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Scheuchenegger A, Windisch B, Pansy J, Resch B. Morbidities and rehospitalizations during the first year of life in moderate and late preterm infants: more similarities than differences? Minerva Pediatr (Torino) 2023; 75:852-861. [PMID: 32508074 DOI: 10.23736/s2724-5276.20.05736-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
BACKGROUND The aim was to compare neonatal morbidities in moderate and late preterm infants and to analyze rates and causes for rehospitalizations during the first year of life. METHODS Prospective follow-up of a group of moderate and late preterm infants at a tertiary care hospital. RESULTS The study population comprised 215 infants (58% males; 60% singletons; 99 moderate and 116 late preterm infants) with a median gestational age of 34 weeks and birth weight of 2100 grams; 20% of them were small for gestational age. Moderate preterm infants more often had a diagnosis of mild respiratory distress syndrome (26% vs. 13%, P<0.01) and feeding problems with longer need for nasogastric tube feeding (median 9.5 vs. 4.2 days, P<0.01) and parenteral nutrition (3.5 vs. 2.7 days, P<0.01), and longer duration of stay at either NICU (10.6 vs. 3.7 days; P<0.01) or hospital (13 vs. 11 days; P<0.01). Fifty-two infants (24.3%) were hospitalized at 67 occasions without differences regarding readmission rates and causes between groups. Median age at readmission was 3 months, median stay 4 days. The most common diagnosis was respiratory illness (43.3%). CONCLUSIONS Moderate preterm infants had more neonatal morbidities diagnosed, but the same rehospitalization rates than late preterm infants.
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Affiliation(s)
- Anna Scheuchenegger
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria -
- Research Unit for Neonatal Infectious Diseases and Epidemiology, Medical University of Graz, Graz, Austria -
| | - Bernadette Windisch
- Research Unit for Neonatal Infectious Diseases and Epidemiology, Medical University of Graz, Graz, Austria
| | - Jasmin Pansy
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Bernhard Resch
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
- Research Unit for Neonatal Infectious Diseases and Epidemiology, Medical University of Graz, Graz, Austria
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Pettinger KJ, Copper C, Boyle E, Blower S, Hewitt C, Fraser L. Risk of Developmental Disorders in Children Born at 32 to 38 Weeks' Gestation: A Meta-Analysis. Pediatrics 2023; 152:e2023061878. [PMID: 37946609 PMCID: PMC10657778 DOI: 10.1542/peds.2023-061878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/23/2023] [Indexed: 11/12/2023] Open
Abstract
CONTEXT Very preterm birth (<32 weeks) is associated with increased risk of developmental disorders. Emerging evidence suggests children born 32 to 38 weeks might also be at risk. OBJECTIVES To determine the relative risk and prevalence of being diagnosed with, or screening positive for, developmental disorders in children born moderately preterm, late preterm, and early term compared with term (≥37 weeks) or full term (39-40/41 weeks). DATA SOURCES Medline, Embase, Psychinfo, Cumulative Index of Nursing, and Allied Health Literature. STUDY SELECTION Reported ≥1 developmental disorder, provided estimates for children born 32 to 38 weeks. DATA EXTRACTION A single reviewer extracted data; a 20% sample was second checked. Data were pooled using random-effects meta-analyses. RESULTS Seventy six studies were included. Compared with term born children, there was increased risk of most developmental disorders, particularly in the moderately preterm group, but also in late preterm and early term groups: the relative risk of cerebral palsy was, for 32 to 33 weeks: 14.1 (95% confidence intervals [CI]: 12.3-16.0), 34 to 36 weeks: 3.52 (95% CI: 3.16-3.92) and 37 to 38 weeks: 1.44 (95% CI: 1.32-1.58). LIMITATIONS Studies assessed children at different ages using varied criteria. The majority were from economically developed countries. All were published in English. Data were variably sparse; subgroup comparisons were sometimes based on single studies. CONCLUSIONS Children born moderately preterm are at increased risk of being diagnosed with or screening positive for developmental disorders compared with term born children. This association is also demonstrated in late preterm and early term groups but effect sizes are smaller.
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Affiliation(s)
| | | | - Elaine Boyle
- University of Leicester, Leicester, United Kingdom
| | | | | | - Lorna Fraser
- University of York, York, United Kingdom
- King’s College London, London, United Kingdom
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Ryckman KK, Holdefer PJ, Sileo E, Carlson C, Weathers N, Jasper EA, Cho H, Oltman SP, Dagle JM, Jelliffe-Pawlowski LL, Rogers EE. The validity of hospital diagnostic and procedure codes reflecting morbidity in preterm neonates born <32 weeks gestation. J Perinatol 2023; 43:1374-1378. [PMID: 37138163 PMCID: PMC10860645 DOI: 10.1038/s41372-023-01685-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 04/11/2023] [Accepted: 04/19/2023] [Indexed: 05/05/2023]
Abstract
OBJECTIVE To determine the validity of diagnostic hospital billing codes for complications of prematurity in neonates <32 weeks gestation. STUDY DESIGN Retrospective cohort data from discharge summaries and clinical notes (n = 160) were reviewed by trained, blinded abstractors for the presence of intraventricular hemorrhage (IVH) grades 3 or 4, periventricular leukomalacia (PVL), necrotizing enterocolitis (NEC), stage 3 or higher, retinopathy of prematurity (ROP), and surgery for NEC or ROP. Data were compared to diagnostic billing codes from the neonatal electronic health record. RESULTS IVH, PVL, ROP and ROP surgery had strong positive predictive values (PPV > 75%) and excellent negative predictive values (NPV > 95%). The PPVs for NEC (66.7%) and NEC surgery (37.1%) were low. CONCLUSION Diagnostic hospital billing codes were observed to be a valid metric to evaluate preterm neonatal morbidities and surgeries except in the instance of more ambiguous diagnoses such as NEC and NEC surgery.
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Affiliation(s)
- Kelli K Ryckman
- Department of Epidemiology, University of Iowa, Iowa City, IA, USA.
- Department of Epidemiology and Biostatistics, Indiana University, Bloomington, IN, USA.
| | - Paul J Holdefer
- Department of Epidemiology, University of Iowa, Iowa City, IA, USA
- Department of Community and Behavioral Health, University of Iowa, Iowa City, IA, USA
| | - Eva Sileo
- Department of Epidemiology, University of Iowa, Iowa City, IA, USA
| | - Claire Carlson
- Department of Epidemiology, University of Iowa, Iowa City, IA, USA
| | - Nancy Weathers
- Department of Epidemiology, University of Iowa, Iowa City, IA, USA
| | - Elizabeth A Jasper
- Division of Quantitative Sciences, Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN, USA
- Center for Precision Medicine, Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Hyunkeun Cho
- Department of Biostatistics, University of Iowa, Iowa City, IA, USA
| | - Scott P Oltman
- Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, CA, USA
- UCSF California Preterm Birth Initiative, San Francisco, CA, USA
| | - John M Dagle
- Department of Pediatrics, University of Iowa, Iowa City, IA, USA
| | - Laura L Jelliffe-Pawlowski
- Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, CA, USA
- UCSF California Preterm Birth Initiative, San Francisco, CA, USA
| | - Elizabeth E Rogers
- UCSF California Preterm Birth Initiative, San Francisco, CA, USA
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA
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Phua DY, Chen H, Yap F, Chong YS, Gluckman PD, Broekman BFP, Eriksson JG, Meaney MJ. Allostatic load in children: The cost of empathic concern. Proc Natl Acad Sci U S A 2023; 120:e2217769120. [PMID: 37725642 PMCID: PMC10523447 DOI: 10.1073/pnas.2217769120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 07/26/2023] [Indexed: 09/21/2023] Open
Abstract
Early-life adversity affects long-term health outcomes but there is considerable interindividual variability in susceptibility to environmental influences. We proposed that positive psychological characteristics that reflect engagement with context, such as being concerned about people or performance on tasks (i.e., empathic concern), could moderate the interindividual variation in sensitivity to the quality of the early environment. We studied 526 children of various Asian nationalities in Singapore (46.6% female, 13.4% below the poverty line) with longitudinal data on perinatal and childhood experiences, maternal report on empathic concern of the child, and a comprehensive set of physiological measures reflecting pediatric allostatic load assessed at 6 y of age. The perinatal and childhood experiences included adversities and positive experiences. We found that cumulative adverse childhood experience was positively associated with allostatic load of children at 6 y of age at higher levels of empathic concern but not significantly associated at lower levels of empathic concern. This finding reveals evidence for the importance of empathic concern as a psychological characteristic that moderates the developmental impact of environmental influences, serving as a source for vulnerability to adversities in children.
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Affiliation(s)
- Desiree Y. Phua
- Translational Neuroscience Programme, Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore117609, Republic of Singapore
| | - Helen Chen
- Department of Psychological Medicine, Kandang Kerbau Women’s and Children’s Hospital, Singapore229899, Republic of Singapore
- Paediatric Medicine Academic Clinical Programme, Duke-National University of Singapore, Singapore169857, Republic of Singapore
| | - Fabian Yap
- Department of Psychological Medicine, Kandang Kerbau Women’s and Children’s Hospital, Singapore229899, Republic of Singapore
- Department of Paediatric Medicine, Kandang Kerbay Women’s and Children’s Hospital, 100 Bukit Timah Road, Singapore229899, Republic of Singapore
| | - Yap Seng Chong
- Translational Neuroscience Programme, Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore117609, Republic of Singapore
- Yong Loo Lin School of Medicine, Human Potential Translational Research Programme and O&G Department, National University of Singapore, Singapore117597, Singapore
| | - Peter D. Gluckman
- Translational Neuroscience Programme, Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore117609, Republic of Singapore
- Centre for Human Evolution, Adaptation and Disease, Liggins Institute, University of Auckland, Auckland1023, New Zealand
- Public Health Research Program, Folkhalsan Research Center, Helsinki00250, Finland
| | - Birit F. P. Broekman
- Department of Psychiatry, Amsterdam University Medical Centers (UMC) and Onze Lieve Vrouwe Gasthuis (OLVG), Vrije Universiteit (VU), Amsterdam1081 HV, The Netherlands
| | - Johan G. Eriksson
- Translational Neuroscience Programme, Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore117609, Republic of Singapore
- Yong Loo Lin School of Medicine, Human Potential Translational Research Programme and O&G Department, National University of Singapore, Singapore117597, Singapore
- Public Health Research Program, Folkhalsan Research Center, Helsinki00250, Finland
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki00100, Finland
| | - Michael J. Meaney
- Translational Neuroscience Programme, Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore117609, Republic of Singapore
- Yong Loo Lin School of Medicine, Human Potential Translational Research Programme and O&G Department, National University of Singapore, Singapore117597, Singapore
- Brain-Body Initiative, Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore117597, Republic of Singapore
- Sackler Program for Epigenetics and Psychobiology at McGill University, MontrealQCH3A 0G4, Canada
- Department of Psychiatry, Douglas Mental Health University Institute, McGill University, MontrealQCH3A 0G4, Canada
- Brain-Body Initiative, Agency for Science, Technology and Research (A*STAR), Singapore138632, Republic of Singapore
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Jin H, Zhang Y, Fan Z, Wang X, Rui C, Xing S, Dong H, Wang Q, Tao F, Zhu Y. Identification of novel cell-free RNAs in maternal plasma as preterm biomarkers in combination with placental RNA profiles. J Transl Med 2023; 21:256. [PMID: 37046301 PMCID: PMC10100253 DOI: 10.1186/s12967-023-04083-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 03/25/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND Preterm birth (PTB) is the main driver of newborn deaths. The identification of pregnancies at risk of PTB remains challenging, as the incomplete understanding of molecular mechanisms associated with PTB. Although several transcriptome studies have been done on the placenta and plasma from PTB women, a comprehensive description of the RNA profiles from plasma and placenta associated with PTB remains lacking. METHODS Candidate markers with consistent trends in the placenta and plasma were identified by implementing differential expression analysis using placental tissue and maternal plasma RNA-seq datasets, and then validated by RT-qPCR in an independent cohort. In combination with bioinformatics analysis tools, we set up two protein-protein interaction networks of the significant PTB-related modules. The support vector machine (SVM) model was used to verify the prediction potential of cell free RNAs (cfRNAs) in plasma for PTB and late PTB. RESULTS We identified 15 genes with consistent regulatory trends in placenta and plasma of PTB while the full term birth (FTB) acts as a control. Subsequently, we verified seven cfRNAs in an independent cohort by RT-qPCR in maternal plasma. The cfRNA ARHGEF28 showed consistence in the experimental validation and performed excellently in prediction of PTB in the model. The AUC achieved 0.990 for whole PTB and 0.986 for late PTB. CONCLUSIONS In a comparison of PTB versus FTB, the combined investigation of placental and plasma RNA profiles has shown a further understanding of the mechanism of PTB. Then, the cfRNA identified has the capacity of predicting whole PTB and late PTB.
