1
|
Feeding Problems and Long-Term Outcomes in Preterm Infants—A Systematic Approach to Evaluation and Management. CHILDREN 2021; 8:children8121158. [PMID: 34943354 PMCID: PMC8700416 DOI: 10.3390/children8121158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 12/03/2021] [Accepted: 12/06/2021] [Indexed: 11/17/2022]
Abstract
Preterm infants are known to have long-term healthcare needs. With advances in neonatal medical care, younger and more preterm infants are surviving, placing a subset of the general population at risk of long-term healthcare needs. Oral feeding problems in this population often play a substantial yet under-appreciated role. Oral feeding competency in preterm infants is deemed an essential requirement for hospital discharge. Despite achieving discharge readiness, feeding problems persist into childhood and can have a residual impact into adulthood. The early diagnosis and management of feeding problems are essential requisites to mitigate any potential long-term challenges in preterm-born adults. This review provides an overview of the physiology of swallowing and oral feeding skills, disruptions to oral feeding in preterm infants, the outcomes of preterm infants with feeding problems, and an algorithmic approach to the evaluation and management of neonatal feeding problems.
Collapse
|
2
|
Individual Attention Patterns in Children Born Very Preterm and Full Term at 7 and 13 Years of Age. J Int Neuropsychol Soc 2021; 27:970-980. [PMID: 33478617 DOI: 10.1017/s1355617720001411] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To identify attention profiles at 7 and 13 years, and transitions in attention profiles over time in children born very preterm (VP; <30 weeks' gestation) and full term (FT), and examine predictors of attention profiles and transitions. METHODS Participants were 167 VP and 60 FT children, evaluated on profiles across five attention domains (selective, shifting and divided attention, processing speed, and behavioral attention) at 7 and 13 years using latent profile analyses. Transitions in profiles were assessed with contingency tables. For VP children, biological and social risk factors were tested as predictors with a multinomial logistic regression. RESULTS At 7 and 13 years, three distinct profiles of attentional functioning were identified. VP children were 2-3 times more likely to show poorer attention profiles compared with FT children. Transition patterns between 7 and 13 years were stable average, stable low, improving, and declining attention. VP children were two times less likely to have a stable average attention pattern and three times more likely to have stable low or improving attention patterns compared with FT children. Groups did not differ in declining attention patterns. For VP children, brain abnormalities on neonatal MRI and greater social risk at 7 years predicted stable low or changing attention patterns over time. CONCLUSIONS VP children show greater variability in attention profiles and transition patterns than FT children, with almost half of the VP children showing adverse attention patterns over time. Early brain pathology and social environment are markers for attentional functioning.
Collapse
|
3
|
Walczak-Kozłowska T, Chrzan-Dętkoś M, Harciarek M. Heterogeneity of the attentional system's efficiency among very prematurely born pre-schoolers. Child Neuropsychol 2021; 28:120-142. [PMID: 34348594 DOI: 10.1080/09297049.2021.1961702] [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: 10/20/2022]
Abstract
Very preterm birth increases the risk of ADHD as well as other neurodevelopmental disorders. Deficits within the attentional system were previously signaled in preterm children; however, studies lacked in consideration of an intragroup differentiation. Thus, this study aimed to verify whether deficits in the attentional mechanisms are inter-individually differentiated among very prematurely born children and if so, which biomedical and non-biomedical factors are associated with the profile of deficits within the attentional system. We tested the efficiency of attentional processes among 5-year-old children with the Attention Network Task - Child Version. The results have indicated that 26% of very preterm children presented with the suboptimal functioning of the attentional system (more than 1 SD below mean score of full-term children in attentional alerting and orienting), whereas 74% were characterized by the normal efficiency of attention. The profile of attentional deficits observed among very preterm preschoolers was associated with significantly lower birth weight and decreased family living standard. Very prematurely born children are thus a relatively heterogeneous group in terms of the efficiency of attentional system and deficits apply to only some of those children. Early developmental support aimed at enhancing attentional functioning should be addressed to children with lower birth weight in the first place.
