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Ginnell L, Boardman JP, Reynolds RM, Fletcher-Watson S. Parent priorities for research and communication concerning childhood outcomes following preterm birth. Wellcome Open Res 2021; 6:151. [PMID: 34746441 PMCID: PMC8546737 DOI: 10.12688/wellcomeopenres.16863.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2021] [Indexed: 04/05/2024] Open
Abstract
Background: Children born preterm (before 37 weeks of gestation) are at risk for several adverse childhood outcomes. Parent priorities for research into these outcomes, and preferences for receiving information about these risks, have not previously been established. Here we report the results of an online survey designed to understand parent priorities for research and their preferences for receiving information about childhood outcomes. Methods: An online survey was circulated through social media and was completed by 148 parents of preterm children between the ages of 0 and 12 years from around the United Kingdom (UK). Survey questions were in the form of rating scale, multiple choice, ranking or open-ended free text questions. Descriptive analysis was applied to the quantitative data. Illustrative quotes were extracted from the qualitative free text data and a subset of these questions were analysed using framework analysis. Results: Parent priorities for research centre around identification of factors which can protect against or improve adverse cognitive or developmental outcomes. The majority of parents would prefer for communication to begin within the first year of the child's life. Parents reported a knowledge gap among health visitors, early years educators and schools. Conclusions: In order to align with parent preferences, research should prioritise identification of protective factors and the development of effective interventions to improve outcomes. Training for health visitors and educational professionals could improve the experiences of families and children.
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Affiliation(s)
- Lorna Ginnell
- Salvesen Mindroom Research Centre, University of Edinburgh, Edinburgh, UK
| | - James P. Boardman
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
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102
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Stoye DQ, Sullivan G, Galdi P, Kirschbaum C, Lamb GJ, Black GS, Evans MJ, Boardman JP, Reynolds RM. Perinatal determinants of neonatal hair glucocorticoid concentrations. Psychoneuroendocrinology 2021; 128:105223. [PMID: 33878601 PMCID: PMC8155393 DOI: 10.1016/j.psyneuen.2021.105223] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 02/21/2021] [Accepted: 04/05/2021] [Indexed: 12/15/2022]
Abstract
Adult hair glucocorticoid concentrations reflect months of hypothalamic-pituitary-adrenal axis activity. However, little is known about the determinants of neonatal hair glucocorticoids. We tested associations between perinatal exposures and neonatal hair glucocorticoids. Cortisol and cortisone were measured by LC-MS/MS in paired maternal and infant hair samples collected within 10 days of birth (n = 49 term, n = 47 preterm), with neonatal samples collected at 6-weeks in n = 54 preterm infants. We demonstrate cortisol accumulation in hair increases with fetal maturity, with hair cortisol being higher in term than preterm born infants after delivery (median 401 vs 106 pg/mg; p < 0.001). In term born infants, neonatal hair cortisol is positively associated with maternal hair cortisol concentration (β = 0.240, p = 0.045) and negatively associated with birthweight z-score (β = -0.340, p = 0.006). Additionally, being born without maternal labour is associated with lower hair cortisol concentrations (β = -0.489, p < 0.001) and a lower ratio of cortisol to cortisone (β = -0.484, p = 0.001). In preterm infants, histological chorioamnionitis is associated with a higher cortisol to cortisone ratio in hair (β = 0.459, p = 0.001). In samples collected 6 weeks after preterm birth, hair cortisol concentration is associated with cortisol hair concentrations measured after birth (β = 0.523, p < 0.001), chorioamnionitis (β = 0.250, p = 0.049) and postnatal exposures including intravenous hydrocortisone therapy (β = 0.343, p < 0.007) and neonatal sepsis (β = 0.290, p = 0.017). In summary, neonatal hair cortisol is associated with birth gestation, maternal hair cortisol concentration and fetal growth. Additionally, exposures at delivery are important determinants of hair cortisol, and should be considered in the design of future research investigating how neonatal hair cortisol relates to prenatal exposures or fetal development.
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Affiliation(s)
- David Q Stoye
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | - Gemma Sullivan
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | - Paola Galdi
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | | | - Gillian J Lamb
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | - Gill S Black
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | - Margaret J Evans
- Department of Pathology, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - James P Boardman
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK; Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Rebecca M Reynolds
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK; Centre for Cardiovascular Science, University of Edinburgh, UK.
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103
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Arnaud C, Ehlinger V, Delobel-Ayoub M, Klapouszczak D, Perra O, Hensey O, Neubauer D, Hollódy K, Virella D, Rackauskaite G, Greitane A, Himmelmann K, Ortibus E, Dakovic I, Andersen GL, Papavasiliou A, Sellier E, Platt MJ, Krägeloh-Mann I. Trends in Prevalence and Severity of Pre/Perinatal Cerebral Palsy Among Children Born Preterm From 2004 to 2010: A SCPE Collaboration Study. Front Neurol 2021; 12:624884. [PMID: 34093391 PMCID: PMC8173253 DOI: 10.3389/fneur.2021.624884] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 04/13/2021] [Indexed: 11/18/2022] Open
Abstract
Aim: To report on prevalence of cerebral palsy (CP), severity rates, and types of brain lesions in children born preterm 2004 to 2010 by gestational age groups. Methods: Data from 12 population-based registries of the Surveillance of Cerebral Palsy in Europe network were used. Children with CP were eligible if they were born preterm (<37 weeks of gestational age) between 2004 and 2010, and were at least 4 years at time of registration. Severity was assessed using the impairment index. The findings of postnatal brain imaging were classified according to the predominant pathogenic pattern. Prevalences were estimated per 1,000 live births with exact 95% confidence intervals within each stratum of gestational age: ≤27, 28–31, 32–36 weeks. Time trends of both overall prevalence and prevalence of severe CP were investigated using multilevel negative binomial regression models. Results: The sample comprised 2,273 children. 25.8% were born from multiple pregnancies. About 2-thirds had a bilateral spastic CP. 43.5% of children born ≤27 weeks had a high impairment index compared to 37.0 and 38.5% in the two other groups. Overall prevalence significantly decreased (incidence rate ratio per year: 0.96 [0.92–1.00[) in children born 32–36 weeks. We showed a decrease until 2009 for children born 28–31 weeks but an increase in 2010 again, and a steady prevalence (incidence rate ratio per year = 0.97 [0.92–1.02] for those born ≤27 weeks. The prevalence of the most severely affected children with CP revealed a similar but not significant trend to the overall prevalence in the corresponding GA groups. Predominant white matter injuries were more frequent in children born <32 weeks: 81.5% (≤27 weeks) and 86.4% (28–31 weeks), compared to 63.6% for children born 32–36 weeks. Conclusion: Prevalence of CP in preterm born children continues to decrease in Europe excepting the extremely immature children, with the most severely affected children showing a similar trend.
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Affiliation(s)
- Catherine Arnaud
- UMR 1027 SPHERE Team, Inserm, Toulouse 3 Paul Sabatier University, Toulouse, France.,Childhood Disability Registry in Haute-Garonne, University Hospital of Toulouse, Toulouse, France.,Clinical Epidemiology Unit, University Hospital of Toulouse, Toulouse, France
| | - Virginie Ehlinger
- UMR 1027 SPHERE Team, Inserm, Toulouse 3 Paul Sabatier University, Toulouse, France.,Childhood Disability Registry in Haute-Garonne, University Hospital of Toulouse, Toulouse, France
| | - Malika Delobel-Ayoub
- UMR 1027 SPHERE Team, Inserm, Toulouse 3 Paul Sabatier University, Toulouse, France.,Childhood Disability Registry in Haute-Garonne, University Hospital of Toulouse, Toulouse, France
| | - Dana Klapouszczak
- UMR 1027 SPHERE Team, Inserm, Toulouse 3 Paul Sabatier University, Toulouse, France.,Childhood Disability Registry in Haute-Garonne, University Hospital of Toulouse, Toulouse, France
| | - Oliver Perra
- School of Nursing & Midwifery and Centre for Evidence and Social Innovation, Queen's University Belfast, Belfast, United Kingdom
| | | | - David Neubauer
- Department of Child, Adolescent & Developmental Neurology, University Children's Hospital Ljubljana, Ljubljana, Slovenia
| | - Katalin Hollódy
- Department of Paediatrics, Medical School, University of Pécs, Pécs, Hungary
| | - Daniel Virella
- Neonatology Intensive Care Unit/Research Center, Central Lisbon Hospital, Lisbon, Portugal
| | - Gija Rackauskaite
- Child and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
| | | | - Kate Himmelmann
- Department of Pediatrics, Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Els Ortibus
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Ivana Dakovic
- Children's Hospital Zagreb, Medical School, University of Zagreb, Zagreb, Croatia
| | - Guro L Andersen
- The Norwegian University of Science and Technology, NTNU, Trondheim, Norway.,The Cerebral Palsy Register of Norway, Vestfold Hospital Trust, Tønsberg, Norway
| | | | - Elodie Sellier
- Grenoble Alpes University, CNRS, Grenoble INP, CHU Grenoble Alpes, TIMC-IMAG, Grenoble, France.,Registre des Handicaps de l'Enfant et Observatoire Périnatal, Grenoble, France
| | - Mary Jane Platt
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Inge Krägeloh-Mann
- Department of Paediatric Neurology and Developmental Medicine, University Children's Hospital, Eberhard Karls Universität Tübingen, Tübingen, Germany
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104
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Menke BM, Hass J, Diener C, Pöschl J. Family-centered music therapy-Empowering premature infants and their primary caregivers through music: Results of a pilot study. PLoS One 2021; 16:e0250071. [PMID: 33989286 PMCID: PMC8121291 DOI: 10.1371/journal.pone.0250071] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 03/30/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In Neonatal Intensive Care Units (NICUs) premature infants are exposed to various acoustic, environmental and emotional stressors which have a negative impact on their development and the mental health of their parents. Family-centred music therapy bears the potential to positively influence these stressors. The few existing studies indicate that interactive live-improvised music therapy interventions both reduce parental stress factors and support preterm infants' development. METHODS The present randomized controlled longitudinal study (RCT) with very low and extremely low birth weight infants (born <30+0 weeks of gestation) and their parents analyzed the influence of music therapy on both the physiological development of premature infants and parental stress factors. In addition, possible interrelations between infant development and parental stress were explored. 65 parent-infant-pairs were enrolled in the study. The treatment group received music therapy twice a week from the 21st day of life till discharge from hospital. The control group received treatment as usual. RESULTS Compared to the control group, infants in the treatment group showed a 11.1 days shortening of caffeine therapy, 12.1 days shortening of nasogastric/ orogastric tube feed and 15.5 days shortening of hospitalization, on average. While these differences were not statistically significant, a factor-analytical compound measure of all three therapy durations was. From pre-to-post-intervention, parents showed a significant reduction in stress factors. However, there were no differences between control and treatment group. A regression analysis showed links between parental stress factors and physiological development of the infants. CONCLUSION This pilot study suggests that a live-improvised interactive music therapy intervention for extremely and very preterm infants and their parents may have a beneficial effect on the therapy duration needed for premature infants before discharge from hospital is possible. The study identified components of the original physiological variables of the infants as appropriate endpoints and suggested a slight change in study design to capture possible effects of music therapy on infants' development as well. Further studies should assess both short-term and long-term effects on premature infants as well as on maternal and paternal health outcomes, to determine whether a family-centered music therapy, actually experienced as an added value to developmental care, should be part of routine care at the NICU.
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Affiliation(s)
- Barbara M. Menke
- Department of Neonatology, University Children’s Hospital, Heidelberg, Germany
- Institute for Applied Research, SRH University Heidelberg, Heidelberg, Germany
| | - Joachim Hass
- Institute for Applied Research, SRH University Heidelberg, Heidelberg, Germany
- Central Institute of Mental Health, University of Heidelberg/Medical Faculty Mannheim, Mannheim, Germany
| | - Carsten Diener
- Institute for Applied Research, SRH University Heidelberg, Heidelberg, Germany
| | - Johannes Pöschl
- Department of Neonatology, University Children’s Hospital, Heidelberg, Germany
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105
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Gould JF, Roberts RM, Anderson PJ, Makrides M, Sullivan TR, Gibson RA, McPhee AJ, Doyle LW, Opie G, Travadi J, Cheong JLY, Davis PG, Sharp M, Simmer K, Tan K, Morris S, Lui K, Bolisetty S, Liley H, Stack J, Best KP, Collins CT. Protocol for assessing if behavioural functioning of infants born <29 weeks' gestation is improved by omega-3 long-chain polyunsaturated fatty acids: follow-up of a randomised controlled trial. BMJ Open 2021; 11:e044740. [PMID: 33952546 PMCID: PMC8103387 DOI: 10.1136/bmjopen-2020-044740] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 03/10/2021] [Accepted: 03/17/2021] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION During the last trimester of pregnancy, the fetal brain undergoes a rapid growth spurt and accumulates essential nutrients including docosahexaenoic acid (DHA). This takes place ex-utero for infants born <29 weeks' gestation, without the in-utero provisions of DHA. Infants born <29 weeks' are more likely to experience behavioural and emotional difficulties than their term-born counterparts. It has been hypothesised that supplementing preterm infants with dietary DHA may alleviate insufficiency and subsequently prevent or minimise behavioural problems. This protocol describes a follow-up of infants born <29 weeks gestation who were enrolled in a randomised controlled trial (RCT) of DHA supplementation. We aim to determine whether DHA supplementation improves the behaviour, and general health of these infants. METHODS AND ANALYSIS Infants born <29 weeks' gestation were enrolled in a multicentre blinded RCT of enteral DHA supplementation. Infants were randomised to receive an enteral emulsion that provided 60 mg/kg/day of DHA or a control emulsion commenced within the first 3 days of enteral feeding, until 36 weeks' postmenstrual age or discharge home, whichever occurred first. Families of surviving children (excluding those who withdrew from the study) from the Australian sites (up to 955) will be invited to complete a survey. The survey will include questions regarding child behavioural and emotional functioning, executive functioning, respiratory health and general health. We hypothesise that the DHA intervention will have a benefit on the primary outcome, parent-rated behaviour and emotional status as measured using the Total Difficulties score of the Strengths and Difficulties Questionnaire. Detecting a 2-point difference between groups (small effect size of 0.25 SD) with 90% power will require follow-up of 676 participants. ETHICS AND DISSEMINATION The Women's and Children Health Network Human Research Ethics Committee reviewed and approved the study (HREC/16/WCHN/184). Results will be disseminated in peer-reviewed publications and conference presentations. TRIAL REGISTRATION NUMBER ACTRN12612000503820.