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Affiliation(s)
- Heyue Jin
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei, Anhui, China
- MOE Key Laboratory of Population Health Across Life Cycle, No 81 Meishan Road, Hefei, Anhui, China
- Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, No 81 Meishan Road, Hefei, Anhui, China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei, Anhui, China
| | - Yimin Zhang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei, Anhui, China
- MOE Key Laboratory of Population Health Across Life Cycle, No 81 Meishan Road, Hefei, Anhui, China
- Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, No 81 Meishan Road, Hefei, Anhui, China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei, Anhui, China
| | - Zhigang Fan
- Department of Neonatology, Ma'anshan Maternal and Child Health Hospital, Ma'anshan, Anhui, China
| | - Xianyan Wang
- Department of Toxicology, School of Public Health, Anhui Medical University, Hefei, Anhui, China
- Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Hefei, Anhui, China
| | - Chen Rui
- Department of Toxicology, School of Public Health, Anhui Medical University, Hefei, Anhui, China
- Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Hefei, Anhui, China
| | - Shaozhen Xing
- MOE Key Laboratory of Bioinformatics, Center for Synthetic and Systems Biology, School of Life Sciences, Tsinghua University, Beijing, China
| | - Hongmei Dong
- Department of Obstetrics, Ma'anshan Maternal and Child Health Hospital, Ma'anshan, Anhui, China
| | - Qunan Wang
- Department of Toxicology, School of Public Health, Anhui Medical University, Hefei, Anhui, China.
- Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Hefei, Anhui, China.
| | - Fangbiao Tao
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei, Anhui, China.
- MOE Key Laboratory of Population Health Across Life Cycle, No 81 Meishan Road, Hefei, Anhui, China.
- Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, No 81 Meishan Road, Hefei, Anhui, China.
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei, Anhui, China.
| | - Yumin Zhu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei, Anhui, China.
- MOE Key Laboratory of Population Health Across Life Cycle, No 81 Meishan Road, Hefei, Anhui, China.
- Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, No 81 Meishan Road, Hefei, Anhui, China.
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei, Anhui, China.
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Hintz SR, deRegnier RA, Vohr BR. Outcomes of Preterm Infants: Shifting Focus, Extending the View. Clin Perinatol 2023; 50:1-16. [PMID: 36868700 DOI: 10.1016/j.clp.2022.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
Advances in perinatal care have led to remarkable long-term survival for infants who are born preterm. This article reviews the broader context of follow-up care, highlighting the need to reenvision some areas, such as improving parental support by embedding parental involvement in the neonatal intensive care unit, incorporating parental perspectives about outcomes into follow-up care models and research, supporting their mental health, addressing social determinants of health and disparities, and advocating for change. Multicenter quality improvement networks allow identification and implementation of best practices for follow-up care.
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Affiliation(s)
- Susan R Hintz
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, 453 Quarry Road, 4th Floor, Palo Alto, CA 94304, USA.
| | - Raye-Ann deRegnier
- Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, 225 East Chicago Avenue, Box 45, Chicago, IL 60611, USA
| | - Betty R Vohr
- Division of Neonatology, Department of Pediatrics, Women & Infants Hospital, Alpert Medical School of Brown University, 101 Dudley Street, Providence, RI 02905, USA
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Miller K, Prokasky A, Roberts H, McMorris C, Needelman H. Associations between risk factors, developmental outcomes, and executive function in neonatal intensive care unit graduates at 2 years: A retrospective study. INFANT AND CHILD DEVELOPMENT 2023. [DOI: 10.1002/icd.2411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Affiliation(s)
- Kerry Miller
- Munroe Meyer Institute University of Nebraska Medical Center Omaha Nebraska USA
| | - Amanda Prokasky
- Munroe Meyer Institute University of Nebraska Medical Center Omaha Nebraska USA
| | - Holly Roberts
- Munroe Meyer Institute University of Nebraska Medical Center Omaha Nebraska USA
| | - Carol McMorris
- Munroe Meyer Institute University of Nebraska Medical Center Omaha Nebraska USA
| | - Howard Needelman
- Munroe Meyer Institute University of Nebraska Medical Center Omaha Nebraska USA
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Simons NE, de Ruigh AA, van 't Hooft J, Aarnoudse-Moens CSH, van Wely M, van der Ham DP, van Teeffelen ASP, Roseboom TJ, Mol BW, Leemhuis AG, Pajkrt E. Childhood outcomes after induction of labor or expectant management for preterm prelabor rupture of membranes: a 10-year follow-up of the PPROMEXIL trials. Am J Obstet Gynecol 2023; 228:588.e1-588.e13. [PMID: 36787813 DOI: 10.1016/j.ajog.2023.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 02/01/2023] [Accepted: 02/02/2023] [Indexed: 02/13/2023]
Abstract
BACKGROUND Management of late preterm prelabor rupture of membranes between 34+0 and 36+6 weeks' gestation balances the risks of preterm birth with the risks of infection for both the mother and the neonate. Expectant management to prolong pregnancy showed similar risks of neonatal sepsis, but children at 2 years of age showed more neurodevelopmental delay when compared with induction of labor. Long-term outcomes on child development after 2 years of age are unknown. OBJECTIVE This study aimed to assess the long-term outcomes of children born after singleton pregnancies complicated by late preterm prelabor rupture of membranes managed by induction of labor in comparison with expectant management. STUDY DESIGN This was a follow-up study of the Preterm Prelabor Rupture of Membranes Expectant Management Versus Induction of Labor (PPROMEXIL) trials (randomized controlled trials between 2007 to 2011) evaluating children at 10 to 12 years of age (Netherlands Trial Register 6953). The primary outcomes were cognition, motor function, and behavior as assessed by the Wechsler Intelligence Scale for Children-V-NL, Movement Assessment Battery for Children-2, and Child Behavior Checklist, respectively. The secondary outcomes were sensory processing, respiratory problems, educational attainment, and general health. Mild delay was defined as -1 standard deviation or corresponding percentile. The relative risk and confidence intervals were calculated using standard methods. RESULTS This follow-up study invited 711 surviving children of the 714 singleton pregnancies randomized in the original trials. In total, 248 (35%) children participated (127 induction of labor, 121 expectant management). Children born after induction of labor had no significant differences in the primary outcomes when compared with those born after expectant management. Mild cognitive delay was observed in 7 of 122 (5.7%) children born after induction of labor in comparison with in 12 of 120 (10.0%) children born after expectant management (relative risk, 0.57; 95% confidence interval, 0.23-1.41). A mild delay in motor function was observed in 42 of 122 (34.4%) children born after induction of labor vs in 55 of 120 (45.8%) children born after expectant management (relative risk, 0.75; 95% confidence interval, 0.55-1.03). Mild abnormal behavior was observed in 37 of 125 (29.6%) children born after induction of labor compared with in 33 of 118 (28.0%) children born after expectant management (relative risk, 1.05; 95% confidence interval, 0.71-1.57). Secondary outcomes were also comparable between the induction of labor and the expectant management groups except that more children born after expectant management had a hospital admission (relative risk, 0.68; 95% confidence interval, 0.52-0.89) or a surgery (relative risk, 0.58; 95% confidence interval, 0.41-0.82). CONCLUSION In children born after pregnancies with late preterm prelabor rupture of membranes, expectant management did not improve long-term outcomes at 10 to 12 years when compared with induction of labor.
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Affiliation(s)
- Noor E Simons
- Department of Obstetrics and Gynecology, Amsterdam University Medical Centers, Amsterdam, The Netherlands; Amsterdam Reproduction and Development, Amsterdam, The Netherlands.
| | - Annemijn A de Ruigh
- Department of Obstetrics and Gynecology, Amsterdam University Medical Centers, Amsterdam, The Netherlands; Amsterdam Reproduction and Development, Amsterdam, The Netherlands
| | - Janneke van 't Hooft
- Department of Obstetrics and Gynecology, Amsterdam University Medical Centers, Amsterdam, The Netherlands; Amsterdam Reproduction and Development, Amsterdam, The Netherlands
| | - Cornelieke S H Aarnoudse-Moens
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands; Department of Neonatology and Pediatrics, Emma Children's Hospital, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Madelon van Wely
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands; Centre for Reproductive Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - David P van der Ham
- Department of Obstetrics and Gynecology, Martini Hospital, Groningen, The Netherlands
| | - Augustinus S P van Teeffelen
- Department of Obstetrics and Gynecology, Grow-School for Oncology and Reproduction, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Tessa J Roseboom
- Department of Obstetrics and Gynecology, Amsterdam University Medical Centers, Amsterdam, The Netherlands; Amsterdam Reproduction and Development, Amsterdam, The Netherlands; Department of Epidemiology and Data Science, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Ben W Mol
- Department of Obstetrics and Gynecology, Monash University, Melbourne, Victoria, Australia
| | - Aleid G Leemhuis
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands; Department of Neonatology and Pediatrics, Emma Children's Hospital, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Eva Pajkrt
- Department of Obstetrics and Gynecology, Amsterdam University Medical Centers, Amsterdam, The Netherlands; Amsterdam Reproduction and Development, Amsterdam, The Netherlands
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Balalian AA, McVeigh KH, Stingone JA. Air pollution, children's academic achievement and the potential mediating role of preterm birth. Int J Hyg Environ Health 2022; 243:113991. [PMID: 35688002 PMCID: PMC9541921 DOI: 10.1016/j.ijheh.2022.113991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 05/31/2022] [Accepted: 06/03/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Previous research has observed relationships between higher prenatal exposure to air pollutants and neurodevelopmental and academic outcomes later in childhood. Identifying intermediate outcomes mediating this relationship would inform prevention and intervention efforts. We aimed to investigate if previously observed associations between prenatal exposure to common urban air pollutants, diesel and perchloroethylene, and performance on third grade standardized tests were mediated through increased risk of preterm birth. METHODS Data from the 1994-1998 birth cohorts within the New York City Longitudinal Study of Early Development were included in this analysis. Exposure was determined by linking the mother's residence at the time of delivery to the U.S. EPA's 1996 National Air Toxic Assessment of estimated ambient concentrations of diesel and perchloroethylene. Children's third grade standardized math and language tests were used as the markers for academic achievement. Missing data on covariates were imputed, while participants with missing information on gestational age and test scores were excluded. Linear regression models and causal mediation analysis were used to examine potential mediation by preterm birth. RESULTS In total, 187,723 and 196,122 participants were included in language and math analyses, respectively. Children with exposure to the fourth quartile of diesel or perchloroethylene had approximately 0.03 (95%CI: 0.02, 0.04) lower math z-scores when compared to individuals with exposure in the first quartile, although there was no consistent decreasing trend in math z-scores over increasing quartiles of diesel or perchloroethylene. We did not find evidence of mediation by preterm birth or exposure-mediator interaction in our models. CONCLUSION We did not find evidence that observed relationships between exposure to common urban air pollutants and test z-scores in childhood were mediated through an increased risk of preterm birth. This suggests other pathways between early exposure to air pollution and neurodevelopment should be investigated with causal mediation approaches.
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Affiliation(s)
- Arin A Balalian
- Columbia University Department of Epidemiology, Mailman School of Public Health, 722 West 168th St. 16thfloor, New York, NY, 10032, USA.
| | - Katharine H McVeigh
- New York City Department of Health and Mental Hygiene, Division of Family and Child Health, 42-09 28thStreet, Queens, NY, 11101, USA.
| | - Jeanette A Stingone
- Columbia University Department of Epidemiology, Mailman School of Public Health, 722 West 168th St. 16thfloor, New York, NY, 10032, USA.
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Silcock RA, Doyle R, Clark JE, Kynaston JA, Thomas M, May ML. Parechovirus infection in infants: Evidence-based parental counselling for paediatricians. J Paediatr Child Health 2022; 58:856-862. [PMID: 34967960 DOI: 10.1111/jpc.15859] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 08/15/2021] [Accepted: 08/30/2021] [Indexed: 11/28/2022]
Abstract
AIM Human parechovirus (HPeV) is an increasingly recognised cause of severe illness and central nervous system infection in infants. Medium- to long-term neurodevelopmental outcomes post-HPeV infection remain unknown. This study aims to assess neurodevelopmental outcomes for children hospitalised as infants with HPeV infection in their second and third years of life. METHODS This prospective cohort study followed children hospitalised with HPeV in Brisbane, Queensland during the 2017/2018 outbreak. Serial application of Ages and Stages Questionnaire (ASQ) was used to assess developmental progress in the second and third years of life. Data from clinical follow-up, audiology and neuroradiology were included. RESULTS In the second year of life, 63% (n = 29) of children showed some or significant concerns for developmental delay. This had largely been ameliorated by the third year of life when only 30% (n = 14) reported developmental concerns. Prematurity and apnoeas were associated with developmental concerns at 27-36 months of age. Communication was the most common domain of concern. CONCLUSIONS The majority of infants hospitalised with HPeV infection in 2017-2018 showed normalisation of developmental progress by 27-36 months of age. Further investigation into more subtle neurological impairments in later childhood is required. These results can help guide clinicians in counselling parents during the acute illness and in planning appropriate follow-up.