Collapse
Affiliation(s)
- Tamara Walczak-Kozłowska
- Division of Neuropsychology, Institute of Psychology, Department of the Social Sciences, University of Gdańsk, Gdańsk, Poland
| | - Magdalena Chrzan-Dętkoś
- Division of Developmental Psychology and Psychopathology, Institute of Psychology, Department of the Social Sciences, University of Gdańsk, Gdańsk, Poland
| | - Michał Harciarek
- Division of Neuropsychology, Institute of Psychology, Department of the Social Sciences, University of Gdańsk, Gdańsk, Poland
| |
Collapse
|
4
|
Perra O, Wass S, McNulty A, Sweet D, Papageorgiou KA, Johnston M, Bilello D, Patterson A, Alderdice F. Very preterm infants engage in an intervention to train their control of attention: results from the feasibility study of the Attention Control Training (ACT) randomised trial. Pilot Feasibility Stud 2021; 7:66. [PMID: 33712090 PMCID: PMC7952829 DOI: 10.1186/s40814-021-00809-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 03/02/2021] [Indexed: 08/29/2023] Open
Abstract
Background Very premature birth (gestational age between 28 and 31 + 6 weeks) is associated with increased risk of cognitive delay and attention deficit disorder, which have been linked to anomalies in the development of executive functions (EFs) and their precursors. In particular, very preterm (VP) infants display anomalies in controlling attention and gathering task-relevant information. Early interventions that support attention control may be pivotal in providing a secure base for VP children’s later attainments. The Attention Control Training (ACT) is a cognitive training intervention that targets infants’ abilities to select visual information according to varying task demands but had not been tested in VP infants. We conducted a feasibility study to test the processes we intend to use in a trial delivering the ACT to VP infants. Methods and design We tested recruitment and retention of VP infants and their families in a randomised trial, as well as acceptability and completion of baseline and outcome measures. To evaluate these aims, we used descriptive quantitative statistics and qualitative methods to analyse feedback from infants’ caregivers. We also investigated the quality of eye-tracking data collected and indicators of infants’ engagement in the training, using descriptive statistics. Results Twelve VP infants were recruited, and 10 (83%) completed the study. Participants’ parents had high education attainment. The rate of completion of baseline and outcome measures was optimal. VP infants demonstrated engagement in the training, completing on average 84 min of training over three visits, and displaying improved performance during this training. Eye-tracking data quality was moderate, but this did not interfere with infants’ engagement in the training. Discussion The results suggest the ACT can be delivered to VP infants. However, challenges remain in recruitment of numerous and diverse samples. We discuss strategies to overcome these challenges informed by results of this study. Trial registration Registered Registration ID: NCT03896490. Retrospectively registered at Clinical Trials Protocol Registration and Results System (clinicaltrials.gov). Supplementary Information The online version contains supplementary material available at 10.1186/s40814-021-00809-z.
Collapse
Affiliation(s)
- Oliver Perra
- School of Nursing and Midwifery, Queen's University Belfast, Medical Biology Building, 97 Lisburn Road, Belfast, BT9 7BL, UK. .,Centre for Evidence and Social Innovation, Queen's University Belfast, Medical Biology Centre, 97 Lisburn Road, Belfast, BT9 7BL, Northern Ireland, UK.
