51
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Schelonka RL, Carlo WA, Bauer CR, Peralta-Carcelen M, Phillips V, Helderman J, Navarrete CT, Moorman JR, Lake DE, Kattwinkel J, Fairchild KD, O’Shea TM. Mortality and Neurodevelopmental Outcomes in the Heart Rate Characteristics Monitoring Randomized Controlled Trial. J Pediatr 2020; 219:48-53. [PMID: 32033793 PMCID: PMC7096280 DOI: 10.1016/j.jpeds.2019.12.066] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 12/27/2019] [Accepted: 12/30/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To test whether the composite outcome of death or neurodevelopmental impairment (NDI) at 18-22 months corrected age for infants ≤1000 g at birth is decreased by continuous monitoring of heart rate characteristics during neonatal intensive care. STUDY DESIGN We studied a subset of participants enrolled in a multicenter randomized trial of heart rate characteristics monitoring. Survivors were evaluated at 18-22 months corrected age with a standardized neurologic examination and the Bayley Scales of Infant Development-III (BSID-III). NDI was defined as Gross Motor Function Classification System of >2 (moderate or severe cerebral palsy), BSID-III language or cognitive scores of <70, severe bilateral hearing impairment, and/or bilateral blindness. RESULTS The composite outcome, death or NDI, was obtained for 628 of 884 study infants (72%). The prevalence of this outcome was 44.4% (136/306) among controls (infants randomized to heart rate characteristics monitored but not displayed) and 38.9% (125/322) among infants randomized to heart rate characteristics monitoring displayed (relative risk, 0.87; 95% CI, 0.73-1.05; P = .17). Mortality was reduced from 32.0% (99/307) among controls to 24.8% (81/326) among monitoring displayed infants (relative risk, 0.75; 95% CI, 0.59 to 0.97; P = .028). The composite outcomes of death or severe CP and death or mildly low Bayley cognitive score occurred less frequently in the displayed group (P < .05). CONCLUSIONS We found no difference in the composite outcome of death or NDI for extremely preterm infants whose heart rate characteristics were and were not displayed during neonatal intensive care. Two outcomes that included mortality or a specific NDI were less frequent in the displayed group.
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Affiliation(s)
- Robert L Schelonka
- Department of Pediatrics, Division of Neonatology, Oregon Health and Science University, Portland, OR.
| | - Waldemar A Carlo
- University of Alabama at Birmingham, Birmingham, Alabama, United States
| | | | | | - Vivien Phillips
- University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Jennifer Helderman
- Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
| | | | | | - Douglas E Lake
- University of Virginia, Charlottesville, Virginia, United States
| | - John Kattwinkel
- University of Virginia, Charlottesville, Virginia, United States
| | | | - T Michael O’Shea
- University of North Carolina, Chapel Hill, North Carolina, United States
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52
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Erdei C, Austin NC, Cherkerzian S, Morris AR, Woodward LJ. Predicting School-Aged Cognitive Impairment in Children Born Very Preterm. Pediatrics 2020; 145:peds.2019-1982. [PMID: 32144122 DOI: 10.1542/peds.2019-1982] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/15/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Children born very preterm (VPT) are at high risk of cognitive impairment that impacts their educational and social opportunities. This study examined the predictive accuracy of assessments at 2, 4, 6, and 9 years in identifying preterm children with cognitive impairment by 12 years. METHODS We prospectively studied a regional cohort of 103 children born VPT (≤32 weeks' gestation) and 109 children born term from birth to corrected age 12 years. Cognitive functioning was assessed by using age-appropriate, standardized measures: Bayley Scales of Infant Development, Second Edition (age 2); Wechsler Preschool and Primary Scale of Intelligence (ages 4 and 6); and Wechsler Intelligence Scale for Children, Fourth Edition (ages 9 and 12). RESULTS By 12 years, children born VPT were more likely to have severe (odds ratio 3.9; 95% confidence interval 1.1-13.5) or any (odds ratio 3.2; 95% confidence interval 1.8-5.6) cognitive impairment compared with children born term. Adopting a severe cognitive impairment criterion at age 2 under-identified 44% of children born VPT with later severe impairment, whereas a more inclusive earlier criterion identified all severely affected children at 12 years. Prediction improved with age, with any delay at age 6 having the highest sensitivity (85%) and positive predictive value (66%) relative to earlier age assessments. Inclusion of family-social circumstances further improved diagnostic accuracy. CONCLUSIONS Cognitive risk prediction improves with age, with assessments at 6 years offering optimal diagnostic accuracy. Intervention for children with early mild delay may be beneficial, especially for those raised in socially disadvantaged family contexts.
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Affiliation(s)
- Carmina Erdei
- Brigham and Women's Hospital, Boston, Massachusetts; .,Department of Pediatrics, Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Nicola C Austin
- Christchurch Women's Hospital, Christchurch, New Zealand.,Department of Pediatrics, University of Otago, Christchurch, New Zealand
| | - Sara Cherkerzian
- Brigham and Women's Hospital, Boston, Massachusetts.,Department of Pediatrics, Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Alyssa R Morris
- Department of Psychology, University of Southern California, Los Angeles, California; and
| | - Lianne J Woodward
- School of Health Sciences, University of Canterbury, Christchurch, New Zealand
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53
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Socioeconomic status and brain injury in children born preterm: modifying neurodevelopmental outcome. Pediatr Res 2020; 87:391-398. [PMID: 31666689 DOI: 10.1038/s41390-019-0646-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 08/30/2019] [Accepted: 10/01/2019] [Indexed: 12/14/2022]
Abstract
Improved intensive care therapies have increased the survival of children born preterm. Yet, many preterm children experience long-term neurodevelopmental sequelae. Indeed, preterm birth remains a leading cause of lifelong neurodevelopmental disability globally, posing significant challenges to the child, family, and society. Neurodevelopmental disability in children born preterm is traditionally linked to acquired brain injuries such as white matter injury and to impaired brain maturation resulting from neonatal illness such as chronic lung disease. Socioeconomic status (SES) has long been recognized to contribute to variation in outcome in children born preterm. Recent brain imaging data in normative term-born cohorts suggest that lower SES itself predicts alterations in brain development, including the growth of the cerebral cortex and subcortical structures. Recent evidence in children born preterm suggests that the response to early-life brain injuries is modified by the socioeconomic circumstances of children and families. Exciting new data points to the potential of more favorable SES circumstances to mitigate the impact of neonatal brain injury. This review addresses emerging evidence suggesting that SES modifies the relationship between early-life exposures, brain injury, and neurodevelopmental outcomes in children born preterm. Better understanding these relationships opens new avenues for research with the ultimate goal of promoting optimal outcomes for those children born preterm at highest risk of neurodevelopmental consequence.
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54
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Maternal mental health and internalizing and externalizing psychopathology in extremely low birth weight adults. J Dev Orig Health Dis 2019; 11:632-639. [PMID: 31753052 DOI: 10.1017/s2040174419000771] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The mental health of adult extremely low birth weight (ELBW) (<1000 g) survivors is poorer than their normal birth weight (NBW) peers. An understanding of the modifiable factors that affect this risk could provide targets for intervention. We set out to determine the extent to which a maternal history of mental health problems influenced mental health in ELBW and NBW offspring in adulthood. A total of 85 ELBW and 88 NBW individuals born between 1977 and 1982 in central west Ontario, Canada self-reported on internalizing (depression, anxiety) and externalizing (attention-deficit hyperactivity and antisocial) problems using the Diagnostic and Statistical Manual of Mental Disorders (DSM) scales of the Young Adult Self-Report at ages 22-26 and 30-35. They also reported on their mother's maternal mental health using the Family History Screen. An interaction was found between birth weight status and maternal history of an anxiety disorder such that ELBW survivors showed a greater increase in internalizing scores than NBW participants at 22-26 (β = 10.27, p = 0.002) and at 30-35 years of age (β = 12.65, p = 0.002). An interaction was also observed between birth weight and maternal history of mood disorder, with higher externalizing scores in ELBW survivors than NBW adults at 22-26 (β = 7.21, p < 0.0001). ELBW adults appear to be more susceptible to the adverse mental health effects of exposure to maternal mood and anxiety disorders than those born at NBW. These links further highlight the importance of detecting and treating mental health problems in the parents of preterm survivors as a means of attempting to reduce the burden of psychopathology in this population.
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55
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De Carli A, Andresen B, Giovannella M, Durduran T, Contini D, Spinelli L, Weigel UM, Passera S, Pesenti N, Mosca F, Torricelli A, Fumagalli M, Greisen G. Cerebral oxygenation and blood flow in term infants during postnatal transition: BabyLux project. Arch Dis Child Fetal Neonatal Ed 2019; 104:F648-F653. [PMID: 31085677 DOI: 10.1136/archdischild-2018-316400] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 02/09/2019] [Accepted: 03/06/2019] [Indexed: 11/04/2022]
Abstract
OBJECTIVES A new device that combines, for the first time, two photonic technologies (time-resolved near-infrared spectroscopy and diffuse correlation spectroscopy) was provided and tested within the BabyLux project. Aim was to validate the expected changes in cerebral oxygenation and blood flow. METHODS A pulse oximeter and the BabyLux device were held in place (right hand/wrist and frontoparietal region, respectively) for 10 min after birth in healthy term infants delivered by elective caesarean section. Pulse oximeter saturation (SpO2), cerebral tissue oxygen saturation (StO2) and blood flow index (BFI) were measured over time. Tissue oxygen extraction (TOE) and cerebral metabolic rate of oxygen index (CMRO2I) were calculated. RESULTS Thirty infants were enrolled in two centres. After validity check of data, 23% of infants were excluded from TOE and CMRO2I calculation due to missing data. As expected, SpO2 (estimate 3.05 %/min; 95% CI 2.78 to 3.31 %/min) and StO2 (estimate 3.95 %/min; 95% CI 3.63 to 4.27 %/min) increased in the first 10 min after birth, whereas BFI (estimate -2.84×10-9 cm2/s/min; 95% CI -2.50×10-9 to -3.24×10-9 cm2/s/min) and TOE (estimate -0.78 %/min; 95% CI -1.12 to -0.45 %/min) decreased. Surprisingly, CMRO2I decreased (estimate -7.94×10-8/min; 95% CI -6.26×10-8 to -9.62×10-8/min). CONCLUSIONS Brain oxygenation and BFI during transition were successfully and simultaneously obtained by the BabyLux device; no adverse effects were recorded, and the BabyLux device did not limit the standard care. The preliminary results from clinical application of the BabyLux device are encouraging in terms of safety and feasibility; they are consistent with previous reports on brain oxygenation during transition, although the interpretation of the decreasing CMRO2I remains open. TRIAL REGISTRATION NUMBER NCT02815618.
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Affiliation(s)
- Agnese De Carli
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico-Neonatal Intensive Care Unit, Milan, Italy
| | - Björn Andresen
- Department of Neonatology, Rigshospitalet, Copenhagen, Denmark
| | - Martina Giovannella
- ICFO, Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Barcelona, Spain
| | - Turgut Durduran
- ICFO, Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Barcelona, Spain.,Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain
| | - Davide Contini
- Dipartimento di Fisica, Politecnico di Milano, Milan, Italy
| | - Lorenzo Spinelli
- Istituto di Fotonica e Nanotecnologie, Consiglio Nazionale delle Ricerche, Milan, Italy
| | | | - Sofia Passera
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico-Neonatal Intensive Care Unit, Milan, Italy
| | - Nicola Pesenti
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico-Neonatal Intensive Care Unit, Milan, Italy
| | - Fabio Mosca
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico-Neonatal Intensive Care Unit, Milan, Italy.,University of Milan - Department of Clinical Sciences and Community Health, Milan, Italy
| | - Alessandro Torricelli
- Dipartimento di Fisica, Politecnico di Milano, Milan, Italy.,Istituto di Fotonica e Nanotecnologie, Consiglio Nazionale delle Ricerche, Milan, Italy
| | - Monica Fumagalli
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico-Neonatal Intensive Care Unit, Milan, Italy.,University of Milan - Department of Clinical Sciences and Community Health, Milan, Italy
| | - Gorm Greisen
- Department of Neonatology, Rigshospitalet, Copenhagen, Denmark
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56
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Jansen L, Peeters-Scholte C, Bruine SWD, van den Berg-Huysmans A, van Klink J, van Steenis A, Rijken M, Vermeiren R, Steggerda S. Classroom-evaluated school performance at nine years of age after very preterm birth. Early Hum Dev 2019; 140:104834. [PMID: 31671378 DOI: 10.1016/j.earlhumdev.2019.104834] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 08/13/2019] [Accepted: 08/13/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To determine classroom-evaluated school performance nine years after preterm birth, predicted by perinatal risk factors and neonatal brain abnormalities. STUDY DESIGN Children were recruited from a consecutive cohort of 113 preterm infants (<32 weeks' gestation), participating in a longitudinal prospective study, investigating brain injury and neurodevelopmental outcome. Data on perinatal risk factors, presence of brain injury at term-equivalent age, and maternal education were collected. Information on school performance included enrollment in special (primary) education, grade repetition and school results from the nationwide standardized Dutch Pupil Monitoring System regarding reading comprehension, spelling, and mathematics. RESULTS Information on school enrollment was available for 87 children (77%), of whom 7 (8%) were in special primary education and 19 (22%) repeated a grade. This was significantly higher compared to national rates (p ≤ .05). Results on school performance were available for 74 children (65%) and showed clearly below average scores in reading comprehension (p = .006), spelling (p = .014) and mathematics (p < .001). Univariate analysis showed that lower performance in reading comprehension was predicted by male sex and low maternal education; spelling by male sex; and mathematics by Bronchopulmonary Dysplasia, white matter injury and maternal education. In a multivariate model, male sex and maternal education were predictive for reading comprehension and white matter injury for mathematics. CONCLUSION Preterm born children more often need special primary education and have higher grade repeat rates. They perform poorer on reading comprehension, spelling and mathematics. Regular follow-up remains important for preterm born children during school age.