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Affiliation(s)
- Robyn A Silcock
- Infectious Diseases, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Rebecca Doyle
- Queensland Health Centre of Children's Health Research, Brisbane, Queensland, Australia
| | - Julia E Clark
- Infectious Diseases, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - J Anne Kynaston
- General Paediatrics, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Marion Thomas
- General Paediatrics, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Meryta L May
- Microbiology, Sullivan and Nicolaides Pathology, Brisbane, Queensland, Australia
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11
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McGowan EC, Sheinkopf SJ. Autism and Preterm Birth: Clarifying Risk and Exploring Mechanisms. Pediatrics 2021; 148:peds.2021-051978. [PMID: 34380777 DOI: 10.1542/peds.2021-051978] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/16/2021] [Indexed: 11/24/2022] Open
Affiliation(s)
| | - Stephen J Sheinkopf
- Women & Infants Hospital.,Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island.,Brown Center for the Study of Children at Risk
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12
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Ciciolla L, Shreffler KM, Tiemeyer S. Maternal Childhood Adversity as a Risk for Perinatal Complications and NICU Hospitalization. J Pediatr Psychol 2021; 46:801-813. [PMID: 34304270 DOI: 10.1093/jpepsy/jsab027] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 01/16/2021] [Accepted: 03/01/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To examine maternal childhood adversity in relation to increased risk for maternal and infant perinatal complications and newborn Neonatal Intensive Care Unit (NICU) admittance. METHODS A sample of 164 women recruited at their first prenatal appointment participated in a longitudinal study through 6 weeks postdelivery. Participants self-reported on their adverse childhood experiences (ACEs), negative health risks (overweight/obesity, smoking, and alcohol use), adverse infant outcomes, NICU admittance, and maternal perinatal complications across three pregnancy assessments and one post-birth assessment. Logistic binomial regression analyses were used to examine associations between maternal ACEs and adverse infant outcomes, NICU admittance, and maternal perinatal complications, controlling for pregnancy-related health risks. RESULTS Findings showed that women with severe ACEs exposure (6+ ACEs) had 4 times the odds of reporting at least one adverse infant outcome (odds ratio [OR] = 4.33, 95% CI: 1.02-18.39), almost 9 times the odds of reporting a NICU admission (OR = 8.70, 95% CI: 1.34-56.65), and 4 times the odds of reporting at least one maternal perinatal outcome (OR = 4.37, 95% CI: 1.43-13.39). CONCLUSIONS The findings demonstrate the extraordinary risk that mothers' ACEs pose for infant and maternal health outcomes over and above the associations with known maternal health risks during pregnancy, including overweight/obesity, smoking, and alcohol use. These results support a biological intergenerational transmission framework, which suggests that risk from maternal adversity is perpetuated in the next generation through biophysical and behavioral mechanisms during pregnancy that negatively affect infant health outcomes.
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Affiliation(s)
| | - Karina M Shreffler
- Department of Human Development and Family Science, Oklahoma State University
| | - Stacy Tiemeyer
- Center for Integrative Research on Childhood Adversity, Oklahoma State University-Center for Health Sciences
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13
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Dhamrait GK, Christian H, O'Donnell M, Pereira G. Gestational age and child development at school entry. Sci Rep 2021; 11:14522. [PMID: 34267259 PMCID: PMC8282628 DOI: 10.1038/s41598-021-93701-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 06/28/2021] [Indexed: 12/12/2022] Open
Abstract
Studies have reported a dose-dependent relationship between gestational age and poorer school readiness. The study objective was to quantify the risk of developmental vulnerability for children at school entry, associated with gestational age at birth and to understand the impact of sociodemographic and other modifiable risk factors on these relationships. Linkage of population-level birth registration, hospital, and perinatal datasets to the Australian Early Development Census (AEDC), enabled follow-up of a cohort of 64,810 singleton children, from birth to school entry in either 2009, 2012, or 2015. The study outcome was teacher-reported child development on the AEDC with developmental vulnerability defined as domain scores < 10th percentile of the 2009 AEDC cohort. We used modified Poisson Regression to estimate relative risks (RR) and risk differences (RD) of developmental vulnerability between; (i) preterm birth and term-born children, and (ii) across gestational age categories. Compared to term-born children, adjustment for sociodemographic characteristics attenuated RR for all preterm birth categories. Further adjustment for modifiable risk factors such as preschool attendance and reading status at home had some additional impact across all gestational age groups, except for children born extremely preterm. The RR and RD for developmental vulnerability followed a reverse J-shaped relationship with gestational age. The RR of being classified as developmentally vulnerable was highest for children born extremely preterm and lowest for children born late-term. Adjustment for sociodemographic characteristics attenuated RR and RD for all gestational age categories, except for early-term born children. Children born prior to full-term are at a greater risk for developmental vulnerabilities at school entry. Elevated developmental vulnerability was largely explained by sociodemographic disadvantage. Elevated vulnerability in children born post-term is not explained by sociodemographic disadvantage to the same extent as in children born prior to full-term.
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Affiliation(s)
- Gursimran K Dhamrait
- Telethon Kids Institute, University of Western Australia, Perth, WA, Australia.
- School of Population and Global Health, The University of Western Australia, Perth, WA, Australia.
| | - Hayley Christian
- Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
- School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
| | - Melissa O'Donnell
- Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
- Australian Centre for Child Protection, University of South Australia, Adelaide, SA, Australia
| | - Gavin Pereira
- Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
- Curtin School of Population Health, Curtin University, Perth, WA, Australia
- Centre for Fertility and Health (CeFH), Norwegian Institute of Public Health, Oslo, Norway
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14
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Shaw JC, Crombie GK, Palliser HK, Hirst JJ. Impaired Oligodendrocyte Development Following Preterm Birth: Promoting GABAergic Action to Improve Outcomes. Front Pediatr 2021; 9:618052. [PMID: 33634057 PMCID: PMC7901941 DOI: 10.3389/fped.2021.618052] [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: 10/16/2020] [Accepted: 01/12/2021] [Indexed: 11/21/2022] Open
Abstract
Preterm birth is associated with poor long-term neurodevelopmental and behavioral outcomes, even in the absence of obvious brain injury at the time of birth. In particular, behavioral disorders characterized by inattention, social difficulties and anxiety are common among children and adolescents who were born moderately to late preterm (32-37 weeks' gestation). Diffuse deficits in white matter microstructure are thought to play a role in these poor outcomes with evidence suggesting that a failure of oligodendrocytes to mature and myelinate axons is responsible. However, there remains a major knowledge gap over the mechanisms by which preterm birth interrupts normal oligodendrocyte development. In utero neurodevelopment occurs in an inhibitory-dominant environment due to the action of placentally derived neurosteroids on the GABAA receptor, thus promoting GABAergic inhibitory activity and maintaining the fetal behavioral state. Following preterm birth, and the subsequent premature exposure to the ex utero environment, this action of neurosteroids on GABAA receptors is greatly reduced. Coinciding with a reduction in GABAergic inhibition, the preterm neonatal brain is also exposed to ex utero environmental insults such as periods of hypoxia and excessive glucocorticoid concentrations. Together, these insults may increase levels of the excitatory neurotransmitter glutamate in the developing brain and result in a shift in the balance of inhibitory: excitatory activity toward excitatory. This review will outline the normal development of oligodendrocytes, how it is disrupted under excitation-dominated conditions and highlight how shifting the balance back toward an inhibitory-dominated environment may improve outcomes.
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Affiliation(s)
- Julia C Shaw
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, NSW, Australia.,Mothers and Babies Research Centre, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Gabrielle K Crombie
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, NSW, Australia.,Mothers and Babies Research Centre, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Hannah K Palliser
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, NSW, Australia.,Mothers and Babies Research Centre, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Jonathan J Hirst
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, NSW, Australia.,Mothers and Babies Research Centre, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
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15
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Gattis M, Winstanley A, Sperotto R, Putnick DL, Bornstein MH. Foundations of attention sharing: Orienting and responding to attention in term and preterm 5-month-old infants. Infant Behav Dev 2020; 61:101466. [PMID: 32927260 PMCID: PMC7768091 DOI: 10.1016/j.infbeh.2020.101466] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 06/01/2020] [Accepted: 07/07/2020] [Indexed: 11/01/2022]
Abstract
Attention is the gateway to perceptual, cognitive, and socioemotional development in humans. We observed 104 5-month-old term and preterm infants and their mothers in social interactions to address three questions about the role of maturation in orienting and responding to attention. We used a fine-grained coding system to allow parallel comparisons across infant and maternal orienting, and sequential analysis to evaluate infant and maternal responding to attention. Orienting and responding to attention differed for attention to people versus objects, as did the relations between maturity and attention. We conclude that maturity contributes to orienting and responding to attention and that orienting and responding to attention are specific rather than homogenous. We discuss the implications of these conclusions for future studies of how attention influences cognitive and communicative development.
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Affiliation(s)
| | | | | | - Diane L Putnick
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Marc H Bornstein
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA; Institute for Fiscal Studies, London, UK; UNICEF, New York, NY, USA
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16
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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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17
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Shaw JC, Berry MJ, Dyson RM, Crombie GK, Hirst JJ, Palliser HK. Reduced Neurosteroid Exposure Following Preterm Birth and Its' Contribution to Neurological Impairment: A Novel Avenue for Preventative Therapies. Front Physiol 2019; 10:599. [PMID: 31156466 PMCID: PMC6529563 DOI: 10.3389/fphys.2019.00599] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 04/26/2019] [Indexed: 12/21/2022] Open
Abstract
Children born preterm are at an increased risk of developing cognitive problems and neuro-behavioral disorders such as attention deficit hyperactivity disorder (ADHD) and anxiety. Whilst neonates born at all gestational ages, even at term, can experience poor cognitive outcomes due to birth-complications such as birth asphyxia, it is becoming widely known that children born preterm in particular are at significant risk for learning difficulties with an increased utilization of special education resources, when compared to their healthy term-born peers. Additionally, those born preterm have evidence of altered cerebral myelination with reductions in white matter volumes of the frontal cortex, hippocampus and cerebellum evident on magnetic resonance imaging (MRI). This disruption to myelination may underlie some of the pathophysiology of preterm-associated brain injury. Compared to a fetus of the same post-conceptional age, the preterm newborn loses access to in utero factors that support and promote healthy brain development. Furthermore, the preterm ex utero environment is hostile to the developing brain with a myriad of environmental, biochemical and excitotoxic stressors. Allopregnanolone is a key neuroprotective fetal neurosteroid which has promyelinating effects in the developing brain. Preterm birth leads to an abrupt loss of the protective effects of allopregnanolone, with a dramatic drop in allopregnanolone concentrations in the preterm neonatal brain compared to the fetal brain. This occurs in conjunction with reduced myelination of the hippocampus, subcortical white matter and cerebellum; thus, damage to neurons, astrocytes and especially oligodendrocytes of the developing nervous system can occur in the vulnerable developmental window prior to term as a consequence reduced allopregnanolone. In an effort to prevent preterm-associated brain injury a number of therapies have been considered, but to date, other than antenatal magnesium sulfate and corticosteroid therapy, none have become part of standard clinical care for vulnerable infants. Therefore, there remains an urgent need for improved therapeutic options to prevent brain injury in preterm neonates. The actions of the placentally derived neurosteroid allopregnanolone on GABAA receptor signaling has a major role in late gestation neurodevelopment. The early loss of this intrauterine neurotrophic support following preterm birth may be pivotal to development of neurodevelopmental morbidity. Thus, restoring the in utero neurosteroid environment for preterm neonates may represent a new and clinically feasible treatment option for promoting better trajectories of myelination and brain development, and therefore reducing neurodevelopmental disorders in children born preterm.
