wide range of cognitive and behavioral problems that may be related to deficits in executive function (EF) skills. EF refers to a series of high-level processes (selective attention, inhibition, set shifting, working memory, planning, goal setting) that develop throughout childhood and adolescence and play an important role in cognitive and social development as well as in school achievement. EF skills have been linked to the prefrontal cortex, as well as to other neural networks and brain regions including the basal ganglia and cerebellum. This paper focuses on studies related to the development of EF and social behavior in children born preterm. The preschool period is a critical time to perform neuropsychological assessment in addition to IQ testing, and to detect the child's specific needs in order to adapt effective intervention to enhance the development of executive processes in these high-risk children.
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Affiliation(s)
- C Borradori Tolsa
- Service du développement et de la croissance, département de l'enfant et de l'adolescent, hôpitaux universitaire de Genève, 1211 Genève, Suisse.
| | - K Barisnikov
- Unité de psychologie clinique et neuropsychologie de l'enfant, faculté de psychologie et des sciences de l'éducation, université de Genève, Genève, Suisse
| | - F Lejeune
- Unité de psychologie clinique et neuropsychologie de l'enfant, faculté de psychologie et des sciences de l'éducation, université de Genève, Genève, Suisse
| | - P Hüppi
- Service du développement et de la croissance, département de l'enfant et de l'adolescent, hôpitaux universitaire de Genève, 1211 Genève, Suisse
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89
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Threlkeld SW, Gaudet CM, La Rue ME, Dugas E, Hill CA, Lim YP, Stonestreet BS. Effects of inter-alpha inhibitor proteins on neonatal brain injury: Age, task and treatment dependent neurobehavioral outcomes. Exp Neurol 2014; 261:424-33. [PMID: 25084519 DOI: 10.1016/j.expneurol.2014.07.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Revised: 07/10/2014] [Accepted: 07/20/2014] [Indexed: 12/18/2022]
Abstract
Hypoxic-ischemic (HI) brain injury is frequently associated with premature and/or full term birth related complications. HI injury often results in learning and processing deficits that reflect widespread damage to an extensive range of cortical and sub-cortical brain structures. Further, inflammation has been implicated in the long-term progression and severity of HI injury. Recently, inter-alpha inhibitor proteins (IAIPs) have been shown to attenuate inflammation in models of systemic infection. Importantly, preclinical studies of neonatal HI injury and neuroprotection often focus on single time windows of assessment or single behavioral domains. This approach limits translational validity, given evidence for a diverse spectrum of neurobehavioral deficits that may change across developmental windows following neonatal brain injury. Therefore, the aims of this research were to assess the effects of human IAIPs on early neocortical cell death (72h post-insult), adult regional brain volume measurements (cerebral cortex, hippocampus, striatum, corpus callosum) and long-term behavioral outcomes in juvenile (P38-50) and adult (P80+) periods across two independent learning domains (spatial and non-spatial learning), after postnatal day 7 HI injury in rats. Here, for the first time, we show that IAIPs reduce acute neocortical neuronal cell death and improve brain weight outcome 72h following HI injury in the neonatal rat. Further, these longitudinal studies are the first to show age, task and treatment dependent improvements in behavioral outcome for both spatial and non-spatial learning following systemic administration of IAIPs in neonatal HI injured rats. Finally, results also show sparing of brain regions critical for spatial and non-spatial learning in adult animals treated with IAIPs at the time of injury onset. These data support the proposal that inter-alpha inhibitor proteins may serve as novel therapeutics for brain injury associated with premature birth and/or neonatal brain injury and highlight the importance of assessing multiple ages, brain regions and behavioral domains when investigating experimental treatment efficacy.