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Affiliation(s)
- Lisette Jansen
- Department of Medical Psychology, Leiden University Medical Center, the Netherlands.
| | | | | | | | - Jeanine van Klink
- Department of Medical Psychology, Leiden University Medical Center, the Netherlands
| | - Andrea van Steenis
- Department of Neonatology, Leiden University Medical Center, the Netherlands
| | - Monique Rijken
- Department of Neonatology, Leiden University Medical Center, the Netherlands
| | - Robert Vermeiren
- Department of Child and Adolescent Psychiatry, University Medical Center, Curium, Leiden, the Netherlands
| | - Sylke Steggerda
- Department of Neonatology, Leiden University Medical Center, the Netherlands
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57
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Lind A, Nyman A, Lehtonen L, Haataja L. Predictive value of psychological assessment at five years of age in the long-term follow-up of very preterm children. Child Neuropsychol 2019; 26:312-323. [DOI: 10.1080/09297049.2019.1674267] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Annika Lind
- Department of Psychology, University of Turku, Turku, Finland
- Turku Institute for Advanced Studies (TIAS), University of Turku, Turku, Finland
| | - Anna Nyman
- Department of Psychology, University of Turku, Turku, Finland
| | - Liisa Lehtonen
- Department of Pediatrics, University of Turku and Turku University Hospital, Turku, Finland
| | - Leena Haataja
- Children’s Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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58
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Sejer EPF, Bruun FJ, Slavensky JA, Mortensen EL, Schiøler Kesmodel U. Impact of gestational age on child intelligence, attention and executive function at age 5: a cohort study. BMJ Open 2019; 9:e028982. [PMID: 31501108 PMCID: PMC6738700 DOI: 10.1136/bmjopen-2019-028982] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Preterm birth can affect cognition, but other factors including parental education and intelligence may also play a role, but few studies have adjusted for these potential confounders. We aimed to assess the impact of gestational age (GA), late preterm birth (34 to <37 weeks GA) and very to moderately preterm birth (<34 weeks GA) on intelligence, attention and executive function in a population of Danish children aged 5 years. DESIGN Population-based prospective cohort study. SETTING Denmark 2003-2008. PARTICIPANTS A cohort of 1776 children and their mothers sampled from the Danish National Birth Cohort with information on GA, family and background factors and completed neuropsychological assessment at age 5. PRIMARY OUTCOME MEASURES Wechsler Preschool and Primary Scale of Intelligence-Revised, Test of Everyday Attention for Children at Five and Behaviour Rating Inventory of Executive Function scores. RESULTS For preterm birth <34 weeks GA (n=8), the mean difference in full-scale intelligence quotient(IQ) was -10.6 points (95% CI -19.4 to -1.8) when compared with the term group ≥37 weeks GA (n=1728), and adjusted for potential confounders. For the teacher-assessed Global Executive Composite, the mean difference was 5.3 points (95% CI 2.4 to 8.3) in the adjusted analysis, indicating more executive function difficulties in the preterm group <34 weeks GA compared with the term group. Maternal intelligence and parental education were weak confounders. No associations between late preterm birth 34 to <37 weeks GA (n=40) and poor cognition were shown. CONCLUSIONS This study showed substantially lower intelligence and poorer executive function in children born <34 weeks GA compared with children born at term. GA may play an important role in determining cognitive abilities independent of maternal intelligence and parental education. Studies with larger sample sizes are needed to confirm these findings, as the proportion of children born preterm in this study population was small.
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Affiliation(s)
| | - Frederik Jager Bruun
- Department of Obstetrics and Gynaecology, Herlev University Hospital, Herlev, Denmark
| | - Julie Anna Slavensky
- Department of Obstetrics and Gynaecology, Herlev University Hospital, Herlev, Denmark
| | - Erik Lykke Mortensen
- Unit of Medical Psychology, Department of Public Health and Center for Healthy Ageing, University of Copenhagen, Copenhagen, Denmark
| | - Ulrik Schiøler Kesmodel
- Department of Obstetrics and Gynaecology, Herlev University Hospital, Herlev, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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59
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Protective effects of delayed intraventricular TLR7 agonist administration on cerebral white and gray matter following asphyxia in the preterm fetal sheep. Sci Rep 2019; 9:9562. [PMID: 31267031 PMCID: PMC6606639 DOI: 10.1038/s41598-019-45872-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 06/13/2019] [Indexed: 01/08/2023] Open
Abstract
Preterm brain injury is highly associated with inflammation, which is likely related in part to sterile responses to hypoxia-ischemia. We have recently shown that neuroprotection with inflammatory pre-conditioning in the immature brain is associated with induction of toll-like receptor 7 (TLR7). We therefore tested the hypothesis that central administration of a synthetic TLR7 agonist, gardiquimod (GDQ), after severe hypoxia-ischemia in preterm-equivalent fetal sheep would improve white and gray matter recovery. Fetal sheep at 0.7 of gestation received sham asphyxia or asphyxia induced by umbilical cord occlusion for 25 minutes, followed by a continuous intracerebroventricular infusion of GDQ or vehicle from 1 to 4 hours (total dose 1.8 mg/kg). Sheep were killed 72 hours after asphyxia for histology. GDQ significantly improved survival of immature and mature oligodendrocytes (2′,3′-cyclic-nucleotide 3′-phosphodiesterase, CNPase) and total oligodendrocytes (oligodendrocyte transcription factor 2, Olig-2) within the periventricular and intragyral white matter. There were reduced numbers of cells showing cleaved caspase-3 positive apoptosis and astrogliosis (glial fibrillary acidic protein, GFAP) in both white matter regions. Neuronal survival was increased in the dentate gyrus, caudate and medial thalamic nucleus. Central infusion of GDQ was associated with a robust increase in fetal plasma concentrations of the anti-inflammatory cytokines, interferon-β (IFN-β) and interleukin-10 (IL-10), with no significant change in the concentration of the pro-inflammatory cytokine, tumor necrosis factor-α (TNF-α). In conclusion, delayed administration of the TLR7 agonist, GDQ, after severe hypoxia-ischemia in the developing brain markedly ameliorated white and gray matter damage, in association with upregulation of anti-inflammatory cytokines. These data strongly support the hypothesis that modulation of secondary inflammation may be a viable therapeutic target for injury of the preterm brain.
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60
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Singh R, Douglass LM, O’Shea TM, Stafstrom CE, Allred EN, Engelke S, Shah B, Leviton A, Hereen TC, Kuban KCK. Antecedents of epilepsy and seizures among children born at extremely low gestational age. J Perinatol 2019; 39:774-783. [PMID: 30918341 PMCID: PMC7216413 DOI: 10.1038/s41372-019-0355-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 02/18/2019] [Accepted: 02/21/2019] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To identify specific risk factors for epilepsy for individuals born extremely preterm. STUDY DESIGN In a prospective cohort study, at 10-year follow-up, children were classified as having epilepsy or seizures not associated with epilepsy. We evaluated for association of perinatal factors using time-oriented, multinomial logistic regression models. RESULTS Of the 888 children included in the study, 66 had epilepsy and 39 had seizures not associated with epilepsy. Epilepsy was associated with an indicator of low socioeconomic status, maternal gestational fever, early physiologic instability, postnatal exposure to hydrocortisone, cerebral white matter disease and severe bronchopulmonary dysplasia. Seizure without epilepsy was associated with indicators of placental infection and inflammation, and hypoxemia during the first 24 postnatal hours. CONCLUSIONS In children born extremely preterm, epilepsy and seizures not associated with epilepsy have different risk profiles. Though both profiles included indicators of infection and inflammation, the profile of risk factors for epilepsy included multiple indicators of endogenous vulnerability.
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Affiliation(s)
| | - Laurie M. Douglass
- Department of Pediatrics, Division of Pediatric Neurology, Boston Medical Center and Boston University School of Medicine, Boston, MA
| | | | - Carl E. Stafstrom
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Elizabeth N. Allred
- Neuroepidemiology Unit, Department of Neurology, Boston Children’s Hospital, Boston, MA,Department of Neurology, Harvard Medical School, Boston, MA
| | - Stephen Engelke
- Department of Pediatrics, East Carolina University Brody School of Medicine, Greenville, NC
| | | | - Alan Leviton
- Neuroepidemiology Unit, Department of Neurology, Boston Children’s Hospital, Boston, MA,Department of Neurology, Harvard Medical School, Boston, MA
| | - Timothy C. Hereen
- Department of Pediatrics, Division of Pediatric Neurology, Boston Medical Center and Boston University School of Medicine, Boston, MA
| | - Karl C. K. Kuban
- Department of Pediatrics, Division of Pediatric Neurology, Boston Medical Center and Boston University School of Medicine, Boston, MA
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61
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Leviton A, Joseph RM, Fichorova RN, Allred EN, Gerry Taylor H, Michael O'Shea T, Dammann O. Executive Dysfunction Early Postnatal Biomarkers among Children Born Extremely Preterm. J Neuroimmune Pharmacol 2019; 14:188-199. [PMID: 30191383 PMCID: PMC6401360 DOI: 10.1007/s11481-018-9804-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Accepted: 08/16/2018] [Indexed: 01/12/2023]
Abstract
We evaluated the relationship between blood levels of inflammatory and neurotrophic proteins during the first postnatal month in 692 children born before the 28th week of gestation and executive function limitations among those 10-year olds who had an IQ ≥ 70. The measures of dysfunction were Z-scores ≤ -1 on the Differential Ability Scales-II working memory (WM) assessment) (N = 164), the NEPSY-II (A Developmental NEuroPSYchological Assessment-II) Inhibition-Inhibition assessment) (N = 350), the NEPSY-II Inhibition-Switching assessment) (N = 345), as well as a Z-score ≤ -1 on all three assessments (identified as the executive dysfunction composite (N = 104). Increased risks of the executive dysfunction composite associated with high concentrations of inflammatory proteins (IL-8, TNF-α, and ICAM-1) were modulated by high concentrations of neurotrophic proteins. This pattern of modulation by neurotrophins of increased risk associated with inflammation was also seen for the working memory limitation, but only with high concentrations of IL-8 and TNF-α, and the switching limitation, but only with high concentrations of ICAM-1. We infer that among children born extremely preterm, risks of executive function limitations might be explained by perinatal systemic inflammation in the absence of adequate neurotrophic capability.
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Affiliation(s)
- Alan Leviton
- Boston Children's Hospital and Harvard Medical School, Boston, MA, 02115-5724, USA.
| | | | - Raina N Fichorova
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02115, USA
| | - Elizabeth N Allred
- Boston Children's Hospital and Harvard Medical School, Boston, MA, 02115-5724, USA
| | - H Gerry Taylor
- Rainbow Babies & Children's Hospital and Case Western Reserve University, Cleveland, OH, USA
| | - T Michael O'Shea
- University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Olaf Dammann
- Tufts University School of Medicine, Boston, MA, 02111, USA
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62
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Benavente-Fernández I, Synnes A, Grunau RE, Chau V, Ramraj C, Glass T, Cayam-Rand D, Siddiqi A, Miller SP. Association of Socioeconomic Status and Brain Injury With Neurodevelopmental Outcomes of Very Preterm Children. JAMA Netw Open 2019; 2:e192914. [PMID: 31050776 PMCID: PMC6503490 DOI: 10.1001/jamanetworkopen.2019.2914] [Citation(s) in RCA: 109] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
IMPORTANCE Studies of socioeconomic status and neurodevelopmental outcome in very preterm neonates have not sensitively accounted for brain injury. OBJECTIVE To determine the association of brain injury and maternal education with motor and cognitive outcomes at age 4.5 years in very preterm neonates. DESIGN, SETTING, AND PARTICIPANTS Prospective cohort study of preterm neonates (24-32 weeks' gestation) recruited August 16, 2006, to September 9, 2013, at British Columbia Women's Hospital in Vancouver, Canada. Analysis of 4.5-year outcome was performed in 2018. MAIN OUTCOMES AND MEASURES At age 4.5 years, full-scale IQ assessed using the Wechsler Primary and Preschool Scale of Intelligence, Fourth Edition, and motor outcome by the percentile score on the Movement Assessment Battery for Children, Second Edition. RESULTS Of 226 survivors, neurodevelopmental outcome was assessed in 170 (80 [47.1%] female). Based on the best model to assess full-scale IQ accounting for gestational age, standardized β coefficients demonstrated the effect size of maternal education (standardized β = 0.21) was similar to that of white matter injury volume (standardized β = 0.23) and intraventricular hemorrhage (standardized β = 0.23). The observed and predicted cognitive scores in preterm children born to mothers with postgraduate education did not differ in those with and without brain injury. The best-performing model to assess for motor outcome accounting for gestational age included being small for gestational age, severe intraventricular hemorrhage, white matter injury volume, and chronic lung disease. CONCLUSIONS AND RELEVANCE At preschool age, cognitive outcome was comparably associated with maternal education and neonatal brain injury. The association of brain injury with poorer cognition was attenuated in children born to mothers of higher education level, suggesting opportunities to promote optimal outcomes.