| | - Sam Wass
- School of Psychology, University of East London, London, UK
| | - Alison McNulty
- TinyLife, The Premature Baby Charity for Northern Ireland, Belfast, Northern Ireland, UK
| | - David Sweet
- Health and Social Care Belfast Trust, Belfast, Northern Ireland, UK
| | | | - Matthew Johnston
- School of Nursing and Midwifery, Queen's University Belfast, Medical Biology Building, 97 Lisburn Road, Belfast, BT9 7BL, UK.,Centre for Evidence and Social Innovation, Queen's University Belfast, Medical Biology Centre, 97 Lisburn Road, Belfast, BT9 7BL, Northern Ireland, UK.,School of Psychology, Queen's University Belfast, Belfast, UK
| | - Delfina Bilello
- School of Nursing and Midwifery, Queen's University Belfast, Medical Biology Building, 97 Lisburn Road, Belfast, BT9 7BL, UK.,Centre for Evidence and Social Innovation, Queen's University Belfast, Medical Biology Centre, 97 Lisburn Road, Belfast, BT9 7BL, Northern Ireland, UK.,School of Psychology, Queen's University Belfast, Belfast, UK
| | - Aaron Patterson
- School of Psychology, Queen's University Belfast, Belfast, UK
| | - Fiona Alderdice
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| |
Collapse
|
5
|
Bogičević L, Verhoeven M, van Baar AL. Distinct Profiles of Attention in Children Born Moderate-to-Late Preterm at 6 Years. J Pediatr Psychol 2021; 45:685-694. [PMID: 32483608 PMCID: PMC7306696 DOI: 10.1093/jpepsy/jsaa038] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 04/29/2020] [Accepted: 05/06/2020] [Indexed: 11/14/2022] Open
Abstract
Objective Attention difficulties are commonly reported by caregivers in school-aged children born moderate-to-late preterm (MLPT; 32–36 weeks’ gestation). We aimed to assess distinct aspects of attentional functioning (i.e. orienting, alerting and executive attention, processing speed and behavioral components) in children born MLPT and full term (FT), profiles of attentional functioning, and associated risk factors such as preterm birth. Methods Participants were 170 (87 MLPT and 83 FT) children, evaluated on cognitive and behavioral attention aspects at 6 years of age. We used a variable-centered approach to compare attentional functioning of children born MLPT and FT at group level, and a person-centered approach to identify profiles of attentional functioning. Neonatal and demographic characteristics of these profiles were compared. Results The variable-centered approach showed that at group level children born MLPT had poorer orienting attention and processing speed, and behavioral attention than children born FT. The person-centered approach revealed four profiles: (a) normal attentional functioning, (b) overall poorer attention, (c) poorer cognitive attention, and (d) behavioral attention problems. Children born MLPT were overrepresented in each of the suboptimal attention profiles, and were more dispersed across profiles than children born FT. Conclusions Children born MLPT are at increased risk of difficulties in some attention aspects, but at group level differences with children born FT are small. However, children born MLPT show considerable variation in the nature of attention difficulties and are twice as likely to show a suboptimal attention profile, indicating a cumulation of poorer attention scores.
Collapse
|
6
|
Della Rosa PA, Canini M, Marchetta E, Cirillo S, Pontesilli S, Scotti R, Natali Sora MG, Poloniato A, Barera G, Falini A, Scifo P, Baldoli C. The effects of the functional interplay between the Default Mode and Executive Control Resting State Networks on cognitive outcome in preterm born infants at 6 months of age. Brain Cogn 2020; 147:105669. [PMID: 33341657 DOI: 10.1016/j.bandc.2020.105669] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 11/27/2020] [Accepted: 12/04/2020] [Indexed: 10/22/2022]
Abstract
Preterm birth can affect cognitive functions, such as attention or more generally executive control mechanisms, with severity in impairments proportional to prematurity. The functional cross-talk between the Default Mode (DMN) and Executive Control (ECN) networks mirrors the integrity of cognitive processing and is directly related to brain development. In this study, a cohort of 20 preterm-born infants was investigated using rs-fMRI. First, we addressed biological maturity of the DMN per se and its interplay with the ECN in terms of patterns of increased functional connectivity. Second, we assessed the impact of the degree of prematurity on the DMN-ECN functional interplay development in relation to cognitive outcome at six months. Our results highlighted the emergence of DMN in preterm neonates, with connectivity strength and synchronization between the anterior DMN hub and frontal areas increasing as a function of biological maturity. Further, cognitive scores at 6 months were predicted by mPFC-ECN connectivity strength with degree of prematurity impacting on mPFC-ECN connectivity and triggering differential patterns of functional maturation of the ECN for very early/early and moderate/late preterm neonates. Our findings suggest that the prematurity window allows to observe precursors of functional plasticity that may underlie different developmental trajectories in preterm children.