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Affiliation(s)
- Jacqueline F Gould
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- School of Psychology and Discipline of Paediatrics, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Rachel M Roberts
- School of Psychology, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Peter J Anderson
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Maria Makrides
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- Discipline of Paediatrics, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Thomas R Sullivan
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- School of Public Health, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Robert A Gibson
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- School of Agriculture, Food and Wine, University of Adelaide, Waite Campus, Glen Osmond, South Australia, Australia
| | - Andrew J McPhee
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- Neonatal Medicine, Women's and Children's Hospital Adelaide, North Adelaide, South Australia, Australia
| | - Lex William Doyle
- Department Obstetrics and Gynaecology, Royal Women's Hospital, Parkville, Victoria, Australia
| | - Gillian Opie
- Neonatal Services, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Javeed Travadi
- Newborn Services, John Hunter Children's Hospital, New Lambton Heights, New South Wales, Australia
- School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Jeanie L Y Cheong
- Neonatal Medicine, Royal Women's Hospital, Parkville, Melbourne, Australia
| | - Peter G Davis
- Neonatal Medicine, Royal Women's Hospital, Parkville, Melbourne, Australia
| | - Mary Sharp
- Neonatal Follow up, King Edward Memorial Hospital for Women Perth, Perth, Western Australia, Australia
| | - Karen Simmer
- Neonatal Research, The University of Western Australia, Perth, Western Australia, Australia
| | - Kenneth Tan
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
- Monash Children's Hospital, Clayton, New South Wales, Australia
| | - Scott Morris
- Paediatric Neonatal Clinic, Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - Kei Lui
- Newborn Care Centre, Royal Hospital for Women, Randwick, New South Wales, Australia
| | - Srinivas Bolisetty
- Newborn Care Centre, Royal Hospital for Women, Randwick, New South Wales, Australia
| | - Helen Liley
- Mater Research - The Faculty of Medicine, The University of Queensland, South Brisbane, Queensland, Australia
| | - Jacqueline Stack
- Neonatal Intensive Care Unit, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Karen P Best
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- Discipline of Paediatrics, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Carmel T Collins
- Discipline of Paediatrics, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- Women and Kids, South Australian Health and Medical Research Institute, North Adelaide, South Australia, Australia
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106
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Fitzgerald E, Boardman JP, Drake AJ. Early life stress and LPS interact to modify the mouse cortical transcriptome in the neonatal period. Brain Behav Immun Health 2021; 13:100219. [PMID: 34589738 PMCID: PMC8474587 DOI: 10.1016/j.bbih.2021.100219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 02/08/2021] [Accepted: 02/09/2021] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION Preterm birth (PTB) is closely associated with atypical cerebral cortical development and cognitive impairment. Early exposure to extrauterine life often results in atypical environmental and biological experiences that co-occur, including early life stress (ELS) and systemic inflammation. Understanding how these experiences interact to shape cortical development is an essential prerequisite to developing therapeutic interventions that will work in the complex postnatal environment of the preterm infant. Here, we studied the effects of a murine model of infection and ELS on the neonatal cortex transcriptome. METHODS We used a mouse model of infection (1 mg/kg LPS at postnatal day (P)3) +/- ELS (modified maternal separation; MMS on days P4-P6) at timepoints with neurodevelopmental relevance to PTB. We used 4 groups: control, LPS, MMS and LPS + MMS. Cortices were dissected at P6 for 3'RNA sequencing. RESULTS LPS exposure resulted in reduced weight gain and increased expression of inflammation-associated genes in the brain. More genes were differentially expressed following LPS (15) and MMS (29) than with LPS + MMS (8). There was significant overlap between the LPS and MMS datasets, particularly amongst upregulated genes, and when comparing LPS and MMS datasets with LPS + MMS. Gene Ontology terms related to the extracellular matrix and cytokine response were enriched following MMS, but not following LPS or LPS + MMS. 26 Reactome pathways were enriched in the LPS group, none of which were enriched in the LPS + MMS group. Finally, a rank-rank hypergeometric overlap test showed similarities, particularly in upregulated genes, in the LPS and MMS conditions, indicating shared mechanisms. CONCLUSION LPS and MMS interact to modify the cortical transcriptome in the neonatal period. This has important implications for understanding the neural basis of atypical cortical development associated with early exposure to extrauterine life.
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Affiliation(s)
- Eamon Fitzgerald
- University/British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, The Queen’s Medical Research Institute, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK
| | - James P. Boardman
- MRC Centre for Reproductive Health, University of Edinburgh, The Queen’s Medical Research Institute, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK
- Centre for Clinical Brain Sciences, University of Edinburgh, Chancellor’s Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Amanda J. Drake
- University/British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, The Queen’s Medical Research Institute, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK
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107
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van Beek PE, Groenendaal F, Broeders L, Dijk PH, Dijkman KP, van den Dungen FAM, van Heijst AFJ, van Hillegersberg JL, Kornelisse RF, Onland W, Schuerman FABA, van Westering-Kroon E, Witlox RSGM, Andriessen P. Survival and causes of death in extremely preterm infants in the Netherlands. Arch Dis Child Fetal Neonatal Ed 2021; 106:251-257. [PMID: 33158971 PMCID: PMC8070636 DOI: 10.1136/archdischild-2020-318978] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 08/27/2020] [Accepted: 09/21/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVE In the Netherlands, the threshold for offering active treatment for spontaneous birth was lowered from 25+0 to 24+0 weeks' gestation in 2010. This study aimed to evaluate the impact of guideline implementation on survival and causes and timing of death in the years following implementation. DESIGN National cohort study, using data from the Netherlands Perinatal Registry. PATIENTS The study population included all 3312 stillborn and live born infants with a gestational age (GA) between 240/7 and 266/7 weeks born between January 2011 and December 2017. Infants with the same GA born between January 2007 and December 2009 (N=1400) were used as the reference group. MAIN OUTCOME MEASURES Survival to discharge, as well as cause and timing of death. RESULTS After guideline implementation, there was a significant increase in neonatal intensive care unit (NICU) admission rate for live born infants born at 24 weeks' GA (27%-69%, p<0.001), resulting in increased survival to discharge in 24-week live born infants (13%-34%, p<0.001). Top three causes of in-hospital mortality were necrotising enterocolitis (28%), respiratory distress syndrome (19%) and intraventricular haemorrhage (17%). A significant decrease in cause of death either complicated or caused by respiratory insufficiency was seen over time (34% in 2011-2014 to 23% in 2015-2017, p=0.006). CONCLUSIONS Implementation of the 2010 guideline resulted as expected in increased NICU admissions rate and postnatal survival of infants born at 24 weeks' GA. In the years after implementation, a shift in cause of death was seen from respiratory insufficiency towards necrotising enterocolitis and sepsis.
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Affiliation(s)
- Pauline E van Beek
- Department of Neonatology, Máxima Medical Centre, Veldhoven, The Netherlands
| | - Floris Groenendaal
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Lisa Broeders
- The Netherlands Perinatal Registry, Utrecht, The Netherlands
| | - Peter H Dijk
- Department of Neonatology, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, The Netherlands
| | - Koen P Dijkman
- Department of Neonatology, Máxima Medical Centre, Veldhoven, The Netherlands
| | | | - Arno F J van Heijst
- Department of Neonatology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - René F Kornelisse
- Department of Pediatrics, Devision of Neonatology, Sophia Children's Hospital, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Wes Onland
- Department of Neonatology, Emma Childrens Hospital, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | | | | | - Ruben S G M Witlox
- Department of Neonatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Peter Andriessen
- Department of Neonatology, Máxima Medical Centre, Veldhoven, The Netherlands
- Department of Applied Physics, Eindhoven University of Technology, Eindhoven, The Netherlands
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108
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Samir A, Nasef N, Fathy K, El-Gilany AH, Yahia S. Effect of cerebrolysin on neurodevelopmental outcome of high risk preterm infants: A randomized controlled trial. J Neonatal Perinatal Med 2021; 15:37-45. [PMID: 33935111 DOI: 10.3233/npm-200659] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND A significant proportion of preterm infants experience developmental delay despite receiving a post discharge early interventional care. Cerebrolysin is a peptide mixture which acts similar to endogenous neurotrophic factors through promoting neurogenesis and enhancing neuronal plasticity. OBJECTIVE To compare the effect of Cerebrolysin plus routine intervention program versus routine intervention program alone on the outcome of preterm infants at high risk for neurodevelopmental delay. METHODS In a randomized controlled trial, high-risk preterm infants < 32 weeks' gestation who have abnormal neurological assessment at two months corrected post-natal age were randomized at 6 months corrected post natal age to receive either early intervention program or early intervention program plus Cerebrolysin injection of 0.1 mL/kg body weight every week for 3 months as an adjuvant therapy. The primary outcome was the rate of failure of the gross motor assessment at 12 months of corrected age and secondary outcomes included fine motor, language, and personal social development at 12 months corrected post-natal age as assessed by Denver Developmental Screening Test II. RESULTS Cerebrolysin group had a significant lower number of infants diagnosed with failed gross motor development compared to infants in the routine intervention group [10 (33%) versus 21 (70%), p = 0.009]. Cerebrolysin group had a significant lower number of infants diagnosed with failed fine motor, language and personal social development compared to infants in the routine intervention group. CONCLUSION Cerebrolysin, as an adjuvant therapy to routine early interventional care, may improve gross motor development of high-risk preterm infants at 12 months corrected post-natal age.
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Affiliation(s)
- A Samir
- Mansoura University Children's Hospital, Mansoura, Egypt
| | - N Nasef
- Mansoura University Children's Hospital, Mansoura, Egypt.,Departemnet of Pediatrics, Faculty of Medicine, University of Mansoura, Mansoura, Egypt
| | - K Fathy
- Mansoura University Children's Hospital, Mansoura, Egypt.,Departemnet of Pediatrics, Faculty of Medicine, University of Mansoura, Mansoura, Egypt
| | - A-H El-Gilany
- Department of Public Health, Faculty of Medicine, University of Mansoura, Mansoura, Egypt
| | - S Yahia
- Mansoura University Children's Hospital, Mansoura, Egypt.,Departemnet of Pediatrics, Faculty of Medicine, University of Mansoura, Mansoura, Egypt
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109
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Pierrat V, Marchand-Martin L, Marret S, Arnaud C, Benhammou V, Cambonie G, Debillon T, Dufourg MN, Gire C, Goffinet F, Kaminski M, Lapillonne A, Morgan AS, Rozé JC, Twilhaar S, Charles MA, Ancel PY. Neurodevelopmental outcomes at age 5 among children born preterm: EPIPAGE-2 cohort study. BMJ 2021; 373:n741. [PMID: 33910920 PMCID: PMC8080137 DOI: 10.1136/bmj.n741] [Citation(s) in RCA: 99] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To describe neurodevelopment at age 5 among children born preterm. DESIGN Population based cohort study, EPIPAGE-2. SETTING France, 2011. PARTICIPANTS 4441 children aged 5½ born at 24-26, 27-31, and 32-34 weeks MAIN OUTCOME MEASURES: Severe/moderate neurodevelopmental disabilities, defined as severe/moderate cerebral palsy (Gross Motor Function Classification System (GMFCS) ≥2), or unilateral or bilateral blindness or deafness, or full scale intelligence quotient less than minus two standard deviations (Wechsler Preschool and Primary Scale of Intelligence, 4th edition). Mild neurodevelopmental disabilities, defined as mild cerebral palsy (GMFCS-1), or visual disability ≥3.2/10 and <5/10, or hearing loss <40 dB, or full scale intelligence quotient (minus two to minus one standard deviation) or developmental coordination disorders (Movement Assessment Battery for Children, 2nd edition, total score less than or equal to the fifth centile), or behavioural difficulties (strengths and difficulties questionnaire, total score greater than or equal to the 90th centile), school assistance (mainstream class with support or special school), complex developmental interventions, and parents' concerns about development. The distributions of the scores in contemporary term born children were used as reference. Results are given after multiple imputation as percentages of outcome measures with exact binomial 95% confidence intervals. RESULTS Among 4441 participants, 3083 (69.4%) children were assessed. Rates of severe/moderate neurodevelopmental disabilities were 28% (95% confidence interval 23.4% to 32.2%), 19% (16.8% to 20.7%), and 12% (9.2% to 14.0%) and of mild disabilities were 38.5% (33.7% to 43.4%), 36% (33.4% to 38.1%), and 34% (30.2% to 37.4%) at 24-26, 27-31, and 32-34 weeks, respectively. Assistance at school was used by 27% (22.9% to 31.7%), 14% (12.1% to 15.9%), and 7% (4.4% to 9.0%) of children at 24-26, 27-31, and 32-34 weeks, respectively. About half of the children born at 24-26 weeks (52% (46.4% to 57.3%)) received at least one developmental intervention which decreased to 26% (21.8% to 29.4%) for those born at 32-34 weeks. Behaviour was the concern most commonly reported by parents. Rates of neurodevelopment disabilities increased as gestational age decreased and were higher in families with low socioeconomic status. CONCLUSIONS In this large cohort of children born preterm, rates of severe/moderate neurodevelopmental disabilities remained high in each gestational age group. Proportions of children receiving school assistance or complex developmental interventions might have a significant impact on educational and health organisations. Parental concerns about behaviour warrant attention.