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Affiliation(s)
- Isabel Benavente-Fernández
- Department of Pediatrics (Neurology), The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics (Neurology), University of Toronto, Toronto, Ontario, Canada
- Department of Pediatrics (Neonatology), University Hospital Puerta del Mar, Cadiz, Spain
| | - Anne Synnes
- British Columbia Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Ruth E. Grunau
- British Columbia Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Vann Chau
- Department of Pediatrics (Neurology), The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics (Neurology), University of Toronto, Toronto, Ontario, Canada
| | - Chantel Ramraj
- Department of Pediatrics (Neonatology), University of British Columbia, British Columbia Women's Hospital and Health Centre, Vancouver, British Columbia, Canada
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Torin Glass
- Department of Pediatrics (Neurology), The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics (Neurology), University of Toronto, Toronto, Ontario, Canada
| | - Dalit Cayam-Rand
- Department of Pediatrics (Neurology), The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics (Neurology), University of Toronto, Toronto, Ontario, Canada
| | - Arjumand Siddiqi
- Department of Pediatrics (Neonatology), University of British Columbia, British Columbia Women's Hospital and Health Centre, Vancouver, British Columbia, Canada
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Steven P. Miller
- Department of Pediatrics (Neurology), The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics (Neurology), University of Toronto, Toronto, Ontario, Canada
- Department of Pediatrics (Neonatology), University Hospital Puerta del Mar, Cadiz, Spain
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63
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Pecheva D, Tournier JD, Pietsch M, Christiaens D, Batalle D, Alexander DC, Hajnal JV, Edwards AD, Zhang H, Counsell SJ. Fixel-based analysis of the preterm brain: Disentangling bundle-specific white matter microstructural and macrostructural changes in relation to clinical risk factors. Neuroimage Clin 2019; 23:101820. [PMID: 30991305 PMCID: PMC6462822 DOI: 10.1016/j.nicl.2019.101820] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 04/05/2019] [Accepted: 04/07/2019] [Indexed: 12/13/2022]
Abstract
Diffusion MRI (dMRI) studies using the tensor model have identified abnormal white matter development associated with perinatal risk factors in preterm infants studied at term equivalent age (TEA). However, this model is an oversimplification of the underlying neuroanatomy. Fixel-based analysis (FBA) is a novel quantitative framework, which identifies microstructural and macrostructural changes in individual fibre populations within voxels containing crossing fibres. The aim of this study was to apply FBA to investigate the relationship between fixel-based measures of apparent fibre density (FD), fibre bundle cross-section (FC), and fibre density and cross-section (FDC) and perinatal risk factors in preterm infants at TEA. We studied 50 infants (28 male) born at 24.0-32.9 (median 30.4) weeks gestational age (GA) and imaged at 38.6-47.1 (median 42.1) weeks postmenstrual age (PMA). dMRI data were acquired in non-collinear directions with b-value 2500 s/mm2 on a 3 Tesla system sited on the neonatal intensive care unit. FBA was performed to assess the relationship between FD, FC, FDC and PMA at scan, GA at birth, days on mechanical ventilation, days on total parenteral nutrition (TPN), birthweight z-score, and sex. FBA reveals fibre population-specific alterations in FD, FC and FDC associated with clinical risk factors. FD was positively correlated with GA at birth and was negatively correlated with number of days requiring ventilation. FC was positively correlated with GA at birth, birthweight z-scores and was higher in males. FC was negatively correlated with number of days on ventilation and days on TPN. FDC was positively correlated with GA at birth and birthweight z-scores, negatively correlated with days on ventilation and days on TPN and higher in males. We demonstrate that these relationships are fibre-specific even within regions of crossing fibres. These results show that aberrant white matter development involves both microstructural changes and macrostructural alterations.
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Affiliation(s)
- Diliana Pecheva
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King''s College London, UK
| | - J-Donald Tournier
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King''s College London, UK
| | - Maximilian Pietsch
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King''s College London, UK
| | - Daan Christiaens
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King''s College London, UK
| | - Dafnis Batalle
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King''s College London, UK; Sackler Institute for Translational Neurodevelopment, Department of Forensic and Neurodelopmental Science, Institute of Psychiatry, Psychology & Neuroscience, King''s College London, UK
| | - Daniel C Alexander
- Department of Computer Science and Centre for Medical Image Computing, University College London, UK
| | - Joseph V Hajnal
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King''s College London, UK
| | - A David Edwards
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King''s College London, UK
| | - Hui Zhang
- Department of Computer Science and Centre for Medical Image Computing, University College London, UK
| | - Serena J Counsell
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King''s College London, UK.
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64
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Carrasco M, Stafstrom CE. How Early Can a Seizure Happen? Pathophysiological Considerations of Extremely Premature Infant Brain Development. Dev Neurosci 2019; 40:417-436. [PMID: 30947192 DOI: 10.1159/000497471] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 02/04/2019] [Indexed: 11/19/2022] Open
Abstract
Seizures in neonates represent a neurologic emergency requiring prompt recognition, determination of etiology, and treatment. Yet, the definition and identification of neonatal seizures remain challenging and controversial, in part due to the unique physiology of brain development at this life stage. These issues are compounded when considering seizures in premature infants, in whom the complexities of brain development may engender different clinical and electrographic seizure features at different points in neuronal maturation. In extremely premature infants (< 28 weeks gestational age), seizure pathophysiology has not been explored in detail. This review discusses the physiological and structural development of the brain in this developmental window, focusing on factors that may lead to seizures and their consequences at this early time point. We hypothesize that the clinical and electrographic phenomenology of seizures in extremely preterm infants reflects the specific pathophysiology of brain development in that age window.
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Affiliation(s)
- Melisa Carrasco
- Division of Pediatric Neurology, Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Carl E Stafstrom
- Division of Pediatric Neurology, Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA,
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65
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"STEP", an early developmental screening tool that predicts one-year outcomes. J Perinatol 2019; 39:153-155. [PMID: 30546059 DOI: 10.1038/s41372-018-0293-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 11/19/2018] [Accepted: 11/27/2018] [Indexed: 11/08/2022]
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66
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Ireland S, Larkins S, Ray R, Woodward L, Devine K. Adequacy of antenatal steroids, rather than place of birth, determines survival to discharge in extreme prematurity in North Queensland. J Paediatr Child Health 2019; 55:205-212. [PMID: 30151906 DOI: 10.1111/jpc.14184] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 06/24/2018] [Accepted: 07/08/2018] [Indexed: 12/26/2022]
Abstract
AIM The Townsville Hospital cares for babies in a large geographical area, many of who are outborn, are of Aboriginal or Torres Strait Islander origin and have families who reside in areas of deprivation. This study examined the outcomes of babies born at all locations in North Queensland to assess the predictors of poor outcomes. METHODS A retrospective observational study examined the survival of 313 babies born from 22 completed weeks gestation to 27 + 6 weeks gestation in North Queensland between January 2010 and December 2016. Additional analyses were performed for the 300 non-syndromal babies whose mothers usually resided in North Queensland, studying demographics of gestation, gender, birthweight, Indigenous status, regionality of maternal residence and adequacy of antenatal steroids. Short-term morbidities of intraventricular haemorrhage/periventricular leukomalacia (IVH/PVL), surgical necrotizing enterocolitis, retinopathy of prematurity requiring treatment and chronic lung disease and death were studied in relation to demographic factors and clinical treatment. RESULTS Adequacy of steroids was significantly associated with a decreased mortality odds ratio of 2.872 (95% confidence interval 1.228-6.715), whilst no difference in outcome was seen by retrieval status or ethnic origin. Babies from remote locations were at increased risk for IVH/PVL, 2.334 (1.037-5.255). Male babies suffered more chronic lung disease, 1.608 (1.010-2.561), and IVH/PVL, 2.572 (1.215-5.445). Aboriginal and Torres Strait Islander babies were at lower risk of IVH/PVL. CONCLUSIONS Steroids should be administered wherever there is any possibility of the provision of intensive care for periviable babies. Place of birth and ethnicity of mother should not unduly influence antenatal counselling.
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Affiliation(s)
- Susan Ireland
- Neonatal Unit, The Townsville Hospital, Townsville, Queensland, Australia
| | - Sarah Larkins
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Robin Ray
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Lynn Woodward
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Kirsty Devine
- The Neonatal Unit, Mater Mothers Hospital, Brisbane, Queensland, Australia
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67
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Kodric J, Sustersic B, Paro-Panjan D. Psychosocial functioning in adolescents: results according to Amiel-Tison neurological assessment in a group of preterm infants. Dev Neurorehabil 2019; 22:47-52. [PMID: 29400610 DOI: 10.1080/17518423.2018.1434699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE This prospective study investigated the relationship between Amiel-Tison neurological assessment (ATNA) in preterm children and their psychosocial functioning in adolescence. METHODS From the initial group of 45 children regularly assessed by the ATNA from term until the age of 2 years, 27 participated in the follow-up at 13 years. RESULTS Of the three groups categorized by neurological signs as normal, intermediate or abnormal, parents of adolescents with normal ATNA reported the lowest number of executive function problems (p = 0.019) and behavioral symptoms (p = 0.011), while the adolescents themselves reported the lowest number of behavioral symptoms (p = 0.005) and the highest quality of life (p = 0.012). The number of problems reported increased with the number of abnormal neurological signs. CONCLUSION Standardized neurological assessment may be a helpful clinical tool for the identification of children at risk for later psychosocial problems who could benefit from prevention and early intervention programs.
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Affiliation(s)
- Jana Kodric
- a University Medical Center Ljubljana , Division of Pediatrics , Ljubljana , Slovenia
| | - Breda Sustersic
- b Developmental Department , Health Center Domzale , Domzale , Slovenia
| | - Darja Paro-Panjan
- a University Medical Center Ljubljana , Division of Pediatrics , Ljubljana , Slovenia
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68
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Abstract
Despite the advances in neonatal intensive care, the preterm brain remains vulnerable to white matter injury (WMI) and disruption of normal brain development (i.e., dysmaturation). Compared to severe cystic WMI encountered in the past decades, contemporary cohorts of preterm neonates experience milder WMIs. More than destructive lesions, disruption of the normal developmental trajectory of cellular elements of the white and the gray matter occurs. In the acute phase, in response to hypoxia-ischemia and/or infection and inflammation, multifocal areas of necrosis within the periventricular white matter involve all cellular elements. Later, chronic WMI is characterized by diffuse WMI with aberrant regeneration of oligodendrocytes, which fail to mature to myelinating oligodendrocytes, leading to myelination disturbances. Complete neuronal degeneration classically accompanies necrotic white matter lesions, while altered neurogenesis, represented by a reduction of the dendritic arbor and synapse formation, is observed in response to diffuse WMI. Neuroimaging studies now provide more insight in assessing both injury and dysmaturation of both gray and white matter. Preterm brain injury remains an important cause of neurodevelopmental disabilities, which are still observed in up to 50% of the preterm survivors and take the form of a complex combination of motor, cognitive, and behavioral concerns.
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Affiliation(s)
- Juliane Schneider
- Department of Woman-Mother-Child, Clinic of Neonatology, University Hospital Center and University of Lausanne, Lausanne, Switzerland
| | - Steven P Miller
- Division of Neurology and Centre for Brain and Mental Health, Hospital for Sick Children, Toronto, ON, Canada.
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69
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Ziegler EE. Human Milk-A Valuable Tool in the Early Days of Life of Premature Infants. Front Pediatr 2019; 7:266. [PMID: 31338351 PMCID: PMC6629769 DOI: 10.3389/fped.2019.00266] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Accepted: 06/12/2019] [Indexed: 12/05/2022] Open
Abstract
The objective of early premature infant nutrition is to maintain, during the turbulent early days of life, a flow of nutrients that differs only minimally from that which would have prevailed had the infant remained in utero. Out of necessity, nutrients have at first to be provided mainly via the parenteral route. While that is going on, the feeding of small amounts of human milk (gut priming) is initiated as soon as practical. As mother's own milk is not available in sufficient quantity at this time, donor milk needs to be used temporarily. If not available, formula should be used. Gastric residuals are physiologic at this stage and are monitored to guide the increase of the size of feedings. As the volume of milk is gradually increased, nutrient fortification is initiated when the milk volume reaches around 20 ml/kg/day. There is no need to start with less than full-strength fortification. Fortification should employ one of the liquid fortifiers. Adjustable fortification may be employed but is labor-intensive and is not a necessity as long as full feeding volumes of around 170 ml/kg/day are maintained. As the infant grows beyond 1,500 g the level of fortification can be reduced gradually by omitting fortification first from one, and then from more feedings. After discharge there is still a need for fortification, which requires the mother to express some of her milk so it can be fortified. Nutrient supplementation directly to the infant would obviate the need for milk expression.
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Affiliation(s)
- Ekhard E Ziegler
- The University of Iowa, Iowa City, IA, United States.,Department of Pediatrics, University of Iowa, Iowa City, IA, United States
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70
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Leijon I, Ingemansson F, Nelson N, Samuelsson S, Wadsby M. Children with a very low birthweight showed poorer reading skills at eight years of age but caught up in most areas by the age of 10. Acta Paediatr 2018; 107:1937-1945. [PMID: 29706015 DOI: 10.1111/apa.14377] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 03/13/2018] [Accepted: 04/23/2018] [Indexed: 11/30/2022]
Abstract
AIM We evaluated the development of reading skills in very low birthweight (VLBW) children and controls at 8-10 years of age. METHODS This study was part of a longitudinal study of VLBW infants born between January 1998 and December 1999 in Sweden. We recruited 49 VLBW children and 44 sex and age-matched full-term controls when they started school at the age of seven and tested them using identical methods for decoding, rapid naming ability, reading comprehension, and spelling and cognitive skills at about eight and 10 years of age. Univariate analysis of variance was performed to assess the effects of VLBW on reading performance at each age and to evaluate the differences between the groups and ages. RESULTS Very low birthweight children scored significantly lower in all domains of reading at 7.8 ± 0.3 years, but the performance gap had narrowed by 9.8 ± 0.3 years. Significant catch-up gains were found in phonological awareness, rapid naming ability and reading comprehension. The differences between the groups were minor at 10 years, when controlled for non-verbal cognition. CONCLUSION Very low birthweight children demonstrated worse reading performance at eight years of age than term-born controls. The gap in reading skills between the groups had largely narrowed two years later.