Collapse
Affiliation(s)
| | - Matteo Canini
- Department of Neuroradiology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Elisa Marchetta
- Department of Neuroradiology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Sara Cirillo
- Department of Neuroradiology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Silvia Pontesilli
- Department of Neuroradiology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Roberta Scotti
- Department of Neuroradiology, IRCCS Ospedale San Raffaele, Milan, Italy
| | | | - Antonella Poloniato
- Unit of Neonatology, Department of Pediatrics, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Graziano Barera
- Unit of Neonatology, Department of Pediatrics, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Andrea Falini
- Department of Neuroradiology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Paola Scifo
- Department of Nuclear Medicine, IRCCS Ospedale San Raffaele, Milan, Italy.
| | - Cristina Baldoli
- Department of Neuroradiology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| |
Collapse
|
7
|
Baumann N, Jaekel J, Breeman L, Bartmann P, Bäuml JG, Avram M, Sorg C, Wolke D. The association of infant crying, feeding, and sleeping problems and inhibitory control with attention regulation at school age. INFANCY 2020; 24:768-786. [PMID: 32677276 DOI: 10.1111/infa.12305] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 04/08/2019] [Accepted: 05/18/2019] [Indexed: 12/24/2022]
Abstract
Regulatory problems in infancy and toddlerhood have previously been associated with an increased risk of developing attention problems in childhood. We hypothesized that early regulatory problems are associated with attention problems via reduced inhibitory control. This prospective study assessed 1,459 children from birth to 8 years. Crying, feeding, and sleeping problems were assessed at 5 and 20 months via parent interviews and neurological examinations. At 20 months, inhibitory control was tested with a behavioral (snack delay) task. Attention regulation was assessed at 6 and 8 years using multiple instruments and informants. Detrimental effects of crying, feeding, and sleeping problems on attention regulation were partly mediated by children's ability to inhibit unwanted behaviors (β = -0.04, p = 0.013). Accounting for cognition diminished this indirect effect (β = -0.01, p = 0.209). Instead, the effects of crying, feeding, and sleeping problems on attention regulation were fully mediated by children's cognitive functioning (β = -0.10, p < 0.001). These results support that inhibitory control abilities partly mediate effects of crying, feeding, and sleeping problems. However, these effects may be accounted for by children's general cognitive abilities. Early regulatory problems may set infants on a course of under control of behavior into school age, and such trajectories are highly associated with general cognitive development.
Collapse
Affiliation(s)
- Nicole Baumann
- Department of Psychology, University of Warwick, Coventry, UK
| | - Julia Jaekel
- Department of Psychology, University of Warwick, Coventry, UK.,Department of Child and Family Studies, University of Tennessee, Knoxville, Tennessee
| | - Linda Breeman
- Department of Psychology, University of Warwick, Coventry, UK.,Department of Youth and Family, Utrecht University, Utrecht, The Netherlands.,Department of Neuroradiology, Technische Universität München, München, Germany
| | - Peter Bartmann
- Department of Neonatology, University Hospital Bonn, Bonn, Germany
| | - Josef G Bäuml
- Department of Neuroradiology, Technische Universität München, München, Germany.,TUM-NIC Neuroimaging Center, Technische Universität München, München, Germany
| | - Mihai Avram
- Department of Neuroradiology, Technische Universität München, München, Germany.,TUM-NIC Neuroimaging Center, Technische Universität München, München, Germany
| | - Christian Sorg
- Department of Neuroradiology, Technische Universität München, München, Germany.,TUM-NIC Neuroimaging Center, Technische Universität München, München, Germany.,Department of Psychiatry, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Dieter Wolke
- Department of Psychology, University of Warwick, Coventry, UK.,Warwick Medical School, University of Warwick, Coventry, UK
| |
Collapse
|
8
|
Perra O, Wass S, McNulty A, Sweet D, Papageorgiou K, Johnston M, Patterson A, Bilello D, Alderdice F. Training attention control of very preterm infants: protocol for a feasibility study of the Attention Control Training (ACT). Pilot Feasibility Stud 2020; 6:17. [PMID: 32055404 PMCID: PMC7008548 DOI: 10.1186/s40814-020-0556-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 01/27/2020] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND Children born preterm may display cognitive, learning, and behaviour difficulties as they grow up. In particular, very premature birth (gestation age between 28 and less than 32 weeks) may put infants at increased risk of intellectual deficits and attention deficit disorder. Evidence suggests that the basis of these problems may lie in difficulties in the development of executive functions. One of the earliest executive functions to emerge around 1 year of age is the ability to control attention. An eye-tracking-based cognitive training programme to support this emerging ability, the Attention Control Training (ACT), has been developed and tested with typically developing infants. The aim of this study is to investigate the feasibility of using the ACT with healthy very preterm (VP) infants when they are 12 months of age (corrected age). The ACT has the potential to address the need for supporting emerging cognitive abilities of VP infants with an early intervention, which may capitalise on infants' neural plasticity. METHODS/DESIGN The feasibility study is designed to investigate whether it is possible to recruit and retain VP infants and their families in a randomised trial that compares attention and social attention of trained infants against those that are exposed to a control procedure. Feasibility issues include the referral/recruitment pathway, attendance, and engagement with testing and training sessions, completion of tasks, retention in the study, acceptability of outcome measures, quality of data collected (particularly, eye-tracking data). The results of the study will inform the development of a larger randomised trial. DISCUSSION Several lines of evidence emphasise the need to support emerging cognitive and learning abilities of preterm infants using early interventions. However, early interventions with preterm infants, and particularly very preterm ones, face difficulties in recruiting and retaining participants. These problems are also augmented by the health vulnerability of this population. This feasibility study will provide the basis for informing the implementation of an early cognitive intervention for very preterm infants. TRIAL REGISTRATION Registered Registration ID: NCT03896490. Retrospectively registered at Clinical Trials Protocol Registration and Results System (clinicaltrials.gov).