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Affiliation(s)
- Véronique Pierrat
- University of Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRAE, F-75004 Paris, France
- CHU Lille, Department of Neonatal Medicine, Jeanne de Flandre Hospital, Lille, France
| | - Laetitia Marchand-Martin
- University of Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRAE, F-75004 Paris, France
| | - Stéphane Marret
- Department of Neonatal Medicine, Intensive Care, and Neuropediatrics, Rouen University Hospital, Rouen, France
- INSERM U1254, Neovascular Team, Perinatal Handicap, Institute of Biomedical Research and Innovation, Normandy University, Rouen, France
| | - Catherine Arnaud
- INSERM U1027, SPHERE Team, France
- Toulouse 3 University Paul-Sabatier, Toulouse, France
- Clinical Epidemiology Unit, University Hospital Toulouse, Toulouse, France
| | - Valérie Benhammou
- University of Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRAE, F-75004 Paris, France
| | - Gilles Cambonie
- Department of Neonatal Medicine, Montpellier University Hospital, Montpellier, France
| | - Thierry Debillon
- Neonatal Intensive Care Unit, Grenoble Alps University Hospital, Grenoble, France
- UMR 5525 Techniques pour l'Evaluation et la Modélisation des Actions de la Santé, Centre National de la Recherche Scientifique, Techniques de l'Ingénierie Médicale et de la Complexité-Informatique, Mathématiques et Applications, Grenoble Alps University, Grenoble, France
| | - Marie-Noëlle Dufourg
- French Institute for Demographic Studies, French Institute for Medical Research and Health, French Blood Agency, ELFE Joint Unit, Paris, France
| | - Catherine Gire
- Department of Neonatology, North Hospital, Assistance Publique des Hôpitaux de Marseille, Marseille, France
| | - François Goffinet
- University of Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRAE, F-75004 Paris, France
- Port-Royal Maternity, Assistance Publique-Hôpitaux de Paris, Centre-University of Paris, Federation Hospitalo-Universitairefor prematurity, Paris, France
| | - Monique Kaminski
- University of Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRAE, F-75004 Paris, France
| | - Alexandre Lapillonne
- Assistance Publique-Hôpitaux de Paris, University Hospital Necker-Enfants Malades, University of Paris, Paris, France
| | - Andrei Scott Morgan
- University of Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRAE, F-75004 Paris, France
- UCL Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| | - Jean-Christophe Rozé
- Department of Neonatal Medicine, Nantes University Hospital, Nantes, France
- Clinical Epidemiology, Clinical Investigation Centre CIC004, Nantes University Hospital, Nantes, France
| | - Sabrina Twilhaar
- University of Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRAE, F-75004 Paris, France
| | - Marie-Aline Charles
- Neonatal Intensive Care Unit, Grenoble Alps University Hospital, Grenoble, France
- University of Paris, CRESS, Team Early Life Research on Later Health, UMR 1153, INSERM, INRAE, Villejuif, France
| | - Pierre-Yves Ancel
- University of Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRAE, F-75004 Paris, France
- Clinical Investigation Centre P1419, Assistance Publique-Hôpitaux de Paris, Paris, France
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110
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Adle-Biassette H. Neurodevelopmental Sequelae of Preterm Infants: Scientific Challenges. J Neuropathol Exp Neurol 2021; 80:390-392. [PMID: 33842955 DOI: 10.1093/jnen/nlab035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Homa Adle-Biassette
- AP-HP, Hôpital Lariboisière, Service Anatomie Pathologique and Université de Paris, NeuroDiderot, Inserm, Paris, France
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111
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Agarwal PK, Zheng Q, Yang PH, Shi L, Rajadurai VS, Khoo PC, Quek BH, Daniel LM. Academic school readiness in children born very preterm and associated risk factors. Early Hum Dev 2021; 155:105325. [PMID: 33611167 DOI: 10.1016/j.earlhumdev.2021.105325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 01/19/2021] [Accepted: 01/28/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND AIMS Although the intelligence quotient (IQ) test is useful to assess general cognitive function, it may miss more specific and subtle deficits of learning, working memory, attention and executive function. This study aims to evaluate cognitive performance and academic school readiness (SR) concepts in preterm very low birth weight (PT/VLBW) children, compared to typically developing term controls and to evaluate factors affecting basic (SR) concepts in children with IQ>85. METHODS A prospective cohort study of 123 PT/VLBW survivors with birth weights ≤1250 g and 74 term controls born between 2007 and 2009 in Singapore were assessed for school readiness using Wechsler Preschool and Primary Scale of Intelligence (WPPSI-III), Bracken School Readiness Assessment (BSRA-3) and Beery-Buktenica Developmental Test of Visual Motor Integration (VMI) at age 5.5 years. Social risk composite score (SRCS) was calculated based on ethnicity, parental education and family income and marital status. Uni- and multi-variable regressions were conducted to evaluate risk factors associated with poor academic SR in the entire cohort and in those with IQ >85. RESULTS Mean gestational age and birth weight of the 123 PT/VLBW children were 27.8 (2.3) weeks and 939 (194) grams while that of the 74 term controls were 38.8 (1.2) weeks and 3165 (402) grams. PT/VLBW survivors had statistically significant lower full composite scores on WPPSI-III (97.0 vs 114), BSRA-3 (98.5 vs 112.3) and VMI (107.2 vs 112.9) compared to controls. The differences remained significant in preterm and children with higher SRCS even after adjustment. CONCLUSIONS Prematurity and high social composite risk scores were risk factors affecting academic SR and this difference persisted in PT/VLBW children with normal cognitive scores with IQ >85.
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Affiliation(s)
- Pratibha Kashev Agarwal
- Department of Child Development, KK Women's and Children's Hospital, Bukit Timah Rd, 100, Singapore 229899, Singapore
| | - Qishi Zheng
- Department of Epidemiology, Singapore Clinical Research Institute, 31 Biopolis Way, Nanos, #01-01, Singapore 138669, Singapore.
| | - Phey Hong Yang
- Department of Child Development, KK Women's and Children's Hospital, Bukit Timah Rd, 100, Singapore 229899, Singapore
| | - Luming Shi
- Department of Epidemiology, Singapore Clinical Research Institute, 31 Biopolis Way, Nanos, #01-01, Singapore 138669, Singapore
| | - Victor Samuel Rajadurai
- Department of Neonatology, KK Women's and Children's Hospital, Bukit Timah Rd, 100, Singapore 229899, Singapore
| | - Poh Choo Khoo
- Department of Neonatology, KK Women's and Children's Hospital, Bukit Timah Rd, 100, Singapore 229899, Singapore
| | - Bin Huey Quek
- Department of Neonatology, KK Women's and Children's Hospital, Bukit Timah Rd, 100, Singapore 229899, Singapore
| | - Lourdes Mary Daniel
- Department of Child Development, KK Women's and Children's Hospital, Bukit Timah Rd, 100, Singapore 229899, Singapore
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112
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Dean B, Ginnell L, Ledsham V, Tsanas A, Telford E, Sparrow S, Fletcher-Watson S, Boardman JP. Eye-tracking for longitudinal assessment of social cognition in children born preterm. J Child Psychol Psychiatry 2021; 62:470-480. [PMID: 32729133 DOI: 10.1111/jcpp.13304] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/24/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVES Preterm birth is associated with atypical social cognition in infancy, and cognitive impairment and social difficulties in childhood. Little is known about the stability of social cognition through childhood, and its relationship with neurodevelopment. We used eye-tracking in preterm and term-born infants to investigate social attentional preference in infancy and at 5 years, its relationship with neurodevelopment and the influence of socioeconomic deprivation. METHODS A cohort of 81 preterm and 66 term infants with mean (range) gestational age at birth 28+5 (23+2 -33+0 ) and 40+0 (37+0 -42+1 ) respectively, completed eye-tracking at 7-9 months, with a subset re-assessed at 5 years. Three free-viewing social tasks of increasing stimulus complexity were presented, and a social preference score was derived from looking time to socially informative areas. Socioeconomic data and the Mullen Scales of Early Learning at 5 years were collected. RESULTS Preterm children had lower social preference scores at 7-9 months compared with term-born controls. Term-born children's scores were stable between time points, whereas preterm children showed a significant increase, reaching equivalent scores by 5 years. Low gestational age and socioeconomic deprivation were associated with reduced social preference scores at 7-9 months. At 5 years, preterm infants had lower Early Learning Composite scores than controls, but this was not associated with social attentional preference in infancy or at 5 years. CONCLUSIONS Preterm children have reduced social attentional preference at 7-9 months compared with term-born controls, but catch up by 5 years. Infant social cognition is influenced by socioeconomic deprivation and gestational age. Social cognition and neurodevelopment have different trajectories following preterm birth.
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Affiliation(s)
- Bethan Dean
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | - Lorna Ginnell
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | - Victoria Ledsham
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | | | - Emma Telford
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | - Sarah Sparrow
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | - Sue Fletcher-Watson
- Salvesen Mindroom Research Centre for Learning Difficulties, University of Edinburgh, Edinburgh, UK
| | - James P Boardman
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK.,Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
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113
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Kakaroukas A, Abrahamse-Berkeveld M, Berrington JE, McNally RJQ, Stewart CJ, Embleton ND, van Elburg RM. An Observational Cohort Study and Nested Randomized Controlled Trial on Nutrition and Growth Outcomes in Moderate and Late Preterm Infants (FLAMINGO). Front Nutr 2021; 8:561419. [PMID: 33763438 PMCID: PMC7982654 DOI: 10.3389/fnut.2021.561419] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 02/02/2021] [Indexed: 12/03/2022] Open
Abstract
Background: Over the past decades, the preterm birth rate has increased, mostly due to a rise in late and moderate preterm (LMPT, 32–36 weeks gestation) births. LMPT birth affects 6–7% of all births in the United Kingdom and is associated with increased morbidity risk after birth in infancy as well as in adulthood. Early life nutrition has a critical role in determining infant growth and development, but there are limited data specifically addressing LMPT infants, which was the rationale for the design of the current study. Objective: The Feeding Late and Moderate Infants and Growth Outcomes (FLAMINGO) study aims to improve understanding of the longitudinal growth, nutritional needs, and body composition of LMPT infants as well as their microbiome development and neurodevelopment. In addition, having a nested non-inferiority trial enables evaluation of the nutritional adequacy of a concept IMF with large milk phospholipid-coated lipid droplets comprising dairy and vegetable lipids. The primary outcome of this RCT is daily weight gain until 3 months corrected age. Methods: A total of 250 healthy LMPT infants (32+0–36+6 weeks gestational age) with birth weight 1.25–3.0 kg will be recruited to the cohort, of which 140 infants are anticipated to be enrolled in the RCT. During six visits over the first 2 years of life, anthropometry, body composition (using dual energy X-Ray absorptiometry), feeding behavior, and developmental outcomes will be measured. Saliva and stool samples will be collected for oral and gut microbiota assessment. Discussion: The FLAMINGO study will improve understanding of the longitudinal growth, body composition development, and feeding characteristics of LMPT infants and gain insights into their microbiome and neurodevelopment. Study Registration:www.isrctn.com; Identifier ISRCTN15469594.
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Affiliation(s)
- Andreas Kakaroukas
- Newcastle Neonatal Service, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals National Health Service (NHS) Foundation Trust, Newcastle upon Tyne, United Kingdom
| | | | - Janet E Berrington
- Newcastle Neonatal Service, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals National Health Service (NHS) Foundation Trust, Newcastle upon Tyne, United Kingdom.,Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Richard J Q McNally
- Faculty of Medical Sciences, Population and Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Christopher J Stewart
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Nicholas D Embleton
- Newcastle Neonatal Service, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals National Health Service (NHS) Foundation Trust, Newcastle upon Tyne, United Kingdom.,Faculty of Medical Sciences, Population and Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Ruurd M van Elburg
- Emma Children's Hospital, Amsterdam University Medical Centers (Amsterdam UMC) Amsterdam, Amsterdam, Netherlands
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114
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Manzotti A, Chiera M, Galli M, Lombardi E, La Rocca S, Biasi P, Esteves J, Lista G, Cerritelli F. The neonatal assessment manual score (NAME) for improving the clinical management of infants: a perspective validity study. Ital J Pediatr 2021; 47:53. [PMID: 33678165 PMCID: PMC7938573 DOI: 10.1186/s13052-021-01012-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 02/26/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The Neonatal Assessment Manual scorE (NAME) was developed to assist in the clinical management of infants in the neonatal ward by assessing their body's compliance and homogeneity. The present study begins its validation process. METHODS An expert panel of neonatal intensive care unit (NICU) professionals investigated the NAME face and content validity. Content validity was assessed through the content validity index (CVI). Construct validity was assessed using data collected from 50 newborns hospitalized in the NICU of "Vittore Buzzi" Children Hospital of Milan, Italy. Kendall's τ and ordinal logistic regressions were used to evaluate the correlation between the NAME scores and infants' gestational age, birth weight, post-menstrual age, weight at the time of assessment, and a complexity index related to organic complications. RESULTS The CVIs for compliance, homogeneity, and the whole scale were respectively 1, 0.9, and 0.95. Construct validity analysis showed significant positive correlations between the NAME and infants' weight and age, and a negative correlation between the NAME and the complexity index (τ = - 0.31 [95% IC: - 0.47, - 0.12], p = 0.016 and OR = 0.56 [95% IC: 0.32, 0.94], p = 0.034 for categorical NAME; τ = - 0.32 [95% IC: - 0.48, - 0.14], p = 0.005 for numerical NAME). CONCLUSIONS The NAME was well accepted by NICU professionals in this study and it demonstrates good construct validity in discriminating the infant's general condition. Future studies are needed to test the NAME reliability and predictive capacity.
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Affiliation(s)
- Andrea Manzotti
- RAISE lab, Foundation COME Collaboration, Corso Europa 29 - 66054 Vasto (Italy), Pescara, Italy
- Division of Neonatology, "V. Buzzi" Children's Hospital, ASST-FBF-Sacco, Milan, Italy
- Research Department, SOMA, Istituto Osteopatia Milano, Milan, Italy
| | - Marco Chiera
- RAISE lab, Foundation COME Collaboration, Corso Europa 29 - 66054 Vasto (Italy), Pescara, Italy
| | - Matteo Galli
- RAISE lab, Foundation COME Collaboration, Corso Europa 29 - 66054 Vasto (Italy), Pescara, Italy
- Research Department, SOMA, Istituto Osteopatia Milano, Milan, Italy
| | - Erica Lombardi
- RAISE lab, Foundation COME Collaboration, Corso Europa 29 - 66054 Vasto (Italy), Pescara, Italy
- Division of Neonatology, "V. Buzzi" Children's Hospital, ASST-FBF-Sacco, Milan, Italy
- Research Department, SOMA, Istituto Osteopatia Milano, Milan, Italy
| | - Simona La Rocca
- RAISE lab, Foundation COME Collaboration, Corso Europa 29 - 66054 Vasto (Italy), Pescara, Italy
- Division of Neonatology, "V. Buzzi" Children's Hospital, ASST-FBF-Sacco, Milan, Italy
- Research Department, SOMA, Istituto Osteopatia Milano, Milan, Italy
| | - Pamela Biasi
- RAISE lab, Foundation COME Collaboration, Corso Europa 29 - 66054 Vasto (Italy), Pescara, Italy
- Division of Neonatology, "V. Buzzi" Children's Hospital, ASST-FBF-Sacco, Milan, Italy
- Research Department, SOMA, Istituto Osteopatia Milano, Milan, Italy
| | - Jorge Esteves
- RAISE lab, Foundation COME Collaboration, Corso Europa 29 - 66054 Vasto (Italy), Pescara, Italy
| | - Gianluca Lista
- Division of Neonatology, "V. Buzzi" Children's Hospital, ASST-FBF-Sacco, Milan, Italy
| | - Francesco Cerritelli
- RAISE lab, Foundation COME Collaboration, Corso Europa 29 - 66054 Vasto (Italy), Pescara, Italy.
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115
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Fitzgerald E, Parent C, Kee MZL, Meaney MJ. Maternal Distress and Offspring Neurodevelopment: Challenges and Opportunities for Pre-clinical Research Models. Front Hum Neurosci 2021; 15:635304. [PMID: 33643013 PMCID: PMC7907173 DOI: 10.3389/fnhum.2021.635304] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 01/21/2021] [Indexed: 12/12/2022] Open
Abstract
Pre-natal exposure to acute maternal trauma or chronic maternal distress can confer increased risk for psychiatric disorders in later life. Acute maternal trauma is the result of unforeseen environmental or personal catastrophes, while chronic maternal distress is associated with anxiety or depression. Animal studies investigating the effects of pre-natal stress have largely used brief stress exposures during pregnancy to identify critical periods of fetal vulnerability, a paradigm which holds face validity to acute maternal trauma in humans. While understanding these effects is undoubtably important, the literature suggests maternal stress in humans is typically chronic and persistent from pre-conception through gestation. In this review, we provide evidence to this effect and suggest a realignment of current animal models to recapitulate this chronicity. We also consider candidate mediators, moderators and mechanisms of maternal distress, and suggest a wider breadth of research is needed, along with the incorporation of advanced -omics technologies, in order to understand the neurodevelopmental etiology of psychiatric risk.