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Affiliation(s)
- Ingemar Leijon
- Department of Clinical and Experimental Medicine; Division of Children's and Women's Health; Linköping University; Linköping Sweden
| | - Fredrik Ingemansson
- Department of Clinical and Experimental Medicine; Division of Children's and Women's Health; Linköping University; Linköping Sweden
- Department of Paediatrics; Ryhov County Hospital; Jönköping County Council; Jonkoping Sweden
| | - Nina Nelson
- Department of Clinical and Experimental Medicine; Division of Children's and Women's Health; Linköping University; Linköping Sweden
- Department of Quality and Patient Safety; Karolinska University Hospital; Stockholm Sweden
| | - Stefan Samuelsson
- Department of Behavioural Sciences and Learning; Linköping University; Linköping Sweden
| | - Marie Wadsby
- Department of Clinical and Experimental Medicine; Department of Child and Adolescent Psychiatry; Linköping University; Linköping Sweden
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71
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Linthavong O, O'Shea TM, Allred E, Perrin E, Bauserman M, Joseph RM, Leviton A, Heeren TC, Kuban KCK. Neurocognitive and Health Correlates of Overweight and Obesity among Ten-Year-Old Children Born Extremely Preterm. J Pediatr 2018; 200:84-90.e4. [PMID: 29960765 PMCID: PMC6109604 DOI: 10.1016/j.jpeds.2018.05.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 04/10/2018] [Accepted: 05/08/2018] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To assess the relationship between overweight (body mass index [BMI] percentile ≥85 and <95) and obesity (BMI ≥95 percentile) and developmental and health outcomes at 10 years of age in a cohort of individuals born extremely preterm. STUDY DESIGN This was an observational cohort study of children born extremely preterm and then assessed at age 10 years for neurocognitive function and parent-reported behavior and health outcomes. Participants included 871 children aged 10 years. To describe the strength of association between overweight or obesity and outcomes, we used logistic regression models adjusting for confounders. Neurocognitive function, academic achievement, parent-reported health outcome surveys, and height and weight were measured. RESULTS BMI category at 10 years of age was not associated with differences in intelligence, language, or academic achievement. Parents of children with obesity were more likely to report their child had asthma (OR 2.2; 95% CI 1.4-3.5), fair/poor general health (OR 3.2; 95% CI 1.4-7.5), and decreased physical function (OR 1.7; 95% CI 1.1-2.9) but less likely to have physician diagnosed attention-deficit/hyperactivity disorder (OR 0.5; 95% CI 0.3-0.97) or an individualized education plan (OR 0.6; 95% CI 0.4-0.99). CONCLUSION Among children born extremely preterm, an elevated BMI, compared with normal or low BMI, is not associated with a difference in neurocognitive function. However, asthma, fair/poor general health, and decreased physical function were more prevalent among study participants with obesity, and attention-deficit/hyperactivity disorder and individualized education plan were less prevalent.
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Affiliation(s)
- Olivia Linthavong
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, University of North Carolina, Chapel Hill, NC.
| | - T Michael O'Shea
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, University of North Carolina, Chapel Hill, NC
| | | | - Eliana Perrin
- Department of Pediatrics and Duke Center for Childhood Obesity Research, Duke University, Durham, NC
| | - Melissa Bauserman
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, University of North Carolina, Chapel Hill, NC
| | - Robert M Joseph
- Department of Anatomy & Neurobiology, Boston University School of Medicine, Boston, MA
| | - Alan Leviton
- Department of Neurology, Harvard University, Boston, MA
| | | | - Karl C K Kuban
- Department of Child Neurology, Boston University, Boston, MA
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72
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Burnett AC, Cheong JLY, Doyle LW. Biological and Social Influences on the Neurodevelopmental Outcomes of Preterm Infants. Clin Perinatol 2018; 45:485-500. [PMID: 30144851 DOI: 10.1016/j.clp.2018.05.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Although very preterm birth and very low birthweight are recognized risk factors for longer term developmental difficulties, there is a wide spectrum of outcomes for children and adolescents born preterm. Biological and social variables have the potential to explain this variability. Although current understanding of these influences and how they interact is incomplete, perinatal factors are related to permanent neurosensory impairments such as cerebral palsy, blindness, and deafness. Cognitive and academic outcomes are variably associated with biological and social variables across development, and the most robust correlates of behavior and mental health difficulties include early behavioral problems and family influences.
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Affiliation(s)
- Alice C Burnett
- Premature Infant Follow-Up Program, The Royal Women's Hospital, 20 Flemington Road, Parkville, Victoria 3052, Australia; Victorian Infant Brain Studies, Murdoch Childrens Research Institute, Flemington Road, Parkville, Melbourne, Victoria 3052, Australia; Department of Pediatrics, University of Melbourne, Parkville, Victoria 3010, Australia; Department of Neonatal Medicine, The Royal Children's Hospital, 50 Flemington Road, Parkville, Victoria 3052, Australia.
| | - Jeanie L Y Cheong
- Premature Infant Follow-Up Program, The Royal Women's Hospital, 20 Flemington Road, Parkville, Victoria 3052, Australia; Victorian Infant Brain Studies, Murdoch Childrens Research Institute, Flemington Road, Parkville, Melbourne, Victoria 3052, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria 3010, Australia; Neonatal Services, The Royal Women's Hospital, 20 Flemington Road, Parkville, Victoria 3052, Australia; Newborn Research, The Royal Women's Hospital, Level 7, 20 Flemington Road, Parkville, Melbourne, Victoria 3052, Australia
| | - Lex W Doyle
- Premature Infant Follow-Up Program, The Royal Women's Hospital, 20 Flemington Road, Parkville, Victoria 3052, Australia; Victorian Infant Brain Studies, Murdoch Childrens Research Institute, Flemington Road, Parkville, Melbourne, Victoria 3052, Australia; Department of Pediatrics, University of Melbourne, Parkville, Victoria 3010, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria 3010, Australia; Newborn Research, The Royal Women's Hospital, Level 7, 20 Flemington Road, Parkville, Melbourne, Victoria 3052, Australia
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73
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Leviton A, Joseph RM, Allred EN, Fichorova RN, O'Shea TM, Kuban KKC, Dammann O. The risk of neurodevelopmental disorders at age 10 years associated with blood concentrations of interleukins 4 and 10 during the first postnatal month of children born extremely preterm. Cytokine 2018; 110:181-188. [PMID: 29763840 DOI: 10.1016/j.cyto.2018.05.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 04/23/2018] [Accepted: 05/07/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND Interleukin (IL)-4 and IL-10 are viewed mainly as anti-inflammatory cytokines. Yet, high concentrations have also been associated with inflammation-related diseases in newborns. METHODS We measured the concentrations of IL-4 and IL-10, as well as IL-8 and ICAM-1 in blood specimens collected on postnatal day 21 (N = 555), day 28 (N = 521), and both days 21 and 28 (N = 449) from children born extremely preterm (EP) (<28 weeks gestation) who at age 10 years had a DAS-II IQ Z-score > -2 (which approximates a score of >70) and the following assessments, CCC-2, and CSI-4, DAS-II, NEPSY-II, OWLS-II, SCQ, and WIAT-III. Selected children also were assessed with the ADI-R and the ADOS-2. We modeled the risk of low scores or dysfunctions associated with top quartile concentrations of IL-4 and IL-10 on each day and on both days. RESULTS The risks of low scores on the Animal Sorting and Arrows components of the NEPSY-II, both components of the OWLS-II, and the PseudoWord and Spelling components of the WIAT-III were heightened among children who had top quartile concentrations of IL-4 on postnatal days 21 and 28. Children who had high concentrations of IL-10 on days 21 and 28, individually and collectively, were at increased risk of low scores on the WIAT-III Spelling component. High concentrations of IL-4 on day 28 were associated with autism spectrum disorder (ASD). High concentrations of IL-10 on day 28 were also associated with a doubling of ASD risk, but this did not achieve statistical significance. Top quartile concentrations of IL-4 and IL10 on both days were not associated with increased risk of social, language, or behavioral dysfunctions. CONCLUSION Among children born EP, those who had top quartile concentrations of IL-4 and/or IL-10 on postnatal days 21 and/or 28 were more likely than their peers to have low scores on components of the NEPSY-II, OWLS-II, and WIAT-III assessments, as well as identification as having an ASD. What is known: What is not known: What this study adds.
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Affiliation(s)
- Alan Leviton
- Boston Children's Hospital and Harvard Medical School, Boston, MA, USA.
| | | | | | - Raina N Fichorova
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA
| | - T Michael O'Shea
- University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Karl K C Kuban
- Boston Medical Center and Boston University School of Medicine, Boston, MA, USA
| | - Olaf Dammann
- Tufts University School of Medicine, Boston, MA 02111, USA; Perinatal Neuroepidemiology Unit, Department of Gynecology and Obstetrics, Hannover Medical School, 30623 Hannover, Germany
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74
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Korzeniewski SJ. Relationships among gestational age and birthweight with cognitive deficits in children and adolescents born very preterm. Dev Med Child Neurol 2018; 60:436. [PMID: 29468676 DOI: 10.1111/dmcn.13716] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Steven J Korzeniewski
- School of Medicine - Obstetrics & Gynecology, Wayne State University, Detroit, MI, USA
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75
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Bolk J, Fredriksson Kaul Y, Hellström-Westas L, Stjernqvist K, Padilla N, Serenius F, Hellgren K, Åden U. National population-based cohort study found that visual-motor integration was commonly affected in extremely preterm born children at six-and-a-half years. Acta Paediatr 2018; 107:831-837. [PMID: 29356073 DOI: 10.1111/apa.14231] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 12/20/2017] [Accepted: 01/16/2018] [Indexed: 11/27/2022]
Abstract
AIM This study aimed to explain the relationship between visual-motor integration (VMI) abilities and extremely preterm (EPT) birth, by exploring the influence of perinatal variables, cognition, manual dexterity and ophthalmological outcomes. METHODS This was part of the population-based national Extremely Preterm Infant Study in Sweden (EXPRESS) study. We studied 355 children, born at a gestational age of <27 weeks from April 2004 to March 2007, and 364 term-born controls. At six-and-a-half years of age, we assessed VMI, cognitive function, motor skills and vision. VMI impairment was classified as <-1 standard deviation (SD). RESULTS The mean (SD) VMI score was 87 (±12) in preterm children compared to 98 (±11) in controls (p < 0.001). VMI impairment was present in 55% of preterm infants and in 78% of children born at 22-23 weeks. Male sex and postnatal steroids showed a weak association with poorer visual-motor performance, whereas low manual dexterity and cognitive function showed a stronger association. CONCLUSION Poor VMI performance was common in this EXPRESS cohort of children born EPT. Its strong association to cognition and manual dexterity confirms that all of these factors need to be taken into account when evaluating risks in preterm born children.
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Affiliation(s)
- Jenny Bolk
- Department of Women's and Children's Health; Karolinska Institutet; Stockholm Sweden
- Sachs' Children and Youth Hospital; Stockholm Sweden
| | - Ylva Fredriksson Kaul
- Department of Women's and Children's Health; Uppsala University Hospital; Uppsala Sweden
| | - Lena Hellström-Westas
- Department of Women's and Children's Health; Uppsala University Hospital; Uppsala Sweden
| | - Karin Stjernqvist
- Division of Developmental Psychology; Department of Psychology; Lund University; Lund Sweden
| | - Nelly Padilla
- Department of Women's and Children's Health; Karolinska Institutet; Stockholm Sweden
| | - Fredrik Serenius
- Department of Women's and Children's Health; Uppsala University Hospital; Uppsala Sweden
- Institute of Clinical Sciences, Pediatrics; University of Umeå; Umeå Sweden
| | - Kerstin Hellgren
- Department of Clinical Neuroscience; Karolinska Institutet; Stockholm Sweden
| | - Ulrika Åden
- Department of Women's and Children's Health; Karolinska Institutet; Stockholm Sweden
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Leviton A, Allred EN, Fichorova RN, O'Shea TM, Fordham LA, Kuban KKC, Dammann O. Circulating biomarkers in extremely preterm infants associated with ultrasound indicators of brain damage. Eur J Paediatr Neurol 2018; 22:440-450. [PMID: 29429901 PMCID: PMC5899659 DOI: 10.1016/j.ejpn.2018.01.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 12/09/2017] [Accepted: 01/20/2018] [Indexed: 02/06/2023]
Abstract
AIM To assess to what extent the blood concentrations of proteins with neurotrophic and angiogenic properties measured during the first postnatal month convey information about the risk of sonographically-identified brain damage among very preterm newborns. METHODS Study participants were 1219 children who had a cranial ultrasound scan during their stay in the intensive care nursery and blood specimens collected on 2 separate days at least a week apart during the first postnatal month. Concentrations of selected proteins in blood spots were measured with electrochemiluminescence or with a multiplex immunobead assay and the risks of cranial ultrasound images associated with top-quartile concentrations were assessed. RESULTS High concentrations of multiple inflammation-related proteins during the first 2 postnatal weeks were associated with increased risk of ventriculomegaly, while high concentrations of just 3 inflammation-related proteins were associated with increased risk of an echolucent/hypoechoic lesion (IL-6, IL-8, ICAM-1), especially on day 7. Concomitant high concentrations of IL6R and bFGF appeared to modulate the increased risks of ventriculomegaly and an echolucent lesion associated with inflammation. More commonly high concentrations of putative protectors/repair-enhancers did not appear to diminish these increased risks. CONCLUSION Our findings provide support for the hypothesis that endogenous proteins are capable of either protecting the brain against damage and/or enhancing repair of damage.