Collapse
Affiliation(s)
- Oliver Perra
- School of Nursing and Midwifery, Queen’s University Belfast, Medical Biology Building, 97 Lisburn Road, Belfast, BT9 7BL Northern Ireland, UK
- Centre for Evidence and Social Innovation, Queen’s University Belfast, Belfast, Northern Ireland, UK
| | - Sam Wass
- School of Psychology, University of East London, London, UK
| | - Alison McNulty
- TinyLife, The Premature Baby Charity for Northern Ireland, Belfast, UK
| | - David Sweet
- Health and Social Care Belfast Trust, Belfast, Northern Ireland, UK
| | - Kostas Papageorgiou
- School of Psychology, Queen’s University Belfast, Belfast, Northern Ireland, UK
| | - Matthew Johnston
- School of Nursing and Midwifery, Queen’s University Belfast, Medical Biology Building, 97 Lisburn Road, Belfast, BT9 7BL Northern Ireland, UK
- Centre for Evidence and Social Innovation, Queen’s University Belfast, Belfast, Northern Ireland, UK
- School of Psychology, Queen’s University Belfast, Belfast, Northern Ireland, UK
| | - Aaron Patterson
- School of Psychology, Queen’s University Belfast, Belfast, Northern Ireland, UK
| | - Delfina Bilello
- School of Nursing and Midwifery, Queen’s University Belfast, Medical Biology Building, 97 Lisburn Road, Belfast, BT9 7BL Northern Ireland, UK
- Centre for Evidence and Social Innovation, Queen’s University Belfast, Belfast, Northern Ireland, UK
- School of Psychology, Queen’s University Belfast, Belfast, Northern Ireland, UK
| | - Fiona Alderdice
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| |
Collapse
|
9
|
Reyes LM, Jaekel J, Heuser KM, Wolke D. Developmental cascades of social inhibition and friendships in preterm and full‐term children. INFANT AND CHILD DEVELOPMENT 2019. [DOI: 10.1002/icd.2165] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Lucia M. Reyes
- Department of Child & Family StudiesUniversity of Tennessee Knoxville Knoxville Tennessee
| | - Julia Jaekel
- Department of Child & Family StudiesUniversity of Tennessee Knoxville Knoxville Tennessee
- Department of PsychologyUniversity of Warwick Coventry UK
| | | | - Dieter Wolke
- Department of PsychologyUniversity of Warwick Coventry UK
| |
Collapse
|
10
|
Early-life growth of preterm infants and its impact on neurodevelopment. Pediatr Res 2019; 85:283-292. [PMID: 30140070 DOI: 10.1038/s41390-018-0139-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 06/08/2018] [Accepted: 07/26/2018] [Indexed: 11/08/2022]
Abstract
BACKGROUND Increasing numbers of preterm-born children survive nowadays, and improving long-term health and neurodevelopment is becoming more important. Early-life growth has been linked to neurodevelopmental outcomes. We aimed to study whether this association has changed with time. METHODS We studied two cohorts of preterm-born children (gestational age ≤32 weeks and/or birth weight ≤1500 g) from 1983 (n = 708) and 2003-2006 (n = 138), respectively. We distinguished four early-life growth patterns at 3 months corrected age: appropriate for gestational age (AGA) with or without growth restriction (AGA GR+/AGA GR-), and small for gestational age (SGA) with or without catch-up growth (SGA CUG+/SGA CUG-). Intelligence quotient (IQ), neuromotor function, and behavior were assessed at ages 19 and 8 years, respectively, for the cohorts. RESULTS In the 2003-2006 cohort, less children had early-life GR. In both cohorts, SGA CUG- subjects had unfavorable growth trajectories and neurodevelopmental outcomes (IQ β -6.5, 95% confidence interval (CI) -9.8; -3.2, P < 0.001; neuromotor score β -1.9%, 95% CI -3.2; -0.6, P = 0.005), while SGA CUG+ subjects were comparable to adequately grown subjects. CONCLUSION Although the incidence of adverse growth patterns decreased between the cohorts, possibly indicating improvements in care over time, the impact of these growth patterns on neurodevelopmental outcomes was not significantly different. Achieving adequate early-life growth may be crucial for improving neurodevelopmental outcomes, especially for preterms born SGA.