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Affiliation(s)
- Julia C. Shaw
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, NSW, Australia
- Mothers and Babies Research Centre, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia
| | - Mary J. Berry
- Department of Paediatrics and Child Health, University of Otago, Wellington, Wellington, New Zealand
- Centre for Translational Physiology, University of Otago, Wellington, Wellington, New Zealand
| | - Rebecca M. Dyson
- Department of Paediatrics and Child Health, University of Otago, Wellington, Wellington, New Zealand
- Centre for Translational Physiology, University of Otago, Wellington, Wellington, New Zealand
| | - Gabrielle K. Crombie
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, NSW, Australia
- Mothers and Babies Research Centre, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia
| | - Jonathan J. Hirst
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, NSW, Australia
- Mothers and Babies Research Centre, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia
| | - Hannah K. Palliser
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, NSW, Australia
- Mothers and Babies Research Centre, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia
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18
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Muukkonen L, Männistö J, Jääskeläinen J, Hannonen R, Huopio H. The effect of hypoglycaemia on neurocognitive outcome in children and adolescents with transient or persistent congenital hyperinsulinism. Dev Med Child Neurol 2019; 61:451-457. [PMID: 30246438 DOI: 10.1111/dmcn.14039] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/03/2018] [Indexed: 02/06/2023]
Abstract
AIM To examine the hypoglycaemic effect on neurodevelopmental outcome in patients with transient and persistent congenital hyperinsulinism (CHI) born in the 21st century. METHOD A cohort of 117 patients (66 males, 51 females) with CHI aged 5 to 16 years (mean age 8y 11mo, SD 2y 7mo) were selected from a Finnish nationwide registry to examine all the patients with similar methods. Neurodevelopment was first evaluated retrospectively. The 83 patients with no risk factors for neurological impairment other than hypoglycaemia were recruited and 44 participated (24 males, 20 females; mean age 9y 7mo, SD 3y 1mo) in neuropsychological assessment with the Wechsler Intelligence Scale for Children, Fourth Edition and the Finnish version of the Developmental Neuropsychological Assessment, Second Edition domains of attention, language, memory, sensorimotor, and visual functioning. RESULTS In retrospective analysis, transient and persistent CHI groups had similar prevalences of mild (22% and 18% respectively) or severe (5% and 7% respectively) neurodevelopmental difficulties. In clinical assessment, the neurocognitive profile was within the average range in both groups, but children with persistent CHI showed significant but restricted deficits in attention, memory, visual, and sensorimotor functions compared with the general population. The transient CHI group did not differ from the standardization samples. INTERPRETATION Besides the more apparent broader neurological deficits, children with persistent CHI have an increased risk for milder specific neurocognitive problems, which should be considered in the follow-up. WHAT THIS PAPER ADDS Children with persistent congenital hyperinsulinism showed deficits in attention, memory, visual, and sensorimotor functions. The deficits were potentially of hypoglycaemic origin. Children with transient hyperinsulinism did not differ from the general population.
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Affiliation(s)
- Liisa Muukkonen
- Department of Child Neurology, Siun sote North Karelia Central Hospital, Joensuu, Finland.,Coronaria Tietotaito, Joensuu, Finland
| | - Jonna Männistö
- Department of Paediatrics, Kuopio University Hospital, Kuopio, Finland.,Department of Paediatrics, University of Eastern Finland, Kuopio, Finland
| | - Jarmo Jääskeläinen
- Department of Paediatrics, Kuopio University Hospital, Kuopio, Finland.,Department of Paediatrics, University of Eastern Finland, Kuopio, Finland
| | - Riitta Hannonen
- Department of Psychology, Carea - Kymenlaakso Social and Health Services, Kotka, Finland.,Department of Psychology, University of Jyväskylä, Jyväskylä, Finland
| | - Hanna Huopio
- Department of Paediatrics, Kuopio University Hospital, Kuopio, Finland
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19
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Loe IM, Heller NA, Chatav M. Behavior problems and executive function impairments in preterm compared to full term preschoolers. Early Hum Dev 2019; 130:87-95. [PMID: 30708271 PMCID: PMC6856007 DOI: 10.1016/j.earlhumdev.2019.01.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 01/14/2019] [Accepted: 01/16/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Children born preterm (PT) are at high risk for behavior problems and deficits in executive function (EF), a set of cognitive processes that guide goal-directed behaviors. Behavior differences have been found as early as 2 years in PT children; EF differences have been found in infancy. Whether behavior problems and EF deficits co-occur at young ages has not been fully investigated. AIMS To determine whether (1) PT children have more behavior problems and EF impairment than full term (FT) children and (2) larger proportions of PT children show behavior problems or EF impairments. DESIGN/METHODS PT (≤34 wks, n = 82) and FT (n = 79) preschoolers (mean age 4.4 years) completed an EF battery. Parents completed rating scales of behavior problems and EF skills. Mean scores and proportions with impairment were compared between groups. Logistic regression predicting to impairment defined odds ratios for PT/FT groups. RESULTS PT compared to FT had more problems on most behavior and EF scales and poorer EF scores on all tasks and greater proportion with impairments on most behavior scales, all EF ratings, and all EF tasks, p < .05. PT had elevated odds for impaired performance-based EF, parent-rated EF and CBCL scores compared to FT, p < .05. Within the PT group, EF impairments were twice as common as behavior impairment. CONCLUSIONS We recommend early identification of EF impairments in PT children. Future research should evaluate whether EF impairments serve as better early markers for later functional difficulties compared to behavior problems, as well as targets for intervention.
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Affiliation(s)
- Irene M. Loe
- Division of Developmental-Behavioral Pediatrics, Department of Pediatrics, Stanford University School of Medicine, 1265 Welch Road, MSOB X109, MC 5415, Stanford, CA, 94305, USA
| | - Nicole A. Heller
- Division of Developmental-Behavioral Pediatrics, Department of Pediatrics, Stanford University School of Medicine, 1265 Welch Road, MSOB X109, MC 5415, Stanford, CA, 94305, USA
| | - Maya Chatav
- Division of Developmental-Behavioral Pediatrics, Department of Pediatrics, Stanford University School of Medicine, 1265 Welch Road, MSOB X109, MC 5415, Stanford, CA, 94305, USA
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20
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Health and educational implications of prematurity in the United States: National Survey of Children's Health 2011/2012 data. J Am Assoc Nurse Pract 2019; 30:131-139. [PMID: 29757881 DOI: 10.1097/jxx.0000000000000021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE Preterm birth is a significant public health issue, with children born prematurely experiencing educational and health difficulties throughout childhood. The aim of the descriptive secondary data analysis was to compare health implications and educational experiences in children born prematurely compared with children born at term. METHODS The 2011/2012 National Survey of Children's Health data set was explored using separate chi-square tests of homogeneity to investigate differences in the occurrence of chronic health conditions and educationally relevant outcomes: individualized family services plan/individualized education plan (IFSP/IEP), and grade repetition between children born prematurely compared with those born at term. CONCLUSIONS The six most frequently occurring chronic health conditions that disproportionally affected children born prematurely include the following: attention deficit disorder/attention deficit hyperactive disorder (odds ratio [OR], 1.59), anxiety (OR, 1.63), asthma (OR, 1.7), learning disability (OR, 2.07), speech problems (OR, 2.27), and developmental delay (OR, 3.17). Preterm birth negatively affects the educational experience of CBP as measured by increased report of IFSP/IEP and repeated grades across all age categories. IMPLICATIONS FOR PRACTICE All health care providers have an important role in preventing preterm birth and in supporting the children and families affected by preterm birth. Appreciation of the incidence and prevalence of the health conditions and educational difficulties associated with preterm birth is essential for facilitating access to appropriate resources. Beyond patient interactions, these modifiable yet additive factors should inform health policy and planning.
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21
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Leps C, Carson C, Quigley MA. Gestational age at birth and wheezing trajectories at 3-11 years. Arch Dis Child 2018; 103:1138-1144. [PMID: 29860226 PMCID: PMC6287557 DOI: 10.1136/archdischild-2017-314541] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 04/19/2018] [Accepted: 04/29/2018] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Children born preterm have an increased risk of asthma in early childhood. We examined whether this persists at 7 and 11 years, and whether wheezing trajectories across childhood are associated with preterm birth. DESIGN Data were from the UK Millennium Cohort Study, which recruited children at 9 months, with follow-up at 3, 5, 7 and 11 years. OUTCOMES Adjusted ORs (aOR) were estimated for recent wheeze and asthma medication use for children born <32, 32-33, 34-36 and 37-38 weeks' gestation, compared with children born at full term (39-41 weeks) at 7 (n=12 198) and 11 years (n=11 690). aORs were also calculated for having 'early-remittent' (wheezing at ages 3 and/or 5 years but not after), 'late' (wheezing at ages 7 and/or 11 years but not before) or 'persistent/relapsing' (wheezing at ages 3 and/or 5 and 7 and/or 11 years) wheeze. RESULTS Birth <32 weeks, and to a lesser extent at 32-33 weeks, were associated with an increased risk of wheeze and asthma medication use at ages 7 and 11, and all three wheezing trajectories. The aOR for 'persistent/relapsing wheeze' at <32 weeks was 4.30 (95% CI 2.33 to 7.91) and was 2.06 (95% CI 1.16 to 2.69) at 32-33 weeks. Birth at 34-36 weeks was not associated with asthma medication use at 7 or 11, nor late wheeze, but was associated with the other wheezing trajectories. Birth at 37-38 weeks was not associated with wheeze nor asthma medication use. CONCLUSIONS Birth <37 weeks is a risk factor for wheezing characterised as 'early-remittent' or 'persistent/relapsing' wheeze.
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Affiliation(s)
- Caroline Leps
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada,National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Claire Carson
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Maria A Quigley
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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22
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Angelhoff C, Blomqvist YT, Sahlén Helmer C, Olsson E, Shorey S, Frostell A, Mörelius E. Effect of skin-to-skin contact on parents' sleep quality, mood, parent-infant interaction and cortisol concentrations in neonatal care units: study protocol of a randomised controlled trial. BMJ Open 2018; 8:e021606. [PMID: 30068615 PMCID: PMC6074633 DOI: 10.1136/bmjopen-2018-021606] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
INTRODUCTION Separation after preterm birth is a major stressor for infants and parents. Skin-to-skin contact (SSC) is a method of care suitable to use in the neonatal intensive care unit (NICU) to minimise separation between parents and infants. Less separation leads to increased possibilities for parent-infant interaction, provided that the parents' sleep quality is satisfactory. We aimed to evaluate the effect of continuous SSC on sleep quality and mood in parents of preterm infants born <33 weeks of gestation as well as the quality of parent-infant interaction and salivary cortisol concentrations at the time of discharge. METHODS AND ANALYSIS A randomised intervention study with two arms-intervention versus standard care. Data will be collected from 50 families. Eligible families will be randomly allocated to intervention or standard care when transferred from the intensive care room to the family-room in the NICU. The intervention consists of continuous SSC for four consecutive days and nights in the family-room. Data will be collected every day during the intervention and again at the time of discharge from the hospital. Outcome measures comprise activity tracker (Actigraph); validated self-rated questionnaires concerning sleep, mood and bonding; observed scorings of parental sensitivity and emotional availability and salivary cortisol. Data will be analysed with pairwise, repeated measures, Mann Whitney U-test will be used to compare groups and analysis of variance will be used to adjust for different hospitals and parents' gender. ETHICS AND DISSEMINATION The study is approved by the Regional Research Ethics Board at an appropriate university (2016/89-31). The results will be published in scientific journals. We will also use conferences and social media to disseminate our findings. TRIAL REGISTRATION NUMBER NCT03004677.