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Affiliation(s)
- Steven W Threlkeld
- Department of Psychology, Rhode Island College, 600 Mount Pleasant Ave., Providence, RI 02904, USA.
| | - Cynthia M Gaudet
- Department of Psychology, Rhode Island College, 600 Mount Pleasant Ave., Providence, RI 02904, USA
| | - Molly E La Rue
- Department of Pediatrics, The Alpert Medical School of Brown University, Women & Infants Hospital of Rhode Island, 101 Dudley Street, Providence, RI 02905, USA
| | - Ethan Dugas
- Department of Psychology, Rhode Island College, 600 Mount Pleasant Ave., Providence, RI 02904, USA
| | - Courtney A Hill
- Department of Pediatrics, The Alpert Medical School of Brown University, Women & Infants Hospital of Rhode Island, 101 Dudley Street, Providence, RI 02905, USA
| | - Yow-Pin Lim
- ProThera Biologics, Inc., East Providence, RI 02914, USA
| | - Barbara S Stonestreet
- Department of Pediatrics, The Alpert Medical School of Brown University, Women & Infants Hospital of Rhode Island, 101 Dudley Street, Providence, RI 02905, USA
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90
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Ortinau C, Neil J. The neuroanatomy of prematurity: Normal brain development and the impact of preterm birth. Clin Anat 2014; 28:168-83. [DOI: 10.1002/ca.22430] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Accepted: 06/09/2014] [Indexed: 12/17/2022]
Affiliation(s)
- Cynthia Ortinau
- Department of Pediatric Newborn Medicine; Brigham and Women's Hospital, Harvard Medical School; Boston, Massachusetts USA
| | - Jeffrey Neil
- Departments of Neurology and Radiology; Boston Children's Hospital, Harvard Medical School; Boston, Massachusetts USA
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91
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Small for gestational age and poor fluid intelligence in childhood predict externalizing behaviors among young adults born at extremely low birth weight. Dev Psychopathol 2014; 27:181-8. [PMID: 25017176 DOI: 10.1017/s0954579414000662] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Although infants born at extremely low birth weight (ELBW; birth weight < 1000 g) are at increased risk for developing later psychopathology, the mechanisms contributing to this association are largely unknown. In the present study, we examined a putative cognitive link to psychopathology in a cohort of ELBW survivors. These individuals were followed up prospectively at age 8 and again at ages 22-26. At 8 years, participants completed measures of fluid and general intelligence. As young adults, a subset of ELBW survivors free of major neurosensory impairments provided self-reports of personality characteristics related to psychopathology. Data from 66 participants indicated that, as predicted, the association between ELBW and externalizing behaviors was moderated by fluid intelligence. Specifically, ELBW individuals with poor fluid intelligence who were born small for gestational age (birth weight < 10th percentile for gestational age) showed the highest level of externalizing behaviors. These findings provide support for a cumulative risk model and suggest that fluid intelligence might be a cognitive mechanism contributing to the development of psychopathology among nonimpaired individuals who were born at ELBW and small for gestational age.
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92
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Lahat A, Van Lieshout RJ, Saigal S, Boyle MH, Schmidt LA. ADHD among young adults born at extremely low birth weight: the role of fluid intelligence in childhood. Front Psychol 2014; 5:446. [PMID: 24904465 PMCID: PMC4032880 DOI: 10.3389/fpsyg.2014.00446] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Accepted: 04/27/2014] [Indexed: 11/13/2022] Open
Abstract
Poor executive function (EF) has been linked to attention-deficit/hyperactivity disorder (ADHD). Children born at extremely low birth weight (ELBW; <1000 g) have been found to show both poor EF, as well as elevated levels of symptoms of ADHD. In the present study, we examined whether fluid intelligence moderates the link between birth weight and later ADHD symptoms by prospectively following a cohort of 179 survivors who were born at ELBW. When participants were 8 years-old, they were matched with 145 normal birth weight (NBW; ≥2500 g) control participants. At age 8, fluid intelligence was measured, and during young adulthood (ages 22–26), participants' self-reported levels of ADHD symptoms were examined. We found that ELBW survivors, who also showed poor fluid intelligence, had the highest rates of ADHD symptoms, and particularly, symptoms of inattention. These findings point to the importance of examining developmental trajectories that contribute to risk for psychopathology in those exposed to intrauterine adversity.