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Affiliation(s)
- Eamon Fitzgerald
- Department of Psychiatry, Faculty of Medicine, Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada
- Ludmer Centre for Neuroinformatics and Mental Health, Douglas Research Centre, McGill University, Montreal, QC, Canada
| | - Carine Parent
- Department of Psychiatry, Faculty of Medicine, Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada
- Ludmer Centre for Neuroinformatics and Mental Health, Douglas Research Centre, McGill University, Montreal, QC, Canada
| | - Michelle Z. L. Kee
- Translational Neuroscience Programme, Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (ASTAR), Singapore, Singapore
| | - Michael J. Meaney
- Department of Psychiatry, Faculty of Medicine, Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada
- Ludmer Centre for Neuroinformatics and Mental Health, Douglas Research Centre, McGill University, Montreal, QC, Canada
- Translational Neuroscience Programme, Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (ASTAR), Singapore, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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116
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Fontana C, Marasca F, Provitera L, Mancinelli S, Pesenti N, Sinha S, Passera S, Abrignani S, Mosca F, Lodato S, Bodega B, Fumagalli M. Early maternal care restores LINE-1 methylation and enhances neurodevelopment in preterm infants. BMC Med 2021; 19:42. [PMID: 33541338 PMCID: PMC7863536 DOI: 10.1186/s12916-020-01896-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 12/22/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Preterm birth affects almost 9-11% of newborns and is one of the leading causes of childhood neurodevelopmental disabilities; the underlying molecular networks are poorly defined. In neurons, retrotransposons LINE-1 (L1) are an active source of genomic mosaicism that is deregulated in several neurological disorders; early life experience has been shown to regulate L1 activity in mice. METHODS Very preterm infants were randomized to receive standard care or early intervention. L1 methylation was measured at birth and at hospital discharge. At 12 and 36 months, infants' neurodevelopment was evaluated with the Griffiths Scales. L1 methylation and CNVs were measured in mouse brain areas at embryonic and postnatal stages. RESULTS Here we report that L1 promoter is hypomethylated in preterm infants at birth and that an early intervention program, based on enhanced maternal care and positive multisensory stimulation, restores L1 methylation levels comparable to healthy newborns and ameliorates neurodevelopment in childhood. We further show that L1 activity is fine-tuned in the perinatal mouse brain, suggesting a sensitive and vulnerable window for the L1 epigenetic setting. CONCLUSIONS Our results open the field on the inspection of L1 activity as a novel molecular and predictive approach to infants' prematurity-related neurodevelopmental outcomes. TRIAL REGISTRATION ClinicalTrial.gov ( NCT02983513 ). Registered on 6 December 2016, retrospectively registered.
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Affiliation(s)
- Camilla Fontana
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Federica Marasca
- Istituto Nazionale di Genetica Molecolare "Enrica e Romeo Invernizzi" (INGM), Milan, Italy
| | - Livia Provitera
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, NICU, Milan, Italy
| | - Sara Mancinelli
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,IRCCS Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Nicola Pesenti
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, NICU, Milan, Italy.,Department of Statistics and Quantitative Methods, Division of Biostatistics, Epidemiology and Public Health, University of Milano-Bicocca, Milan, Italy
| | - Shruti Sinha
- Istituto Nazionale di Genetica Molecolare "Enrica e Romeo Invernizzi" (INGM), Milan, Italy
| | - Sofia Passera
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, NICU, Milan, Italy
| | - Sergio Abrignani
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Istituto Nazionale di Genetica Molecolare "Enrica e Romeo Invernizzi" (INGM), Milan, Italy
| | - Fabio Mosca
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, NICU, Milan, Italy
| | - Simona Lodato
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,IRCCS Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Beatrice Bodega
- Istituto Nazionale di Genetica Molecolare "Enrica e Romeo Invernizzi" (INGM), Milan, Italy.
| | - Monica Fumagalli
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy. .,Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, NICU, Milan, Italy.
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Toulmin H, O'Muircheartaigh J, Counsell SJ, Falconer S, Chew A, Beckmann CF, Edwards AD. Functional thalamocortical connectivity at term equivalent age and outcome at 2 years in infants born preterm. Cortex 2021; 135:17-29. [PMID: 33359978 PMCID: PMC7859832 DOI: 10.1016/j.cortex.2020.09.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 02/05/2020] [Accepted: 09/23/2020] [Indexed: 11/19/2022]
Abstract
Infants born preterm are at high risk of long-term motor and neurocognitive deficits. In the majority of these infants structural MRI at the time of normal birth does not predict motor or cognitive outcomes accurately, and many infants without apparent brain lesions later develop motor and cognitive deficits. Thalamocortical connections are known to be necessary for normal brain function; they develop during late fetal life and are vulnerable to perinatal adversity. This study addressed the hypothesis that abnormalities in the functional connectivity between cortex and thalamus underlie neurocognitive impairments seen after preterm birth. Using resting state functional connectivity magnetic resonance imaging (fMRI) in a group of 102 very preterm infants without major focal brain lesions, we used partial correlations between thalamus and functionally-derived cortical areas to determine significant connectivity between cortical areas and thalamus, and correlated the parameter estimates of these connections with standardised neurocognitive assessments in each infant at 20 months of age. Pre-motor association cortex connectivity to thalamus correlates with motor function, while connectivity between primary sensory-motor cortex and thalamus correlates with cognitive scores. These results demonstrate the importance and vulnerability of functional thalamocortical connectivity development in the perinatal period for later neurocognitive functioning.
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Affiliation(s)
- Hilary Toulmin
- Centre for the Developing Brain, Division of Imaging Sciences and Biomedical Engineering, King's College London, St Thomas' Hospital, London SE1 7EH, UK; Neurodevelopmental Service, Brookside Family Clinic, Cambridge and Peterborough NHS Foundation NHS Trust, 18 Trumpington Road, CB2 8AH, UK; Cambridgeshire Community Services NHS Trust, Peacock Centre, Brookfields Hospital, Cambridge, CB1 3DF, UK.
| | - Jonathan O'Muircheartaigh
- Centre for the Developing Brain, Division of Imaging Sciences and Biomedical Engineering, King's College London, St Thomas' Hospital, London SE1 7EH, UK; Department of Forensic and Neurodevelopmental Sciences, Sackler Institute for Translational Neurodevelopment, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; MRC Centre for Neurodevelopmental Disorders, King's College London, London, UK
| | - Serena J Counsell
- Centre for the Developing Brain, Division of Imaging Sciences and Biomedical Engineering, King's College London, St Thomas' Hospital, London SE1 7EH, UK; MRC Centre for Neurodevelopmental Disorders, King's College London, London, UK
| | - Shona Falconer
- Centre for the Developing Brain, Division of Imaging Sciences and Biomedical Engineering, King's College London, St Thomas' Hospital, London SE1 7EH, UK
| | - Andrew Chew
- Centre for the Developing Brain, Division of Imaging Sciences and Biomedical Engineering, King's College London, St Thomas' Hospital, London SE1 7EH, UK
| | - Christian F Beckmann
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, 6500 HC, Nijmegen, the Netherlands; Department of Clinical Neuroscience, Radboud University Medical Centre, 6500 HB, Nijmegen, the Netherlands; Oxford Centre for Functional Magnetic Resonance Imaging of the Brain (FMRIB), University of Oxford, Oxford, OX3 9DU, UK
| | - A David Edwards
- Centre for the Developing Brain, Division of Imaging Sciences and Biomedical Engineering, King's College London, St Thomas' Hospital, London SE1 7EH, UK; MRC Centre for Neurodevelopmental Disorders, King's College London, London, UK; Department of Bioengineering, Imperial College London, London, SW7 2AZ, UK
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Frantz MF, Schaefer MP, Donelli TMS. Follow-Up de Nascidos Prematuros: Uma Revisão Sistemática da Literatura. PSICOLOGIA: TEORIA E PESQUISA 2021. [DOI: 10.1590/0102.3772e37316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Objetivou-se mapear estudos científicos sobre follow-up de prematuros na área da psicologia. Buscou-se no portal BVS artigos empíricos publicados até dezembro de 2017 pelos descritores prematur* AND follow up AND child AND psychology. A partir dos critérios adotados, analisou-se 48 artigos, nas categorias: faixa etária em que os prematuros foram avaliados; objetivos do estudo; tipo de avaliação realizada; e resultados encontrados. Destaca-se que a metade realizou o follow-up entre o nascimento e a adolescência, a maioria investigou o desenvolvimento neuropsicológico e encontrou associações entre a prematuridade, déficits cognitivos e psicológicos. Compreende-se que os estudos priorizam as repercussões no desenvolvimento de habilidades e competências, dando pouca atenção aos aspectos psíquicos e às interações criança-pais-ambiente.
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Zhu Z, Wang J, Chen C, Zhou J. Hospitalization charges for extremely preterm infants: a ten-year analysis in Shanghai, China. J Med Econ 2020; 23:1610-1617. [PMID: 33084446 DOI: 10.1080/13696998.2020.1839272] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVES Extreme prematurity exerts a substantial economic burden on families and societies worldwide, especially in developing countries with limited healthcare resources. This study aimed to estimate initial hospitalization charges after extremely preterm birth in China over the previous decade. METHODS A retrospective study was conducted in the largest tertiary neonatal intensive care unit in Shanghai, China, including 441 extremely preterm infants (gestational age <28 weeks) discharged between 2010 and 2019. Hospitalization data and medical charges were obtained from electronic inpatient medical records. Subgroup analysis was conducted to examine how the charges and length of stay varied by gestational age, discharge year, survival status, and major morbidities. RESULTS The median total hospitalization charge was $20,770.70 with a median length of stay of 70.0 days. Total and daily charges declined as gestational age increased. A rising trend was found over time for overall and daily medical charges. Compared with decedents, survivors had a longer length of stay and higher total hospitalization charges, but their charge per day was lower. Total hospitalization charges were significantly higher in infants with necrotizing enterocolitis (Stage II-III), bronchopulmonary dysplasia, and sepsis when compared with neonates of the same gestational age without these co-morbidities. Charges for treatments accounted for the highest proportion (31.3%). LIMITATIONS Local statistics collected retrospectively might limit generalizability to other regions. Long-term medical charges were not reported. CONCLUSION Economic burden of the initial hospitalization for extremely preterm infants was substantial in China. Such economic factors should be fully taken into account for perinatal consultations, medical insurance policy-making, and clinical decisions.
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Affiliation(s)
- Zhicheng Zhu
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China
| | - Jin Wang
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China
| | - Chao Chen
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China
| | - Jianguo Zhou
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China
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Neurodevelopmental Outcome in Extremely Low Birth Weight Infants at 2-3 Years of Age. ACTA ACUST UNITED AC 2020; 56:medicina56120649. [PMID: 33256108 PMCID: PMC7760848 DOI: 10.3390/medicina56120649] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 11/20/2020] [Accepted: 11/23/2020] [Indexed: 11/17/2022]
Abstract
Background and objectives: The aims of this study were to examine the relationship between neurological outcomes at 3- and 6-months corrected age with the neurodevelopmental outcome at 3 years of age; to identify the perinatal/neonatal risk factors for poor neurodevelopmental outcomes at 3 years of age. Materials and methods: In our single-centre longitudinal cohort study, of the 73 consecutive infants admitted to our Neonatal Intensive Care Unit (NICU), 49 infants (80%) received both Hammersmith Infant Neurological Examination (HINE) at 3- and 6-months corrected age and Bayley–III neurodevelopmental assessment at 2–3 years chronological age. At 3 months follow up, 8.2% had suboptimal scores (below 10th percentile) on the HINE. At 6 months follow up, 4.1% had suboptimal scores (below 10th percentile) on the HINE. The means(±SD) for Bayley-III cognitive, language, and motor subscales were (96.3 ± 9.8), (99.9 ± 11.9), (93.2 ± 9.9). Results: At 3 months corrected age, higher total HINE scores and subscores for function of cranial nerves, posture, tone, were associated with better cognitive scores while poorer scores for function of cranial nerves, posture, movements, tone, and total HINE score were associated with lower motor scores. Infants with a HINE subscore of function of cranial nerves in the suboptimal range have three times higher odds of having a motor delay. Infants with a HINE subscore of function of cranial nerves in the suboptimal range have more than two times higher odds of having a language delay. At 6 months corrected age, poorer scores for function of cranial nerves, movements, tone, reflexes, and total HINE score were associated with worse Bayley-III motor scores whilst infants who have a total HINE score and a subscore of reflexes in the suboptimal range have four and seven times, respectively, higher odds of having a motor delay. Conclusions: Early identification of infants at risk for adverse long-term outcomes is essential in introducing early intervention therapies for optimizing neurodevelopmental outcomes.
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Perrone S, Laschi E, Negro S, Tei M, Urilli D, Buonocore G. Personality, emotional and cognitive functions in young adults born preterm. Brain Dev 2020; 42:713-719. [PMID: 32653254 DOI: 10.1016/j.braindev.2020.06.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 04/23/2020] [Accepted: 06/22/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Survival of preterm very low birthweight infants resulted in high risk for developmental cognitive deficits, poor academic achievement, and behaviour disorders. While numerous studies evaluated the prevalence of neurodevelopmental disability in early childhood, poor literature is available for infants born very low birthweight in adulthood. MATERIALS AND METHODS Fifty-five young adults born preterm (mean age: 18 ± 2.42 years; <33 weeks of gestational age and/or with birth weight <1500 g) were enrolled. The Verbal Intelligence Quotient (vIQ), Performance Intelligence Quotient (pIQ) and Total Intelligence Quotient (tIQ) were assessed through the Wechsler Adult Intelligence Scale - Revised (WAIS-R). Personality profiles were investigated using Rorschach test. Both WAIS-R and Rorschach scores were subsequently compared to 13 matched controls born at term. Data were analysed with the SPSS v20 for Windows statistical package. RESULTS Young adults born preterm showed lower IQ scores than young adults born at term: tIQ 90.95 ± 22.46 versus 108.77 ± 16.14, p = 0.006; vIQ 89.85 ± 21.85 versus 107.69 ± 18.33, p = 0.009, and pIQ 92.40 ± 22.90 versus 108.31 ± 14.52, p = 0.011. No differences emerged in personality profile as most subjects showed adequate internal resources in both groups, but a trend towards anxiety and insecurity were identified in young adult born preterm. CONCLUSIONS Young adults born preterm show psychological fragility and lower cognitive pattern than young adults born at term. Data support the need of an early psychological intervention that could help these individuals at greater risk to face a young society that is changing and that necessarily requires stronger internal resources.