Collapse
|
11
|
Zeitlin J, Bonamy AKE, Piedvache A, Cuttini M, Barros H, Van Reempts P, Mazela J, Jarreau PH, Gortner L, Draper ES, Maier RF. Variation in term birthweight across European countries affects the prevalence of small for gestational age among very preterm infants. Acta Paediatr 2017; 106:1447-1455. [PMID: 28470839 DOI: 10.1111/apa.13899] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Revised: 02/18/2017] [Accepted: 04/03/2017] [Indexed: 12/14/2022]
Abstract
AIM This study assessed the prevalence of small for gestational age (SGA) among very preterm (VPT) infants using national and European intrauterine references. METHODS We generated country-specific and common European intrauterine growth references for 11 European countries, according to Gardosi's approach and Hadlock's foetal growth model, using national data on birthweights by sex. These references were applied to the Effective Perinatal Intensive Care in Europe (EPICE) cohort, which comprised 7766 live VPT births without severe congenital anomalies under 32 weeks of gestation in 2011-2012, to estimate the prevalence of infants with SGA birthweights, namely those below the 10th percentile. RESULTS The SGA prevalence was 31.8% with country-specific references and 34.0% with common European references. The European references yielded a 10-point difference in the SGA prevalence between countries with lower term birthweights (39.9%) - Portugal, Italy and France - and higher term birthweights, namely Denmark, the Netherlands, Sweden (28.9%; p < 0.001). This was not observed with country-specific references, where the respective figures were 32.4% and 33.9% (p = 0.34), respectively. CONCLUSION One-third of VPT infants were SGA according to intrauterine references. Common European references showed significant differences in SGA prevalence between countries with high and low-term birthweights.
Collapse
Affiliation(s)
- Jennifer Zeitlin
- INSERM; Obstetrical, Perinatal and Pediatric Epidemiology Research Team; Centre for Epidemiology and Biostatistics (U1153); Paris-Descartes University; Paris France
| | - Anna-Karin Edstedt Bonamy
- Clinical Epidemiology Unit; Department of Medicine Solna and Department of Women's and Children's Health; Karolinska Institutet; Stockholm Sweden
| | - Aurelie Piedvache
- INSERM; Obstetrical, Perinatal and Pediatric Epidemiology Research Team; Centre for Epidemiology and Biostatistics (U1153); Paris-Descartes University; Paris France
| | - Marina Cuttini
- Clinical Care and Management Innovation Research Area; Bambino Gesù Children's Hospital; IRCCS, Rome Italy
| | - Henrique Barros
- EPIUnit-Institute of Public Health; University of Porto; Porto Portugal
- Department of Clinical Epidemiology, Predictive Medicine and Public Health; University of Porto Medical School; Porto Portugal
| | - Patrick Van Reempts
- Department of Neonatology; Antwerp University Hospital; University of Antwerp; Edegem and Study Centre for Perinatal Epidemiology Flanders; Brussel Belgium
| | - Jan Mazela
- Poznan University of Medical Sciences; Poznan Poland
| | - Pierre-Henri Jarreau
- Université Paris V René Descartes and Assistance Publique Hôpitaux de Paris; Hôpitaux Universitaire Paris Centre Site Cochin; Service de Médecine et Réanimation néonatales de Port-Royal; Paris France
| | - Ludwig Gortner
- Children's Hospital; University Hospital; University of Saarland; Homburg/Saar Germany
| | | | - Rolf F. Maier
- Children's Hospital; University Hospital; Philipps University; Marburg Germany
| | | |
Collapse
|
12
|
Bhutta ZA, Guerrant RL, Nelson CA. Neurodevelopment, Nutrition, and Inflammation: The Evolving Global Child Health Landscape. Pediatrics 2017; 139:S12-S22. [PMID: 28562245 DOI: 10.1542/peds.2016-2828d] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/21/2016] [Indexed: 11/24/2022] Open
Abstract
