101
|
Oral-motor Dysfunction at 10 Months Corrected Gestational Age in Infants Born Less Than 37 Weeks Preterm. Dysphagia 2008; 24:20-5. [DOI: 10.1007/s00455-008-9161-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2007] [Accepted: 03/18/2008] [Indexed: 11/27/2022]
|
102
|
Ng SM, Turner MA, Gamble C, Didi M, Victor S, Malamateniou C, Parkes LM, Tietze A, Gregory L, Sluming V, Abernethy L, Weindling AM. TIPIT: a randomised controlled trial of thyroxine in preterm infants under 28 weeks gestation: magnetic resonance imaging and magnetic resonance angiography protocol. BMC Pediatr 2008; 8:26. [PMID: 18590560 PMCID: PMC2464591 DOI: 10.1186/1471-2431-8-26] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2008] [Accepted: 06/30/2008] [Indexed: 11/10/2022] Open
Abstract
Background Infants born at extreme prematurity are at high risk of developmental disability. A major risk factor for disability is having a low level of thyroid hormone described as hypothyroxinaemia, which is recognised to be a frequent phenomenon in these infants. Derangements of critical thyroid function during the sensitive window in prematurity when early development occurs, may have a range of long term effects for brain development. Further research in preterm infants using neuroimaging techniques will increase our understanding of the specificity of the effects of hypothyroxinaemia on the developing foetal brain. This is an explanatory double blinded randomised controlled trial which is aimed to assess the effect of thyroid hormone supplementation on brain size, key brain structures, extent of myelination, white matter integrity and vessel morphology, somatic growth and the hypothalamic-pituitary-adrenal axis. Methods The study is a multi-centred double blinded randomised controlled trial of thyroid hormone supplementation in babies born below 28 weeks' gestation. All infants will receive either levothyroxine or placebo until 32 weeks corrected gestational age. The primary outcomes will be width of the sub-arachnoid space measured using cranial ultrasound and head circumference at 36 weeks corrected gestational age. The secondary outcomes will be thyroid hormone concentrations, the hypothalamic pituitary axis status and auxological data between birth and expected date of delivery; thyroid gland volume, brain size, volumes of key brain structures, extent of myelination and brain vessel morphology at expected date of delivery and markers of morbidity which include duration of mechanical ventilation and/or oxygen requirement and chronic lung disease. Trial registration Current Controlled Trials ISRCTN89493983
Collapse
Affiliation(s)
- Sze M Ng
- School of Reproductive and Developmental Medicine, University of Liverpool, Liverpool, UK.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
103
|
Cheong JLY, Hunt RW, Anderson PJ, Howard K, Thompson DK, Wang HX, Bear MJ, Inder TE, Doyle LW. Head growth in preterm infants: correlation with magnetic resonance imaging and neurodevelopmental outcome. Pediatrics 2008; 121:e1534-40. [PMID: 18519457 DOI: 10.1542/peds.2007-2671] [Citation(s) in RCA: 177] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Extremely preterm birth is associated with adverse neurodevelopmental sequelae. Head circumference has been used as a measure of brain growth. There are limited data relating head circumference to MRI. The purpose of this work was to establish the relationship between head circumference with brain MRI at term-equivalent age and to relate head circumference with neurodevelopmental outcome at 2 years. PATIENTS AND METHODS Two hundred and twenty-seven preterm infants (birth weight of <1250 g or <30 weeks' gestation) were recruited. Head circumference was measured at birth, term, and 2 years' corrected age, and z scores were computed. Microcephaly was defined as a head circumference z score of less than -2 SDs for age and gender. MRI scans at term (n = 214) were graded for white and gray matter abnormalities, and segmented volumes were calculated for different tissue types. Outcome at 2 years' corrected age (n = 202) included scores on the Bayley Scales of Infant Development II. RESULTS Microcephaly increased from 7.5% at term to 29.7% at 2 years. There was no significant relationship between head circumference and white or gray matter abnormalities on MRI. There was a strong correlation between head circumference and brain volume at term. At term, microcephalic infants had significantly decreased volumes for total brain tissue and most segmented volumes compared with infants with normal head circumference, but only deep nuclear gray matter volume remained significantly lower when adjusted for total intracranial volume. At 2 years, microcephaly was associated with poorer cognitive and motor development and an increased rate of cerebral palsy. CONCLUSIONS Brain volume is a determinant of head size at term. Microcephaly is associated with a reduction of brain tissue volumes, especially deep nuclear gray matter, which suggests a selective vulnerability. Poor postnatal head growth in preterm infants becomes more evident by 2 years and is strongly associated with poor neurodevelopmental outcome and cerebral palsy.
Collapse
Affiliation(s)
- Jeanie L Y Cheong
- Royal Women's Hospital, Department of Neonatal Services, 132 Grattan St, Carlton 3053, Melbourne, Australia.
| | | | | | | | | | | | | | | | | |
Collapse
|
104
|
Abstract
OBJECTIVE To test the hypothesis that three changes in the early management of extremely low birth weight (ELBW) neonates would decrease the incidence of extra-uterine growth restriction (EUGR) by 25%. The three early management practice changes (EMPC) included surfactant at delivery followed by immediate extubation to nasal continuous positive airway pressure (CPAP), decreased oxygen exposure and early parenteral amino acids. STUDY DESIGN Historical cohort study of preterm infants<or=1000 g birth weight (BW) born at the University of Texas Medical Branch between January 2001 and June 2002 (pre-EMPC, before changes, n=87) and July 2004 to December 2005 (post-EMPC, after changes, n=76). Outcomes measured included feeding and growth parameters, morbidities and interventions. Statistical analysis included chi2-analysis, Student's t-test, and analysis of variance. RESULT Infants in the post-EMPC cohort regained BW more quickly, maintained appropriate size for weight at 36 weeks and had less morbidity associated with poor long-term outcome. Predictors of EUGR included BW<750 g and surgical necrotizing enterocolitis. CONCLUSION The introduction of surfactant at delivery followed by immediate extubation to CPAP, decreased oxygen exposure and early parenteral amino acids in ELBW infants is possible, safe and associated with improvements in growth and morbidity.