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Affiliation(s)
- Charlotte Angelhoff
- Department of Social and Welfare Studies, Division of Nursing Science, Linköping University, Norrköping, Sweden
- Department of Clinical and Experimental Medicine and Department of Paediatrics, Linköping University, Linköping, Sweden
| | | | - Charlotte Sahlén Helmer
- Department of Social and Welfare Studies, Division of Nursing Science, Linköping University, Norrköping, Sweden
- Department of Clinical and Experimental Medicine and Department of Paediatrics, Linköping University, Linköping, Sweden
| | - Emma Olsson
- Department of Pediatrics and Centre for Health Care Sciences, Örebro University, Örebro, Sweden
| | - Shefaly Shorey
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore
| | - Anneli Frostell
- Division of Psychology, Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden
| | - Evalotte Mörelius
- Department of Social and Welfare Studies, Division of Nursing Science, Linköping University, Norrköping, Sweden
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Khouja JN, Simpkin AJ, O'Keeffe LM, Wade KH, Houtepen LC, Relton CL, Suderman M, Howe LD. Epigenetic gestational age acceleration: a prospective cohort study investigating associations with familial, sociodemographic and birth characteristics. Clin Epigenetics 2018; 10:86. [PMID: 29983833 PMCID: PMC6020346 DOI: 10.1186/s13148-018-0520-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 06/14/2018] [Indexed: 11/20/2022] Open
Abstract
Background Gestational age at delivery is associated with health and social outcomes. Recently, cord blood DNA methylation data has been used to predict gestational age. The discrepancy between gestational age predicted from DNA methylation and determined by ultrasound or last menstrual period is known as gestational age acceleration. This study investigated associations of sex, socioeconomic status, parental behaviours and characteristics and birth outcomes with gestational age acceleration. Results Using data from the Avon Longitudinal Study of Parents and Children (n = 863), we found that pre-pregnancy maternal overweight and obesity were associated with greater gestational age acceleration (mean difference = 1.6 days, 95% CI 0.7 to 2.6, and 2.9 days, 95% CI 1.3 to 4.4, respectively, compared with a body mass index < 25 kg/m2, p < .001). There was evidence of an association between male sex and greater gestational age acceleration. Greater gestational age acceleration was associated with higher birthweight, birth length and head circumference of the child (mean differences per week higher gestational age acceleration: birthweight 0.1 kg, 95% CI 0.1 to 0.2, p < .001; birth length 0.4 cm, 95% CI 0.2 to 0.7, p < .001; head circumference 0.2 cm, 95% CI 0.1 to − 0.4, p < .001). There was evidence of an association between gestational age acceleration and mode of delivery (assisted versus unassisted delivery, odds ratio = 0.9 per week higher gestational age acceleration, 95% CI 0.7, 1.3 (p = .05); caesarean section versus unassisted delivery, odds ratio = 0.6, 95% CI 0.4 to 0.9 per week higher gestational age acceleration (p = .05)). There was no evidence of association for other parental and perinatal characteristics. Conclusions The associations of higher maternal body mass index and larger birth size with greater gestational age acceleration may imply that maternal overweight and obesity is associated with more rapid development of the fetus in utero. The implications of gestational age acceleration for postnatal health warrant further investigation. Electronic supplementary material The online version of this article (10.1186/s13148-018-0520-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jasmine N Khouja
- 1MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, England.,2Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England.,3School of Experimental Psychology at the University of Bristol, Bristol, England
| | - Andrew J Simpkin
- 1MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, England.,2Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England
| | - Linda M O'Keeffe
- 1MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, England.,2Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England
| | - Kaitlin H Wade
- 1MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, England.,2Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England
| | - Lotte C Houtepen
- 1MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, England.,2Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England
| | - Caroline L Relton
- 1MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, England.,2Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England
| | - Matthew Suderman
- 1MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, England.,2Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England
| | - Laura D Howe
- 1MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, England.,2Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England
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Starnberg J, Norman M, Westrup B, Domellöf M, Berglund SK. Lower cognitive test scores at age 7 in children born with marginally low birth weight. Pediatr Res 2018. [PMID: 29538361 DOI: 10.1038/pr.2018.35] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BackgroundBeing born with very low birth weight (<1500 g) is associated with poorer neurocognition later in life. The aim of this study was to explore neurodevelopmental functions in those born with marginally LBW (2000-2500 g).MethodsThis was originally a randomized controlled trial investigating the effects of early iron supplementation in 285 marginally LBW children. Herein, we explored the combined marginally LBW group and compared their results to 95 normal birth weight (NBW; 2501-4500 g) controls in an observational design. At 7 years, a pediatric psychologist tested the children using Wechsler Intelligence Scale for Children (WISC IV), Beery-Buktenica developmental test of Visual-Motor Integration (Beery VMI), and Test of Everyday Attention for Children (TEA-Ch).ResultsThe marginally LBW children had lower verbal comprehension intelligence quotient (IQ) (104 vs. 107, P=0.004), lower VMI scores (96.5 vs. 100, P=0.028), and lower total mean TEA-Ch scores (8.5 vs. 9.7, P=0.006), compared to controls. Also, the marginally LBW children group had a higher proportion of children below -1 SD for VMI and TEA-Ch.ConclusionsMarginally LBW children had lower verbal comprehension IQ, lower visual-motor integration, and lower attention performance than NBW children, suggesting an increased risk of cognitive difficulties in early school age.
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Affiliation(s)
- Josefine Starnberg
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
| | - Mikael Norman
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Björn Westrup
- Division of Neonatology, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Magnus Domellöf
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
| | - Staffan K Berglund
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
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25
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Perszyk DR, Ferguson B, Waxman SR. Maturation constrains the effect of exposure in linking language and thought: evidence from healthy preterm infants. Dev Sci 2018; 21:10.1111/desc.12522. [PMID: 28032433 PMCID: PMC5519447 DOI: 10.1111/desc.12522] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 09/20/2016] [Indexed: 01/27/2023]
Abstract
The power of human language rests upon its intricate links to human cognition. By 3 months of age, listening to language supports infants' ability to form object categories, a building block of cognition. Moreover, infants display a systematic shift between 3 and 4 months - a shift from familiarity to novelty preferences - in their expression of this link between language and core cognitive processes. Here, we capitalize on this tightly-timed developmental shift in fullterm infants to assess (a) whether it also appears in preterm infants and (b) whether it reflects infants' maturational status or the duration of their postnatal experience. Healthy late preterm infants (N = 22) participated in an object categorization task while listening to language. Their performance, coupled with that of fullterm infants, reveals that this developmental shift is evident in preterm infants and unfolds on the same maturational timetable as in their fullterm counterparts.
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Affiliation(s)
| | - Brock Ferguson
- Department of Psychology, Northwestern University, Evanston, IL, USA
| | - Sandra R Waxman
- Department of Psychology, Northwestern University, Evanston, IL, USA
- Institue for Policy Research, Northwestern University, Evanston, IL, USA
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26
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Shaw JC, Palliser HK, Dyson RM, Berry MJ, Hirst JJ. Disruptions to the cerebellar GABAergic system in juvenile guinea pigs following preterm birth. Int J Dev Neurosci 2017; 65:1-10. [PMID: 29024720 DOI: 10.1016/j.ijdevneu.2017.10.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 10/05/2017] [Accepted: 10/06/2017] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND Children that are born preterm are at an increased risk of developing cognitive problems and behavioural disorders, such as attention deficit hyperactivity disorder (ADHD). There is increasing interest in the role of the cerebellum in these processes and the potential involvement of GABAergic pathways in neurodevelopmental disorders. We propose that preterm birth, and the associated loss of the trophic intrauterine environment, alters the development of the cerebellum, contributing to ongoing neurobehavioral disorders. METHODS Guinea pigs were delivered preterm (GA62) or spontaneously at term (GA69), and tissues collected at corrected postnatal day (PND) 28. Neurodevelopmental and GABAergic markers myelin basic protein (MBP), neuronal nuclei (NeuN), calbindin (Purkinje cells), and GAD67 (GABA synthesis enzyme) were analysed in cerebellar lobules IX and X by immunohistochemistry. Protein expression of GAD67 and GAT1 (GABA transporter enzyme) were quantified by western blot, whilst neurosteroid-sensitive GABAA receptor subunits were measured by RT-PCR. RESULTS MBP immunostaining was increased in lobule IX of preterm males, and reduced in lobule X of preterm females when compared to their term counterparts. GAD67 staining was decreased in lobule IX and X of the preterm males, but only in lobule X of the preterm females compared to term cohorts for each sex. Internal granule cell layer width of lobule X was decreased in preterm cohorts of both sexes compared to terms. There were no differences between gestational age groups for NeuN staining, GAD67 and GAT1 protein expression as measured by western blotting, or GABAA receptor subunits as measured by RT-PCR between preterm and term for either sex. CONCLUSIONS The present findings suggest that components of the cerebellar GABAergic system of the ex-preterm cerebellum are disrupted. The higher expression of myelin in the preterm males may be due to a deficit in axonal pruning, whereas females have a deficit in myelination at 28 corrected days of age. Together these ongoing alterations may contribute to the neurodevelopmental and behavioural disorders observed in those born preterm.
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Affiliation(s)
- Julia C Shaw
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, Australia; Mothers and Babies Research Centre, Hunter Medical Research Institute, Australia.
| | - Hannah K Palliser
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, Australia; Mothers and Babies Research Centre, Hunter Medical Research Institute, Australia
| | - Rebecca M Dyson
- Department of Paediatrics and Child Health, University of Otago, Wellington, New Zealand; Centre for Translational Physiology, University of Otago, Wellington, New Zealand
| | - Mary J Berry
- Department of Paediatrics and Child Health, University of Otago, Wellington, New Zealand; Centre for Translational Physiology, University of Otago, Wellington, New Zealand
| | - Jonathan J Hirst
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, Australia; Mothers and Babies Research Centre, Hunter Medical Research Institute, Australia
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Mughal MK, Ginn CS, Magill-Evans J, Benzies KM. Parenting stress and development of late preterm infants at 4 months corrected age. Res Nurs Health 2017; 40:414-423. [DOI: 10.1002/nur.21809] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 06/06/2017] [Indexed: 01/13/2023]
Affiliation(s)
| | | | - Joyce Magill-Evans
- Department of Occupational Therapy; University of Alberta; Edmonton Alberta Canada
| | - Karen M. Benzies
- Faculty of Nursing, Department of Paediatrics; University of Calgary; Calgary Alberta Canada
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Kelly MM, Dean S. Utilization of the Premature Birth Knowledge Scale to Assess Pediatric Provider Knowledge of Neurodevelopmental Outcomes. J Pediatr Health Care 2017; 31:476-483. [PMID: 28238611 DOI: 10.1016/j.pedhc.2016.12.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2016] [Revised: 12/28/2016] [Accepted: 12/28/2016] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Prematurity affects a significant portion (10-12%) of children in the Unites States, with potential for physical, psychological, neurodevelopmental, and behavioral impairments continuing long past the neonatal period. The specific aim of this research was to evaluate pediatric primary and specialty care providers' knowledge and understanding of neurodevelopmental outcomes of children born prematurely. METHODS Pediatric nurse practitioner (PNP) members of the National Association of Pediatric Nurse Practitioners participated in an online survey using the 33-item Premature Birth Knowledge Scale (PB-KS) to assess their knowledge of current neurodevelopmental outcomes of children born prematurely. RESULTS Neither years of practice as a registered nurse nor as a PNP predicted performance on the PB-KS. The mean score on the PB-KS in the PNP sample was 17.8 (possible score = 0-33), with a mean accuracy of 53.9%. Higher scores on the PB-KS were correlated with higher perceived level of preparation to care for children born prematurely. DISCUSSION To our knowledge, this is the first study to use the PB-KS with pediatric primary and specialty providers. PNPs are uniquely situated to educate and support families facing the long-term consequences of premature birth; to do so they must maintain accurate understanding of current outcomes.
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Benzies KM, Magill-Evans J, Ballantyne M, Kurilova J. Longitudinal patterns of early development in Canadian late preterm infants: A prospective cohort study. J Child Health Care 2017; 21:85-93. [PMID: 29119804 DOI: 10.1177/1367493516689167] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This prospective, longitudinal cohort study examined longitudinal patterns of early development in Canadian children born late preterm. A convenience sample of 82 mothers and their healthy, singleton, late preterm children participated. Mothers completed the Ages and Stages Questionnaires at 4, 8, and 18 months corrected age. Concerns were most commonly reported in the communication and gross motor domains, especially early in development. The proportion of children scoring below the referral cut-off in at least one domain at 4, 8, and 18 months was, respectively, 25.6, 25.6, and 14.6%. Only two children (2.4%) scored below referral cut-off in at least one domain at all three time points. At ages four and eight months, the late preterm sample had significantly lower communication and gross motor scores than the Ages and Stages Questionnaires normative sample. At age four months, there was also a significant difference on the fine motor domain. There were no significant differences at age 18 months. Healthy late preterm children appear to catch up to population norms by age 18 months corrected age. Longer term studies are needed to further clarify early indicators of delay in late preterm children and identity those who require close developmental monitoring.
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Affiliation(s)
- Karen M Benzies
- 1 Faculty of Nursing and Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Joyce Magill-Evans
- 2 Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
| | - Marilyn Ballantyne
- 3 Holland Bloorview Kids Rehabilitation Hospital, University of Toronto, Ontario, Canada
| | - Jana Kurilova
- 1 Faculty of Nursing and Cumming School of Medicine, University of Calgary, Calgary, Canada
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30
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Early developmental outcomes predicted by gestational age from 35 to 41weeks. Early Hum Dev 2016; 103:85-90. [PMID: 27536852 DOI: 10.1016/j.earlhumdev.2016.07.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Revised: 06/30/2016] [Accepted: 07/17/2016] [Indexed: 01/14/2023]
Abstract
BACKGROUND Recent studies have indicated that children born only a few weeks earlier than their due date experience more health and cognitive problems than previously realized. AIMS Our study investigated whether gestational age (GA) at birth (35-41weeks) predicted developmental outcomes at 8, 12, 20, or 24months of age. STUDY DESIGN Archival records of developmental screening scores collected between 2006 and 2012 were analyzed using negative binomial and logistic regressions models. SUBJECTS Eight-month (N=3319), 12-month (N=2303), 20-month (N=1461) and 24-month (N=1222) old children were assessed in a county-wide developmental screening program. OUTCOME MEASURES Ages and Stage Questionnaires (ASQs) scores. RESULTS After controlling for demographic covariates, from 35weeks of gestation on, each additional week of gestation (through 41) significantly reduced the overall risk for developmental delay at 8,12, 20 and 24-months of age. Gestational age also uniquely predicted specific risk for delay in the domains of communication, personal-social, fine-motor, and problem solving at various time-points during the first two years of life. CONCLUSIONS With each additional week of gestation past 35weeks there was a graded decrease in the overall risk of developmental delay as well as in specific domains such as communication across the first two years of life. This evidence for the "dose-response" effect of GA on later development suggests that close monitoring of developmental outcomes for children born before 40weeks is warranted.