The last decade has witnessed major reductions in child mortality and a focus on saving lives with key interventions targeting major causes of child deaths, such as neonatal deaths and those due to childhood diarrhea and pneumonia. With the transition to Sustainable Development Goals, the global health community is expanding child health initiatives to address not only the ongoing need for reduced mortality, but also to decrease morbidity and adverse exposures toward improving health and developmental outcomes. The relationship between adverse environmental exposures frequently associated with factors operating in the prepregnancy period and during fetal development is well established. Also well appreciated are the developmental impacts (both short- and long-term) associated with postnatal factors, such as immunostimulation and environmental enteropathy, and the additional risks posed by the confluence of factors related to malnutrition, poor living conditions, and the high burden of infections. This article provides our current thinking on the pathogenesis and risk factors for adverse developmental outcomes among young children, setting the scene for potential interventions that can ameliorate these adversities among families and children at risk.
Collapse
Affiliation(s)
- Zulfiqar A Bhutta
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada; .,Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Richard L Guerrant
- Center for Global Health, Division of Infectious Diseases and International Health, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Charles A Nelson
- Laboratories of Cognitive Neuroscience, Boston Children's Hospital, Boston, Massachusetts.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; and.,Human Development Program, Harvard Graduate School of Education, Cambridge, Massachusetts
| |
Collapse
|
13
|
|
14
|
Daamen M, Bäuml JG, Scheef L, Meng C, Jurcoane A, Jaekel J, Sorg C, Busch B, Baumann N, Bartmann P, Wolke D, Wohlschläger A, Boecker H. Neural correlates of executive attention in adults born very preterm. NEUROIMAGE-CLINICAL 2015; 9:581-91. [PMID: 26640769 PMCID: PMC4633838 DOI: 10.1016/j.nicl.2015.09.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Revised: 08/31/2015] [Accepted: 09/07/2015] [Indexed: 01/16/2023]
Abstract
Very preterm birth is associated with an increased prevalence of attention problems and may especially impair executive attention, i.e., top-down control of attentional selection in situations where distracting information interferes with the processing of task-relevant stimuli. While there are initial findings linking structural brain alterations in preterm-born individuals with attention problems, the functional basis of these problems are not well understood. The present study used an fMRI adaptation of the Attentional Network Test to examine the neural correlates of executive attention in a large sample of N = 86 adults born very preterm and/or with very low birth weight (VP/VLBW), and N = 100 term-born controls. Executive attention was measured by comparing task behavior and brain activations associated with the processing of incongruent vs. congruent arrow flanker stimuli. Consistent with subtle impairments of executive attention, the VP/VLBW group showed lower accuracy and a tendency for increased response times during the processing of incongruent stimuli. Both groups showed similar activation patters, especially within expected fronto-cingulo-parietal areas, but no significant between-group differences. Our results argue for a maintained attention-relevant network organization in high-functioning preterm born adults in spite of subtle deficits in executive attention. Gestational age and neonatal treatment variables showed associations with task behavior, and brain activation in the dorsal ACC and lateral occipital areas, suggesting that the degree of prematurity (and related neonatal complications) has subtle modulatory influences on executive attention processing. fMRI study examines neural correlates of executive attention in preterm-born adults. Preterm-born adults show subtle behavioral deficits. Preterm-born adults show maintained organization of attention-related networks. Modulatory effects of gestational age and neonatal treatment variables are observed.