Collapse
|
105
|
Jiménez Martín A, Servera Ginard C, Roca Jaume A, Frontera Juan G, Pérez Rodríguez J. Seguimiento de recién nacidos de peso menor o igual a 1.000 g durante los tres primeros años de vida. An Pediatr (Barc) 2008; 68:320-8. [DOI: 10.1157/13117701] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
|
106
|
Ng SM, Turner MA, Gamble C, Didi M, Victor S, Weindling AM. TIPIT: A randomised controlled trial of thyroxine in preterm infants under 28 weeks' gestation. Trials 2008; 9:17. [PMID: 18366798 PMCID: PMC2335090 DOI: 10.1186/1745-6215-9-17] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2007] [Accepted: 03/26/2008] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND Infants born at extreme prematurity (below 28 weeks' gestation) are at high risk of developmental disability. A major risk factor for disability is having a low level of thyroid hormone which is recognised to be a frequent phenomenon in these infants. At present it is unclear whether low levels of thyroid hormone are a cause of disability, or a consequence of concurrent adversity. METHODS We propose an explanatory multi-centre double blind randomised controlled trial of thyroid hormone supplementation in babies born below 28 weeks' gestation. All infants will receive either levothyroxine or placebo until 32 weeks' corrected gestational age. The primary outcome will be brain growth. This will be assessed by the width of the sub-arachnoid space measured using cranial ultrasound and head circumference at 36 weeks' corrected gestational. The secondary outcomes will be (a) thyroid hormone concentrations measured at increasing postnatal age, (b) status of the hypothalamic pituitary axis, (c) auxological data between birth and 36 weeks' corrected gestational age, (d) thyroid gland volume, (e) volumes of brain structures (measured by magnetic resonance imaging), (f) determination of the extent of myelination and white matter integrity (measured by diffusion weighted MRI) and brain vessel morphology (measured by magnetic resonance angiography) at expected date of delivery and (g) markers of morbidity including duration of mechanical ventilation and chronic lung disease.We will also examine how activity of the hypothalamic-pituitary-adrenal axis modulates the effects of thyroid supplementation. This will contribute to decisions about which confounding variables to assess in large-scale studies. TRIAL REGISTRATION Current Controlled Trials ISRCTN89493983.
Collapse
Affiliation(s)
- Sze M Ng
- School of Reproductive and Developmental Medicine, University of Liverpool, Liverpool, UK.
| | | | | | | | | | | |
Collapse
|
107
|
Abstract
Survival rates have greatly improved in recent years for infants of borderline viability; however, these infants remain at risk of developing a wide array of complications, not only in the neonatal unit, but also in the long term. Morbidity is inversely related to gestational age; however, there is no gestational age, including term, that is wholly exempt. Neurodevelopmental disabilities and recurrent health problems take a toll in early childhood. Subsequently hidden disabilities such as school difficulties and behavioural problems become apparent and persist into adolescence. Reassuringly, however, most children born very preterm adjust remarkably well during their transition into adulthood. Because mortality rates have fallen, the focus for perinatal interventions is to develop strategies to reduce long-term morbidity, especially the prevention of brain injury and abnormal brain development. In addition, follow-up to middle age and beyond is warranted to identify the risks, especially for cardiovascular and metabolic disorders that are likely to be experienced by preterm survivors.
Collapse
Affiliation(s)
- Saroj Saigal
- Department of Paediatrics, McMaster University, Hamilton, ON, Canada.
| | | |
Collapse
|
108
|
Marlow N, Hennessy EM, Bracewell MA, Wolke D. Motor and executive function at 6 years of age after extremely preterm birth. Pediatrics 2007; 120:793-804. [PMID: 17908767 DOI: 10.1542/peds.2007-0440] [Citation(s) in RCA: 308] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Studies of very preterm infants have demonstrated impairments in multiple neurocognitive domains. We hypothesized that neuromotor and executive-function deficits may independently contribute to school failure. METHODS We studied children who were born at < or = 25 completed weeks' gestation in the United Kingdom and Ireland in 1995 at early school age. Children underwent standardized cognitive and neuromotor assessments, including the Kaufman Assessment Battery for Children and NEPSY, and a teacher-based assessment of academic achievement. RESULTS Of 308 surviving children, 241 (78%) were assessed at a median age of 6 years 4 months. Compared with 160 term classmates, 180 extremely preterm children without cerebral palsy and attending mainstream school performed less well on 3 simple motor tasks: posting coins, heel walking, and 1-leg standing. They more frequently had non-right-hand preferences (28% vs 10%) and more associated/overflow movements during motor tasks. Standardized scores for visuospatial and sensorimotor function performance differed from classmates by 1.6 and 1.1 SDs of the classmates' scores, respectively. These differences attenuated but remained significant after controlling for overall cognitive scores. Cognitive, visuospatial scores, and motor scores explained 54% of the variance in teachers' ratings of performance in the whole set; in the extremely preterm group, additional variance was explained by attention-executive tasks and gender. CONCLUSIONS Impairment of motor, visuospatial, and sensorimotor function, including planning, self-regulation, inhibition, and motor persistence, contributes excess morbidity over cognitive impairment in extremely preterm children and contributes independently to poor classroom performance at 6 years of age.