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Affiliation(s)
- Ayelet Lahat
- Department of Psychology, Neuroscience and Behaviour, McMaster University Hamilton, ON, Canada
| | - Ryan J Van Lieshout
- Department of Psychiatry and Behavioural Neurosciences, McMaster University Hamilton, ON, Canada
| | - Saroj Saigal
- Department of Pediatrics, McMaster University Hamilton, ON, Canada
| | - Michael H Boyle
- Department of Psychiatry and Behavioural Neurosciences, McMaster University Hamilton, ON, Canada
| | - Louis A Schmidt
- Department of Psychology, Neuroscience and Behaviour, McMaster University Hamilton, ON, Canada
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93
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Shankaran S, Lin A, Maller-Kesselman J, Zhang H, O’Shea TM, Bada HS, Kaiser JR, Lifton RP, Bauer CR, Ment LR. Maternal race, demography, and health care disparities impact risk for intraventricular hemorrhage in preterm neonates. J Pediatr 2014; 164:1005-1011.e3. [PMID: 24589078 PMCID: PMC4095864 DOI: 10.1016/j.jpeds.2014.01.036] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Revised: 12/19/2013] [Accepted: 01/17/2014] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To determine whether risk factors associated with grade 2-4 intraventricular hemorrhage (IVH) differs between infants of African ancestry and white infants. STUDY DESIGN Inborn, appropriate for gestational age infants with birth weight 500-1250 g and exposure to at least 1 dose of antenatal steroids were enrolled in 24 neonatal intensive care units. Cases had grade 2-4 IVH and controls matched for site, race, and birth weight range had 2 normal ultrasounds read centrally. Multivariate logistic regression modeling identified factors associated with IVH across African ancestry and white race. RESULTS Subjects included 579 African ancestry or white race infants with grade 2-4 IVH and 532 controls. Mothers of African ancestry children were less educated, and white case mothers were more likely to have more than 1 prenatal visit and multiple gestation (P ≤ .01 for all). Increasing gestational age (P = .01), preeclampsia (P < .001), complete antenatal steroid exposure (P = .02), cesarean delivery (P < .001), and white race (P = .01) were associated with decreased risk for IVH. Chorioamnionitis (P = .01), 5-minute Apgar score <3 (P < .004), surfactant use (P < .001), and high-frequency ventilation (P < .001) were associated with increased risk for IVH. Among African ancestry infants, having more than 1 prenatal visit was associated with decreased risk (P = .02). Among white infants, multiple gestation was associated with increased risk (P < .001), and higher maternal education was associated with decreased risk (P < .05). CONCLUSION The risk for IVH differs between infants of African ancestry and white infants, possibly attributable to both race and health care disparities.
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Affiliation(s)
- Seetha Shankaran
- Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI.
| | - Aiping Lin
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT
| | | | - Heping Zhang
- Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, CT
| | - T. Michael O’Shea
- Department of Pediatrics, Wake Forest School of Medicine, Winston Salem, NC
| | - Henrietta S. Bada
- Department of Pediatrics, University of Kentucky College of Medicine
| | - Jeffrey R. Kaiser
- Departments of Pediatrics and Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX
| | - Richard P. Lifton
- Department of Genetics and the Howard Hughes Medical Institute, Yale University School of Medicine, New Haven, CT
| | - Charles R. Bauer
- Department of Pediatrics, University of Miami Miller School of Medicine
| | - Laura R. Ment
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT,Department of Neurology, Yale University School of Medicine, New Haven, CT
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94
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Executive functions in very-low-birth-weight young adults: a comparison between self-report and neuropsychological test results. J Int Neuropsychol Soc 2014; 20:506-15. [PMID: 24735984 DOI: 10.1017/s1355617714000332] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Executive functions are goal-directed control mechanisms that modulate the operation of other cognitive processes. Preterm born very-low-birth-weight (VLBW: birth weight<1500 grams) children have more problems with attention/executive function than their term born peers. The objective of this study is to examine if VLBW young adults had more self-reported attention/ executive problems and lower neuropsychological test results than controls. Furthermore, to investigate the relationship between self-reported attention/executive problems, general cognitive ability (IQ) and test results. Forty-two VLBW [mean birth weight 1237 (219) grams, and gestational age 29.3 (2.4) weeks] and 63 term born controls at age 19 years completed The BRIEF-A self-report of attention/executive functions in everyday life. The Wechsler Adult Intelligence Scale III was used to obtain IQ scores; subtests from Delis-Kaplan were used to assess attention/executive function. There were no differences between the VLBW young adults and controls on any of the BRIEF-A measures, but the VLBW subjects had lower scores on 8 of the 18 neuropsychological subtests (p<.01). Some correlations between BRIEF-A and the Stroop and TMT tests were found in the VLBW group. VLBW young adults do not report more problems regarding attention/executive function in daily life than controls despite lower results on several neuropsychological tests.