Collapse
Key Words
- ACC, anterior cingulate cortex
- ANT, Attentional Network Test
- Anterior cingulate
- Attentional Network Test
- BLS, Bavarian Longitudinal Study
- BW, birth weight
- CSF, cerebrospinal fluid
- DLPFC, dorsolateral prefrontal cortex
- DNTI, duration of neonatal intensive treatment
- EHI, Edinburgh Handedness Inventory
- ELBW, extremely low birth weight
- EP, extremely preterm
- Executive attention
- FWE, familywise error
- GA, gestational age
- GM, gray matter
- Gestational age
- ICV, intracranial volume
- INTI, intensity of neonatal intensive treatment
- IVH, intraventricular hemorrhage
- PFC, prefrontal cortex
- Preterm birth
- VLBW, very low birth weight
- VP, very preterm
- WM, white matter
- fMRI, functional magnetic resonance imaging
Collapse
Affiliation(s)
- Marcel Daamen
- Department of Radiology, University Hospital Bonn, Sigmund Freud-Str. 25, 53105 Bonn, Germany ; Department of Neonatology, University Hospital Bonn, Sigmund Freud-Str. 25, 53105 Bonn, Germany
| | - Josef G Bäuml
- Department of Neuroradiology, Klinikum Rechts der Isar, Technische Universität München, Ismaninger str. 22, 81664 Munich, Germany ; TUM-Neuroimaging Center of Klinikum rechts der Isar, Technische Universität München, Ismaninger str. 22, Munich 81664, Germany
| | - Lukas Scheef
- Department of Radiology, University Hospital Bonn, Sigmund Freud-Str. 25, 53105 Bonn, Germany
| | - Chun Meng
- Department of Neuroradiology, Klinikum Rechts der Isar, Technische Universität München, Ismaninger str. 22, 81664 Munich, Germany ; TUM-Neuroimaging Center of Klinikum rechts der Isar, Technische Universität München, Ismaninger str. 22, Munich 81664, Germany ; Graduate School of Systemic Neurosciences GSN, Ludwig Maximilians Universität, Biocenter, Department Biology II Neurobiology, Großhaderner Str. 2, D-82152 Planegg-Martinsried, Germany
| | - Alina Jurcoane
- Department of Radiology, University Hospital Bonn, Sigmund Freud-Str. 25, 53105 Bonn, Germany ; Department of Neonatology, University Hospital Bonn, Sigmund Freud-Str. 25, 53105 Bonn, Germany
| | - Julia Jaekel
- Department of Developmental Psychology, Ruhr-University Bochum, Universitätsstraße 150, Bochum 44801, Germany ; Department of Psychology, University of Warwick, University Road, Coventry CV4 7AL, UK
| | - Christian Sorg
- Department of Neuroradiology, Klinikum Rechts der Isar, Technische Universität München, Ismaninger str. 22, 81664 Munich, Germany ; Department of Psychiatry, Klinikum Rechts der Isar, Technische Universität München, Ismaninger str. 22, Munich 81664, Germany ; TUM-Neuroimaging Center of Klinikum rechts der Isar, Technische Universität München, Ismaninger str. 22, Munich 81664, Germany
| | - Barbara Busch
- Department of Neonatology, University Hospital Bonn, Sigmund Freud-Str. 25, 53105 Bonn, Germany
| | - Nicole Baumann
- Department of Psychology, University of Warwick, University Road, Coventry CV4 7AL, UK
| | - Peter Bartmann
- Department of Radiology, University Hospital Bonn, Sigmund Freud-Str. 25, 53105 Bonn, Germany
| | - Dieter Wolke
- Department of Psychology, University of Warwick, University Road, Coventry CV4 7AL, UK ; Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
| | - Afra Wohlschläger
- Department of Neuroradiology, Klinikum Rechts der Isar, Technische Universität München, Ismaninger str. 22, 81664 Munich, Germany ; TUM-Neuroimaging Center of Klinikum rechts der Isar, Technische Universität München, Ismaninger str. 22, Munich 81664, Germany ; Graduate School of Systemic Neurosciences GSN, Ludwig Maximilians Universität, Biocenter, Department Biology II Neurobiology, Großhaderner Str. 2, D-82152 Planegg-Martinsried, Germany
| | - Henning Boecker
- Department of Radiology, University Hospital Bonn, Sigmund Freud-Str. 25, 53105 Bonn, Germany
| |
Collapse
|