Collapse
Affiliation(s)
- Neil Marlow
- School of Human Development, University of Nottingham, Nottingham, United Kingdom.
| | | | | | | |
Collapse
|
109
|
de Vries LS, Cowan FM. Should cranial MRI screening of preterm infants become routine? ACTA ACUST UNITED AC 2007; 3:532-3. [PMID: 17724489 DOI: 10.1038/ncpneuro0608] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2007] [Accepted: 06/13/2007] [Indexed: 11/09/2022]
Affiliation(s)
- Linda S de Vries
- Department of Neonatology, Wilhelmina Children's Hospital, Utrecht, The Netherlands.
| | | |
Collapse
|
110
|
Thoyre SM. Feeding outcomes of extremely premature infants after neonatal care. J Obstet Gynecol Neonatal Nurs 2007; 36:366-75; quiz 376. [PMID: 17594415 DOI: 10.1111/j.1552-6909.2007.00158.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Feeding is a primary concern for families of extremely preterm (EP) infants following discharge from neonatal care. An increasing number of EP children are being referred for treatment of feeding problems, including eating only a few types of food or very small portions, difficulty transitioning to textured foods, and refusing food. These issues have the potential for significant consequences for the children's growth and development as well as their family's well-being. An understanding of the kinds of feeding problems faced by families of EP infants can help nurses guide families to be ready for and respond to these issues. In this article, the evidence for and the nature of feeding problems in EP children after discharge from neonatal care are examined.
Collapse
Affiliation(s)
- Suzanne M Thoyre
- School of Nursing, Carrington Hall, University of North Carolina at Chapel Hill, NC 27599-7460, USA.
| |
Collapse
|
111
|
Rijken M, Wit JM, Le Cessie S, Veen S. The effect of perinatal risk factors on growth in very preterm infants at 2 years of age: the Leiden Follow-Up Project on Prematurity. Early Hum Dev 2007; 83:527-34. [PMID: 17140751 DOI: 10.1016/j.earlhumdev.2006.10.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2006] [Revised: 09/12/2006] [Accepted: 10/12/2006] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To describe growth in infants <32 weeks GA. To assess the relationship between growth and perinatal factors (like intrauterine growth retardation and the postnatal use of dexamethasone) and neurodevelopmental outcome. DESIGN Regional, prospective study in two health regions in the Netherlands. Part of the Leiden Follow-Up Project on Prematurity (LFUPP). PATIENTS 196 live born infants with GA <32 weeks. METHODS At two years corrected age length, weight and head circumference of 160 of 196 surviving infants (82%) were evaluated. Standard Deviation Scores were calculated and means were compared to Dutch growth references. Mean SDS for length was corrected for the mean SDS for target height. Birth weight (BW)-SDS for gestational age (GA) was calculated according to Swedish references. RESULTS Length, weight and weight-for-length were equally impaired in both sexes at two years in premature infants compared to Dutch growth charts. Catch-up in length and weight occurred mostly in the first year of life. Intrauterine growth retardation was associated with impairment of all growth parameters. The use of postnatal dexamethasone was associated with shorter length, lower weight, lower weight for length and smaller head circumference; this effect remained after correction for GA, BW and BW-SDS. Growth retardation (length and weight) was associated with an abnormal neurologic examination; smaller head circumference also with mental and psychomotor delay. CONCLUSION Growth at two years corrected age in children born <32 weeks is impaired. Postnatal dexamethasone is associated with impairment of all growth parameters including head circumference, which may be a significant contributing factor for abnormal neurodevelopmental outcome.
Collapse
Affiliation(s)
- Monique Rijken
- Department of Paediatrics, Leiden University Medical Center, Leiden, the Netherlands.
| | | | | | | |
Collapse
|
112
|
Rugolo LMSS, Bentlin MR, Rugolo Junior A, Dalben I, Trindade CEP. Crescimento de prematuros de extremo baixo peso nos primeiros dois anos de vida. REVISTA PAULISTA DE PEDIATRIA 2007. [DOI: 10.1590/s0103-05822007000200008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJETIVO: Analisar o padrão de crescimento de prematuros de extremo baixo peso (EBP) até 24 meses de idade corrigida, a influência da displasia broncopulmonar (DBP) e os fatores de risco para falha de crescimento. MÉTODOS: Coorte de prematuros <1.000g de gestação única, nascidos e acompanhados em um centro terciário. O crescimento foi avaliado por meio de escores-z para peso, comprimento e perímetro cefálico ao nascimento, com 40 semanas, aos 3, 6, 12, 18 e 24 meses de idade corrigida. Dentre 81 sobreviventes, 70 foram estudados e estratificados em dois grupos: DBP (n=41) e sem DBP (n=29). Foi realizada análise bivariada com teste t ou Mann-Whitney, qui-quadrado ou Exato de Fisher, e análise multivariada com regressão logística. RESULTADOS: Em ambos os grupos, o escore-z de peso diminuiu significantemente entre o nascimento e 40 semanas. Houve um pico de incremento nos escores-z de peso, comprimento e perímetro cefálico entre 40 semanas e três meses. No grupo sem DBP, os escores-z atingiram a faixa normal a partir dos seis meses e assim permaneceram até 24 meses de idade corrigida. Crianças com DBP tiveram menores escores-z de peso e perímetro cefálico no primeiro ano, mas equipararam-se às sem DBP no segundo ano de vida. A regressão logística mostrou que catch-down no escore-z de peso com 40 semanas foi fator de risco para falha de crescimento. CONCLUSÕES: Prematuros EBP apresentam catch-up precoce do crescimento nos primeiros dois anos. Crianças com DBP têm pior crescimento ponderal. A restrição do crescimento pós-natal prediz a falha de crescimento nos primeiros anos.