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Affiliation(s)
- Serafina Perrone
- Department of Medicine and Surgery, University of Parma, Parma, Italy.
| | - Elisa Laschi
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Simona Negro
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Monica Tei
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Daniela Urilli
- Department of Psychiatry, University of Siena, Siena, Italy
| | - Giuseppe Buonocore
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy.
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Bucci S, Bevilacqua F, De Marchis C, Coletti MF, Gentile S, Dall’Oglio AM. Learning Abilities in a Population of Italian Healthy Preterm Children at the End of Primary School. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17207599. [PMID: 33086703 PMCID: PMC7589140 DOI: 10.3390/ijerph17207599] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 10/12/2020] [Accepted: 10/15/2020] [Indexed: 11/30/2022]
Abstract
Background: Delays in learning skills have been extensively reported for very preterm children. However, few studies have examined academic achievement profiles in Italian preterm children as a function of their neonatal immaturity. Methods: A cross-sectional study was performed that included 82 healthy Italian children born very and extremely preterm (without major neurosensory outcomes; IQ ≥85). Children were evaluated for academic and neurocognitive performances at the second cycle of primary school. Results: Healthy preterm children showed on average academic and neurocognitive profiles that did not differ according to gestational age. Impairment was seen to one or more learning domains in 14.6% of the healthy preterm children. Conclusions: Italian children born very and extremely preterm without major neurosensory damage and/or cognitive delay showed on average learning and neurocognitive profiles within the normal range, regardless of gestational age. Nevertheless, they showed higher proportions of learning impairment than a normative Italian population during their final years of primary school. Healthcare providers should be aware of this result, and long-term surveillance should be organized to promptly identify those children who are in need of therapeutic intervention.
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Affiliation(s)
- Silvia Bucci
- Unit of Clinical Psychology, Department of Neurological and Psychiatric Sciences, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (M.F.C.); (S.G.); (A.M.D.)
- Correspondence: (S.B.); (F.B.)
| | - Francesca Bevilacqua
- Unit of Clinical Psychology, Department of Neurological and Psychiatric Sciences, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (M.F.C.); (S.G.); (A.M.D.)
- Correspondence: (S.B.); (F.B.)
| | - Chiara De Marchis
- Department of Neonatal Medicine and Surgery, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy;
| | - Maria Franca Coletti
- Unit of Clinical Psychology, Department of Neurological and Psychiatric Sciences, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (M.F.C.); (S.G.); (A.M.D.)
| | - Simonetta Gentile
- Unit of Clinical Psychology, Department of Neurological and Psychiatric Sciences, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (M.F.C.); (S.G.); (A.M.D.)
| | - Anna Maria Dall’Oglio
- Unit of Clinical Psychology, Department of Neurological and Psychiatric Sciences, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (M.F.C.); (S.G.); (A.M.D.)
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Garioud ALDB, Skoven FH, Gregersen R, Lange T, Buchvald F, Greisen G. The increased susceptibility to airway infections after preterm birth does not persist into adolescence. PLoS One 2020; 15:e0238382. [PMID: 32881953 PMCID: PMC7470365 DOI: 10.1371/journal.pone.0238382] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 08/14/2020] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Preterm birth is associated with increased risk of airway infections in childhood, more frequent purchase of prescription antibiotics and hospital admissions for airway infections. With this study, we aimed to investigate whether this association persists into adolescence. METHODS We conducted a longitudinal observational register-based study of a national cohort of all infants born in Denmark in 1992-2007. We used purchase of antibiotics, including penicillins and macrolides, and hospital admissions as proxies for milder and more severe forms of airway infections respectively in 1995-2010. Associations between gestational age (GA), age, year and repeated cross-sectional evaluations of antibiotic purchase and hospital admissions were explored by logistic regression analyses. RESULTS We included 1,043,411 children in our study population. We found a statistically significant association between GA and prescription of antibiotics as well as hospital admissions due to airway infections. In the youngest age groups, children with higher GA had lower adjusted mean rates of prescribed antibiotics for airway infections, but from the age of 10-11 years the opposite trend was noted in what appears to be a dose-response relationship. During childhood, we found an inverse dose-response relationship where ex-preterms with GA 23-27 at age 4-5 years had twice the odds of hospital admission compared to children in the same age group born at term. During adolescence, these higher odds diminished and appeared equivalent among teenagers born at term and preterm. We only found statistically significant interactions between gestational age and age. CONCLUSION We confirmed that preterm birth is associated with higher rates of prescribed antibiotics and higher odds of hospitalization for airway infections during childhood. However, in adolescence we found that there was no increase in hospital admissions for airway infections among ex-preterms, whereas adolescents with low GA actually appeared to purchase less prescribed antibiotics. Whether this trend persists into adulthood and the physiological explanation therefor remains to be investigated.
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Affiliation(s)
| | - Frederikke Høeg Skoven
- Department of Neonatology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Rasmus Gregersen
- Department of Neonatology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Theis Lange
- Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Fsrederik Buchvald
- Department of Pediatrics, Pulmonary Service, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Gorm Greisen
- Department of Neonatology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
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Kelly MM, Griffith PB. Umbrella Review of School Age Health Outcomes of Preterm Birth Survivors. J Pediatr Health Care 2020; 34:e59-e76. [PMID: 32660808 DOI: 10.1016/j.pedhc.2020.05.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/18/2020] [Accepted: 05/21/2020] [Indexed: 11/18/2022]
Abstract
Preterm birth affects approximately 10% of U.S. births, with survival rates close to 95%. All health care providers, regardless of population or setting, are treating preterm birth survivors. The purpose of this manuscript is to present an umbrella review of the health outcomes of 2- to 12-year-old children who were born preterm. The current umbrella review consisted of 29 reviews, 14 meta-analyses, eight systematic reviews, and seven described as both meta-analysis and systematic review. Studies were grouped into six health outcome categories: neurodevelopmental, motor and/or cerebral palsy, pulmonary, mental and/or behavioral health, quality of life and/or leisure, and eczema. The analysis supports a resounding recommendation to recognize preterm birth, at all gestations, as a risk factor to health and educational outcomes. Increased attention to developmental screenings is critical, specifically recognition that children who are on the lower ranges of normal may benefit from therapies or interventions that support the attainment of future skills.
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125
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Meregaglia M, Croci I, Brusco C, Herich LC, Di Lallo D, Gargano G, Carnielli V, Zeitlin J, Fattore G, Cuttini M. Low socio-economic conditions and prematurity-related morbidities explain healthcare use and costs for 2-year-old very preterm children. Acta Paediatr 2020; 109:1791-1800. [PMID: 31977107 DOI: 10.1111/apa.15183] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 01/14/2020] [Accepted: 01/20/2020] [Indexed: 12/29/2022]
Abstract
AIM To estimate healthcare use and related costs for 2-year-old very preterm (VP) children after discharge from the neonatal unit. METHODS As part of a European project, we recruited an area-based cohort including all VP infants born in three Italian regions (Lazio, Emilia-Romagna and Marche) in 2011-2012. At 2 years corrected age, parents completed a questionnaire on their child health and healthcare use (N = 732, response rate 75.6%). Cost values were assigned based on national reimbursement tariffs. We used multivariable analyses to identify factors associated with any rehospitalisation and overall healthcare costs. RESULTS The most frequently consulted physicians were the paediatrician (85% of children), the ophthalmologist (36%) and the neurologist/neuropsychiatrist (26%); 38% of children were hospitalised at least once after the initial discharge, for a total of 513 admissions and over one million euros cost, corresponding to 75% of total healthcare costs. Low maternal education and parental occupation index, congenital anomalies and postnatal prematurity-related morbidities significantly increased the risk of rehospitalisation and total healthcare costs. CONCLUSION Rehospitalisation and outpatient care are frequent in VP children, confirming a substantial health and economic burden. These findings should inform the allocation of resources to preventive and rehabilitation services for these children.
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Affiliation(s)
- Michela Meregaglia
- Centre for Research on Health and Social Care Management (CERGAS) SDA Bocconi Milan Italy
| | - Ileana Croci
- Clinical Care and Management Innovation Research Area Bambino Gesù Children’s Hospital IRCCS Rome Italy
| | - Carla Brusco
- Medical Direction Department, Bambino Gesù Children’s Hospital IRCCS Rome Italy
| | - Lena C. Herich
- Clinical Care and Management Innovation Research Area Bambino Gesù Children’s Hospital IRCCS Rome Italy
| | | | - Giancarlo Gargano
- Neonatal Intensive Care Unit Department of Obstetrics and Pediatrics Arcispedale Santa Maria Nuova IRCCS Reggio Emilia Italy
| | - Virgilio Carnielli
- Maternal and Child Health Institute Marche University and Salesi Hospital Ancona Italy
| | - Jennifer Zeitlin
- Obstetrics, Perinatal and Pediatric Epidemiology Research Team Centre for Epidemiology and Biostatistics (U1153), INSERM and DHU Risks in Pregnancy, Paris‐Descartes UniversityParis France
| | - Giovanni Fattore
- Department of Social and Political Sciences Bocconi University & Centre for Research on Health and Social Care Management (CERGAS) SDA Bocconi Milan Italy
| | - Marina Cuttini
- Clinical Care and Management Innovation Research Area Bambino Gesù Children’s Hospital IRCCS Rome Italy
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Poppe T, Thompson B, Boardman JP, Bastin ME, Alsweiler J, Deib G, Harding JE, Crowther CA. Effect of antenatal magnesium sulphate on MRI biomarkers of white matter development at term equivalent age: The magnum study. EBioMedicine 2020; 59:102957. [PMID: 32858399 PMCID: PMC7452670 DOI: 10.1016/j.ebiom.2020.102957] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 07/23/2020] [Accepted: 08/04/2020] [Indexed: 02/07/2023] Open
Abstract
Background Magnesium sulphate given to women immediately prior to very preterm birth protects the perinatal brain, so fewer babies die or develop cerebral palsy. How magnesium sulphate exerts these beneficial effects remains uncertain. The aim of the MagNUM Study was to assess the effect of exposure to antenatal magnesium sulphate on MRI measures of brain white matter microstructure at term equivalent age. Methods Nested cohort study within the randomised Magnesium sulphate at 30 to <34 weeks’ Gestational age Neuroprotection Trial (MAGENTA). Mothers at risk of preterm birth at 30 to <34 weeks’ gestation were randomised to receive either 4 g of magnesium sulphate heptahydrate [8 mmol magnesium ions], or saline placebo, infused over 30 min when preterm birth was planned or expected within 24 h. Participating babies underwent diffusion tensor MRI at term equivalent age. The main outcomes were fractional anisotropy across the white matter tract skeleton compared using Tract-based Spatial Statistics (TBSS), with adjustment for postmenstrual age at birth and at MRI, and MRI site. Researchers and families were blind to treatment group allocation during data collection and analyses. Findings Of the 109 participating babies the demographics of the 60 babies exposed to magnesium sulphate were similar to the 49 babies exposed to placebo. In babies whose mothers were allocated to magnesium sulphate, fractional anisotropy was higher within the corticospinal tracts and corona radiata, the superior and inferior longitudinal fasciculi, and the inferior fronto-occipital fasciculi compared to babies whose mothers were allocated placebo (P < 0.05). Interpretation In babies born preterm, antenatal magnesium sulphate exposure promotes development of white matter microstructure in pathways affecting both motor and cognitive function. This may be one mechanism for the neuroprotective effect of magnesium sulphate treatment prior to preterm birth. Funding Health Research Council of New Zealand.
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Affiliation(s)
- Tanya Poppe
- Department of Optometry and Vision Science, University of Auckland, Auckland, New Zealand; Centre for the Developing Brain, Department of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Benjamin Thompson
- Department of Optometry and Vision Science, University of Auckland, Auckland, New Zealand; School of Optometry and Vision Science, University of Waterloo, Waterloo, Canada
| | - James P Boardman
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom; MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, United Kingdom
| | - Mark E Bastin
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Jane Alsweiler
- Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - Gerard Deib
- Department of Radiology, West Virginia University Hospital, W.Va, United States
| | - Jane E Harding
- Liggins Institute, University of Auckland, Building 503, Level 2, 85 Park Road, Auckland 1142, New Zealand
| | - Caroline A Crowther
- Liggins Institute, University of Auckland, Building 503, Level 2, 85 Park Road, Auckland 1142, New Zealand.
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Pereira S, Reeves J, Birch M, Finton-James S, Verma K, Krug R, Sinha A, Kempley S. A realistic flow phantom model of the carotid artery in preterm infants for training and research. ULTRASOUND : JOURNAL OF THE BRITISH MEDICAL ULTRASOUND SOCIETY 2020; 28:145-154. [PMID: 32831887 DOI: 10.1177/1742271x20902189] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 12/17/2019] [Indexed: 11/15/2022]
Abstract
Introduction Cerebral blood flow is increasingly monitored in preterm infants. Doppler ultrasound of the carotid artery is a widely available method but is operator dependent. Our aim was to design and produce a realistic flow phantom model of the carotid artery of preterm infants. Methods Data from cerebral blood flow measurements using Doppler ultrasound of the right common carotid artery from 21 premature newborn infants were used to produce a Doppler flow phantom model with three different vessel diameters. Vessel diameter, continuous and pulsatile flow volume measurements were performed by two blinded observers (with more than eight and 20 years of experience). Results Vessel diameter measurements using the phantom were underestimated by 7%. Continuous flow volume measurements were overestimated by 7% by both observers (observer 1 mean difference 1.5 ± 1.96 SD -3.3 to 6.3 ml/min versus observer 2, 1.9 ± 1.96 SD -3.6 to 7.4 ml/min). Pulsatile flow measurements were overestimated by 12.6% by observer 1 (2.7 ± 1.96 SD -0.6 to 5.9 ml/min) and by 7.8% by observer 2 (1.7 ± 1.96 SD -1.6 to 4.9 ml/min). There was good interobserver and intraobserver reliability for the majority of measurements using continuous and pulsatile flow. Conclusion It is feasible to produce a realistic flow phantom model of the neonatal carotid artery of preterm infants. Diameter measurements were underestimated and flow measurements were overestimated. These errors fell within acceptable limits for in vivo measurements. If these limitations were related to materials, this could be explored using a wall-less model. The flow phantom could be utilised for research and training clinicians in measuring cerebral blood flow using the carotid artery in this vulnerable group of infants.