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Affiliation(s)
- Alan Leviton
- Boston Children's Hospital, and Harvard Medical School, Boston, MA, USA.
| | | | - Raina N Fichorova
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | | | | | - Karl K C Kuban
- Boston Medical Center and Boston University School of Medicine, Boston, MA, USA
| | - Olaf Dammann
- Tufts University School of Medicine, Boston, MA, USA
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77
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Twilhaar ES, Wade RM, de Kieviet JF, van Goudoever JB, van Elburg RM, Oosterlaan J. Cognitive Outcomes of Children Born Extremely or Very Preterm Since the 1990s and Associated Risk Factors: A Meta-analysis and Meta-regression. JAMA Pediatr 2018; 172:361-367. [PMID: 29459939 PMCID: PMC5875339 DOI: 10.1001/jamapediatrics.2017.5323] [Citation(s) in RCA: 322] [Impact Index Per Article: 53.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 11/22/2017] [Indexed: 11/14/2022]
Abstract
Importance Despite apparent progress in perinatal care, children born extremely or very preterm (EP/VP) remain at high risk for cognitive deficits. Insight into factors contributing to cognitive outcome is key to improve outcomes after EP/VP birth. Objective To examine the cognitive abilities of children of EP/VP birth (EP/VP children) and the role of perinatal and demographic risk factors. Data Sources PubMed, Web of Science, and PsycINFO were searched without language restriction (last search March 2, 2017). Key search terms included preterm, low birth weight, and intelligence. Study Selection Peer-reviewed studies reporting intelligence scores of EP/VP children (<32 weeks of gestation) and full-term controls at age 5 years or older, born in the antenatal corticosteroids and surfactant era, were included. A total of 268 studies met selection criteria, of which 71 covered unique cohorts. Data Extraction and Synthesis MOOSE guidelines were followed. Data were independently extracted by 2 researchers. Standardized mean differences in intelligence per study were pooled using random-effects meta-analysis. Heterogeneity in effect size across studies was studied using multivariate, random-effects meta-regression analysis. Main Outcomes and Measures Primary outcome was intelligence. Covariates included gestational age, birth weight, birth year, age at assessment, sex, race/ethnicity, socioeconomic status, small for gestational age, intraventricular hemorrhage, periventricular leukomalacia, bronchopulmonary dysplasia (BPD), necrotizing enterocolitis, sepsis, and postnatal corticosteroid use. Results The 71 included studies comprised 7752 EP/VP children and 5155 controls. Median gestational age was 28.5 weeks (interquartile range [IQR], 2.4 weeks) and the mean age at assessment ranged from 5.0 to 20.1 years. The median proportion of males was 50.0% (IQR, 8.7%). Preterm children had a 0.86-SD lower IQ compared with controls (95% CI, -0.94 to -0.78, P < .001). Results were heterogeneous across studies (I2 = 74.13; P < .001). This heterogeneity could not be explained by birth year of the cohort. Multivariate meta-regression analysis with backward elimination revealed that BPD explained 65% of the variance in intelligence across studies, with each percent increase in BPD rate across studies associated with a 0.01-SD decrease in IQ (0.15 IQ points) (P < .001). Conclusions and Relevance Extremely or very preterm children born in the antenatal corticosteroids and surfactant era show large deficits in intelligence. No improvement in cognitive outcome was observed between 1990 and 2008. These findings emphasize that improving outcomes after EP/VP birth remains a major challenge. Bronchopulmonary dysplasia was found to be a crucial factor for cognitive outcome. Lowering the high incidence of BPD may be key to improving long-term outcomes after EP/VP birth.
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Affiliation(s)
- E. Sabrina Twilhaar
- Clinical Neuropsychology Section, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Rebecca M. Wade
- Clinical Neuropsychology Section, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Jorrit F. de Kieviet
- Clinical Neuropsychology Section, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Johannes B. van Goudoever
- Department of Pediatrics, Emma Children’s Hospital, Academic Medical Center, Amsterdam, the Netherlands
- Department of Pediatrics, Vrije Universiteit Medical Center, Amsterdam, the Netherlands
| | - Ruurd M. van Elburg
- Department of Pediatrics, Emma Children’s Hospital, Academic Medical Center, Amsterdam, the Netherlands
- Nutricia Research, Utrecht, the Netherlands
| | - Jaap Oosterlaan
- Clinical Neuropsychology Section, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Department of Pediatrics, Emma Children’s Hospital, Academic Medical Center, Amsterdam, the Netherlands
- Department of Pediatrics, Vrije Universiteit Medical Center, Amsterdam, the Netherlands
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Maternal educational status at birth, maternal educational advancement, and neurocognitive outcomes at age 10 years among children born extremely preterm. Pediatr Res 2018; 83:767-777. [PMID: 29072866 PMCID: PMC6684154 DOI: 10.1038/pr.2017.267] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 09/25/2017] [Indexed: 01/24/2023]
Abstract
BackgroundTo determine if a key marker of socioeconomic status, maternal education, is associated with later neurocognitive and academic outcomes among children born extremely preterm (EP).MethodEight hundred and seventy-three children born at 23 to 27 weeks of gestation were assessed for cognitive and academic ability at age 10 years. With adjustments for gestational age (GA) and potential confounders, outcomes of children whose mothers had fewer years of education at the time of delivery and children whose mother advanced in education between birth and 10 years were examined.ResultsChildren of mothers in the lowest education stratum at birth were significantly more likely to score ≥2 SDs below normative expectation on 17 of 18 tests administered. Children of mothers who advanced in education (n=199) were at reduced risk for scoring ≥2 SDs on 15 of 18 measures, but this reduction was statistically significant on only 2 of 18 measures.ConclusionAmong EP children, socioeconomic disadvantage at birth, indexed by maternal education, is associated with significantly poorer neurocognitive and academic outcomes at 10 years of age, independently of GA. Maternal educational advancement during the child's first 10 years of life is associated with modestly improved neurocognitive outcomes.
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79
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Leviton A, Hooper SR, Hunter SJ, Scott MN, Allred EN, Joseph RM, O’Shea TM, Kuban K. Antecedents of Screening Positive for Attention Deficit Hyperactivity Disorder in Ten-Year-Old Children Born Extremely Preterm. Pediatr Neurol 2018; 81. [PMID: 29523493 PMCID: PMC5903941 DOI: 10.1016/j.pediatrneurol.2017.12.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND The incidence of attention deficit hyperactivity disorder is higher among children born very preterm than among children who are mature at birth. METHODS We studied 583 ten-year-old children who were born before 28 weeks of gestation whose IQ was above 84 and had a parent-completed Child Symptom Inventory-4, which allowed classification of the child as having or not having symptoms of attention deficit hyperactivity disorder. For 422 children, we also had a teacher report, and for 583 children, we also had a parent report of whether or not a physician made an attention deficit hyperactivity disorder diagnosis. RESULTS The risk profile of screening positive for attention deficit hyperactivity disorder based on a parent's report differed from the risk profile based on the teacher's report, whereas the risk profile according to a physician and according to any two observers closely resembled the parent-reported profile. Among the statistically significant risk factors were young maternal age (parent, physician, and two observers), maternal obesity (parent, physician, and two observers), maternal smoking (parent, physician, and two observers), magnesium given at delivery for seizure prophylaxis (parent and two observers), recovery of Mycoplasma sp. from the placenta (teacher and two observers), low gestational age (parent and two observers), low birth weight (teacher and physician), singleton (parent, physician, and two observers), male (parent, teacher, physician, and two observers), mechanical ventilation on postnatal day seven (physician), receipt of a sedative (parent and two observers), retinopathy of prematurity (parent), necrotizing enterocolitis (physician), antibiotic receipt (physician and two observers), and ventriculomegaly on brain scan (parent and two observers). CONCLUSIONS The multiplicity of risk factors identified can be subsumed as components of four broad themes: low socioeconomic state, immaturity or vulnerability, inflammation, and epigenetic phenomena.
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Affiliation(s)
- Alan Leviton
- Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts.
| | - Stephen R Hooper
- University of North Carolina School of Medicine, Chapel Hill NC, USA
| | - Scott J. Hunter
- The University of Chicago Medicine Comer Children’s Hospital, Chicago IL, USA
| | - Megan N. Scott
- The University of Chicago Medicine Comer Children’s Hospital, Chicago IL, USA
| | | | | | - T. Michael O’Shea
- University of North Carolina School of Medicine, Chapel Hill NC, USA
| | - Karl Kuban
- Boston Medical Center and Boston University School of Medicine, Boston, MA, USA
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Abstract
Background The placenta is the central regulator of maternal and fetal interactions. Perturbations of placental structure and function have been associated with adverse neurodevelopmental outcomes later in life. Placental CpG methylation represents an epigenetic modification with the potential to impact placental function, fetal development and child health later in life. Study design Genome-wide placental CpG methylation levels were compared between spontaneous versus indicated deliveries from extremely preterm births (EPTBs) (n = 84). The association between the identified differentially methylated CpG sites and neurocognitive outcome at ten years of age was then evaluated. Results Spontaneous EPTB was associated with differential CpG methylation levels in 250 CpG sites (217 unique genes) with the majority displaying hypermethylation. The identified genes are known to play a role in neurodevelopment and are enriched for basic helix-loop-helix transcription factor binding sites. The placental CpG methylation levels for 17 of these sites predicted cognitive function at ten years of age. Conclusion A hypermethylation signature is present in DNA from placentas in infants with spontaneous EPTB. CpG methylation levels of critical neurodevelopment genes in the placenta predicted later life cognitive function, supporting the developmental origins of health and disease hypothesis (DOHaD).
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81
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Leviton A, Joseph RM, Allred EN, O’Shea TM, Taylor HG, Kuban KKC. Antenatal and Neonatal Antecedents of Executive Dysfunctions in Extremely Preterm Children. J Child Neurol 2018; 33:198-208. [PMID: 29322860 PMCID: PMC5807158 DOI: 10.1177/0883073817750499] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
To find out why children born extremely preterm are at heightened risk of executive dysfunctions, the authors assessed 716 children who were 10 years old born extremely preterm whose IQ was ≥ 70. A working memory dysfunction (n = 169), an inhibition dysfunction (n = 360), a switching dysfunction (355), and all 3 (executive dysfunction; n = 107) were defined on the basis of Z-scores ≤ -1 on the Differential Ability Scales-II Working Memory composite, and/or on the NEPSY-II Inhibition-Inhibition and Inhibition-Switching subtests. All risk profiles include an indicator of socioeconomic disadvantage. The risk profile of each of the 3 individual dysfunctions includes an indicator of the newborn's immaturity, and the risk profiles of the inhibition dysfunction and switching dysfunction also include an indicator of inflammation. Only the switching dysfunction was associated with fetal growth restriction. The risk factors for executive dysfunction can be subsumed under the 4 themes of socioeconomic disadvantage, immaturity/vulnerability, inflammation, and fetal growth restriction.
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Affiliation(s)
- Alan Leviton
- Boston Children’s Hospital and Harvard Medical School,
Boston MA, USA
| | | | | | - T. Michael O’Shea
- University of North Carolina School of Medicine, Chapel Hill NC,
USA
| | - H. Gerry Taylor
- Nationwide Children’s Hospital and The Ohio State
University, Columbus, OH, USA
| | - Karl KC Kuban
- Boston Medical Center and Boston University School of Medicine,
Boston, MA, USA
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82
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Hirschberger RG, Kuban KCK, O'Shea TM, Joseph RM, Heeren T, Douglass LM, Stafstrom CE, Jara H, Frazier JA, Hirtz D, Rollins JV, Paneth N. Co-occurrence and Severity of Neurodevelopmental Burden (Cognitive Impairment, Cerebral Palsy, Autism Spectrum Disorder, and Epilepsy) at Age Ten Years in Children Born Extremely Preterm. Pediatr Neurol 2018; 79:45-52. [PMID: 29310907 PMCID: PMC5803305 DOI: 10.1016/j.pediatrneurol.2017.11.002] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Revised: 11/03/2017] [Accepted: 11/04/2017] [Indexed: 01/21/2023]
Abstract
BACKGROUND This study aims to determine the prevalence of neurodevelopmental impairments at age ten years among children born extremely preterm (less than 28 weeks gestational age) and to offer a framework for categorizing neurological limitations. METHODS A multicenter, prospective cohort follow-up study recruited 889 ten-year-old children born from 2002 to 2004. We assessed prevalence of cognitive impairment, measured by intelligent quotient and tests of executive function, cerebral palsy (CP), autism spectrum disorder (ASD), and epilepsy singly and in combination. The three levels of impairment severity were: category I-no major neurodevelopmental impairment; category II-normal cognitive ability with CP, ASD, and/or epilepsy; and category III-children with cognitive impairment. RESULTS A total 214 of 873 children (25%) had cognitive impairment, 93 of 849 children (11%) had CP, 61 of 857 children (7%) had ASD, and 66 of 888 children (7%) had epilepsy. Further, 19% of all children had one diagnosis, 10% had two diagnoses, and 3% had three diagnoses. Decreasing gestational age was associated with increasing number of impairments (P < 0.001). Half the children with cognitive impairment and one third of children with CP, ASD, or epilepsy had a single impairment. Six hundred one (68% [95% CI, 64.5%-70.7%]) children were in category I, 74 (8% [95% CI, 6.6%-10.3%]) were in category II, and 214 (24% [95% CI 21.7%-27.4%]) were in category III. CONCLUSIONS Three quarters of children had normal intellect at age ten years; nearly 70% were free of neurodevelopmental impairment. Forty percent of children with impairments had multiple diagnoses.