Collapse
|
113
|
The Extremely Low Birth Weight Infant. APOLLO MEDICINE 2007. [DOI: 10.1016/s0976-0016(11)60113-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
|
114
|
Rees CM, Pierro A, Eaton S. Neurodevelopmental outcomes of neonates with medically and surgically treated necrotizing enterocolitis. Arch Dis Child Fetal Neonatal Ed 2007; 92:F193-8. [PMID: 16984980 PMCID: PMC2675329 DOI: 10.1136/adc.2006.099929] [Citation(s) in RCA: 269] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES (1) To characterise neurodevelopmental outcome of neonates with necrotizing enterocolitis (NEC); (2) to define whether NEC increases risk of neurodevelopmental impairment in very low birth weight neonates; (3) to investigate whether stage of disease or need for surgery increase risk of poor outcome. DESIGN A systematic review was performed. Searches identified 182 relevant papers. Ten studies compared extremely low birthweight neonates with NEC to infants of similar age and gestation who did not develop NEC. Data are reported as OR (95% CIs, p values for test for overall effect) and compared by chi2. RESULTS 7843 children (821 with NEC) were included in the meta-analysis. Median follow-up was 20 months (range 12 to 156). Overall, 45% of children who had neonatal NEC were neurodevelopmentally impaired. Infants with NEC were significantly more likely than infants of similar age and gestation who did not develop NEC to be neurodevelopmentally impaired (1.6 (1.3 to 2.0), p = 0.0001) including a higher risk of cerebral palsy (1.5 (1.2 to 2.0), p = 0.001), visual (2.3 (1.0 to 5.1), p = 0.04), cognitive (1.7 (1.4 to 2.2), p<0.0001) and psychomotor impairment (1.7 (1.3 to 2.2), p<0.0001). The odds ratio of neurodevelopmental impairment was also 2.3 times higher in neonates with Bell's stage III disease or requiring surgery ((1.5 to 3.6), p = 0.0001). CONCLUSIONS NEC is associated with significantly worse neurodevelopmental outcome than prematurity alone. Presence of advanced NEC and need for surgery increase the risk of neurological impairment.
Collapse
Affiliation(s)
- Clare M Rees
- Department of Paediatric Surgery, Institute of Child Health, London, UK
| | | | | |
Collapse
|
115
|
Abstract
Depending on the definitions used, up to 10% of all live-born neonates are small for gestational age (SGA). Although the vast majority of these children show catch-up growth by 2 yr of age, one in 10 does not. It is increasingly recognized that those who are born SGA are at risk of developing metabolic disease later in life. Reduced fetal growth has been shown to be associated with an increased risk of insulin resistance, obesity, cardiovascular disease, and type 2 diabetes mellitus. The majority of pathology is seen in adults who show spontaneous catch-up growth as children. There is evidence to suggest that some of the metabolic consequences of intrauterine growth retardation in children born SGA can be mitigated by ensuring early appropriate catch-up growth, while avoiding excessive weight gain. Implicitly, this argument questions current infant formula feeding practices. The risk is less clear for individuals who do not show catch-up growth and who are treated with GH for short stature. Recent data, however, suggest that long-term treatment with GH does not increase the risk of type 2 diabetes mellitus and the metabolic syndrome in young adults born SGA.
Collapse
Affiliation(s)
- Paul Saenger
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York 10467, USA.
| | | | | | | |
Collapse
|
116
|
Fanaroff AA, Stoll BJ, Wright LL, Carlo WA, Ehrenkranz RA, Stark AR, Bauer CR, Donovan EF, Korones SB, Laptook AR, Lemons JA, Oh W, Papile LA, Shankaran S, Stevenson DK, Tyson JE, Poole WK. Trends in neonatal morbidity and mortality for very low birthweight infants. Am J Obstet Gynecol 2007; 196:147.e1-8. [PMID: 17306659 DOI: 10.1016/j.ajog.2006.09.014] [Citation(s) in RCA: 750] [Impact Index Per Article: 44.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2006] [Revised: 08/23/2006] [Accepted: 09/19/2006] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To document the mortality and morbidity of infants weighing 501-1500 g at birth according to gestational age, birthweight, and sex. STUDY DESIGN Prospective collection of perinatal events and neonatal course to 120 days of life, discharge, or death from January 1990 through December 2002 for infants born at 16 participating centers of the National Institute of Child Health & Human Development Neonatal Research Network. RESULTS Compared with 1995-1996, for 1997-2002 the survival of infants with birthweight of 501-1500 g increased by 1 percentage point (from 84% to 85%). Survival without major neonatal morbidity remained static, at 70%; this includes bronchopulmonary dysplasia (BPD), intraventricular hemorrhage (IVH), and necrotizing enterocolitis (NEC). Survival increased for multiple births (26%, up from 22%), antenatal corticosteroid use (79%, up from 71%), and maternal antibiotics (70%, up from 62%) (P < .05). From 1997 to 2002, birthweight-specific survival was 55% for infants weighing 501-750 g, 88% for 751-1000 g, 94% for 1001-1250 g, and 96% for 1251-1500 g. More females survived. The incidence of NEC (7%), severe IVH (12%), and late-onset septicemia (22%) remained essentially unchanged, but BPD decreased slightly, from 23% to 22%. The use of postnatal corticosteroids declined from 20% in 1997-2000 to 12% in 2001-2002. Growth failure (weight <10th percentile) at 36 weeks' postmenstrual age decreased from 97% in 1995-1996 to 91% in 1997-2002. CONCLUSION There have been no significant increases in survival without neonatal and long-term morbidity among VLBW infants between 1997 and 2002. We speculate that to improve survival without morbidity requires determining, disseminating, and applying best practices using therapies currently available, and also identifying new strategies and interventions.