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31
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Sheehan JC, Kerns KA, Müller U. The effect of task complexity on planning in preterm-born children. Clin Neuropsychol 2016; 31:438-458. [DOI: 10.1080/13854046.2016.1244248] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- John C. Sheehan
- Department of Psychology, University of Victoria, Victoria, Canada
| | | | - Ulrich Müller
- Department of Psychology, University of Victoria, Victoria, Canada
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Abstract
There have been amazing changes in outcomes of preterm (PT) infants in the past decades. Whereas early studies reported only survival rates, Dr. Julius Hess published the first outcome study of PT infants in Chicago in 1953. Dr. Lubchenco then published the 10-year follow-up of premature infants born in 1947-1953 and identified a 68% handicap rate. As a result of these early studies, the importance of evaluating NICU graduates both for surveillance and as an outcome of trials was recognized. During the 1970s, there was a gradual expansion in the number of follow-up programs in the United States (US) with an increasing number of follow-up studies published. In the 1980s, the importance of multicenter clinical research networks was recognized and the NICHD Neonatal Research Network (NRN) was initiated in 1986. Follow-up protocols, definitions, and outcomes have evolved over the last 30 years and will be reviewed with a focus on NICHD NRN studies.
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Affiliation(s)
- Susan R Hintz
- Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, 750 Welch Rd, Suite 315, Palo Alto, CA 94304
| | - Jamie E Newman
- Public Health Research Division, RTI International, Research Triangle Park, NC
| | - Betty R Vohr
- Alpert Medical School of Brown University, Providence, RI; Department of Pediatrics Women & Infants Hospital of Rhode Island, Providence, RI.
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Kelly MM. Educational Implications of Preterm Birth: A National Sample of 8- to 11-Year-Old Children Born Prematurely and Their Full-Term Peers. J Pediatr Health Care 2016; 30:464-70. [PMID: 26691236 DOI: 10.1016/j.pedhc.2015.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2015] [Accepted: 11/06/2015] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Preterm birth remains a significant public health issue, with children born prematurely experiencing health and educational difficulties throughout childhood. The specific aim of this study was to evaluate the educational implications of actual or potential health risks of premature birth for children in middle childhood compared with children of the same age who were born at term. METHODS This descriptive study is a secondary analysis of the 2011/2012 National Survey of Children's Health, specifically an 8- to 11-year-old subset, comparing children identified as being born premature and those born at term. Educational and health outcome variables were explored. RESULTS Preterm birth negatively affects the educational experience of children born prematurely. Logistic modeling provides insight into predicting risk. DISCUSSION Collaboration between primary care providers, educators, and families is recommended to improve care coordination and address educational need of children born premature.
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PREMM: preterm early massage by the mother: protocol of a randomised controlled trial of massage therapy in very preterm infants. BMC Pediatr 2016; 16:146. [PMID: 27568006 PMCID: PMC5002318 DOI: 10.1186/s12887-016-0678-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 08/16/2016] [Indexed: 12/13/2022] Open
Abstract
Background Preterm infants follow an altered neurodevelopmental trajectory compared to their term born peers as a result of the influence of early birth, and the altered environment. Infant massage in the preterm infant has shown positive effects on weight gain and reduced length of hospital stay. There is however, limited current evidence of improved neurodevelopment or improved attachment, maternal mood or anxiety. The aim of this study is to investigate the effects of infant massage performed by the mother in very preterm (VPT) infants. Effects on the infant will be assessed at the electrophysiological, neuroradiological and clinical levels. Effects on maternal mood, anxiety and mother-infant attachment will also be measured. Methods/Design A randomised controlled trial to investigate the effect of massage therapy in VPT infants. Sixty VPT infants, born at 28 to 32 weeks and 6 days gestational age, who are stable, off supplemental oxygen therapy and have normal cranial ultrasounds will be recruited and randomised to an intervention (infant massage) group or a control (standard care) group. Ten healthy term born infants will be recruited as a reference comparison group. The intervention group will receive standardised massage therapy administered by the mother from recruitment, until term equivalent age (TEA). The control group will receive care as usual (CAU). Infants and their mothers will be assessed at baseline, TEA, 12 months and 24 months corrected age (CA), with a battery of clinical, neuroimaging and electrophysiological measures, as well as structured questionnaires, psychoanalytic observations and neurodevelopmental assessments. Discussion Optimising preterm infant neurodevelopment is a key aim of neonatal research, which could substantially improve long-term outcomes and reduce the socio-economic impact of VPT birth. This study has the potential to give insights into the mother-baby relationship and any positive effects of infant massage on neurodevelopment. An early intervention such as massage that is relatively easy to administer and could alter the trajectory of preterm infant brain development, holds potential to improve neurodevelopmental outcomes in this vulnerable population. Trial registration Australian New Zealand Clinical Trials Registry: ACTRN12612000335897. Date registered: 22/3/2012.
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Shah P, Kaciroti N, Richards B, Oh W, Lumeng JC. Developmental Outcomes of Late Preterm Infants From Infancy to Kindergarten. Pediatrics 2016; 138:peds.2015-3496. [PMID: 27456513 PMCID: PMC4960722 DOI: 10.1542/peds.2015-3496] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/23/2016] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To compare developmental outcomes of late preterm infants (34-36 weeks' gestation) with infants born at early term (37-38 weeks' gestation) and term (39-41 weeks' gestation), from infancy through kindergarten. METHODS Sample included 1000 late preterm, 1800 early term, and 3200 term infants ascertained from the Early Childhood Longitudinal Study, Birth Cohort. Direct assessments of development were performed at 9 and 24 months by using the Bayley Short Form-Research Edition T-scores and at preschool and kindergarten using the Early Childhood Longitudinal Study, Birth Cohort reading and mathematics θ scores. Maternal and infant characteristics were obtained from birth certificate data and parent questionnaires. After controlling for covariates, we compared mean developmental outcomes between late preterm and full-term groups in serial cross-sectional analyses at each timepoint using multilinear regression, with pairwise comparisons testing for group differences by gestational age categories. RESULTS With covariates controlled at all timepoints, at 9 months late preterm infants demonstrated less optimal developmental outcomes (T = 47.31) compared with infants born early term (T = 49.12) and term (T = 50.09) (P < .0001). This association was not seen at 24 months, (P = .66) but reemerged at preschool. Late preterm infants demonstrated less optimal scores in preschool reading (P = .0006), preschool mathematics (P = .0014), and kindergarten reading (P = .0007) compared with infants born at term gestation. CONCLUSIONS Although late preterm infants demonstrate comparable developmental outcomes to full-term infants (early term and full-term gestation) at 24 months, they demonstrate less optimal reading outcomes at preschool and kindergarten timepoints. Ongoing developmental surveillance for late preterm infants is warranted into preschool and kindergarten.
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Affiliation(s)
- Prachi Shah
- Division of Developmental Behavioral Pediatrics, Department of Pediatrics, School of Medicine, Center for Human Growth and Development, and
| | | | | | - Wonjung Oh
- Department of Human Development and Family Studies, College of Human Sciences, Texas Tech University, Lubbock, Texas
| | - Julie C. Lumeng
- Division of Developmental Behavioral Pediatrics, Department of Pediatrics, School of Medicine,,Center for Human Growth and Development, and,Department of Nutritional Sciences, School of Public of Health, University of Michigan, Ann Arbor, Michigan; and
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Kelly MM. National Perspective of Health Outcomes of 8- to 11-Year-Old Children Born Prematurely and Their Full-Term Peers. J Pediatr Nurs 2016; 31:422-9. [PMID: 26880238 DOI: 10.1016/j.pedn.2016.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 01/19/2016] [Accepted: 01/28/2016] [Indexed: 11/27/2022]
Abstract
UNLABELLED The specific aim of this study was to evaluate the health sequelae of preterm birth on children 8 to 11years of age as compared to same age children born at term; selected variables include special health care needs, chronic conditions, and caregiver perception of health. DESIGN/METHODS A secondary data analysis was conducted to evaluate the health outcomes of children 8 to 11years of age who were born prematurely compared to a sample of children born at term. The 2011/2012 National Survey of Children's Health (NSCH) is a nationally representative telephone interview survey of parents/caregivers of children 0 to 17years of age. Preterm birth was determined by parent report of birth more than 3weeks early. RESULTS Utilizing the Children with Special Health Care Needs (CSHCN) Screener, 35% of children born prematurely, compared to 24% of children born at term were identified as having a special health care need. The 5 most prevalent conditions were the same in both groups of 8 to 11year old children and in the larger total sample of children 2 to 17years of age. However 82% of children born prematurely were described by parents as having excellent or very good health. CONCLUSIONS Premature birth places children at increased risk for conditions that impede the crucial activities of childhood (education, psychosocial development and play). These conditions may require both medications and increased health care services. IMPLICATIONS FOR PRACTICE Understanding the relationship between preterm birth and ongoing health risks has the potential to inform the health care providers' ability to provide care that maximizes the potential of children born prematurely. Health care providers need to be cognizant of this risk, utilizing early screening and encouraging intervention and family supports.
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Manuck TA, Rice MM, Bailit JL, Grobman WA, Reddy UM, Wapner RJ, Thorp JM, Caritis SN, Prasad M, Tita AT, Saade GR, Sorokin Y, Rouse DJ, Blackwell SC, Tolosa JE, Varner M, Hill K, Sowles A, Postma J, Alexander S, Andersen G, Scott V, Morby V, Jolley K, Miller J, Berg B, Talucci M, Zylfijaj M, Reid Z, Leed R, Benson J, Forester S, Kitto C, Davis S, Falk M, Perez C, Dorman K, Mitchell J, Kaluta E, Clark K, Spicer K, Timlin S, Wilson K, Leveno K, Moseley L, Santillan M, Price J, Buentipo K, Bludau V, Thomas T, Fay L, Melton C, Kingsbery J, Benezue R, Simhan H, Bickus M, Fischer D, Kamon T, DeAngelis D, Mercer B, Milluzzi C, Dalton W, Dotson T, McDonald P, Brezine C, McGrail A, Latimer C, Guzzo L, Johnson F, Gerwig L, Fyffe S, Loux D, Frantz S, Cline D, Wylie S, Iams J, Wallace M, Northen A, Grant J, Colquitt C, Rouse D, Andrews W, Mallett G, Ramos-Brinson M, Roy A, Stein L, Campbell P, Collins C, Jackson N, Dinsmoor M, Senka J, Paychek K, Peaceman A, Moss J, Salazar A, Acosta A, Hankins G, Hauff N, Palmer L, Lockhart P, Driscoll D, Wynn L, Sudz C, Dengate D, Girard C, Field S, Breault P, Smith F, Annunziata N, Allard D, Silva J, Gamage M, Hunt J, Tillinghast J, Corcoran N, Jimenez M, Ortiz F, Givens P, Rech B, Moran C, Hutchinson M, Spears Z, Carreno C, Heaps B, Zamora G, Seguin J, Rincon M, Snyder J, Farrar C, Lairson E, Bonino C, Smith W, Beach K, Van Dyke S, Butcher S, Thom E, Zhao Y, McGee P, Momirova V, Palugod R, Reamer B, Larsen M, Williams T, Spangler T, Lozitska A, Spong C, Tolivaisa S, VanDorsten J. Preterm neonatal morbidity and mortality by gestational age: a contemporary cohort. Am J Obstet Gynecol 2016; 215:103.e1-103.e14. [PMID: 26772790 PMCID: PMC4921282 DOI: 10.1016/j.ajog.2016.01.004] [Citation(s) in RCA: 309] [Impact Index Per Article: 38.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 12/28/2015] [Accepted: 01/02/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Although preterm birth <37 weeks' gestation is the leading cause of neonatal morbidity and mortality in the United States, the majority of data regarding preterm neonatal outcomes come from older studies, and many reports have been limited to only very preterm neonates. Delineation of neonatal outcomes by delivery gestational age is needed to further clarify the continuum of mortality and morbidity frequencies among preterm neonates. OBJECTIVE We sought to describe the contemporary frequencies of neonatal death, neonatal morbidities, and neonatal length of stay across the spectrum of preterm gestational ages. STUDY DESIGN This was a secondary analysis of an obstetric cohort of 115,502 women and their neonates who were born in 25 hospitals nationwide, 2008 through 2011. All liveborn nonanomalous singleton preterm (23.0-36.9 weeks of gestation) neonates were included in this analysis. The frequency of neonatal death, major neonatal morbidity (intraventricular hemorrhage grade III/IV, seizures, hypoxic-ischemic encephalopathy, necrotizing enterocolitis stage II/III, bronchopulmonary dysplasia, persistent pulmonary hypertension), and minor neonatal morbidity (hypotension requiring treatment, intraventricular hemorrhage grade I/II, necrotizing enterocolitis stage I, respiratory distress syndrome, hyperbilirubinemia requiring treatment) were calculated by delivery gestational age; each neonate was classified once by the worst outcome for which criteria was met. RESULTS In all, 8334 deliveries met inclusion criteria. There were 119 (1.4%) neonatal deaths. In all, 657 (7.9%) neonates had major morbidity, 3136 (37.6%) had minor morbidity, and 4422 (53.1%) survived without any of the studied morbidities. Deaths declined rapidly with each advancing week of gestation. This decline in death was accompanied by an increase in major neonatal morbidity, which peaked at 54.8% at 25 weeks of gestation. As frequencies of death and major neonatal morbidity fell, minor neonatal morbidity increased, peaking at 81.7% at 31 weeks of gestation. The frequency of all morbidities fell >32 weeks. After 25 weeks, neonatal length of hospital stay decreased significantly with each additional completed week of pregnancy; among babies delivered from 26-32 weeks of gestation, each additional week in utero reduced the subsequent length of neonatal hospitalization by a minimum of 8 days. The median postmenstrual age at discharge nadired around 36 weeks' postmenstrual age for babies born at 31-35 weeks of gestation. CONCLUSION Our data show that there is a continuum of outcomes, with each additional week of gestation conferring survival benefit while reducing the length of initial hospitalization. These contemporary data can be useful for patient counseling regarding preterm outcomes.