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95
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Smith AL, Hill CA, Alexander M, Szalkowski CE, Chrobak JJ, Rosenkrantz TS, Fitch RH. Spatial working memory deficits in male rats following neonatal hypoxic ischemic brain injury can be attenuated by task modifications. Brain Sci 2014; 4:240-72. [PMID: 24961760 PMCID: PMC4101476 DOI: 10.3390/brainsci4020240] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Revised: 01/22/2014] [Accepted: 03/18/2014] [Indexed: 12/19/2022] Open
Abstract
Hypoxia-ischemia (HI; reduction in blood/oxygen supply) is common in infants with serious birth complications, such as prolonged labor and cord prolapse, as well as in infants born prematurely (<37 weeks gestational age; GA). Most often, HI can lead to brain injury in the form of cortical and subcortical damage, as well as later cognitive/behavioral deficits. A common domain of impairment is working memory, which can be associated with heightened incidence of developmental disorders. To further characterize these clinical issues, the current investigation describes data from a rodent model of HI induced on postnatal (P)7, an age comparable to a term (GA 36–38) human. Specifically, we sought to assess working memory using an eight-arm radial water maze paradigm. Study 1 used a modified version of the paradigm, which requires a step-wise change in spatial memory via progressively more difficult tasks, as well as multiple daily trials for extra learning opportunity. Results were surprising and revealed a small HI deficit only for the final and most difficult condition, when a delay before test trial was introduced. Study 2 again used the modified radial arm maze, but presented the most difficult condition from the start, and only one daily test trial. Here, results were expected and revealed a robust and consistent HI deficit across all weeks. Combined results indicate that male HI rats can learn a difficult spatial working memory task if it is presented in a graded multi-trial format, but performance is poor and does not appear to remediate if the task is presented with high initial memory demand. Male HI rats in both studies displayed impulsive characteristics throughout testing evidenced as reduced choice latencies despite more errors. This aspect of behavioral results is consistent with impulsiveness as a core symptom of ADHD—a diagnosis common in children with HI insult. Overall findings suggest that task specific behavioral modifications are crucial to accommodating memory deficits in children suffering from cognitive impairments following neonatal HI.
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Affiliation(s)
- Amanda L Smith
- Behavioral Neuroscience Division, Department of Psychology, University of Connecticut, 406 Babbidge Road, Unit 1020, Storrs, CT 06269, USA.
| | - Courtney A Hill
- Behavioral Neuroscience Division, Department of Psychology, University of Connecticut, 406 Babbidge Road, Unit 1020, Storrs, CT 06269, USA.
| | - Michelle Alexander
- Division of Neonatology, Department of Pediatrics, University of Minnesota, 516 Delaware Street S.E. Minneapolis, MN 55454, USA.
| | - Caitlin E Szalkowski
- Behavioral Neuroscience Division, Department of Psychology, University of Connecticut, 406 Babbidge Road, Unit 1020, Storrs, CT 06269, USA.
| | - James J Chrobak
- Behavioral Neuroscience Division, Department of Psychology, University of Connecticut, 406 Babbidge Road, Unit 1020, Storrs, CT 06269, USA.
| | - Ted S Rosenkrantz
- Department of Pediatrics, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030, USA.
| | - R Holly Fitch
- Behavioral Neuroscience Division, Department of Psychology, University of Connecticut, 406 Babbidge Road, Unit 1020, Storrs, CT 06269, USA.
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96
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Maitra K, Park HY, Eggenberger J, Matthiessen A, Knight E, Ng B. Difficulty in Mental, Neuromusculoskeletal, and Movement-Related School Functions Associated With Low Birthweight or Preterm Birth: A Meta-Analysis. Am J Occup Ther 2014; 68:140-8. [DOI: 10.5014/ajot.2014.009985] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
OBJECTIVE. Our objective was to perform a meta-analysis to investigate whether low birthweight (LBW) or preterm birth was associated with difficulty in mental, neuromusculoskeletal, and movement-related school function tasks.
METHOD. Two search strategies produced 40 studies that met the inclusion criteria for the meta-analysis and yielded 549 effect sizes (d). Heterogeneity was evaluated by obtaining Q and I-squared values. Egger’s regression intercept test and a funnel plot were used to check for publication bias.