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Affiliation(s)
- Rachel G Hirschberger
- Division of Pediatric Neurology, Department of Pediatrics, Boston Medical Center, Boston, Massachusetts.
| | - Karl C K Kuban
- Division of Pediatric Neurology, Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
| | | | - Robert M Joseph
- Department of Psychology and Neuroanatomy, Boston University, Boston, Massachusetts
| | - Tim Heeren
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Laurie M Douglass
- Division of Pediatric Neurology, Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
| | - Carl E Stafstrom
- Division of Pediatric Neurology, Department of Neurology, Johns Hopkins Hospital, Baltimore, Maryland
| | - Hernan Jara
- Department of Radiology, Boston Medical Center, Boston University, Boston, Massachusetts
| | - Jean A Frazier
- Departments of Psychiatry and Pediatrics, UMASS Medical School/ University of Massachusetts Memorial Health Care, Worcester, Massachusetts
| | - Deborah Hirtz
- National Institute of Neurological Disorders and Stroke, Bethesda, Maryland
| | | | - Nigel Paneth
- Department of Epidemiology and Biostatistics and Pediatrics and Human Development, Michigan State University, East Lansing, Michigan
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83
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Thomas AR, Lacadie C, Vohr B, Ment LR, Scheinost D. Fine Motor Skill Mediates Visual Memory Ability with Microstructural Neuro-correlates in Cerebellar Peduncles in Prematurely Born Adolescents. Cereb Cortex 2018; 27:322-329. [PMID: 28108493 PMCID: PMC5939198 DOI: 10.1093/cercor/bhw415] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Indexed: 12/22/2022] Open
Abstract
Adolescents born preterm (PT) with no evidence of neonatal brain injury are at risk of deficits in visual memory and fine motor skills that diminish academic performance. The association between these deficits and white matter microstructure is relatively unexplored. We studied 190 PTs with no brain injury and 92 term controls at age 16 years. The Rey-Osterrieth Complex Figure Test (ROCF), the Beery visual-motor integration (VMI), and the Grooved Pegboard Test (GPT) were collected for all participants, while a subset (40 PTs and 40 terms) underwent diffusion-weighted magnetic resonance imaging. PTs performed more poorly than terms on ROCF, VMI, and GPT (all P < 0.01). Mediation analysis showed fine motor skill (GPT score) significantly mediates group difference in ROCF and VMI (all P < 0.001). PTs showed a negative correlation (P < 0.05, corrected) between fractional anisotropy (FA) in the bilateral middle cerebellar peduncles and GPT score, with higher FA correlating to lower (faster task completion) GPT scores, and between FA in the right superior cerebellar peduncle and ROCF scores. PTs also had a positive correlation (P < 0.05, corrected) between VMI and left middle cerebellar peduncle FA. Novel strategies to target fine motor skills and the cerebellum may help PTs reach their full academic potential.
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Affiliation(s)
- Alyssa R Thomas
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA
| | - Cheryl Lacadie
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
| | - Betty Vohr
- Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Laura R Ment
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA.,Department of Neurology, Yale University School of Medicine, New Haven, CT, USA
| | - Dustin Scheinost
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
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84
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Burnett AC, Anderson PJ, Lee KJ, Roberts G, Doyle LW, Cheong JLY. Trends in Executive Functioning in Extremely Preterm Children Across 3 Birth Eras. Pediatrics 2018; 141:peds.2017-1958. [PMID: 29196505 DOI: 10.1542/peds.2017-1958] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/27/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES To determine if executive functioning outcomes at school age are different for extremely preterm (EP; <28 weeks' gestation) or extremely low birth weight (ELBW; <1000 g birth weight) children born in 1991 to 1992, 1997, and 2005 relative to their term-born peers. METHODS Population-based cohorts of all EP/ELBW survivors born in the state of Victoria, Australia, in 1991 to 1992, 1997, and 2005, and contemporaneous controls (matched for expected date of birth, sex, mother's country of birth [English speaking or not], and health insurance status) were recruited at birth. At 7 to 8 years of age, parents of 613 children who were EP/ELBW and 564 children who were controls rated their children's executive functioning on the Behavior Rating Inventory of Executive Function (BRIEF). The proportion of children with elevated BRIEF scores (in the clinically significant range) in each birth group and era was compared by using logistic regression. Sensitivity analyses explored these associations after excluding children with intellectual impairment. RESULTS Across the eras, EP/ELBW children had higher rates of elevated scores than controls in almost all BRIEF domains. The 2005 EP/ELBW cohort had increased executive dysfunction compared with earlier cohorts, particularly in working memory and planning and organization. This effect persisted after accounting for demographic factors and weakened slightly when those with intellectual impairment were excluded. CONCLUSIONS These results indicate a concerning trend of increasing executive dysfunction for EP/ELBW children who were born more recently. This may have adverse implications for other functional domains, such as academic achievement and social-emotional well-being.
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Affiliation(s)
- Alice C Burnett
- Premature Infant Follow-Up Program and .,Victorian Infant Brain Studies.,Departments of Pediatrics and.,Department of Neonatal Medicine and
| | - Peter J Anderson
- Premature Infant Follow-Up Program and.,Victorian Infant Brain Studies.,Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Melbourne, Australia
| | - Katherine J Lee
- Victorian Infant Brain Studies.,Clinical Epidemiology and Biostatistics Unit, and
| | - Gehan Roberts
- Victorian Infant Brain Studies.,Departments of Pediatrics and.,Population Health, Murdoch Children's Research Institute, Melbourne, Australia.,Centre for Community Child Health, Royal Children's Hospital, Melbourne, Australia; and
| | - Lex W Doyle
- Premature Infant Follow-Up Program and.,Victorian Infant Brain Studies.,Departments of Pediatrics and.,Obstetrics and Gynaecology, University of Melbourne, Melbourne, Australia
| | - Jeanie L Y Cheong
- Premature Infant Follow-Up Program and.,Victorian Infant Brain Studies.,Obstetrics and Gynaecology, University of Melbourne, Melbourne, Australia.,Neonatal Services, Royal Women's Hospital, Melbourne, Australia
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Rodríguez-Trujillo A, Ríos J, Ángeles MA, Posadas DE, Murillo C, Rueda C, Botet F, Bosch J, Vergara A, Gratacós E, Palacio M, Cobo T. Influence of perinatal inflammation on the neurodevelopmental outcome of premature infants. J Matern Fetal Neonatal Med 2017; 32:1069-1077. [DOI: 10.1080/14767058.2017.1399118] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- Adriano Rodríguez-Trujillo
- BCNatal – Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Fetal i + D Fetal Medicine Research Center, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - José Ríos
- Biostatistics and Data Management Core Facility, IDIBAPS, Hospital Clinic, Barcelona, Spain
- Biostatistics Unit, Faculty of Medicine, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Martina A. Ángeles
- BCNatal – Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Fetal i + D Fetal Medicine Research Center, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - David E. Posadas
- BCNatal – Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Fetal i + D Fetal Medicine Research Center, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Clara Murillo
- BCNatal – Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Fetal i + D Fetal Medicine Research Center, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Claudia Rueda
- BCNatal – Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Fetal i + D Fetal Medicine Research Center, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Francesc Botet
- BCNatal – Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Fetal i + D Fetal Medicine Research Center, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Jordi Bosch
- Microbiology, Biomedical Diagnostic Center, Hospital Clínic and ISGlobal (Barcelona Institute for Global Health), University of Barcelona, Barcelona, Spain
| | - Andrea Vergara
- Microbiology, Biomedical Diagnostic Center, Hospital Clínic and ISGlobal (Barcelona Institute for Global Health), University of Barcelona, Barcelona, Spain
| | - Eduard Gratacós
- BCNatal – Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Fetal i + D Fetal Medicine Research Center, IDIBAPS, University of Barcelona, Barcelona, Spain
- Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - Montse Palacio
- BCNatal – Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Fetal i + D Fetal Medicine Research Center, IDIBAPS, University of Barcelona, Barcelona, Spain
- Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - Teresa Cobo
- BCNatal – Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Fetal i + D Fetal Medicine Research Center, IDIBAPS, University of Barcelona, Barcelona, Spain
- Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
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Korzeniewski SJ, Allred EN, Joseph RM, Heeren T, Kuban KC, O’Shea TM, Leviton A. Neurodevelopment at Age 10 Years of Children Born <28 Weeks With Fetal Growth Restriction. Pediatrics 2017; 140:peds.2017-0697. [PMID: 29030525 PMCID: PMC5654396 DOI: 10.1542/peds.2017-0697] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/21/2017] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES We sought to evaluate the relationships between fetal growth restriction (FGR) (both severe and less severe) and assessments of cognitive, academic, and adaptive behavior brain function at age 10 years. METHODS At age 10 years, the Extremely Low Gestational Age Newborns Cohort Study assessed the cognitive function, academic achievement, social-communicative function, psychiatric symptoms, and overall quality of life of 889 children born before 28 weeks' gestation. A pediatric epileptologist also interviewed parents as part of a seizure evaluation. The 52 children whose birth weight z scores were <-2 were classified as having severe FGR, and the 113 whose birth weight z scores were between -2 and -1 were considered to have less severe FGR. RESULTS The more severe the growth restriction in utero, the lower the level of function on multiple cognitive and academic achievement assessments performed at age 10 years. Growth-restricted children were also more likely than their extremely preterm peers to have social awareness impairments, autistic mannerisms, autism spectrum diagnoses, difficulty with semantics and speech coherence, and diminished social and psychosocial functioning. They also more frequently had phobias, obsessions, and compulsions (according to teacher, but not parent, report). CONCLUSIONS Among children born extremely preterm, those with severe FGR appear to be at increased risk of multiple cognitive and behavioral dysfunctions at age 10 years, raising the possibility that whatever adversely affected their intrauterine growth also adversely affected multiple domains of cognitive and neurobehavioral development.
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Affiliation(s)
- Steven J. Korzeniewski
- Department of Obstetrics and Gynecology, School of Medicine, Wayne State University, Detroit, Michigan;,Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan
| | - Elizabeth N. Allred
- Department of Neurology, Boston Children’s Hospital, Boston, Massachusetts;,Department of Neurology, Harvard Medical School, Harvard University, Boston, Massachusetts
| | | | - Tim Heeren
- Department of Biostatistics, School of Public Health
| | - Karl C.K. Kuban
- Boston University, Boston, Massachusetts;,Departments of Pediatrics, Boston Medical Center, Boston, Massachusetts; and
| | - T. Michael O’Shea
- Department of Pediatrics, Wake Forest University, Winston-Salem, North Carolina
| | - Alan Leviton
- Department of Neurology, Boston Children’s Hospital, Boston, Massachusetts;,Department of Neurology, Harvard Medical School, Harvard University, Boston, Massachusetts
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Academic Achievement Deficits and Their Neuropsychological Correlates in Children Born Extremely Preterm. J Dev Behav Pediatr 2017; 38:627-637. [PMID: 28877090 PMCID: PMC5646684 DOI: 10.1097/dbp.0000000000000479] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The purpose of this study was to examine the risks associated with learning disabilities (LDs) in a large sample of children born extremely preterm. We predicted higher than expected rates of LD, particularly in math, and children with LD in math, reading, or both would have lower intelligence quotients (IQs) and specific patterns of neuropsychological deficits. METHODS We evaluated academic achievement, rates of LD, and their neuropsychological correlates in the Extremely Low Gestational Age Newborns (ELGANs) Study cohort of 10-year-old children born at 23 to 27 weeks gestational age. Primary analyses focused on children without intellectual disability (verbal IQ > 70 and nonverbal IQ > 70; N = 668). Low achievement was defined as a standard score ≤85 on the reading or math measures. RESULTS The risk of low math achievement scores (27%) was 1.5 times higher than the risk of low reading achievement scores (17%). Children were classified as having LD based on low achievement criteria in reading only (RD, 6.4% of sample), math only (MD, 16.2%), both reading and math (RD/MD, 8.3%), or no reading or math disabilities (No LD, 69.1%). Although all 3 LD groups had multiple neuropsychological weaknesses compared with the No LD group, the RD and MD groups had different patterns of neuropsychological impairment. CONCLUSION These children from the ELGAN cohort had higher than expected rates of LD, particularly in mathematics, even after taking socioeconomic status into consideration. These results indicate specific cognitive weaknesses that differ between extremely preterm children with RD and MD.
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88
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Heeren T, Joseph RM, Allred EN, O'Shea TM, Leviton A, Kuban KCK. Cognitive functioning at the age of 10 years among children born extremely preterm: a latent profile approach. Pediatr Res 2017; 82:614-619. [PMID: 28582386 PMCID: PMC5909197 DOI: 10.1038/pr.2017.82] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 03/11/2017] [Indexed: 12/18/2022]
Abstract
BackgroundSchool-age children born extremely preterm (EP) are more likely than their term peers to have multiple neurocognitive limitations. We identify subgroups of EP children who share similar profiles on measures of intelligence quotient (IQ) and executive function (EF), and describe the nature and prevalence of cognitive impairment in EP children.MethodsOn the basis of measures of IQ and EF, subgroups of EP children with common neurocognitive function are identified using latent profile analysis (LPA). On the basis of these subgroups, we describe the nature and prevalence of impairment in EP children, and examine associations between cognitive function, gestational age, and academic achievement. Classification of neurocognitive function using IQ and EF is compared with a standard classification based on IQ Z-scores.ResultsLPA identified four neurocognitive profiles in EP children, with 34% of EP children classified as normal, 41% low-normal, 17% moderately impaired, and 8% severely impaired. Impaired children exhibited global impairment across cognitive domains, whereas children in the low-normal group tended to have impaired inhibition relative to their reasoning and working memory skills.ConclusionWithin categories of EP children defined in terms of IQ, there is substantial variation in EF; thus, both IQ and EF assessments are needed when describing school-age outcome of EP children.
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Affiliation(s)
| | - Robert M. Joseph
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA
| | | | - Thomas M. O'Shea
- University of North Carolina School of Medicine, Chapel Hill, NC
| | - Alan Leviton
- Harvard Medical School, Boston, MA,Boston Children's Hospital, Boston, MA
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89
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Leviton A, Hunter SJ, Scott MN, Hooper SR, Joseph RM, O'Shea TM, Allred EN, Kuban K. Observer variability identifying attention deficit/hyperactivity disorder in 10-year-old children born extremely preterm. Acta Paediatr 2017; 106:1317-1322. [PMID: 28390106 DOI: 10.1111/apa.13869] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
AIM A DSM-5 diagnosis of attention deficit/hyperactive disorder (ADHD) requires that symptoms be present in two settings. We wanted to see how teachers and parents compare on their assessments. METHODS We evaluated how well Child Symptom Inventory-4 (CSI-4) reports from 871 parents and 634 teachers of 10-year-old children born before the 28th week of gestation provided information about indicators of school dysfunction. RESULTS Kappa values for parent and teacher agreement of any ADHD were at best fair to poor (<0.41). Nevertheless, ADHD identified by each alone provided a moderate amount of information about such indicators of school dysfunction as grade repetition. Only occasionally did agreement provide more information than provided by only one reporter. Mother's social class and intelligence level did not discriminate between parents who did and did not agree with the teacher. CONCLUSION ADHD identified by a single observer can provide appreciable information about a range of the child's functions needed for success in school and, therefore, should not be discounted when another observer does not consider the child to have ADHD symptoms.