Collapse
Affiliation(s)
- Avroy A Fanaroff
- Department of Pediatrics, Case Western Reserve University, Cleveland, OH
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
117
|
Sices L, Wilson-Costello D, Minich N, Friedman H, Hack M. Postdischarge growth failure among extremely low birth weight infants: Correlates and consequences. Paediatr Child Health 2007; 12:22-28. [PMID: 19030335 PMCID: PMC2528665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2006] [Indexed: 05/27/2023] Open
Abstract
OBJECTIVE To describe the prevalence and correlates of postdis-charge growth failure among extremely low birth weight (ELBW) infants (weighing less than 1 kg) and its impact on growth and development. METHODS One hundred fifty-four ELBW infants were followed to 20 months corrected age. Growth failure was defined as a decrease in weight z score (standard deviation score) of over 0.67 during one of three periods: between 40 weeks and four months (period I), between four and eight months (period II), and between eight and 20 months corrected age (period III). A decrease in weight z score of this magnitude is comparable to crossing major growth percentiles (eg, from 25th to 10th percentile). Developmental outcomes were assessed at 20 months. RESULTS Growth failure occurred in 8% of infants during period I, 28% during period II and 12% during period III. This resulted in poorer growth attainment and motor function at 20 months. Significant predictors of growth failure included chronic lung disease during periods I and III, and cerebral palsy during period III. Growth failure during period II, while more common, was not associated with specific sequelae of prematurity. It may represent a physiological process comparable to shifts in weight percentiles in term-born infants. CONCLUSIONS Postdischarge growth failure is common among ELBW infants and contributes to poorer growth outcomes. It is associated with poorer motor outcomes when it occurs early after discharge or later in infancy. A decrease in weight z score of over 0.67 can serve as a useful indicator of growth failure in ELBW infants.
Collapse
Affiliation(s)
- Laura Sices
- Correspondence: Dr Laura Sices, Division of Behavioral Pediatrics and Psychology – RBC 6038, Rainbow Babies and Children’s Hospital, 11100 Euclid Avenue, Cleveland, Ohio 44106-6038, USA. Telephone 216-844-3230, fax 216-844-7601, e-mail
| | | | | | | | | |
Collapse
|
118
|
Saigal S, Stoskopf B, Streiner D, Paneth N, Pinelli J, Boyle M. Growth trajectories of extremely low birth weight infants from birth to young adulthood: a longitudinal, population-based study. Pediatr Res 2006; 60:751-8. [PMID: 17065570 DOI: 10.1203/01.pdr.0000246201.93662.8e] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
We compared sex-specific growth attainment of a population-based cohort of 147/166 (89%) extremely low birthweight (ELBW < 1000 g) and 131/145 (90%) sociodemographically comparable normal birthweight (NBW) cohort at young adulthood, and examined the pattern of growth trajectories and correlates of growth at ages 1, 2, 3, and 8 y, and teen and young adulthood (mean age, 23.3 versus 23.6 y). The proportion considered small for gestational age was ELBW 25% versus NBW 3%; and 26% versus 2% had neurosensory impairments. Weight for age z-scores for ELBW showed substantial decline to age 3 y, with subsequent significant catch-up to adolescence and smaller gains to adulthood. Height for age z-scores showed both sexes of ELBW were disadvantaged at every age compared with NBW and their expected mid-parental height. The BMI z-scores for ELBW showed a sustained incline from age 3 to adulthood, where both sexes normalized to above zero, and were comparable to their peers. ELBW children showed growth failure during infancy, followed by accelerated weight gain and crossing of BMI percentiles at adolescence, a pattern that may increase the risk of insulin resistance and coronary heart disease. However, normalization of BMI for both sexes at adulthood suggests that final growth was proportionate.
Collapse
Affiliation(s)
- Saroj Saigal
- Department of Pediatrics, McMaster University, Hamilton, Ontario, L8N 3Z5, Canada.
| | | | | | | | | | | |
Collapse
|
119
|
Farooqi A, Hägglöf B, Sedin G, Gothefors L, Serenius F. Growth in 10- to 12-year-old children born at 23 to 25 weeks' gestation in the 1990s: a Swedish national prospective follow-up study. Pediatrics 2006; 118:e1452-65. [PMID: 17079546 DOI: 10.1542/peds.2006-1069] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Knowledge of long-term growth of extremely preterm infants in relation to gestational age is incomplete, and there are concerns regarding their poor growth in early childhood. As part of a longitudinal study of a national cohort of infants born at <26 weeks' gestation (extremely immature), growth development from birth to the age of 11 years was examined, and correlates of growth attainment were analyzed. METHODS Two hundred forty-seven extremely immature children were born alive from April 1990 through March 1992 in the whole of Sweden, and 89 (36%) survived. Growth and neurosensory outcomes of all extremely immature survivors were evaluated at 36 months of age. Eighty-six (97%) extremely immature children were identified and assessed at 11 years of age. In this growth study, 83 extremely immature infants (mean [SD]: birth weight, 772 g [110 g]; gestational age, 24.6 weeks [0.6 weeks]) without severe motor disability were followed up prospectively from birth to 11 years old and compared with a matched group of 83 children born at term. z scores for weight, height, head circumference, and BMI were computed for all children. We also examined gender-specific longitudinal growth measures. Predictors of 11-year growth were studied by multivariate analyses. RESULTS Extremely immature children were significantly smaller in all 3 growth parameters than the controls at 11 years. Extremely immature children showed a sharp decline in weight and height z scores up to 3 months' corrected age, followed by catch-up growth in both weight and height up to 11 years. In contrast to weight and height, extremely immature children did not exhibit catch-up growth in head circumference after the first 6 months of life. The mean BMI z scores increased significantly from 1 to 11 years in both groups. The mean BMI change between 1 and 11 years of age was significantly larger in extremely immature than in control participants. Extremely immature girls showed a faster weight increase than extremely immature boys, whereas catch-up growth in height and head circumference was similar in these groups. Multiple-regression analyses revealed that preterm birth and parental height were significant predictors of 11-year height, and group status (prematurity) correlated strongly with head circumference. CONCLUSIONS Children born at the limit of viability attain poor growth in early childhood, followed by catch-up growth to age 11 years, but remain smaller than their term-born peers. Strategies that improve early growth might improve the outcome.