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Affiliation(s)
- Sujith Pereira
- Neonatal Unit, Homerton University Hospital NHS Foundation Trust, London, UK.,Centre for Genomics and Child Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK
| | - Jonathan Reeves
- Clinical Physics, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Malcolm Birch
- Clinical Physics, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Sakthi Finton-James
- Barts and the London School of Medicine and Dentistry, Queen Mary, University of London, London, UK
| | - Komal Verma
- Barts and the London School of Medicine and Dentistry, Queen Mary, University of London, London, UK
| | - Robert Krug
- Barts and the London School of Medicine and Dentistry, Queen Mary, University of London, London, UK
| | - Ajay Sinha
- Centre for Genomics and Child Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK.,Neonatal Unit, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Stephen Kempley
- Centre for Genomics and Child Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK
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Marleau I, Vona M, Gagner C, Luu TM, Beauchamp MH. [Formula: see text] Social cognition, adaptive functioning, and behavior problems in preschoolers born extremely preterm. Child Neuropsychol 2020; 27:96-108. [PMID: 32716689 DOI: 10.1080/09297049.2020.1797656] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Despite medical advances, prematurity is associated with a higher risk of neurodevelopmental problems. Although social impairments are commonly reported in preterm children, their origins are not clearly determined though they may be associated with the integrity of social cognitive skills, such as theory of mind. This study aimed to assess social cognitive, social adaptive, and social behavior functioning in children born extremely prematurely. Thirty children born between 22 and 28 weeks of gestation and 30 children born at term completed measures of social cognition (theory of mind, affect recognition) between 4:6, 5:11 years of age (mean = 5.29, standard deviation = 0.28 years). Parents completed questionnaires measuring their child's adaptive social functioning and social behavior. Analyses of covariance controlling for cognitive, attentional, executive, sociodemographic, and perinatal characteristics were performed. Children born between 22 and 28 weeks displayed poorer theory of mind (p < 0.01) and affect recognition (p < 0.01) than term controls, and their parents reported lower adaptive social functioning (p < 0.01) and prosocial behavior (p = 0.04). Social cognitive, adaptive, and behavior functioning appear to be affected by extreme preterm birth. These findings may explain the social challenges experienced by extremely preterm children and provide potential loci for targeted interventions to optimize social functioning.
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Affiliation(s)
- Isabelle Marleau
- Department of Psychology, University of Sherbrooke , Sherbrooke, Canada.,Department of Pediatrics, Ste-Justine University Hospital , Montreal, Canada
| | - Mélissa Vona
- Department of Psychology, University of Montreal , Montreal, Canada
| | - Charlotte Gagner
- Department of Psychology, University of Montreal , Montreal, Canada
| | - Thuy Mai Luu
- Department of Pediatrics, Ste-Justine University Hospital , Montreal, Canada.,Research Center, Sainte-Justine Hospital , Montreal, Canada
| | - Miriam H Beauchamp
- Department of Psychology, University of Montreal , Montreal, Canada.,Research Center, Sainte-Justine Hospital , Montreal, Canada
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129
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Zuccarini M, Guarini A, Savini S, Faldella G, Sansavini A. Do 6-Month Motor Skills Have Cascading Effects on 12-Month Motor and Cognitive Development in Extremely Preterm and Full-Term Infants? Front Psychol 2020; 11:1297. [PMID: 32670158 PMCID: PMC7332837 DOI: 10.3389/fpsyg.2020.01297] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 05/18/2020] [Indexed: 11/17/2022] Open
Abstract
In this study, we analyzed whether 6-month gross and fine motor skills were related to 12-month gross and fine motor skills and cognitive development, controlling for 6-month cognitive skills, and neonatal status (extremely low gestational age ELGA ≤ 28 weeks vs. full-term FT ≥ 37 weeks). We also investigated, at 6 months, predictive indexes for motor and cognitive delay at 12-months. We assessed 40 infants (20 ELGA and 20 FT) at 6 and 12 months (corrected age for the ELGA infants). Six-month gross motor skills were related to 12-month gross motor, fine motor, and cognitive skills and predicted 12-month gross motor delay. Six-month cognitive skills explained an additional amount of variance of 12-month gross motor skills, whereas neonatal status explained an additional amount of variance of 12-month cognitive skills. Considering the intradomain and cross-domain cascading effects of early gross motor skills on later motor and cognitive development, these skills should be repeatedly assessed in ELGA infants in the first year of life for early identification of infants with delayed gross motor skills and implementation of customized interventions.
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Affiliation(s)
| | | | - Silvia Savini
- Department of Psychology, University of Bologna, Bologna, Italy
| | - Giacomo Faldella
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
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130
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A Randomized Trial of Continuous Versus Intermittent Skin-to-Skin Contact After Premature Birth and the Effects on Mother-Infant Interaction. Adv Neonatal Care 2020; 20:E48-E56. [PMID: 31764209 DOI: 10.1097/anc.0000000000000675] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Premature birth affects opportunities for interaction between infants and mothers. Skin-to-skin contact (SSC) is standard care in neonatal care but has not been sufficiently studied regarding the effects on interaction between preterm infant and mothers. PURPOSE The purpose of this study was to compare interaction between preterm infants and their mothers after continuous versus intermittent SSC from birth to discharge. A secondary aim was to study a potential dose-response effect between time in SSC and quality of interaction. METHODS Families were randomly assigned to either continuous (n = 17) or intermittent (n = 14) SSC before delivery. Interaction was measured from videotapes of a Still-Face Paradigm collected at 4 months' corrected age. Face-to-face interaction was coded according to Ainsworth's Maternal Sensitivity Scales and the Maternal Sensitivity and Responsivity Scales-R. Dose-response correlations were calculated between mean time spent in SSC and each of the interaction scales. RESULTS There were no statistically significant differences between groups in maternal interactive behavior toward their infants regarding sensitivity, interference, availability, acceptance, withdrawal, or intrusivity. There was no correlation between mean time in SSC and quality of interaction. IMPLICATIONS FOR PRACTICE Continuous SSC from birth to discharge was not superior to intermittent SSC concerning mother-infant interaction between preterm infants and their mothers at 4 months' corrected age. However, compared with other studies, mean time in SSC was also high in the intermittent group. IMPLICATIONS FOR RESEARCH Further studies are needed to find out how interaction between parents and preterm infants can be improved, supported, and facilitated in the neonatal intensive care unit (NICU) and whether there is an optimal dose for SSC.
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131
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Hadaya L, Nosarti C. The neurobiological correlates of cognitive outcomes in adolescence and adulthood following very preterm birth. Semin Fetal Neonatal Med 2020; 25:101117. [PMID: 32451305 DOI: 10.1016/j.siny.2020.101117] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Very preterm birth (<33 weeks of gestation) has been associated with alterations in structural and functional brain development in regions that are believed to underlie a variety of cognitive processes. While such alterations have been often studied in the context of cognitive vulnerability, early disruption to programmed developmental processes may also lead to neuroplastic and functional adaptations, which support cognitive performance. In this review, we will focus on executive function and intelligence as the main cognitive outcomes following very preterm birth in adolescence and adulthood in relation to their structural and functional neurobiological correlates. The neuroimaging modalities we review provide quantitative assessments of brain morphology, white matter macro and micro-structure, structural and functional connectivity and haemodynamic responses associated with specific cognitive operations. Identifying the neurobiological underpinning of the long-term sequelae associated with very preterm birth may guide the development and implementation of targeted neurobehaviourally-informed interventions for those at high risk.
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Affiliation(s)
- Laila Hadaya
- Centre for the Developing Brain, Department of Perinatal Imaging and Health, Faculty of Life Science and Medicine, King's College London, London, United Kingdom; Department of Child and Adolescent Psychiatry, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, United Kingdom.
| | - Chiara Nosarti
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, United Kingdom.
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132
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Abstract
Social problems are an important feature of the preterm behavioral phenotype but are diverse and multidimensional. A model of social competence comprised of the three interrelated components of social cognition, social interaction, and social adjustment is useful in conceptualizing these problems. Weaknesses in social cognition in very preterm (VPT) children, although rarely studied, are found on tasks involving interpretation of social cues. Difficulties in social interaction in VPT infants and young children are documented by structured observations of their interactions with adults. Problems in social adjustment are endorsed on parent and teacher ratings of VPT infants and youth and on self-reports of VPT adults. These multiple deficits likely stem from early disruptions in neural development, are related to other consequences of preterm birth, and subject to postnatal environment influences. Further research is needed to more fully account for the effects of VPT birth on the development of social competence.
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Affiliation(s)
- H Gerry Taylor
- Abigail Wexner Research Institute at Nationwide Children's Hospital and The Ohio State University, Columbus, OH, USA.
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133
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Armstrong-Buisseret L, Powers K, Dorling J, Bradshaw L, Johnson S, Mitchell E, Duley L. Randomised trial of cord clamping at very preterm birth: outcomes at 2 years. Arch Dis Child Fetal Neonatal Ed 2020; 105:292-298. [PMID: 31371434 PMCID: PMC7363783 DOI: 10.1136/archdischild-2019-316912] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 07/15/2019] [Accepted: 07/17/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To report outcomes at 2 years corrected age for children of women recruited to a trial comparing alternative policies for timing of cord clamping and immediate neonatal care at very preterm birth. DESIGN Parallel group randomised (1:1) trial. SETTING Eight UK tertiary maternity units. PARTICIPANTS Two hundred and seventy-six babies born to 261 women expected to have a live birth before 32+0 weeks' gestation. INTERVENTIONS Deferred cord clamping (≥2 min) and immediate neonatal care with cord intact or immediate (≤20 s) clamping and immediate neonatal care after clamping. MAIN OUTCOME MEASURE Composite of death or adverse neurodevelopmental outcome at 2 years corrected age. RESULTS Six babies born after 35+6 weeks were excluded. At 2 years corrected age, outcome data were not available for a further 52 children, leaving 218 for analysis (115 deferred clamping, 103 immediate clamping). Overall, 24/115 (21%) children allocated deferred clamping died or had an adverse neurodevelopmental outcome compared with 35/103 (34%) allocated immediate clamping; risk ratio (RR) 0.61 (95% CI 0.39 to 0.96); risk difference (RD) -13% (95% CI -25% to -1%). Multiple imputation for missing data gave an RR 0.69 (95% CI 0.44 to 1.09) and RD -9% (95% CI -21% to 2%). CONCLUSIONS Deferred clamping and immediate neonatal care with cord intact may reduce the risk of death or adverse neurodevelopmental outcome at 2 years of age for children born very premature. Confirmation in larger studies is needed to determine the real benefits and harms. TRIAL REGISTRATION NUMBER ISRCTN21456601.
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Affiliation(s)
| | - Katie Powers
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - Jon Dorling
- Division of Neonatal-Perinatal Medicine, Dalhousie University, Halifax, Canada
| | - Lucy Bradshaw
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - Samantha Johnson
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Eleanor Mitchell
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - Lelia Duley
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
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134
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Burnett A, Spittle A. Early intervention starting in the neonatal nursery to improve child development. Acta Paediatr 2020; 109:1071-1072. [PMID: 31997400 DOI: 10.1111/apa.15147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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135
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Poulimeneas D, Bathrellou E, Antonogeorgos G, Mamalaki E, Kouvari M, Kuligowski J, Gormaz M, Panagiotakos DB, Yannakoulia M. Feeding the preterm infant: an overview of the evidence. Int J Food Sci Nutr 2020; 72:4-13. [PMID: 32340495 DOI: 10.1080/09637486.2020.1754352] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Feeding from own mother's milk is not always an option for preterm infants, and choosing between alternative means of feeding should be made in light of their effect on infants' health. In this work, we aimed to present evidence regarding feeding pre-term infants with human milk, either own mother's or donor milk (DM), and the potential effects on growth and other health related outcomes. Exclusive breastfeeding (BF) remains the optimal option, whereas feeding with DM as a sole diet or supplemental to maternal milk confers immunological advantages and fewer rates of necrotising enterocolitis against preterm formula feeding, yet the latter results in greater growth velocity. Literature gaps in the use of DM, practical suggestions for choosing suitable feeding means (i.e. continuous support of BF, adequate education regarding feeding preterm infants, including DM), and future perspectives on the potential effects of dietary manipulations of the maternal diet, are also discussed.
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Affiliation(s)
- Dimitrios Poulimeneas
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, Athens, Greece
| | - Eirini Bathrellou
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, Athens, Greece
| | - George Antonogeorgos
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, Athens, Greece
| | - Eirini Mamalaki
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, Athens, Greece
| | - Matina Kouvari
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, Athens, Greece
| | - Julia Kuligowski
- Neonatal Research Group, Health Research Institute La Fe, Valencia, Spain
| | - María Gormaz
- Neonatal Research Group, Health Research Institute La Fe, Valencia, Spain.,Neonatal Unit, University and Polytechnic Hospital La Fe, Valencia, Spain
| | - Demosthenes B Panagiotakos
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, Athens, Greece
| | - Mary Yannakoulia
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, Athens, Greece
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136
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Boardman JP, Hall J, Thrippleton MJ, Reynolds RM, Bogaert D, Davidson DJ, Schwarze J, Drake AJ, Chandran S, Bastin ME, Fletcher-Watson S. Impact of preterm birth on brain development and long-term outcome: protocol for a cohort study in Scotland. BMJ Open 2020; 10:e035854. [PMID: 32139495 PMCID: PMC7059503 DOI: 10.1136/bmjopen-2019-035854] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Preterm birth is closely associated with altered brain development and is a leading cause of neurodevelopmental, cognitive and behavioural impairments across the life course. We aimed to investigate neuroanatomic variation and adverse outcomes associated with preterm birth by studying a cohort of preterm infants and controls born at term using brain MRI linked to biosamples and clinical, environmental and neuropsychological data. METHODS AND ANALYSIS Theirworld Edinburgh Birth Cohort is a prospective longitudinal cohort study at the University of Edinburgh. We plan to recruit 300 infants born at <33 weeks of gestational age (GA) and 100 healthy control infants born after 37 weeks of GA. Multiple domains are assessed: maternal and infant clinical and demographic information; placental histology; immunoregulatory and trophic proteins in umbilical cord and neonatal blood; brain macrostructure and microstructure from structural and diffusion MRI (dMRI); DNA methylation; hypothalamic-pituitary-adrenal axis activity; social cognition, attention and processing speed from eye tracking during infancy and childhood; neurodevelopment; gut and respiratory microbiota; susceptibility to viral infections; and participant experience. Main analyses include creation of novel methods for extracting information from neonatal structural and dMRI, regression analyses of predictors of brain maldevelopment and neurocognitive outcome associated with preterm birth, and determination of the quantitative predictive performance of MRI and other early life factors for childhood outcome. ETHICS AND DISSEMINATION Ethical approval has been obtained from the National Research Ethics Service (NRES), South East Scotland Research Ethics Committee (NRES numbers 11/55/0061 and 13/SS/0143 (phase I) and 16/SS/0154 (phase II)), and NHS Lothian Research and Development (2016/0255). Results are disseminated through open access journals, scientific meetings, social media, newsletters anda study website (www.tebc.ed.ac.uk), and we engage with the University of Edinburgh public relations and media office to ensure maximum publicity and benefit.