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Affiliation(s)
- Alan Leviton
- Boston Children's Hospital; Harvard Medical School; Boston MA USA
| | - Scott J. Hunter
- The University of Chicago Medicine Comer Children's Hospital; Chicago IL USA
| | - Megan N. Scott
- The University of Chicago Medicine Comer Children's Hospital; Chicago IL USA
| | | | | | | | | | - Karl Kuban
- Boston Medical Center; Boston University School of Medicine; Boston MA USA
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90
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Bright HR, Babata K, Allred EN, Erdei C, Kuban KCK, Joseph RM, O’Shea TM, Leviton A, Dammann O. Neurocognitive Outcomes at 10 Years of Age in Extremely Preterm Newborns with Late-Onset Bacteremia. J Pediatr 2017; 187:43-49.e1. [PMID: 28526224 PMCID: PMC5533634 DOI: 10.1016/j.jpeds.2017.04.045] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 03/15/2017] [Accepted: 04/20/2017] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To evaluate the difference in 10-year neurocognitive outcomes between extremely low gestational age newborns without bacteremia and those with suspected or confirmed late-onset bacteremia. STUDY DESIGN Neurocognitive function was evaluated at 10 years of age in 889 children born at <28 weeks of gestation and followed from birth. Definite (culture-positive) late-onset bacteremia during postnatal weeks 2-4 was identified in 223 children, and 129 children had suspected bacteremia. RESULTS Infants with the lowest gestational age and birth weight z-score had the highest prevalence of definite and suspected late-onset bacteremia. Compared with peers with no or suspected bacteremia, infants with definite bacteremia performed worse on tests of general cognitive ability, language, academic achievement, and executive function, even after adjustment for potential confounders. Adjustment for low IQ attenuated the associations between bacteremia and all dysfunctions at age 10 years. Children with suspected bacteremia did not differ appreciably from those with no evidence of bacteremia. The motor domain was unaffected. CONCLUSIONS Extremely low gestational age newborns who had definite late bacteremia during postnatal weeks 2-4 are at heightened risk of neurocognitive limitations at age 10 years.
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Affiliation(s)
- H. Reeve Bright
- Tufts University School of Medicine, Boston, Massachusetts, United States,Corresponding Author: Kikelomo Babata, MD, Phone: 347.421.4414. Fax: 617.636.1456. . Tufts Medical Center Floating Hospital for Children, Division of Newborn, Medicine 800, Washington Street, Boston, MA 02111
| | - Kikelomo Babata
- Department of Newborn Medicine, Tufts Medical Center, Boston, MA.
| | - Elizabeth N. Allred
- Harvard Medical School, Boston, Massachusetts, United States,Department of Neurology, Boston Children’s Hospital, Boston, Massachusetts, United States
| | - Carmina Erdei
- Harvard Medical School, Boston, Massachusetts, United States,Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States
| | - Karl C. K. Kuban
- Department of Pediatrics, Division of Pediatric Neurology, Boston University Medical Center, Boston, Massachusetts, United States
| | - Robert M. Joseph
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, Massachusetts, United States
| | - T. Michael O’Shea
- Department of Pediatrics, University of North Carolina, Chapel Hill, North Carolina, United States
| | - Alan Leviton
- Harvard Medical School, Boston, Massachusetts, United States,Department of Neurology, Boston Children’s Hospital, Boston, Massachusetts, United States
| | - Olaf Dammann
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts, United States,Perinatal Neuroepidemiology Unit, Hannover Medical School, Hannover, Germany
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91
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Garfield CF, Karbownik K, Murthy K, Falciglia G, Guryan J, Figlio DN, Roth J. Educational Performance of Children Born Prematurely. JAMA Pediatr 2017; 171:764-770. [PMID: 28604933 PMCID: PMC5710633 DOI: 10.1001/jamapediatrics.2017.1020] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
IMPORTANCE Survivors of preterm birth often present with medical morbidities; however, variation in their long-term educational performance has not been well described. OBJECTIVE To estimate the association between gestational age and 4 outcomes in school-aged children: readiness to enter kindergarten, scores on standardized tests in elementary and middle school, gifted status, and low performance. DESIGN, SETTING, AND PARTICIPANTS In a retrospective cohort study, children born in Florida between 1992 and 2002 at 23 to 41 weeks' gestation who entered Florida's public schools between 1995 and 2012 were assessed for kindergarten readiness and tested in mathematics and reading in grades 3 through 8. Data analysis was performed from January 12, 2016, to March 1, 2017. EXPOSURES Gestational age at birth. MAIN OUTCOMES AND MEASURES Kindergarten readiness, scores on the Florida Comprehensive Achievement Test (FCAT), classified as gifted, and classified as low performance. RESULTS A total of 1 527 113 singleton infants with gestational ages of 23 to 41 weeks born between 1992 and 2002 were matched to Florida public school records. Of these, 1 301 497 children were included in the analysis; 641 479 (49.3%) were girls. A total of 301 (65.0%) Florida children born at 23 to 24 weeks' gestation were designated as ready to start kindergarten. When the FCAT test scores were adjusted for potentially confounding maternal and infant variables, children born at 23 to 24 weeks' gestation performed 0.66 SD (95% CI, -0.73 to -0.59) lower compared with those born at full term. A total of 123 554 (9.5%) of all Florida-born public school students were considered gifted, including 17 (1.8%) of those born at 23 to 24 weeks' gestation. In comparison, 75 458 (5.8%) of all Florida-born public school students were low performing; 310 (33.5%) of these children had been born at 23 to 24 weeks' gestation. Kindergarten readiness, FCAT scores, and gifted status were positively related to gestational age, whereas low performance was inversely related to gestational age. CONCLUSIONS AND RELEVANCE Although gestational age has long been associated with poor educational performance, a sufficient proportion of children born near the limits of viability performed within expected school norms, warranting further investigation into how and why certain children are able to overcome the educational burdens that may follow preterm birth.
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Affiliation(s)
- Craig F. Garfield
- Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois,Institute for Policy Research, Northwestern University, Evanston, Illinois
| | | | - Karna Murthy
- Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Gustave Falciglia
- Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jonathan Guryan
- Institute for Policy Research, Northwestern University, Evanston, Illinois,Human Development and Social Policy, Northwestern University School of Education and Social Policy, Evanston, Illinois
| | - David N. Figlio
- Institute for Policy Research, Northwestern University, Evanston, Illinois,Human Development and Social Policy, Northwestern University School of Education and Social Policy, Evanston, Illinois
| | - Jeffrey Roth
- Department of Pediatrics, University of Florida, Gainesville
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92
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Jensen ET, van der Burg JW, O'Shea TM, Joseph RM, Allred EN, Heeren T, Leviton A, Kuban KCK. The Relationship of Maternal Prepregnancy Body Mass Index and Pregnancy Weight Gain to Neurocognitive Function at Age 10 Years among Children Born Extremely Preterm. J Pediatr 2017; 187:50-57.e3. [PMID: 28341527 PMCID: PMC5533624 DOI: 10.1016/j.jpeds.2017.02.064] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 02/10/2017] [Accepted: 02/23/2017] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To assess the association between maternal prepregnancy body mass index and adequacy of pregnancy weight gain in relation to neurocognitive function in school-aged children born extremely preterm. STUDY DESIGN Study participants were 535 ten-year-old children enrolled previously in the prospective multicenter Extremely Low Gestational Age Newborns cohort study who were products of singleton pregnancies. Soon after delivery, mothers provided information about prepregnancy weight. Prepregnancy body mass index and adequacy of weight gain were characterized based on this information. Children underwent a neurocognitive evaluation at 10 years of age. RESULTS Maternal prepregnancy obesity was associated with increased odds of a lower score for Differential Ability Scales-II Verbal IQ, for Developmental Neuropsychological Assessment-II measures of processing speed and visual fine motor control, and for Wechsler Individual Achievement Test-III Spelling. Children born to mothers who gained an excessive amount of weight were at increased odds of a low score on the Oral and Written Language Scales Oral Expression assessment. Conversely, children whose mother did not gain an adequate amount of weight were at increased odds of a lower score on the Oral and Written Language Scales Oral Expression and Wechsler Individual Achievement Test-III Word Reading assessments. CONCLUSION In this cohort of infants born extremely preterm, maternal obesity was associated with poorer performance on some assessments of neurocognitive function. Our findings are consistent with the observational and experimental literature and suggest that opportunities may exist to mitigate risk through education and behavioral intervention before pregnancy.
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Affiliation(s)
- Elizabeth T Jensen
- Department of Epidemiology and Prevention, Wake Forest University Public Health Sciences, Winston-Salem, NC
| | - Jelske W van der Burg
- Department of Health and Life Sciences, Faculty of Earth and Life Sciences, VU University Amsterdam, Amsterdam, The Netherlands
| | - Thomas M O'Shea
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC.
| | - Robert M Joseph
- Department of Psychology and Neuroanatomy, Boston University, Boston, MA
| | - Elizabeth N Allred
- Neuroepidemiology Unit, Department of Neurology, Boston Children's Hospital, Boston, MA; Department of Neurology, Harvard Medical School, Boston, MA
| | - Tim Heeren
- Department of Biostatistics, Boston University School of Public Health, Boston, MA
| | - Alan Leviton
- Neuroepidemiology Unit, Department of Neurology, Boston Children's Hospital, Boston, MA; Department of Neurology, Harvard Medical School, Boston, MA
| | - Karl C K Kuban
- Department of Pediatrics, Boston Medical Center, Boston, MA
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93
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Tilley SK, Joseph RM, Kuban KCK, Dammann OU, O’Shea TM, Fry RC. Genomic biomarkers of prenatal intrauterine inflammation in umbilical cord tissue predict later life neurological outcomes. PLoS One 2017; 12:e0176953. [PMID: 28493900 PMCID: PMC5426658 DOI: 10.1371/journal.pone.0176953] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 04/19/2017] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Preterm birth is a major risk factor for neurodevelopmental delays and disorders. This study aimed to identify genomic biomarkers of intrauterine inflammation in umbilical cord tissue in preterm neonates that predict cognitive impairment at 10 years of age. STUDY DESIGN Genome-wide messenger RNA (mRNA) levels from umbilical cord tissue were obtained from 43 neonates born before 28 weeks of gestation. Genes that were differentially expressed across four indicators of intrauterine inflammation were identified and their functions examined. Exact logistic regression was used to test whether expression levels in umbilical cord tissue predicted neurocognitive function at 10 years of age. RESULTS Placental indicators of inflammation were associated with changes in the mRNA expression of 445 genes in umbilical cord tissue. Transcripts with decreased expression showed significant enrichment for biological signaling processes related to neuronal development and growth. The altered expression of six genes was found to predict neurocognitive impairment when children were 10 years old These genes include two that encode for proteins involved in neuronal development. CONCLUSION Prenatal intrauterine inflammation is associated with altered gene expression in umbilical cord tissue. A set of six of the differentially expressed genes predict cognitive impairment later in life, suggesting that the fetal environment is associated with significant adverse effects on neurodevelopment that persist into later childhood.
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Affiliation(s)
- Sloane K. Tilley
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Robert M. Joseph
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, Massachusetts, United States of America
| | - Karl C. K. Kuban
- Department of Pediatrics, Boston University School of Medicine, Boston, Massachusetts, United States of America
| | - Olaf U. Dammann
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts, United States of America
| | - T. Michael O’Shea
- Department of Pediatrics, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Rebecca C. Fry
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States of America
- Curriculum in Toxicology, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, United States of America
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94
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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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95
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Logan JW, Dammann O, Allred EN, Dammann C, Beam K, Joseph RM, O'Shea TM, Leviton A, Kuban KCK. Early postnatal illness severity scores predict neurodevelopmental impairments at 10 years of age in children born extremely preterm. J Perinatol 2017; 37:606-614. [PMID: 28079875 PMCID: PMC5407946 DOI: 10.1038/jp.2016.242] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 10/20/2016] [Accepted: 11/01/2016] [Indexed: 12/23/2022]
Abstract
OBJECTIVE A neonatal illness severity score, The Score for Neonatal Acute Physiology-II (SNAP-II), predicts neurodevelopmental impairments at two years of age among children born extremely preterm. We sought to evaluate to what extent SNAP-II is predictive of cognitive and other neurodevelopmental impairments at 10 years of age. STUDY DESIGN In a cohort of 874 children born before 28 weeks of gestation, we prospectively collected clinical, physiologic and laboratory data to calculate SNAP-II for each infant. When the children were 10 years old, examiners who were unaware of the child's medical history assessed neurodevelopmental outcomes, including neurocognitive, gross motor, social and communication functions, diagnosis and treatment of seizures or attention deficit hyperactivity disorder (ADHD), academic achievement, and quality of life. We used logistic regression to adjust for potential confounders. RESULTS An undesirably high SNAP-II (⩾30), present in 23% of participants, was associated with an increased risk of cognitive impairment (IQ, executive function, language ability), adverse neurological outcomes (epilepsy, impaired gross motor function), behavioral abnormalities (attention deficit disorder and hyperactivity), social dysfunction (autistic spectrum disorder) and education-related adversities (school achievement and need for educational supports. In analyses that adjusted for potential confounders, Z-scores ⩽-1 on 11 of 18 cognitive outcomes were associated with SNAP-II in the highest category, and 6 of 18 were associated with SNAP-II in the intermediate category. Odds ratios and 95% confidence intervals ranged from 1.4 (1.01, 2.1) to 2.1 (1.4, 3.1). Similarly, 2 of the 8 social dysfunctions were associated with SNAP-II in the highest category, and 3 of 8 were associated with SNAP-II in the intermediate category. Odds ratios and 95% confidence intervals were slightly higher for these assessments, ranging from 1.6 (1.1, 2.4) to 2.3 (1.2, 4.6). CONCLUSION Among very preterm newborns, physiologic derangements present in the first 12 postnatal hours are associated with dysfunctions in several neurodevelopmental domains at 10 years of age. We are unable to make inferences about causality.