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Chan E, Leong P, Malouf R, Quigley MA. Long-term cognitive and school outcomes of late-preterm and early-term births: a systematic review. Child Care Health Dev 2016; 42:297-312. [PMID: 26860873 DOI: 10.1111/cch.12320] [Citation(s) in RCA: 97] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 11/14/2015] [Accepted: 12/27/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Children born before full term (39-41 weeks' gestation) are at increased risk of adverse cognitive outcomes. Risk quantification is important as late-preterm (LPT; 34-36 weeks) and early-term (ET; 37-38 weeks) births are common. METHOD This review analyses the effect of LPT and ET births on long-term cognitive and educational outcomes. The primary outcome was general cognitive ability. Secondary outcomes included verbal/non-verbal intelligence quotient, subject-specific school performance and special educational needs. The search strategy included Medline and Embase from January 1975 to June 2013. Eligible studies investigated specified outcomes and included suitable gestational age participants assessed at 2 years and older. Outcome measures and socio-demographic descriptors were extracted, and data meta-analysed where possible. RESULTS Eight studies compared ET birth with full-term birth. Fourteen studies compared LPT birth with either term birth (>37 weeks, n = 12 studies) or full-term birth (39-41 weeks, n = 2 studies). Substantial between-study heterogeneity existed. LPT and ET children underperformed in most outcomes compared with their term/full-term counterparts, respectively. For example, LPT children had an increased risk of lower general cognitive ability (adjusted risk ratio 1.38 [95% confidence interval 1.06-1.79]), and full-term children performed 5% of a standard deviation higher (z-score 0.05 [0.02, 0.08]) than ET children. Poorer outcomes persist into adulthood; term cohorts performed 5% of a standard deviation higher than LPT cohorts (z-score 0.05 [0.04, 0.07]), and full-term cohorts performed 3% of a standard deviation higher than ET cohorts (z-score 0.03 [0.02, 0.04]). CONCLUSION This review critically examines the knowledge around long-term cognitive outcomes of LPT and ET births, demonstrating multiple, small, adverse differences between LPT/ET and term/full-term births.
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Affiliation(s)
- E Chan
- National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK.,Royal Children's Hospital, Parkville, Vic., Australia
| | - P Leong
- Monash Lung and Sleep, Monash Medical Centre, Clayton, Vic., Australia
| | - R Malouf
- National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
| | - M A Quigley
- National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
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Ichikawa K, Fujiwara T, Nakayama T. Effectiveness of Home Visits in Pregnancy as a Public Health Measure to Improve Birth Outcomes. PLoS One 2015; 10:e0137307. [PMID: 26348847 PMCID: PMC4562632 DOI: 10.1371/journal.pone.0137307] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 08/14/2015] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Birth outcomes, such as preterm birth, low birth weight (LBW), and small for gestational age (SGA), are crucial indicators of child development and health. PURPOSE To evaluate whether home visits from public health nurses for high-risk pregnant women prevent adverse birth outcomes. METHODS In this quasi-experimental cohort study in Kyoto city, Japan, high-risk pregnant women were defined as teenage girls (range 14-19 years old), women with a twin pregnancy, women who registered their pregnancy late, had a physical or mental illness, were of single marital status, non-Japanese women who were not fluent in Japanese, or elderly primiparas. We collected data from all high-risk pregnant women at pregnancy registration interviews held at a public health centers between 1 July 2011 and 30 June 2012, as well as birth outcomes when delivered from the Maternal and Child Health Handbook (N = 964), which is a record of prenatal check-ups, delivery, child development and vaccinations. Of these women, 622 women were selected based on the home-visit program propensity score-matched sample (pair of N = 311) and included in the analysis. Data were analyzed between January and June 2014. RESULTS In the propensity score-matched sample, women who received the home-visit program had lower odds of preterm birth (odds ratio [OR], 0.62; 95% confidence interval [CI], 0.39 to 0.98) and showed a 0.55-week difference in gestational age (95% CI: 0.18 to 0.92) compared to the matched controlled sample. Although the program did not prevent LBW and SGA, children born to mothers who received the program showed an increase in birth weight by 107.8 g (95% CI: 27.0 to 188.5). CONCLUSION Home visits by public health nurses for high-risk pregnant women in Japan might be effective in preventing preterm birth, but not SGA.
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Affiliation(s)
- Kayoko Ichikawa
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan
- Department of Social Medicine, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Takeo Fujiwara
- Department of Social Medicine, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Takeo Nakayama
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan
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Spatial Patterns, Longitudinal Development, and Hemispheric Asymmetries of Cortical Thickness in Infants from Birth to 2 Years of Age. J Neurosci 2015; 35:9150-62. [PMID: 26085637 DOI: 10.1523/jneurosci.4107-14.2015] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Cortical thickness (CT) is related to normal development and neurodevelopmental disorders. It remains largely unclear how the characteristic patterns of CT evolve in the first 2 years. In this paper, we systematically characterized for the first time the detailed vertex-wise patterns of spatial distribution, longitudinal development, and hemispheric asymmetries of CT at 0, 1, and 2 years of age, via surface-based analysis of 219 longitudinal magnetic resonance images from 73 infants. Despite the dynamic increase of CT in the first year and the little change of CT in the second year, we found that the overall spatial distribution of thin and thick cortices was largely present at birth, and evolved only modestly during the first 2 years. Specifically, the precentral gyrus, postcentral gyrus, occipital cortex, and superior parietal region had thin cortices, whereas the prefrontal, lateral temporal, insula, and inferior parietal regions had thick cortices. We revealed that in the first year thin cortices exhibited low growth rates of CT, whereas thick cortices exhibited high growth rates. We also found that gyri were thicker than sulci, and that the anterior bank of the central sulcus was thicker than the posterior bank. Moreover, we showed rightward hemispheric asymmetries of CT in the lateral temporal and posterior insula regions at birth, which shrank gradually in the first 2 years, and also leftward asymmetries in the medial prefrontal, paracentral, and anterior cingulate cortices, which expanded substantially during this period. This study provides the first comprehensive picture of early patterns and evolution of CT during infancy.
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Abstract
PURPOSE OF REVIEW To provide an overview of the literature regarding medical and developmental risks for moderate to late preterm infants (32-36 weeks gestation), with particular attention to the pediatrician's role in care during both inpatient and outpatient periods. RECENT FINDINGS Although the risks of medical issues and developmental delays decrease with increasing gestational age, research suggests that infants born after 32 weeks' gestation often exhibit significant morbidities associated with prematurity. These infants, often referred to as 'macro preemies', have been found to be at a greater risk for medical complications secondary to immature organ systems including impairments in temperature regulation, respiratory functioning, feeding coordination, bilirubin excretion, glucose control, and infection susceptibility. Recent studies of macro preemies also suggest a higher incidence of significant deficits noted in gross and fine motor skills, speech and communication, and learning and behavior compared to their full-term counterparts. Without careful attention from birth, macro preemie infants could be susceptible to both medical issues and developmental delays. SUMMARY Physicians should be aware of the research regarding increased medical and developmental risks for all infants born before term in order to provide their patients with comprehensive medical and neurodevelopmental follow-up care.
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Alterations of resting state networks and structural connectivity in relation to the prefrontal and anterior cingulate cortices in late prematurity. Neuroreport 2015; 26:22-6. [PMID: 25426826 DOI: 10.1097/wnr.0000000000000296] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Late preterm birth is increasingly recognized as a risk factor for cognitive and social deficits. The prefrontal cortex is particularly vulnerable to injury in late prematurity because of its protracted development and extensive cortical connections. Our study examined children born late preterm without access to advanced postnatal care to assess structural and functional connectivity related to the prefrontal cortex. Thirty-eight preadolescents [19 born late preterm (34-36 /7 weeks gestational age) and 19 at term] were recruited from a developing community in Brazil. Participants underwent neuropsychological testing. Individuals underwent three-dimensional T1-weighted, diffusion-weighted, and resting state functional MRI. Probabilistic tractography and functional connectivity analyses were carried out using unilateral seeds combining the medial prefrontal cortex and the anterior cingulate cortex. Late preterm children showed increased functional connectivity within regions of the default mode, salience, and central-executive networks from both right and left frontal cortex seeds. Decreased functional connectivity was observed within the right parahippocampal region from left frontal seeding. Probabilistic tractography showed a pattern of decreased streamlines in frontal white matter pathways and the corpus callosum, but also increased streamlines in the left orbitofrontal white matter and the right frontal white matter when seeded from the right. Late preterm children and term control children scored similarly on neuropsychological testing. Prefrontal cortical connectivity is altered in late prematurity, with hyperconnectivity observed in key resting state networks in the absence of neuropsychological deficits. Abnormal structural connectivity indicated by probabilistic tractography suggests subtle changes in white matter development, implying disruption of normal maturation during the late gestational period.
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Degnan AJ, Wisnowski JL, Choi S, Ceschin R, Bhushan C, Leahy RM, Corby P, Schmithorst VJ, Panigrahy A. Altered Structural and Functional Connectivity in Late Preterm Preadolescence: An Anatomic Seed-Based Study of Resting State Networks Related to the Posteromedial and Lateral Parietal Cortex. PLoS One 2015; 10:e0130686. [PMID: 26098888 PMCID: PMC4476681 DOI: 10.1371/journal.pone.0130686] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 05/22/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Late preterm birth confers increased risk of developmental delay, academic difficulties and social deficits. The late third trimester may represent a critical period of development of neural networks including the default mode network (DMN), which is essential to normal cognition. Our objective is to identify functional and structural connectivity differences in the posteromedial cortex related to late preterm birth. METHODS Thirty-eight preadolescents (ages 9-13; 19 born in the late preterm period (≥32 weeks gestational age) and 19 at term) without access to advanced neonatal care were recruited from a low socioeconomic status community in Brazil. Participants underwent neurocognitive testing, 3-dimensional T1-weighted imaging, diffusion-weighted imaging and resting state functional MRI (RS-fMRI). Seed-based probabilistic diffusion tractography and RS-fMRI analyses were performed using unilateral seeds within the posterior DMN (posterior cingulate cortex, precuneus) and lateral parietal DMN (superior marginal and angular gyri). RESULTS Late preterm children demonstrated increased functional connectivity within the posterior default mode networks and increased anti-correlation with the central-executive network when seeded from the posteromedial cortex (PMC). Key differences were demonstrated between PMC components with increased anti-correlation with the salience network seen only with posterior cingulate cortex seeding but not with precuneus seeding. Probabilistic tractography showed increased streamlines within the right inferior longitudinal fasciculus and inferior fronto-occipital fasciculus within late preterm children while decreased intrahemispheric streamlines were also observed. No significant differences in neurocognitive testing were demonstrated between groups. CONCLUSION Late preterm preadolescence is associated with altered functional connectivity from the PMC and lateral parietal cortex to known distributed functional cortical networks despite no significant executive neurocognitive differences. Selective increased structural connectivity was observed in the setting of decreased posterior interhemispheric connections. Future work is needed to determine if these findings represent a compensatory adaptation employing alternate neural circuitry or could reflect subtle pathology resulting in emotional processing deficits not seen with neurocognitive testing.