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Affiliation(s)
- James P Boardman
- MRC Centre for Reproductive Health, The University of Edinburgh, Edinburgh, UK
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
| | - Jill Hall
- MRC Centre for Reproductive Health, The University of Edinburgh, Edinburgh, UK
| | | | - Rebecca M Reynolds
- Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK
| | - Debby Bogaert
- Centre for Inflammation Research, The University of Edinburgh, Edinburgh, UK
| | - Donald J Davidson
- Centre for Inflammation Research, The University of Edinburgh, Edinburgh, UK
| | - Jurgen Schwarze
- Centre for Inflammation Research, The University of Edinburgh, Edinburgh, UK
| | - Amanda J Drake
- Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK
| | | | - Mark E Bastin
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
| | - Sue Fletcher-Watson
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
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137
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Fontana C, De Carli A, Ricci D, Dessimone F, Passera S, Pesenti N, Bonzini M, Bassi L, Squarcina L, Cinnante C, Mosca F, Fumagalli M. Effects of Early Intervention on Visual Function in Preterm Infants: A Randomized Controlled Trial. Front Pediatr 2020; 8:291. [PMID: 32582595 PMCID: PMC7287146 DOI: 10.3389/fped.2020.00291] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 05/07/2020] [Indexed: 11/25/2022] Open
Abstract
Objectives: To determine the effectiveness of an early intervention program in enhancing visual function in very preterm infants. Methods: We conducted a RCT. We included preterm infants born between 25+0 and 29+6 weeks of gestational age (GA), without severe morbidities, and their families. Infants were randomized to either receive Standard Care (SC) or Early Intervention (EI). SC, according to NICU protocols, included Kangaroo Mother Care and minimal handling. EI included, in addition to routine care, parental training according to the PremieStart program, and multisensory stimulation (infant massage and visual interaction) performed by parents. Visual function was assessed at term equivalent age (TEA) using a prevalidated battery evaluating ocular spontaneous motility, ability to fix and follow a target, reaction to color, stripes discrimination and visual attention at distance. Results: Seventy preterm (EI n = 34, SC n = 36) infants were enrolled. Thirteen were excluded according to protocol. Fifty-seven infants (EI = 27, SC = 30) were assessed at TEA. The two groups were comparable for parental and infant characteristics. In total, 59% of infants in the EI group achieved the highest score in all the nine assessed items compared to 17% in the SC group (p = 0.001): all infants in both groups showed complete maturation in four items, but EI infants showed more mature findings in the other five items (ocular motility both spontaneous and with target, tracking arc, stripes discrimination and attention at distance). Conclusions: Our results suggest that EI has a positive effect on visual function maturation in preterm infants at TEA. Trial Registration: clinicalTrial.gov (NCT02983513).
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Affiliation(s)
- Camilla Fontana
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Agnese De Carli
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, NICU, Milan, Italy
| | - Daniela Ricci
- Pediatric Neurology, Department of Human and Child Health and Public Health, Child Health Area, Catholic University UCSC, Rome, Italy.,Department of Ophthalmology, National Centre of Services and Research for the Prevention of Blindness and Rehabilitation of the Visually Impaired, IAPB, Rome, Italy
| | - Francesca Dessimone
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, NICU, Milan, Italy
| | - Sofia Passera
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, NICU, Milan, Italy
| | - Nicola Pesenti
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, NICU, Milan, Italy.,Department of Statistics and Quantitative Methods, Division of Biostatistics, Epidemiology and Public Health, University of Milano-Bicocca, Milan, Italy
| | - Matteo Bonzini
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Occupational Health Unit, Milan, Italy
| | - Laura Bassi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, NICU, Milan, Italy
| | - Letizia Squarcina
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Claudia Cinnante
- Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Neuroradiology Unit, Milan, Italy
| | - Fabio Mosca
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, NICU, Milan, Italy
| | - Monica Fumagalli
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, NICU, Milan, Italy
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138
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Abstract
In our aim to improve patient outcome we are transitioning from a "one-size-fits-all" protocolized approach toward an individualized hemodynamic management, that is tailored to the cardiovascular (patho-)physiology and the specific clinical characteristics of each individual patient. In this narrative review an overview is provided about an individualized approach toward various neonatal hemodynamic conditions.
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Affiliation(s)
- Willem P de Boode
- Division of Neonatology, Department of Pediatrics, Radboud University Medical Center, Radboud Institute for Health Sciences, Amalia Children's Hospital, Nijmegen, Netherlands
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139
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Prawesti A, Emaliyawati E, Mirwanti R, Nuraeni A. The Effectiveness of Prone and Supine Nesting Positions on Changes of Oxygen Saturation and Weight in Premature Babies. JURNAL NERS 2019. [DOI: 10.20473/jn.v14i2.7755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction: Stress experienced by the baby will affect the body’s function by increasing the body’s metabolism. Nesting is used to reduce stress in premature babies. Nesting can be done in a supine or prone position. Few studies have examined the effects of body position on body weight and oxygen saturation. The objective of the study was to determine the difference in oxygen saturation and weight change on the use of nesting in the prone and supine positions in premature babies.Methods: The research used a quasi-experimental design. The sample consisted of 30 premature babies, which was obtained using a consecutive sample technique. The independent variables were nesting positioning (supine and prone), and the dependent variables were oxygen saturation and body weight. The data of oxygen saturation and the baby’s weight were collected using pulse oximetry; the baby’s weight scale used observation sheets. The data was analysed using the t-test, Wilcoxon Sign Ranks Test, and Mann Whitney U Test.Results: The results showed that there was a difference in oxygen saturation before and after the use of nesting in the supine (p=0.001) and prone position (p=0.000). There was a weight difference before and after the use of nesting in both supine (p=0.000) and prone position (p=0.000). There was no difference in oxygen saturation value and infant weight, before or after, between the supine position and the prone position (p=0.18; p=0.9).Conclusion: The use of nesting in both positions (supine or prone) can increase oxygen saturation and infant weight. Researchers recommend the use of nesting with supine or prone positions routinely in premature babies.
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140
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Zierden HC, Ortiz Ortiz JI, Dimitrion P, Laney V, Bensouda S, Anders NM, Scardina M, Hoang T, Ronnett BM, Hanes J, Burd I, Mahendroo M, Ensign LM. Characterization of an Adapted Murine Model of Intrauterine Inflammation-Induced Preterm Birth. THE AMERICAN JOURNAL OF PATHOLOGY 2019; 190:295-305. [PMID: 31837289 DOI: 10.1016/j.ajpath.2019.10.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 09/11/2019] [Accepted: 10/03/2019] [Indexed: 11/17/2022]
Abstract
Preterm birth (PTB) affects nearly 15 million infants each year. Of these PTBs, >25% are a result of inflammation or infection. Animal models have improved our understanding of the mechanisms leading to PTB. Prior work has described induction of intrauterine inflammation in mice with a single injection of lipopolysaccharide (LPS). Herein, we have improved the reproducibility and potency of LPS in the model using two injections distal to the cervix. An in vivo imaging system revealed more uniform distribution of Evans Blue Dye using a double distal injection (DDI) approach compared with a single proximal injection (SPI). Endotoxin concentrations in vaginal lavage fluid from SPI dams were significantly higher than from DDI dams. At equivalent LPS doses, DDI consistently induced more PTB than SPI, and DDI showed a linear dose-response, whereas SPI did not. Gene expression in myometrial tissue revealed increased levels of inflammatory markers in dams that received LPS DDI compared with LPS SPI. The SPI group showed more significant overexpression in cervical remodeling genes, likely due to the leakage of LPS from the uterine horns through the cervix. The more reliable PTB induction and uniform uterine exposure provided by this new model will be useful for further studying fetal outcomes and potential therapeutics for the prevention of inflammation-induced PTB.
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Affiliation(s)
- Hannah C Zierden
- The Center for Nanomedicine, The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Chemical and Biomolecular Engineering, Johns Hopkins University, Baltimore, Maryland
| | - Jairo I Ortiz Ortiz
- The Center for Nanomedicine, The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Ophthalmology, The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Peter Dimitrion
- The Center for Nanomedicine, The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Victoria Laney
- The Center for Nanomedicine, The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Chemical and Biomolecular Engineering, Johns Hopkins University, Baltimore, Maryland
| | - Sabrine Bensouda
- The Center for Nanomedicine, The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Nicole M Anders
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Morgan Scardina
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Thuy Hoang
- The Center for Nanomedicine, The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Pharmacology and Molecular Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Brigitte M Ronnett
- Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Justin Hanes
- The Center for Nanomedicine, The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Chemical and Biomolecular Engineering, Johns Hopkins University, Baltimore, Maryland; Department of Ophthalmology, The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland; The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Pharmacology and Molecular Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Irina Burd
- Division of Maternal Fetal Medicine, Department of Gynecology and Obstetrics, Integrated Research Center for Fetal Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Mala Mahendroo
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Laura M Ensign
- The Center for Nanomedicine, The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Chemical and Biomolecular Engineering, Johns Hopkins University, Baltimore, Maryland; Department of Ophthalmology, The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland; The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Pharmacology and Molecular Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland; Division of Maternal Fetal Medicine, Department of Gynecology and Obstetrics, Integrated Research Center for Fetal Medicine, Johns Hopkins University, Baltimore, Maryland.
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141
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Boardman JP, Counsell SJ. Invited Review: Factors associated with atypical brain development in preterm infants: insights from magnetic resonance imaging. Neuropathol Appl Neurobiol 2019; 46:413-421. [PMID: 31747472 PMCID: PMC7496638 DOI: 10.1111/nan.12589] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 11/13/2019] [Indexed: 12/18/2022]
Abstract
Preterm birth (PTB) is a leading cause of neurodevelopmental and neurocognitive impairment in childhood and is closely associated with psychiatric disease. The biological and environmental factors that confer risk and resilience for healthy brain development and long‐term outcome after PTB are uncertain, which presents challenges for risk stratification and for the discovery and evaluation of neuroprotective strategies. Neonatal magnetic resonance imaging reveals a signature of PTB that includes dysconnectivity of neural networks and atypical development of cortical and deep grey matter structures. Here we provide a brief review of perinatal factors that are associated with the MRI signature of PTB. We consider maternal and foetal factors including chorioamnionitis, foetal growth restriction, socioeconomic deprivation and prenatal alcohol, drug and stress exposures; and neonatal factors including co‐morbidities of PTB, nutrition, pain and medication during neonatal intensive care and variation conferred by the genome/epigenome. Association studies offer the first insights into pathways to adversity and resilience after PTB. Future challenges are to analyse quantitative brain MRI data with collateral biological and environmental data in study designs that support causal inference, and ultimately to use the output of such analyses to stratify infants for clinical trials of therapies designed to improve outcome.
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Affiliation(s)
- J P Boardman
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | - S J Counsell
- Centre for the Developing Brain, School of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
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142
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Leikos S, Tokariev A, Koolen N, Nevalainen P, Vanhatalo S. Cortical responses to tactile stimuli in preterm infants. Eur J Neurosci 2019; 51:1059-1073. [PMID: 31679163 DOI: 10.1111/ejn.14613] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 10/07/2019] [Accepted: 10/22/2019] [Indexed: 12/22/2022]
Abstract
The conventional assessment of preterm somatosensory functions using averaged cortical responses to electrical stimulation ignores the characteristic components of preterm somatosensory evoked responses (SERs). Our study aimed to systematically evaluate the occurrence and development of SERs after tactile stimulus in preterm infants. We analysed SERs performed during 45 electroencephalograms (EEGs) from 29 infants at the mean post-menstrual age of 30.7 weeks. Altogether 2,087 SERs were identified visually at single-trial level from unfiltered signals capturing also their slowest components. We observed salient SERs with a high-amplitude slow component at a high success rate after hand (95%) and foot (83%) stimuli. There was a clear developmental change in both the slow wave and the higher-frequency components of the SERs. Infants with intraventricular haemorrhage (IVH; eleven infants) had initially normal SERs, but those with bilateral IVH later showed a developmental decrease in the ipsilateral SER occurrence after 30 weeks of post-menstrual age. Our study shows that tactile stimulus applied at bedside elicits salient SERs with a large slow component and an overriding fast oscillation, which are specific to the preterm period. Prior experimental research indicates that such SERs allow studying both subplate and cortical functions. Our present findings further suggest that they might offer a window to the emergence of neurodevelopmental sequelae after major structural brain lesions and, hence, an additional tool for both research and clinical neurophysiological evaluation of infants before term age.
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Affiliation(s)
- Susanna Leikos
- Children's Clinical Neurophysiology, BABA Center, Children's Hospital, HUS Medical Imaging Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Anton Tokariev
- Children's Clinical Neurophysiology, BABA Center, Children's Hospital, HUS Medical Imaging Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Ninah Koolen
- Children's Clinical Neurophysiology, BABA Center, Children's Hospital, HUS Medical Imaging Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Päivi Nevalainen
- Children's Clinical Neurophysiology, BABA Center, Children's Hospital, HUS Medical Imaging Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Sampsa Vanhatalo
- Children's Clinical Neurophysiology, BABA Center, Children's Hospital, HUS Medical Imaging Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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143
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Smith LEH, Hellström A, Stahl A, Fielder A, Chambers W, Moseley J, Toth C, Wallace D, Darlow BA, Aranda JV, Hallberg B, Davis JM. Development of a Retinopathy of Prematurity Activity Scale and Clinical Outcome Measures for Use in Clinical Trials. JAMA Ophthalmol 2019; 137:305-311. [PMID: 30543348 DOI: 10.1001/jamaophthalmol.2018.5984] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance To facilitate drug and device development for neonates, the International Neonatal Consortium brings together key stakeholders, including pharmaceutical companies, practitioners, regulators, funding agencies, scientists, and families, to address the need for objective, standardized clinical trial outcome measurements to fulfill regulatory requirements. Retinopathy of prematurity (ROP) is a disease that affects preterm neonates. The current International Classification of Retinopathy of Prematurity does not take into account all of the characteristics of ROP and does not adequately discriminate small changes in disease after treatment. These factors are critical for evaluating outcomes in clinical trials. Observations There is need for an updated ROP acute disease activity and structure scale as well as end-stage structure and ophthalmologic outcome measures designed for use at different ages. The scale and measures, based on current diagnostic methods and treatments, could be used as a guideline for clinical intervention trials. The scale is intended to be validated against retrospective data and revised for use in future trials. An iterative revision process can be accomplished if new measures are added to clinical trials and evaluated at the end of each trial for prognostic value. The new measures would then be incorporated into a new version of the activity scale and the outcome measures revised. Conclusions and Relevance An ROP activity scale and outcome measures to obtain the most robust and discriminatory data for clinical trials are needed. The scales should be dynamic and modified as knowledge and imaging modalities improve and then validated using data from well-documented clinical trials. This approach is relevant to improving clinical trial data quality.