RESULTS. Children born LBW exhibited considerable difficulties in mental (d = −0.655, p < .0001) and neuromusculoskeletal and movement-related tasks (d = −0.391, p < .0001) compared with children of normal birthweight. Children born preterm also exhibited significant difficulties compared with full-term children in mental, neuromusculoskeletal, and movement-related tasks (d = −0.237, p < .0001).
CONCLUSION. Deficits in mental and motor functions in children born LBW or preterm appear to have significant effects on school readiness and academic achievement.
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Affiliation(s)
- Kinsuk Maitra
- Kinsuk Maitra, PhD, OTR/L, is Chair and Professor, Department of Occupational Therapy, College of Nursing and Health Sciences, Florida International University, 11200 SW Eighth Street, MMC, AHC3 443, Miami, FL 33199;
| | - Hae Yean Park
- Hae Yean Park, PhD, OT, is Postdoctoral Fellow, Department of Occupational Therapy, Florida International University, Miami
| | - Jaime Eggenberger
- Jaime Eggenberger, Erin Knight, and Betty Ng are Students, Department of Occupational Therapy, Florida International University, Miami
| | - Angela Matthiessen
- Jaime Eggenberger, Erin Knight, and Betty Ng are Students, Department of Occupational Therapy, Florida International University, Miami
| | - Erin Knight
- Jaime Eggenberger, Erin Knight, and Betty Ng are Students, Department of Occupational Therapy, Florida International University, Miami
| | - Betty Ng
- Angela Matthiessen, MSOT, OTR/L, is Director, CreatAbility, Inc., Atlanta, GA
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97
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Abstract
Survival of extremely preterm infants has improved since 2000. Neurodevelopmental impairment rates remain high at the limits of viability. Although improved survival and neurodevelopmental impairment rates are associated with higher gestational age and more recent year of birth, significant variability in findings among geographic areas and networks is evident, and seems related to differences in population, management style, regional protocols, definitions, and outcome assessments. Outcome studies during adolescence and young adult age are needed to determine the long-term impact of extremely preterm birth.
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Affiliation(s)
- Betty R Vohr
- Neonatal Follow-up Program, Women and Infants Hospital, Alpert Medical School of Brown University, 101 Dudley Street, Providence, RI 02905, USA.
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98
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Huhtala M, Korja R, Lehtonen L, Haataja L, Lapinleimu H, Rautava P. Associations between parental psychological well-being and socio-emotional development in 5-year-old preterm children. Early Hum Dev 2014; 90:119-24. [PMID: 24418104 DOI: 10.1016/j.earlhumdev.2013.12.009] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Revised: 12/19/2013] [Accepted: 12/24/2013] [Indexed: 11/17/2022]
Abstract
BACKGROUND Preterm children are at risk for developing behavioral and emotional problems, as well as being less socially competent. Premature birth causes chronic distress in the parents. AIMS The aim of the paper is to discover whether parental psychological well-being is associated with the social, behavioral, and functional development of very low birth weight (VLBW, ≤1500g) children at 5years of age. STUDY DESIGN A longitudinal prospective cohort study. SUBJECTS A cohort of 201 VLBW infants (≤1500g, <37weeks of gestation) born during 2001-2006 in Turku University Hospital, Finland was studied. OUTCOME MEASURES At 4-year chronological age of their child, parents independently completed validated questionnaires (Beck Depression Inventory, Parenting Stress Index and Sense of Coherence Scale). At 5years, parents and day-care providers evaluated the development of the child by completing the Five to Fifteen questionnaire. RESULTS The parents of VLBW children reported significantly more problems in child development compared to the Finnish normative data. Depressive symptoms and weaker sense of coherence in mothers, but not in fathers, were associated with more problems in child development. Parenting stress, for both mothers and fathers, was associated with developmental problems in their child at 5years of age. CONCLUSIONS Maternal depressive symptoms and parenting stress of both parents may be risk factors for the social, behavioral, and functional development of 5-year-old preterm children. On the other hand, stronger maternal sense of coherence may be a protective factor.