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Affiliation(s)
- J. Wells Logan
- Department of Pediatrics and Neonatology, Nationwide Children's Hospital, and The Ohio State University, Columbus, OH
| | - Olaf Dammann
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA,Perinatal Neuroepidemiology Unit, Hannover Medical School, Hannover, Germany
| | | | - Christiane Dammann
- Department of Pediatrics and Neonatology, Tufts University School of Medicine, Boston, MA
| | - Kristyn Beam
- Department of Pediatrics and Neonatology, Tufts University School of Medicine, Boston, MA
| | - Robert M. Joseph
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA
| | - T. Michael O'Shea
- Department of Pediatrics and Neonatology, University of North Carolina, Chapel Hill, NC
| | - Alan Leviton
- Harvard Medical School, Boston, MA,Boston Children's Hospital, Boston, MA
| | - Karl C. K. Kuban
- Department of Pediatrics, Division of Pediatric Neurology, Boston University School of Medicine, Boston, MA
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96
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Scott MN, Hunter SJ, Joseph RM, OʼShea TM, Hooper SR, Allred EN, Leviton A, Kuban K. Neurocognitive Correlates of Attention-Deficit Hyperactivity Disorder Symptoms in Children Born at Extremely Low Gestational Age. J Dev Behav Pediatr 2017; 38:249-259. [PMID: 28410255 PMCID: PMC5746049 DOI: 10.1097/dbp.0000000000000436] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Compared with children born near term, those born extremely preterm (EP) are at much higher risk for attention-deficit hyperactivity disorder (ADHD). Little information is available about differences in neuropsychological outcomes among EP children with and without ADHD. Our analyses aimed to evaluate the neuropsychological correlates of ADHD symptoms in extremely low gestational age newborns (ELGANs). METHODS We obtained Child Symptom Inventory-4 reports from parents (n = 871) and teachers (n = 634) of 10-year-old children born before the 28th week of gestation. Participants completed standardized assessments of neurocognitive and academic functioning. RESULTS In the total sample, children who screened positive for ADHD symptoms were at increased risk for neurocognitive limitations. These associations were weaker when the sample was limited to those with intelligence quotient (IQ) ≥70 or ≥85. Even those with IQ ≥85 who screened positive for ADHD symptoms were more likely than their peers to have deficits on the DAS-II Working Memory Cluster and the NEPSY-II Auditory Response subtest. The risks for impaired academic performance (Z ≤ -1) on components of the WIAT-III were 2-to-3 times higher in this group than among ELGANs not classified as having ADHD symptoms. CONCLUSION Among children born EP, those with ADHD symptoms are more likely to have global neurocognitive impairment. When IQ is within normal limits, ADHD symptoms are associated with deficits in executive functioning skills. These findings highlight a group at risk for executive functioning deficits and related academic difficulties, even in the absence of intellectual disability.
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Affiliation(s)
- Megan N Scott
- *Department of Psychiatry and Behavioral Neuroscience, The University of Chicago Medicine, Chicago, IL; †Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA; ‡Division of Neonatology, Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC; §Department of Allied Health Sciences, University of North Carolina School of Medicine, Chapel Hill, NC; Departments of ‖Neurology and ¶Neurology Research, Boston Children's Hospital and Harvard Medical School, Boston MA; **Division of Pediatric Neurology, Boston Medical Center, Boston University School of Medicine, Boston, MA
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97
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Leviton A, Allred EN, Joseph RM, O'Shea TM, Kuban KCK. Newborn blood gas derangements of children born extremely preterm and neurocognitive dysfunctions at age 10 years. Respir Physiol Neurobiol 2017; 242:66-72. [PMID: 28396202 DOI: 10.1016/j.resp.2017.04.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 03/30/2017] [Accepted: 04/01/2017] [Indexed: 01/03/2023]
Abstract
Among 740 children born extremely preterm, we evaluated the relationship between the highest and lowest quartiles of the distributions of PaO2 and PaCO2, as well as the lowest quartile of pH on one day, and separately on two days, and the risk of neurocognitive, language, and behavioral dysfunctions at age 10 years. Children who had hypoxemia, hyperoxemia, hypocapnia, hypercapnia, and acidemia, sometimes on only one day, and sometimes on two or more days, were more likely than others to have a high illness severity score (within the first 12 postnatal hours), and 10 years later to have multiple dysfunctions. The tendency of blood gas derangements to be associated with high illness severity scores and with multiple dysfunctions 10 years later is compatible with the possibility that blood gas derangements are indicators of physiologic instability/vulnerability/immaturity rather than contributors to brain damage.
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Affiliation(s)
- Alan Leviton
- Boston Children's Hospital and Harvard Medical School, Boston, MA, USA.
| | | | | | - T Michael O'Shea
- University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Karl C K Kuban
- Boston University School of Medicine, Boston, MA, USA; Boston Medical Center, Boston, MA, USA
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98
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Oei JL, Melhuish E, Uebel H, Azzam N, Breen C, Burns L, Hilder L, Bajuk B, Abdel-Latif ME, Ward M, Feller JM, Falconer J, Clews S, Eastwood J, Li A, Wright IM. Neonatal Abstinence Syndrome and High School Performance. Pediatrics 2017; 139:peds.2016-2651. [PMID: 28093465 DOI: 10.1542/peds.2016-2651] [Citation(s) in RCA: 108] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/14/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Little is known of the long-term, including school, outcomes of children diagnosed with Neonatal abstinence syndrome (NAS) (International Statistical Classification of Disease and Related Problems [10th Edition], Australian Modification, P96.1). METHODS Linked analysis of health and curriculum-based test data for all children born in the state of New South Wales (NSW), Australia, between 2000 and 2006. Children with NAS (n = 2234) were compared with a control group matched for gestation, socioeconomic status, and gender (n = 4330, control) and with other NSW children (n = 598 265, population) for results on the National Assessment Program: Literacy and Numeracy, in grades 3, 5, and 7. RESULTS Mean test scores (range 0-1000) for children with NAS were significantly lower in grade 3 (359 vs control: 410 vs population: 421). The deficit was progressive. By grade 7, children with NAS scored lower than other children in grade 5. The risk of not meeting minimum standards was independently associated with NAS (adjusted odds ratio [aOR], 2.5; 95% confidence interval [CI], 2.2-2.7), indigenous status (aOR, 2.2; 95% CI, 2.2-2.3), male gender (aOR, 1.3; 95% CI, 1.3-1.4), and low parental education (aOR, 1.5; 95% CI, 1.1-1.6), with all Ps < .001. CONCLUSIONS A neonatal diagnostic code of NAS is strongly associated with poor and deteriorating school performance. Parental education may decrease the risk of failure. Children with NAS and their families must be identified early and provided with support to minimize the consequences of poor educational outcomes.
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Affiliation(s)
- Ju Lee Oei
- School of Women's and Children's Health, .,Department of Newborn Care, Royal Hospital for Women, Randwick, New South Wales, Australia.,Ingham Research Centre, Liverpool, New South Wales, Australia
| | - Edward Melhuish
- Early Start Research Institute and.,Department of Education, University of Oxford, Oxford, United Kingdom.,Department of Psychological Sciences, Birkbeck, University of London, London, United Kingdom
| | | | | | | | | | - Lisa Hilder
- National Perinatal Epidemiology and Statistics Unit, University of New South Wales, Sydney, New South Wales, Australia
| | | | - Mohamed E Abdel-Latif
- Department of Neonatology, The Canberra Hospital, Garran, Australian Capital Territory, Australia.,Faculty of Medicine, the Australian National University, Deakin, Australian Capital Territory, Australia
| | - Meredith Ward
- School of Women's and Children's Health.,Department of Newborn Care, Royal Hospital for Women, Randwick, New South Wales, Australia
| | - John M Feller
- School of Women's and Children's Health.,Sydney Children's Hospital, Sydney Children's Hospital Network, Randwick, New South Wales, Australia
| | - Janet Falconer
- The Langton Centre, Surry Hills, New South Wales, Australia
| | - Sara Clews
- The Langton Centre, Surry Hills, New South Wales, Australia
| | - John Eastwood
- School of Women's and Children's Health.,Ingham Research Centre, Liverpool, New South Wales, Australia.,Community Health Services, Sydney Local Health District, Sydney, New South Wales, Australia.,School of Public Health, Menzies Centre for Health Policy, and Charles Perkins Centre, University of Sydney, Camperdown, New South Wales, Australia; and.,School of Medicine, Griffith University, Gold Coast, Queensland, Australia
| | - Annie Li
- School of Women's and Children's Health
| | - Ian M Wright
- Early Start Research Institute and.,Illawarra Health and Medical Research Institute and School of Medicine, The University of Wollongong, Wollongong, New South Wales, Australia.,Department of Paediatrics, The Wollongong Hospital, Wollongong, New South Wales, Australia
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99
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Social Responsiveness Scale Assessment of the Preterm Behavioral Phenotype in 10-Year-Olds Born Extremely Preterm. J Dev Behav Pediatr 2017; 38:697-705. [PMID: 28857804 PMCID: PMC5668158 DOI: 10.1097/dbp.0000000000000485] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To evaluate the correlates of a clinically significant high score on the Social Responsiveness Scale (SRS) in 10-year-old children who were born extremely preterm and who did not meet criteria for autism spectrum disorder (ASD). METHODS After excluding 61 participants diagnosed with ASD, we grouped children by IQ < or ≥85 and then compared the prevalence of neurocognitive and other deficits between those who had SRS total and component scores ≥65 and their peers who had lower scores. RESULTS Among children who had IQ ≥ 85, the prevalence of SRS total scores ≥65 was 16% (n = 103/628), and among children who had IQ < 85, it was 27% (n = 40/148), higher than the 4% prevalence expected based on normative population data. Among children who had IQ ≥ 85, those who had high SRS scores more often than their peers had deficits in attention and executive function, and language and communication, and they were more often rated by their parents and teachers as having behavioral (e.g., attention-deficit hyperactivity disorder [ADHD]) and emotional (e.g., anxiety and depression) problems. CONCLUSION Social Responsiveness Scale-defined social impairment was much more common in our cohort of 10-year-old children born extremely preterm than was expected based on general population norms. High SRS scores were characteristic of children who had intellectual, neurocognitive, language, and communication limitations, as well as deficits in behavior and emotion regulation.
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100
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Lidzba K, Rodemann S, Goelz R, Krägeloh-Mann I, Bevot A. Growth in very preterm children: Head growth after discharge is the best independent predictor for cognitive outcome. Early Hum Dev 2016; 103:183-188. [PMID: 27716567 DOI: 10.1016/j.earlhumdev.2016.09.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 09/27/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND The contribution of growth parameters to the cognitive outcome of very low birth weight (VLBW)/very preterm (VP) infants is difficult to disentangle from other preterm-birth related factors. AIMS We hypothesized that long-term cognitive and motor outcome of VLBW/VP infants is most strongly associated with growth in head circumference after hospital discharge. STUDY DESIGN Single-centre prospective longitudinal study: anthropometric measures at different time points (birth, discharge, school-age). SUBJECTS 136 VLBW/VP infants (<32weeks gestation/birth weight<1.500g). OUTCOME MEASURES Cognitive and motor function (Kaufman Assessment Battery for Children; Movement Assessment Battery for Children) at school-age (6.7-10.0years, mean=8.2). RESULTS In hierarchical multiple regression analyses, growth from birth to discharge significantly predicted cognitive outcome (weight: R2change=0.063, p=0.014; length: R2change=0.078, p=0.007; HC: R2change=0.050, p=0.030), as well as weight gain (R2change=0.096, p=0.001) and head growth (R2change=0.134, p<0.001) from discharge to school-age. While most growth parameters, especially those from birth to discharge, were significantly influenced by prenatal growth and immaturity related morbidity (R2=0.151 to 0.605, all p≤0.001), head growth after discharge was not (R2=0.029, p=0.461). CONCLUSIONS Amongst all anthropometric measures, head growth between discharge and school-age is the best independent predictor for cognitive outcome in VLBW/VP infants. Determinants of head growth after discharge need further studies to identify targets for intervention.
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Affiliation(s)
- Karen Lidzba
- University Children's Hospital Tübingen, Department of Pediatric Neurology and Developmental Medicine, Hoppe-Seyler-Str. 1, 72076 Tübingen, Germany.
| | - Susanne Rodemann
- University Children's Hospital Tübingen, Department of Pediatric Neurology and Developmental Medicine, Hoppe-Seyler-Str. 1, 72076 Tübingen, Germany.
| | - Rangmar Goelz
- University Children's Hospital Tübingen, Department of Neonatology, Calwerstr. 7, 72076 Tübingen, Germany.
| | - Ingeborg Krägeloh-Mann
- University Children's Hospital Tübingen, Department of Pediatric Neurology and Developmental Medicine, Hoppe-Seyler-Str. 1, 72076 Tübingen, Germany.
| | - Andrea Bevot
- University Children's Hospital Tübingen, Department of Pediatric Neurology and Developmental Medicine, Hoppe-Seyler-Str. 1, 72076 Tübingen, Germany.
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