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Affiliation(s)
- Andrew J. Degnan
- Department of Pediatric Radiology, Children's Hospital of Pittsburgh of UPMC, 4401 Penn Avenue, Floor 2, Pittsburgh, PA, 15224, United States of America
- Department of Radiology, University of Pittsburgh Medical Center (UPMC), 3950 Presby South Tower, 200 Lothrop Street, Pittsburgh, PA 15213, United States of America
| | - Jessica L. Wisnowski
- Department of Pediatric Radiology, Children's Hospital of Pittsburgh of UPMC, 4401 Penn Avenue, Floor 2, Pittsburgh, PA, 15224, United States of America
- Brain and Creativity Institute, University of Southern California, 3620A McClintock Avenue, Los Angeles, CA 90089, United States of America
- Department of Radiology, Children’s Hospital Los Angeles, Los Angeles, CA 90027, United States of America
| | - SoYoung Choi
- Brain and Creativity Institute, University of Southern California, 3620A McClintock Avenue, Los Angeles, CA 90089, United States of America
| | - Rafael Ceschin
- Department of Pediatric Radiology, Children's Hospital of Pittsburgh of UPMC, 4401 Penn Avenue, Floor 2, Pittsburgh, PA, 15224, United States of America
- Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Chitresh Bhushan
- Signal and Image Processing Institute, University of Southern California, Los Angeles, CA 90089, United States of America
| | - Richard M. Leahy
- Signal and Image Processing Institute, University of Southern California, Los Angeles, CA 90089, United States of America
| | - Patricia Corby
- Twins Institute for Genetics Research, Montes Claros, Minas Gerais 39400–115, Brazil
- New York University Bluestone Center for Clinical Research, 421 1st Ave, New York, NY 10010, United States of America
| | - Vincent J. Schmithorst
- Department of Pediatric Radiology, Children's Hospital of Pittsburgh of UPMC, 4401 Penn Avenue, Floor 2, Pittsburgh, PA, 15224, United States of America
| | - Ashok Panigrahy
- Department of Pediatric Radiology, Children's Hospital of Pittsburgh of UPMC, 4401 Penn Avenue, Floor 2, Pittsburgh, PA, 15224, United States of America
- Brain and Creativity Institute, University of Southern California, 3620A McClintock Avenue, Los Angeles, CA 90089, United States of America
- Department of Radiology, Children’s Hospital Los Angeles, Los Angeles, CA 90027, United States of America
- Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, PA, United States of America
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Kollmann M, Gaulhofer J, Lang U, Klaritsch P. Placenta praevia: incidence, risk factors and outcome. J Matern Fetal Neonatal Med 2015; 29:1395-8. [PMID: 26043298 DOI: 10.3109/14767058.2015.1049152] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Aim of this study was to evaluate the incidence, potential risk factors and the respective outcomes of pregnancies with placenta praevia. METHODS Data were prospectively collected from women diagnosed with placenta praevia in 10 Austrian hospitals in in the province of Styria between 1993 and 2012. We analyzed the incidence, potential risk factors and the respective outcomes of pregnancies with placenta praevia. Differences between women with major placenta praevia (complete or partial placenta praevia) and minor placenta praevia (marginal placenta praevia or low-lying placenta) were evaluated. RESULTS 328 patients with placenta praevia were identified. The province wide incidence of placenta praevia was 0.15%. Maternal morbidity was high (ante-partum bleeding [42.3%], post-partum hemorrhage [7.1%], maternal anemia [30%], comorbid adherent placentation [4%], and hysterectomy [5.2%]) and neonatal complications were frequent (preterm birth [54.9%], low birth weight <2500 g [35.6%], Apgar-score after five minutes <7 [5.8%], and fetal mortality [1.5%]. Women with major placenta praevia had a significant higher incidence of preterm delivery, birthweight <2500 g and Apgar-score after five minutes <7. CONCLUSIONS Placenta praevia was associated with adverse maternal (34.15%) and neonatal (60.06%) outcome. The extent of placenta praevia was not related with differences regarding risk factors and maternal outcome.
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Affiliation(s)
- Martina Kollmann
- a Department of Obstetrics and Gynecology , Medical University of Graz , Graz , Austria
| | - Jakob Gaulhofer
- a Department of Obstetrics and Gynecology , Medical University of Graz , Graz , Austria
| | - Uwe Lang
- a Department of Obstetrics and Gynecology , Medical University of Graz , Graz , Austria
| | - Philipp Klaritsch
- a Department of Obstetrics and Gynecology , Medical University of Graz , Graz , Austria
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Heinonen K, Eriksson JG, Lahti J, Kajantie E, Pesonen AK, Tuovinen S, Osmond C, Raikkonen K. Late preterm birth and neurocognitive performance in late adulthood: a birth cohort study. Pediatrics 2015; 135:e818-25. [PMID: 25733746 DOI: 10.1542/peds.2014-3556] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/14/2015] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES We studied if late preterm birth (34 weeks 0 days-36 weeks 6 days of gestation) is associated with performance on the Consortium to Establish a Registry for Alzheimer's Disease Neuropsychological Battery (CERAD-NB) in late adulthood and if maximum attained lifetime education moderated these associations. METHODS Participants were 919 Finnish men and women born between 1934 and 1944, who participated in the Helsinki Birth Cohort Study. They underwent the CERAD-NB at a mean age of 68.1 years. Data regarding gestational age (late preterm versus term) were extracted from hospital birth records, and educational attainment data were gathered from Statistics Finland. RESULTS After adjustment for major confounders, those born late preterm scored lower on word list recognition (mean difference: -0.33 SD; P = .03) than those born at term. Among those who had attained a basic or upper secondary education, late preterm birth was associated with lower scores on word list recognition, constructional praxis, constructional praxis recall, clock drawing, Mini-Mental State Examination, and memory total and CERAD total 2 compound scores (mean differences: >0.40 SD; P values <.05), and had a 2.70 times higher risk of mild cognitive impairment (Mini-Mental State Examination score: <26 points) (P = .02). Among those with tertiary levels of education, late preterm birth was not associated with CERAD-NB scores. CONCLUSIONS Our findings offer new insight into the lifelong consequences of late preterm birth, and they add late preterm birth as a novel risk factor to the list of neurocognitive impairment in late adulthood. Our findings also suggest that attained lifetime education may mitigate aging-related neurocognitive impairment, especially among those born late preterm.
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Affiliation(s)
| | - Johan G Eriksson
- National Institute for Health and Welfare, Helsinki, Finland; Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland; Vasa Central Hospital, Vasa, Finland; Unit of General Practice, Helsinki University Central Hospital, Helsinki, Finland; Folkhälsan Research Centre, Helsinki, Finland
| | | | - Eero Kajantie
- National Institute for Health and Welfare, Helsinki, Finland; Children's Hospital, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland; Department of Obstetrics and Gynecology, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland; and
| | | | | | - Clive Osmond
- MRC Lifecourse Epidemiology Unit (University of Southampton), Southampton General Hospital, United Kingdom
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Vohr B. Expanding the definition of long-term follow-up to late adulthood. Pediatrics 2015; 135:e1038-9. [PMID: 25733756 DOI: 10.1542/peds.2015-0227] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/22/2015] [Indexed: 11/24/2022] Open
Affiliation(s)
- Betty Vohr
- Department of Pediatrics, Alpert Medical School of Brown University, Providence, Rhode Island; and Women and Infants Hospital, Providence, Rhode Island
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[Course and neurological/behavioral development of preterm children]. Arch Pediatr 2014; 22:195-202. [PMID: 25541510 DOI: 10.1016/j.arcped.2014.11.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Revised: 10/11/2014] [Accepted: 11/19/2014] [Indexed: 11/21/2022]
Abstract
Preterm birth remains a public health priority given that one child out of ten is born before 37 weeks of gestation. Survival without major neonatal morbidity has increased in high-income countries, in particular in France and in cases of extreme preterm birth before 27 weeks of gestation. Rate of severe handicaps, such as cerebral palsy, is probably decreasing, but specific cognitive disabilities in a variety of domains remain frequent, interfering with normal learning abilities at school and explaining the high rate of special education needs. Prevalence of sequelae increases when gestational age at birth decreases. However, because there are more moderate to late preterm children compared to very preterm children, the absolute number of children with specific cognitive or neurological disabilities is equivalent in these two groups. Better characterization of the development in a recent cohort of very preterm children is necessary to improve the early detection of variations in normal neurodevelopment and to propose trials with remediation actions targeting working memory and language for example. These protocols could decrease the rates of learning disabilities at school.
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Quesada AA, Tristão RM, Pratesi R, Wolf OT. Hyper-responsiveness to acute stress, emotional problems and poorer memory in former preterm children. Stress 2014; 17:389-99. [PMID: 25089937 DOI: 10.3109/10253890.2014.949667] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The prevalence of preterm birth (PTB) is high worldwide, especially in developing countries like Brazil. PTB is marked by a stressful environment in intra- as well as extrauterine life, which can affect neurodevelopment and hormonal and physiological systems and lead to long-term negative outcomes. Nevertheless, little is known about PTB and related outcomes later on in childhood. Thus, the goals of the current study were threefold: (1) comparing cortisol and alpha-amylase (sAA) profiles, including cortisol awakening response (CAR), between preterm and full-term children; (2) evaluating whether preterm children are more responsive to acute stress and (3) assessing their memory skills and emotional and behavioral profiles. Basal cortisol and sAA profiles, including CAR of 30 preterm children, aged 6 to 10 years, were evaluated. Further, we assessed memory functions using the Wide Range Assessment of Memory and Learning, and we screened behavior/emotion using the Strengths and Difficulties Questionnaire. The results of preterm children were compared to an age- and sex-matched control group. One week later, participants were exposed to a standardized laboratory stressor [Trier Social Stress Test for Children (TSST-C)], in which cortisol and sAA were measured at baseline, 1, 10 and 25 min after stressor exposure. Preterm children had higher cortisol concentrations at awakening, a flattened CAR and an exaggerated response to TSST-C compared to full-term children. These alterations were more pronounced in girls. In addition, preterm children were characterized by more emotional problems and poorer memory performance. Our findings illustrate the long-lasting and in part sex-dependent effects of PTB on the hypothalamic-pituitary-adrenal (HPA) axis, internalizing behavior and memory. The findings are in line with the idea that early adversity alters the set-point of the HPA axis, thereby creating a more vulnerable phenotype.
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Affiliation(s)
- Andrea A Quesada
- Department of Cognitive Psychology, Institute of Cognitive Neuroscience, Ruhr-University Bochum , Bochum , Germany
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Reuner G, Weinschenk A, Pauen S, Pietz J. Cognitive development in 7- to 24-month-old extremely/very-to-moderately/late preterm and full-term born infants: The mediating role of focused attention. Child Neuropsychol 2014; 21:314-30. [PMID: 24697340 DOI: 10.1080/09297049.2014.899571] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The present study analyzed the links between prematurity, attention, and global cognitive performance in infancy and early childhood. At 7 months, focused attention (FA) was examined with an object examination task in 93 preterm infants (39 of them born extremely/very preterm, 54 born moderately/late preterm, and 38 infants born full-term). Global cognition was assessed at 7 and 24 months with the Bayley-II cognitive scale. Groups did not differ with respect to global cognitive performance but FA of infants born extremely/very preterm was significantly lower than in infants born moderately/late preterm. FA correlated significantly with both prematurity and cognitive performance at 7 months of age but not with global cognition in childhood. Findings point to a subtle adverse effect of prematurity on early attention and reveal evidence for the mediating role of FA on the effect of prematurity on cognition.
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Affiliation(s)
- Gitta Reuner
- a Section Neuropediatrics , Children's University Hospital , Heidelberg , Baden-Wuerttemberg , Germany
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Gonzales FA, Le HN, Perry DF. Using an Optimality Index to Understand Perinatal Health Disparities: A Pilot Study With Latina Immigrants. J Transcult Nurs 2014; 25:265-72. [PMID: 24518061 DOI: 10.1177/1043659614522302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE This study demonstrates preliminary evidence of the utility of an optimality index as a simple tool for monitoring complications across the perinatal period. METHOD The medical records of 147 Latina women participating in a preventive randomized controlled trial for perinatal depression were reviewed for outcomes across the perinatal period. RESULTS Application of the optimality index found optimality scores ranging from 77.3% to 97.7% in a Latina immigrant population known to have low rates of low-birthweight infants and preterm birth. Optimality scores were significantly lower among women who had a preterm birth or low-birthweight infant. DISCUSSION The ability of optimality indices to capture within-group variability will allow for a more nuanced understanding of the antecedents and sequelae of negative birth outcomes. IMPLICATIONS FOR PRACTICE Increasing reliance on electronic medical records will facilitate the calculation of optimality scores that can be used to track patterns of perinatal health disparities.
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Affiliation(s)
| | - Huynh-Nhu Le
- The George Washington University, Washington, DC, USA
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