Collapse
Affiliation(s)
- Aijaz Farooqi
- Department of Pediatrics, University Hospital, SE-901 85 Umeå, Sweden.
| | | | | | | | | |
Collapse
|
120
|
Wilson TT, Waters L, Patterson CC, McCusker CG, Rooney NM, Marlow N, Halliday HL. Neurodevelopmental and respiratory follow-up results at 7 years for children from the United Kingdom and Ireland enrolled in a randomized trial of early and late postnatal corticosteroid treatment, systemic and inhaled (the Open Study of Early Corticosteroid Treatment). Pediatrics 2006; 117:2196-205. [PMID: 16740865 DOI: 10.1542/peds.2005-2194] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES The goals were to compare early school-age neurodevelopmental and respiratory outcomes for children who were treated with either early (<3 days) or delayed selective (>15 days) postnatal corticosteroid therapy and to compare systemic dexamethasone treatment with inhaled budesonide treatment. METHODS One hundred twenty-seven (84%) of 152 survivors from the United Kingdom and Ireland who were recruited to the Open Study of Early Corticosteroid Treatment, a randomized trial of inhaled and systemic corticosteroid therapy to prevent chronic lung disease, were traced and assessed at a median age of 7 years. Outcome measures were level of disability, presence of cerebral palsy, cognitive ability, behavioral difficulties and competencies, growth, and respiratory symptoms. Results were adjusted for potential confounding variables (gestational age, birth weight, gender, prenatal steroid therapy, method of delivery, Apgar score at 5 minutes, and Clinical Risk Index for Babies score). RESULTS There were no significant differences among the treatment groups in cognitive ability, behavioral competencies or difficulties, overall disability rates, cerebral palsy, combined outcomes of death or cerebral palsy and death or moderate/severe disability, growth, respiratory morbidity, or diastolic blood pressure. Those assigned to dexamethasone were more likely to have high systolic blood pressure and to have a diagnosis of asthma than were those assigned to budesonide. CONCLUSIONS Although postnatal steroid therapy has been associated with poor long-term outcomes, this study failed to show significant differences in cognitive function between dexamethasone- and budesonide-allocated groups. There may be increased systolic blood pressure and a greater likelihood of developing asthma in childhood after postnatal dexamethasone treatment.
Collapse
Affiliation(s)
- Trevor T Wilson
- Regional Neonatal Unit, Royal Maternity Hospital, Belfast BT12 6BB, Northern Ireland
| | | | | | | | | | | | | |
Collapse
|
121
|
Abstract
BACKGROUND Poor growth after preterm birth, particularly poor head growth, is associated with impaired neurodevelopmental outcome. OBJECTIVE To evaluate weight gain and head growth between birth and term in a contemporary cohort of preterm infants, taking into account breast milk intake and illness severity. METHODS Subjects were inborn infants <or=32 weeks gestation who remained in the neonatal unit up to >or=37 weeks postmenstrual age. Weight and head circumference (HC) were expressed as standard deviation score (SDS), growth between birth and discharge as SDS gain (SDSG), and illness severity and breast milk exposure as the number of days of level 1 (full) intensive care (%L1IC) and the number of days on which breast milk was received (%BM) as a percentage of days from birth to discharge. RESULTS Infants showed poor postnatal weight gain but accelerated head growth. There was a highly significant fall in mean (SD) weight SDS between birth and discharge (-0.31 (0.96) and -1.32 (1.02) respectively, p<0.001) and a highly significant increase in HC SDS (-0.52 (0.95) and -0.03 (1.25) respectively, p = 0.003). %L1IC had a highly significant negative impact on weight SDSG (p = 0.006), and %BM had a significant positive impact on HC SDSG (p = 0.043). CONCLUSIONS Accelerated postnatal head growth suggests catch up after antenatal restraint. This raises the possibility that poor neurocognitive outcomes after extremely preterm birth may in part be consequent on poor intrauterine brain growth. As postnatal head growth may be facilitated by breast milk, there is an urgent need to evaluate the optimal use of breast milk in preterm neonates. Illness severity is a significant determinant of poor postnatal weight gain.
Collapse
Affiliation(s)
- J Cockerill
- Faculty of Medicine, Imperial College London, Chelsea and Westminster Hospital, 369 Fulham Road, London, SW10 9NH.
| | | | | | | |
Collapse
|
122
|
Abstract
There is considerable evidence to show that babies born prematurely have poor postnatal growth, and the more premature the baby, the greater the impairment is likely to be and the longer it will persist. Nutrition has been shown to play an important part in this, but adequate nutrition is difficult, if not impossible, to achieve in these infants. In the most immature infants, growth retardation may continue for many months and catch-up may be delayed and incomplete. Evidence from long-term studies suggests that preterm infants will be shorter and lighter than term controls and that reduced stature and head size may be linked with lower intelligence. Although there is evidence linking better growth to better neurodevelopmental outcome, with reports suggesting that this can be achieved with dietary manipulation, there are also data that suggest that there could be a link between increased postnatal growth and increased morbidity and mortality in later childhood and adult life. Here, we provide an overview of current understanding of growth impairment in infants born prematurely and the effects in later life.