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Affiliation(s)
- Mira Huhtala
- Department of Public Health, University of Turku, Turku, Finland; Department of Pediatrics, Turku University Hospital, Turku, Finland.
| | - Riikka Korja
- Department of Child Psychiatry, Turku University Hospital, Turku, Finland
| | - Liisa Lehtonen
- Department of Pediatrics, Turku University Hospital, Turku, Finland
| | - Leena Haataja
- Department of Pediatric Neurology, Turku University Hospital and University of Turku, Turku, Finland
| | | | - Päivi Rautava
- Turku Clinical Research Centre, Turku University Hospital, Turku, Finland; The Department of Public Health, University of Turku, Turku, Finland
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99
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Sex differences in behavioral outcome following neonatal hypoxia ischemia: insights from a clinical meta-analysis and a rodent model of induced hypoxic ischemic brain injury. Exp Neurol 2014; 254:54-67. [PMID: 24434477 DOI: 10.1016/j.expneurol.2014.01.003] [Citation(s) in RCA: 119] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Revised: 01/01/2014] [Accepted: 01/02/2014] [Indexed: 01/10/2023]
Abstract
Hypoxia ischemia (HI; reduced oxygen and/or blood flow to the brain) is one of the most common injuries among preterm infants and term infants with birth complications. Both populations show cognitive/behavioral deficits, including impairments in sensory, learning/memory, and attention domains. Clinical data suggests a sex difference in HI outcomes, with males exhibiting more severe cognitive/behavioral deficits relative to matched females. Our laboratory has also reported more severe behavioral deficits among male rats with induced HI relative to females with comparable injury (Hill et al., 2011a,b). The current study initially examined published clinical studies from the past 20years where long-term IQ outcome scores for matched groups of male and female premature infants were reported separately (IQ being the most common outcome measure). A meta-analysis revealed a female "advantage," as indicated by significantly better scores on performance and full scale IQ (but not verbal IQ) for premature females. We then utilized a rodent model of neonatal HI injury to assess sham and postnatal day 7 (P7) HI male and female rats on a battery of behavioral tasks. Results showed expected deficits in HI male rats, but also showed task-dependent sex differences, with HI males having significantly larger deficits than HI females on some tasks but equivalent deficits on other tasks. In contrast to behavioral results, post mortem neuropathology associated with HI was comparable across sex. These findings suggest: 1) neonatal female "protection" in some behavioral domains, as indexed by superior outcome following early injury relative to males; and 2) female protection may entail sex-specific plasticity or compensation, rather than a reduction in gross neuropathology. Further exploration of the mechanisms underlying this sex effect could aid in neuroprotection efforts for at-risk neonates in general, and males in particular. Moreover, our current report of comparable anatomical damage coupled with differences in cognitive outcomes (by sex) provides a framework for future studies to examine neural mechanisms underlying sex differences in cognition and behavior in general.
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100
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Gene-environment interactions in severe intraventricular hemorrhage of preterm neonates. Pediatr Res 2014; 75:241-50. [PMID: 24192699 PMCID: PMC3946468 DOI: 10.1038/pr.2013.195] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Accepted: 08/06/2013] [Indexed: 12/20/2022]
Abstract
Intraventricular hemorrhage (IVH) of the preterm neonate is a complex developmental disorder, with contributions from both the environment and the genome. IVH, or hemorrhage into the germinal matrix of the developing brain with secondary periventricular infarction, occurs in that critical period of time before the 32nd to 33rd wk postconception and has been attributed to changes in cerebral blood flow to the immature germinal matrix microvasculature. Emerging data suggest that genes subserving coagulation, inflammatory, and vascular pathways and their interactions with environmental triggers may influence both the incidence and severity of cerebral injury and are the subject of this review. Polymorphisms in the Factor V Leiden gene are associated with the atypical timing of IVH, suggesting an as yet unknown environmental trigger. The methylenetetrahydrofolate reductase (MTHFR) variants render neonates more vulnerable to cerebral injury in the presence of perinatal hypoxia. The present study demonstrates that the MTHFR 677C>T polymorphism and low 5-min Apgar score additively increase the risk of IVH. Finally, review of published preclinical data suggests the stressors of delivery result in hemorrhage in the presence of mutations in collagen 4A1, a major structural protein of the developing cerebral vasculature. Maternal genetics and fetal environment may also play a role.
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