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Affiliation(s)
- Lois E H Smith
- Department of Ophthalmology, Harvard Medical School, Boston Children's Hospital, Boston, Massachusetts
| | - Ann Hellström
- Department of Clinical Neuroscience at Institute of Neuroscience and Physiology, University of Göteborg, Göteborg, Sweden
| | - Andreas Stahl
- Department of Ophthalmology, University of Freiburg, Freiburg, Germany
| | - Alistair Fielder
- Department of Optometry & Visual Science, City University of London, London, United Kingdom
| | - Wiley Chambers
- Division of Transplant and Ophthalmology Products, US Food and Drug Administration, Bethesda, Maryland
| | - Jane Moseley
- Human Medicines Research and Development Support Division, European Medicines Agency, London, United Kingdom
| | - Cynthia Toth
- Department of Ophthalmology, Duke University, Durham, North Carolina
| | - David Wallace
- Department of Ophthalmology, Indiana University, Indianapolis
| | - Brian A Darlow
- Department of Pathology and Biomedical Science, University of Otago, Christchurch, New Zealand
| | - Jacob V Aranda
- Department of Ophthalmology, State University of New York Downstate Medical Center, Brooklyn
| | - Boubou Hallberg
- Division of Paediatrics, Karolinska University Hospital, Stockholm, Sweden
| | - Jonathan M Davis
- The Floating Hospital for Children, Tufts Medical Center, Boston, Massachusetts.,Department of Pediatrics, Tufts University School of Medicine, Boston, Massachusetts
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144
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Benavides A, Conrad AL, Brumbaugh JE, Magnotta V, Bell EF, Nopoulos P. Long-term outcome of brain structure in female preterm infants: possible associations of liberal versus restrictive red blood cell transfusions. J Matern Fetal Neonatal Med 2019; 34:3292-3299. [PMID: 31722594 DOI: 10.1080/14767058.2019.1683157] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Preterm infants who receive differential red blood cell (RBC) transfusions at birth may show brain structure differences across development, including abnormalities in white matter (WM) structure and organization. This study investigated long-term outcomes of brain structure in female infants born preterm, at an average age of 13 years old, who received red blood cell (RBC) transfusions in the neonatal period according to a liberal or restrictive approach. Results from this study will increase understanding of the effects of transfusion on the developing brain. STUDY DESIGN AND METHODS This follow-up study included female preterm infants who participated in a clinical trial and had been randomized at birth to either a liberal or restrictive hematocrit threshold. Brain structures were measured in childhood using structural magnetic resonance imaging (MRI) scans. Due to the low number of females in the restrictive transfusion group at follow-up, additional females were recruited for inclusion. Main outcome measures included cerebral and subcortical brain region volumes. RESULTS Total intracranial volume was significantly decreased in females who were randomized to higher average hematocrit levels at birth. Infants in the liberal transfusion group had proportionately smaller volumes in all measures of regional cerebral WM and subcortical brain volumes, reaching significance for temporal lobe WM and caudate volumes. CONCLUSION Female premature infants who received a liberal transfusion threshold at birth had decreased WM volumes, which suggests the potential long-term neurodevelopmental risks associated with liberal transfusion practices.
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Affiliation(s)
- Amanda Benavides
- Department of Psychiatry, University of Iowa, Iowa City, IA, USA
| | - Amy L Conrad
- University of Iowa Stead Family Children's Hospital, Iowa City, IA, USA
| | - Jane E Brumbaugh
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Edward F Bell
- University of Iowa Stead Family Children's Hospital, Iowa City, IA, USA
| | - Peggy Nopoulos
- Department of Psychiatry, University of Iowa, Iowa City, IA, USA
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145
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Fuller MG, Vaucher YE, Bann CM, Das A, Vohr BR. Lack of social support as measured by the Family Resource Scale screening tool is associated with early adverse cognitive outcome in extremely low birth weight children. J Perinatol 2019; 39:1546-1554. [PMID: 31431654 PMCID: PMC7035947 DOI: 10.1038/s41372-019-0462-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 06/24/2019] [Accepted: 07/08/2019] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Extremely low birth weight children are at high risk for cognitive impairment. STUDY DESIGN Cognitive outcome of extremely low birth weight children participating in a Neonatal Research Network, randomized trial was evaluated at 18 and 30 months corrected age using the Bayley Scales of Infant Development, 2nd ed. Family resources and social support were assessed using a Family Resource Scale parent questionnaire. Regression analysis was used to determine independent demographic, medical, and family resource factors influencing longitudinal cognitive outcome. RESULT Higher Family Resource Scale scores at 18 months were associated with greater improvement in cognitive scores between 18 and 30 months. Cognitive outcome was most adversely affected in children whose families had the least resources and social support. The adverse effect of poor social support was independent of family income. CONCLUSION Poor interpersonal social support has an independent, adverse impact on cognitive outcomes of extremely low birth weight infants.
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Affiliation(s)
- Martha G Fuller
- Division of Neonatology, Department of Pediatrics, University of California San Diego, San Diego, CA, USA.
| | - Yvonne E Vaucher
- Division of Neonatology, Department of Pediatrics, University of California San Diego, San Diego, CA, USA
| | - Carla M Bann
- RTI International, Research Triangle Park, North Carolina, NC, USA
| | - Abhik Das
- RTI International, Research Triangle Park, North Carolina, NC, USA
| | - Betty R Vohr
- Department of Pediatrics, Women, and Infants Hospital, Brown University, Providence, RI, USA
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146
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Godeluck A, Gérardin P, Lenclume V, Mussard C, Robillard PY, Sampériz S, Benhammou V, Truffert P, Ancel PY, Ramful D. Mortality and severe morbidity of very preterm infants: comparison of two French cohort studies. BMC Pediatr 2019; 19:360. [PMID: 31623604 PMCID: PMC6796444 DOI: 10.1186/s12887-019-1700-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 08/29/2019] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND In Reunion Island, a French overseas department, the burden of preterm birth and perinatal mortality exceed those observed in mainland France, despite similar access to standard perinatal care. The purpose of the study was to compare the outcome of two cohorts of NICU-admitted very preterm infants born between 24 and 31 weeks of gestation (WG): the registry-based OGP (Observatoire de la Grande Prématurité, Reunion Island, 2008-2013) cohort, and the nationwide EPIPAGE-2 (mainland France, 2011) observational cohort. METHODS The primary outcome was adverse neonatal outcomes defined as a composite indicator of in-hospital mortality or any of three following severe morbidities: bronchopulmonary dysplasia (BPD), necrotising enterocolitis, or severe neurological injury (periventricular leukomalacia or grade III-IV intraventricular haemorrhages). Logistic regression modelling adjusting for confounders was performed. RESULTS A total of 1272 very preterm infants from the Reunionese OGP cohort and 3669 peers from the mainland EPIPAGE-2 cohort were compared. Adverse neonatal outcomes were more likely observed in the OGP cohort (32.6% versus 26.6%, p < 0.001), as result of both increased in-hospital mortality across all gestational age strata and increased BPD among the survivors of the 29-31 WG stratum. After adjusting for gestational age, gender and multiple perinatal factors, the risk of adverse neonatal outcomes was higher in the OGP cohort than in the EPIPAGE-2 cohort across all gestational age strata. CONCLUSIONS Despite similar guidelines for standard perinatal care, very preterm infants born in Reunion Island have a higher risk for death or severe morbidity compared with those born in mainland France.
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Affiliation(s)
| | - Patrick Gérardin
- INSERM CIC1410 Epidémiologie Clinique, CHU de la Réunion, Saint Pierre, Réunion
| | - Victorine Lenclume
- INSERM CIC1410 Epidémiologie Clinique, CHU de la Réunion, Saint Pierre, Réunion
| | - Corinne Mussard
- INSERM CIC1410 Epidémiologie Clinique, CHU de la Réunion, Saint Pierre, Réunion
| | - Pierre-Yves Robillard
- CHU de la Réunion, Saint Pierre, Réunion
- Centre d'Etudes Périnatales de l'Océan Indien (CEPOI), Université de la Réunion, EA 7388, Saint-Denis, France
| | | | | | - Patrick Truffert
- CHU Lille, EA 2694 Public Health, Epidemiology and Quality of Care unit, F-59000, Lille, France
| | - Pierre-Yves Ancel
- INSERM U 1153, CHU Cochin Hôtel Dieu, Paris, France
- Université Paris Descartes, Paris, France
- URC - CIC1419 Plurithématique, Cochin Hôtel Dieu, Paris, France
| | - Duksha Ramful
- CHU de la Réunion, Saint Denis, Réunion.
- INSERM CIC1410 Epidémiologie Clinique, CHU de la Réunion, Saint Pierre, Réunion.
- Postal address: Neonatal and pediatric intensive care unit, Félix Guyon Hospital, CHU de La Réunion, Allée des Topazes, CS 11021, 97400, Saint-Denis Cedex, La Réunion, France.
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147
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Martino MSD, Alves LLF, Ortiz Sobrinho C, Barbosa ADM. Comparison on cognitive performance among schoolchildren born prematurely according to the presence of intracranial hemorrhage in the neonatal period. REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2019. [DOI: 10.1590/1806-93042019000300002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Abstract Objectives: to compare the cognitive performance of schoolchildren born prematurely according to the presence of intracranial hemorrhage (ICH) during the neonatal period. Methods: a cross-sectional cohort study of schoolchildren between the ages of 6-8 years old, born prematurely with or without a history of neonatal ICH. Between January and December 2015, some children were followed up at the outpatient clinic of a tertiary hospital and underwent a cognitive evaluation by using the Wechsler Intelligence Scale for Children, Third Edition (WISC-III) and they were divided into two groups: those with no history of ICH (control group) and those with ICH (case group), confirmed by a transfontanelar ultrasound in the prenatal period. Results: 39 schoolchildren were included, 21 cases and 18 controls. There was no difference in gestational age or chronological age at evaluation between the groups. Also there was no significant difference in subtest scores between the groups. Conclusions: WISC-III evaluated the cognitive performance in children, born preterm, aged 6-8 years old, and had neonatal ICH did not differ from those of their peers without a history of ICH. These findings suggest that, in preterm infants, a neonatal diagnosis of ICH may not be associated with cognitive performance at school age and this should be investigated through a longitudinal study.
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148
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Johnson S, O'Reilly H, Ni Y, Wolke D, Marlow N. Psychiatric Symptoms and Disorders in Extremely Preterm Young Adults at 19 Years of Age and Longitudinal Findings From Middle Childhood. J Am Acad Child Adolesc Psychiatry 2019; 58:820-826.e6. [PMID: 31009655 DOI: 10.1016/j.jaac.2019.02.020] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Revised: 02/20/2019] [Accepted: 04/08/2019] [Indexed: 12/27/2022]
Abstract
Since the 1980s, the long-term outcomes of extremely preterm birth (before 28 weeks of gestation) have garnered considerable interest as a result of significant improvements in neonatal care and the consequent increase in survival rates. Compared with birth at full term, extremely preterm birth places infants at increased risk for neurodevelopmental disorders, intellectual impairments, and psychiatric sequelae that persist throughout childhood and adolescence.1 There is increasing interest in the longer-term outcomes for these babies; in particular, whether adverse outcomes persist or increase in adulthood or whether survivors can outgrow earlier problems.
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Affiliation(s)
| | - Helen O'Reilly
- Institute for Women's Health, University College London, UK; University College Dublin, Ireland
| | - Yanyan Ni
- Institute for Women's Health, University College London, UK
| | | | - Neil Marlow
- Institute for Women's Health, University College London, UK
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Lærum AMW, Reitan SK, Evensen KAI, Lydersen S, Brubakk AM, Skranes J, Indredavik MS. Psychiatric symptoms and risk factors in adults born preterm with very low birthweight or born small for gestational age at term. BMC Psychiatry 2019; 19:223. [PMID: 31315591 PMCID: PMC6636134 DOI: 10.1186/s12888-019-2202-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 07/02/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND We aimed to examine psychiatric symptoms in adults born preterm with very low birthweight or born at term small for gestational age compared with normal birthweight peers, and examine associations with perinatal factors and childhood motor and cognitive function. METHODS In this longitudinal cohort study, one preterm born group with very low birthweight (VLBW: birthweight ≤1500 g), one term-born Small for Gestational Age (SGA: birthweight <10th percentile) group and one term-born non-SGA control group, were assessed at 26 years of age. Primary outcomes were scores on self-reported questionnaires: Achenbach System of Empirically Based Assessment - Adult Self-Report, The Autism-Spectrum Quotient and Peters et al. Delusions Inventory. Exposure variables were perinatal data, while childhood motor and cognitive function were examined as possible early markers. RESULTS Both the preterm VLBW and the term SGA group reported higher levels of attention, internalizing and externalizing problems compared to the control group. In addition, the VLBW participants reported more critical items and a higher proportion had intermediate level autistic traits, while the SGA participants reported more intrusive behavior. Increasing length of respiratory support and hospital stay in the neonatal period, and motor problems in early adolescence, were associated with adult psychiatric symptoms in the VLBW group. CONCLUSIONS Psychiatric symptoms were frequent in the preterm VLBW group and also in the term-born SGA group. Those who were sickest as babies were most at risk. Motor problems can possibly serve as an early marker of adult psychiatric symptoms in low birthweight individuals.
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Affiliation(s)
- Astrid M. W. Lærum
- 0000 0001 1516 2393grid.5947.fDepartment of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Unit for Pediatrics, 6th floor, Kvinne-barn-senteret, Olav Kyrres gt. 11, 7030 Trondheim, Norway ,0000 0004 0627 3560grid.52522.32Children’s Clinic, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Solveig Klæbo Reitan
- 0000 0001 1516 2393grid.5947.fDepartment of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway ,0000 0004 0627 3560grid.52522.32Department of Mental Health, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Kari Anne I. Evensen
- 0000 0001 1516 2393grid.5947.fDepartment of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Unit for Pediatrics, 6th floor, Kvinne-barn-senteret, Olav Kyrres gt. 11, 7030 Trondheim, Norway ,0000 0001 1516 2393grid.5947.fDepartment of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway ,Unit for Physiotherapy Services, Trondheim Municipality, Norway ,Department of Physiotherapy, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Stian Lydersen
- 0000 0001 1516 2393grid.5947.fDepartment of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Ann-Mari Brubakk
- 0000 0001 1516 2393grid.5947.fDepartment of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Unit for Pediatrics, 6th floor, Kvinne-barn-senteret, Olav Kyrres gt. 11, 7030 Trondheim, Norway ,0000 0004 0627 3560grid.52522.32Children’s Clinic, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Jon Skranes
- 0000 0001 1516 2393grid.5947.fDepartment of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Unit for Pediatrics, 6th floor, Kvinne-barn-senteret, Olav Kyrres gt. 11, 7030 Trondheim, Norway ,0000 0004 0414 4503grid.414311.2Department of Pediatrics, Sørlandet Hospital, Arendal, Norway
| | - Marit S. Indredavik
- 0000 0001 1516 2393grid.5947.fDepartment of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Unit for Pediatrics, 6th floor, Kvinne-barn-senteret, Olav Kyrres gt. 11, 7030 Trondheim, Norway
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Kelly MM, Michalek R. Children Born Preterm: How Are We Educating Providers? J Nurs Educ 2019; 58:339-346. [DOI: 10.3928/01484834-20190521-04] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 02/20/2019] [Indexed: 12/19/2022]
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