Collapse
|
123
|
Srinivasan L, Allsop J, Counsell SJ, Boardman JP, Edwards AD, Rutherford M. Smaller cerebellar volumes in very preterm infants at term-equivalent age are associated with the presence of supratentorial lesions. AJNR Am J Neuroradiol 2006; 27:573-9. [PMID: 16551994 PMCID: PMC7976967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
BACKGROUND AND PURPOSE Traditionally cerebellar functions are thought to be related to control of tone, posture, gait, and coordination of skilled motor activity. However, there is an increasing body of evidence implicating the cerebellum in cognition, language, memory, and motor learning. Preterm infants are at increased risk of neurodevelopmental delay, cognitive dysfunction, and behavioral and emotional disturbances. The role of the cerebellum in these adverse outcomes is unclear. OBJECTIVE The objective of this study was to determine whether absolute cerebellar volumes differ between term-equivalent preterm infants and term-born control infants and to assess whether cerebellar volume is influenced by any possible antenatal, perinatal, and postnatal factors. METHODS The study compared the MR imaging cerebellar volume by using a manual quantification program of 113 preterm infants at term-equivalent age and 15 term-born control infants. RESULTS The median cerebellar volume of preterm at term-equivalent age was 25.4 cm3 and that of term-born control infants was 26.9 cm3. On initial analysis, there was a significant median difference of 2.0 cm3 (95% CI, 1.2 cm3 to 2.7 cm3) (2-sided P < .0001). However multiple regression analysis of perinatal variables showed that only infants with supratentorial lesions (P = .003) were significantly associated with the reduction in cerebellar volumes. The median cerebellar volumes were the following: supratentorial lesions, 18.9 cm3; no supratentorial lesions, 26.1 cm3; and term infants, 26.9 cm3 (analysis of variance, P < .0001). Hence, there was no significant difference in cerebellar volumes of preterm infants at term-equivalent age in the absence of supratentorial lesions. The median vermal volumes were 0.7 cm3 and were significantly related to cerebellar volumes both in preterm infants with and without lesions and in term-control infants. CONCLUSION Premature infants at term-equivalent age have similar total cerebellar and vermal volumes compared with term infants in the presence of normal brain imaging. Reduced cerebellar volume in preterm infants at term-equivalent age is seen in association with supratentorial pathology such as hemorrhagic parenchymal infarction, intraventricular hemorrhage with dilation, and periventricular leukomalacia.
Collapse
Affiliation(s)
- L Srinivasan
- Department of Paediatrics, MRC Clinical Sciences Centre, Imperial College Faculty of Medicine, Hammersmith Hospital, London, UK
| | | | | | | | | | | |
Collapse
|
124
|
Abstract
The rapid progress of medical technology has resulted in more opportunities to maintain the life of infants in serious and potentially life threatening situations. Whether to treat such infants is a common dilemma. The burden of these difficult decisions rests almost equally on distraught parents and relatives and on the professional staff of neonatal units. Sometimes, either parents or care teams choose to seek a decision from the courts. Ways of reaching the best possible and most inclusive consensus decisions are examined in this review.
Collapse
Affiliation(s)
- J Tripp
- Peninsula Medical School, Universities of Exeter and Plymouth, Drake Circus, Plymouth PL4 8BX, Devon, UK.
| | | |
Collapse
|
125
|
Mikkola K, Ritari N, Tommiska V, Salokorpi T, Lehtonen L, Tammela O, Pääkkönen L, Olsen P, Korkman M, Fellman V. Neurodevelopmental outcome at 5 years of age of a national cohort of extremely low birth weight infants who were born in 1996-1997. Pediatrics 2005; 116:1391-400. [PMID: 16322163 DOI: 10.1542/peds.2005-0171] [Citation(s) in RCA: 236] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Increasing survival of extremely low birth weight (ELBW; birth weight < 1000 g) infants raises a concern regarding the risks of adverse long-term outcome such as cognitive dysfunction. Few studies have reported long-term follow-up of representative regional cohorts. The objective of this study was to assess the 5-year outcome of a prospectively followed national ELBW infant cohort. METHODS Of all live-born ELBW infants (n = 351) who were delivered in the 2-year period 1996-1997 in Finland, 206 (59%) survived until the age of 5 years. Of these, 103 were born at < 27 gestational weeks (GW). A total of 172 children were assessed with neurocognitive tests (Wechsler Preschool and Primary Scale of Intelligence-Revised and a Developmental Neuropsychological Assessment [NEPSY]). Nine children with cognitive impairment and inability to cooperate in testing were not assessed. Motor development was assessed with a modified Touwen test. RESULTS The rate of cognitive impairment in the ELBW survivors was 9%. The rate of cerebral palsy was 14% (19% of ELBW infants who were born at < 27 GW). The mean full-scale IQ of the assessed children was 96 +/- 19 and in children of GW < 27 was 94 +/- 19. Attention, language, sensorimotor, visuospatial, and verbal memory values of NEPSY assessment were significantly poorer compared with normal population means. Four percent needed a hearing aid, and 30% had ophthalmic findings. Of 21 children who had been treated with laser/cryo for retinopathy of prematurity, 17 (81%) had abnormal ophthalmic findings. Of the whole cohort, 41 (20%) exhibited major disabilities, 38 (19%) exhibited minor disabilities, and 124 (61%) showed development with no functional abnormalities but subtle departures from the norm. Only 53 (26%) of the total ELBW infant cohort were classified to have normal outcome excluding any abnormal ophthalmic, auditory, neurologic, or developmental findings. Being small for gestational age at birth was associated with suboptimal growth at least until age 5. CONCLUSIONS Only one fourth of the ELBW infants were classified as normally developed at age 5. The high rate of cognitive dysfunction suggests an increased risk for learning difficulties that needs to be evaluated at a later age. Extended follow-up should be the rule in outcome studies of ELBW infant cohorts to elucidate the impact of immaturity on school achievement and social behavior later in life.
Collapse
Affiliation(s)
- Kaija Mikkola
- Hospital for Children and Adolescents, Helsinki University Central Hospital, Helsinki, Finland.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
126
|
Markestad T, Kaaresen PI, Rønnestad A, Reigstad H, Lossius K, Medbø S, Zanussi G, Engelund IE, Skjaerven R, Irgens LM. Early death, morbidity, and need of treatment among extremely premature infants. Pediatrics 2005; 115:1289-98. [PMID: 15867037 DOI: 10.1542/peds.2004-1482] [Citation(s) in RCA: 247] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To determine outcomes, in terms of perinatal and early death, need for treatment, and morbidity at the time of discharge home, among extremely preterm infants. DESIGN A prospective observational study of all infants with a gestational age (GA) of 22 to 27 completed weeks or a birth weight of 500 to 999 g who were born in Norway in 1999 and 2000. RESULTS Of 636 births, 174 infants (27%) were stillborn or died in the delivery room, 86 (14%) died in the NICU, and 376 (59%) were discharged from the hospital. The risk of being registered as stillborn or not being resuscitated increased with decreasing GA below 25 weeks. The survival rates for all births and for infants admitted to a NICU were, respectively, 0% for <23 weeks, 16% and 39% for 23 weeks, 44% and 60% for 24 weeks, 66% and 80% for 25 weeks, 72% and 84% for 26 weeks, 82% and 93% for 27 weeks, and 69% and 90% for >27 weeks. For the survivors, days of mechanical ventilation decreased from a median of 37 days to 3 days and the proportion in need of oxygen at 36 weeks' postconceptional age decreased from 67% to 26% at 23 and 27 weeks' GA, respectively. At 40 weeks' postconceptional age, the respective figures were 11% and 6%. The proportion with retinopathy of prematurity (ROP) requiring treatment decreased from 33% for GA of 23 weeks to 0% for >25 weeks. Periventricular hemorrhage of more than grade 2 occurred for 6% of the survivors and significant periventricular leukomalacia occurred for 5%, with no significant association with GA. The proportion of survivors without severe neurosensory or pulmonary morbidity increased from 44% for 23 weeks' to 86% for 27 weeks' GA. Apart from ROP, the morbidity rate was not associated with GA. CONCLUSIONS The survival rate was high and the morbidity rate at discharge home was low in the present study, compared with previous population-based studies. With the exception of ROP, the morbidity rates among the survivors were not higher at the lowest GAs, possibly because withholding treatment was considered more acceptable for the most immature infants. The need for intensive care increased markedly for survivors with the lowest GAs.
Collapse
Affiliation(s)
- Trond Markestad
- Department of Pediatrics, Haukeland University Hospital, Bergen, Norway.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
127
|
Ombelet W, De Sutter P, Van der Elst J, Martens G. Multiple gestation and infertility treatment: registration, reflection and reaction—the Belgian project. Hum Reprod Update 2005; 11:3-14. [PMID: 15528214 DOI: 10.1093/humupd/dmh048] [Citation(s) in RCA: 142] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Multiple pregnancies associated with infertility treatment are recognized as an adverse outcome and are responsible for morbidity and mortality related to prematurity and very low birthweight population. Due to the epidemic of iatrogenic multiple births, the incidence of maternal, perinatal and childhood morbidity and mortality has increased. This results in a hidden healthcare cost of infertility therapy and this may lead to social and political concern. Reducing the number of embryos transferred and the use of natural cycle IVF will surely decrease the number of multiple gestations. Consequently, optimized cryopreservation programmes will be essential. For non-IVF hormonal stimulation, responsible for more than one-third of all multiple pregnancies after infertility treatment, a strict ovarian stimulation protocol aiming at mono-ovulation is crucial. Multifetal pregnancy reduction is an effective method to reduce high order multiplets but carries its own risk of medical and emotional complications. Excellent data collection of all infertility treatments is needed in our discussion with policy makers. The Belgian project, in which reimbursement of assisted reproduction technology-related laboratory activities is linked to a transfer policy aiming at substantial multiple pregnancy reduction, is a good example of cost-efficient health care through responsible, well considered clinical practice.
Collapse
Affiliation(s)
- Willem Ombelet
- Genk Institute for Fertility Technology, Department of Obstetrics and Gynaecology, Genk, Belgium.
| | | | | | | |
Collapse
|
128
|
Rogers B, Arvedson J. Assessment of infant oral sensorimotor and swallowing function. ACTA ACUST UNITED AC 2005; 11:74-82. [PMID: 15856438 DOI: 10.1002/mrdd.20055] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The development of feeding and swallowing is the result of a complex interface between the developing nervous system, various physiological systems, and the environment. The purpose of this article is to review the neurobiology, development, and assessment of feeding and swallowing during early infancy. In recent years, there have been exciting advances in our understanding of the physiology and neurological control of feeding and swallowing. These advances may prove useful in furthering our understanding of the pathophysiology of dysphagia in infancy. Progress in developing standardized, reliable, and valid measures of oral sensorimotor and swallowing function in infancy has been slow. However, there have been significant advances in the instrumental analysis of feeding and swallowing disorders in infancy, including manometric analyses of sucking and swallowing, measures of respiration during feeding, videofluoroscopic swallow evaluations, ultrasonography, and flexible endoscopic examination of swallowing. Further efforts are needed to develop clinical evaluative measures of dysphagia in infancy.
Collapse
Affiliation(s)
- Brian Rogers
- Child Development and Rehabilitation Center, Oregon Health & Science University, Portland, Oregon 97207, USA.
| | | |
Collapse
|
129
|
Lee E. Debating late abortion: time to tell the truth. JOURNAL OF FAMILY PLANNING AND REPRODUCTIVE HEALTH CARE 2005; 31:7, 9. [PMID: 15720839 DOI: 10.1783/0000000052972933] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Ellie Lee
- School of Social Policy, Sociology and Social Research, University of Kent, Canterbury, UK.
| |
Collapse
|
130
|
|