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Moshfeghinia R, Torabi A, Mostafavi S, Rahbar S, Moradi MS, Sadeghi E, Mootz J, Vardanjani HM. Maternal psychological stress during pregnancy and newborn telomere length: a systematic review and meta-analysis. BMC Psychiatry 2023; 23:947. [PMID: 38102621 PMCID: PMC10724935 DOI: 10.1186/s12888-023-05387-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 11/20/2023] [Indexed: 12/17/2023] Open
Abstract
INTRODUCTION Telomeres protect the ends of chromosomes, and shorter leukocyte telomeres are associated with major group diseases. Maternal psychological stress may be related to the shortening of telomeres in infants. This systematic review and meta-analysis set out to consolidate the varying effect sizes found in studies of maternal psychological stress and telomere length (TL) in newborns and identify moderators of the relationship between stress during pregnancy and newborn TL. METHODS Our systematic review was registered in Prospero. Six databases (PubMed, Scopus, Embase, PsycINFO, Web of Science, and CINAHL Complete) were searched for records in English from inception to February 10, 2023. Observational studies were included that measured the relationship of psychological stress of the mother during pregnancy on the TL of the newborn. The Newcastle-Ottawa quality assessment scale was used to assess the quality of the included studies. A random-effect model was selected. Statistical analysis performed by Stata software version 17. RESULTS Eight studies were included for qualitative and four for quantitative analysis. There was an inverse statistically significant relationship between maternal stress and newborn TL; A one score increase in maternal psychological stress resulted in a 0.04 decrease in the TL of the newborn (B = -0.04, 95% CI = [-0.08, 0.00], p = 0.05). Selectivity analysis showed that the pooled effect size was sensitive to one study; After removing this study, the pooled effect size remained significant (B = -0.06, 95% CI = [-0. 10, -0.02], p < 0.001). CONCLUSION Physiological and environmental factors can significantly affect the TL of newborns. Our results support a significant impact of maternal psychological stress on the TL of a newborn. This association demonstrates the significance of stress in influencing the telomere length, which can be a contributing factor in the infant's future. Therefore, recognizing this association is crucial for understanding and addressing potential health risks and necessitates the need for additional future studies to validate our findings.
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Affiliation(s)
- Reza Moshfeghinia
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
- MD-MPH Department, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
- Research Center for Psychiatry and Behavioral Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Torabi
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
- MD-MPH Department, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sara Mostafavi
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
- MD-MPH Department, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shiva Rahbar
- Islamic Azad University, Shiraz Branch, Shiraz, Iran
| | | | - Erfan Sadeghi
- Research Consultation Center (RCC), Shiraz University of Medical Sciences, Shiraz, Iran
| | - Jennifer Mootz
- Department of Psychiatry, Columbia University, New York, NYC, USA.
| | - Hossein Molavi Vardanjani
- MD-MPH Department, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
- Research Center for Traditional Medicine and History of Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran, Shiraz, Iran.
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Prasad A, Lin J, Jelliffe-Pawlowski L, Coleman-Phox K, Rand L, Wojcicki JM. Sub-optimal maternal gestational gain is associated with shorter leukocyte telomere length at birth in a predominantly Latinx cohort of newborns. Matern Health Neonatol Perinatol 2023; 9:14. [PMID: 37919818 PMCID: PMC10623801 DOI: 10.1186/s40748-023-00167-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 09/20/2023] [Indexed: 11/04/2023] Open
Abstract
OBJECTIVE To assess in utero exposures associated with leukocyte telomere length (LTL) at birth and maternal LTL in a primarily Latinx birth cohort. STUDY DESIGN Mothers and newborns were recruited postnatally before 24 h of life. Newborn LTL was collected via heelstick at birth and maternal LTL was collected postnatally. LTL was determined by quantitative PCR. Using a longitudinal design, we evaluated associations between neonatal and maternal LTL and appropriate maternal gestational gain as indicated by the American College of Obstetrics and Gynecology (ACOG). RESULT Mean infant LTL was 2.02 ± 0.30 T/S (n = 386) and maternal LTL was 1.54 ± 0.26 T/S (n = 58). Independent risk factors for shorter LTL at birth included longer gestational duration (Coeff:-0.03, 95%CI: -0.05-0.01;p < 0.01) and maternal gestational weight gain below ACOG recommendations (Coeff:-0.10, 95%CI: -0.18 - -0.02; p = 0.01). CONCLUSION Gestational weight gain below ACOG recommendations may adversely impact neonatal health in Latinx infants as indicated by shorter LTL at birth.
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Affiliation(s)
- Apurva Prasad
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of California, San Francisco, USA
| | - Jue Lin
- Department of Biochemistry and Biophysics, University of California, San Francisco, USA
| | - Laura Jelliffe-Pawlowski
- Preterm Birth Initiative, University of California, San Francisco, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
| | - Kimberley Coleman-Phox
- Department of Obstetrics, Gynecology and Reproductive Health Sciences, University of California, San Francisco, USA
| | - Larry Rand
- Department of Obstetrics, Gynecology and Reproductive Health Sciences, University of California, San Francisco, USA
| | - Janet M Wojcicki
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of California, San Francisco, USA.
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA.
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Vicente‐Perez S, Robleda G, Gich I, Nolla T, Ponce‐Taylor J, Verd S, Ginovart G. Physiological responses and behavioural organization of very low birth weight infants during swaddled versus traditional weighing. Nurs Open 2023; 10:6896-6902. [PMID: 37458256 PMCID: PMC10495735 DOI: 10.1002/nop2.1943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 02/20/2023] [Accepted: 07/07/2023] [Indexed: 09/13/2023] Open
Abstract
AIM Despite the consequences of neonatal distress and agitation, preterm infants undergo stress owing to weighing procedures. The objective of this study was to enable very low birth weight infants to maintain adequate self-regulation during weighing. DESIGN This prospective crossover study utilizes a within-subjects design, where intervention days were compared to control days. METHOD Infants were exposed to both swaddled and unswaddled weighing in an intensive care nursery setting. Nineteen very low birth weight infants were weighed on two consecutive days. Variables of heart rate, respiratory rate and ALPS-Neo score were recorded. RESULTS Stress score decreased significantly from 1.65 (pre-weight) to 0.23 (weight measurement) in swaddled-intervention periods; conversely, it increased significantly from 1.26 (pre-weight) to 4.97 (weight measurement) in control periods. During weight measurement, heart and respiratory rate were significantly lower for swaddled-intervention days when compared to control days. Given the significant impact of swaddled weighing in reducing stress, this method can be used as an appropriate weighing procedure in intensive care. This research has no patient or public contribution.
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Affiliation(s)
| | - Gemma Robleda
- Campus docent Sant Joan de DéuBarcelona UniversityBarcelonaSpain
- Iberoamerican Cochrane CentreHospital de la Santa Creu i Sant PauBarcelonaSpain
| | - Ignasi Gich
- Clinical Epidemiology UnitHospital de la Santa Creu i Sant PauBarcelonaSpain
| | - Tania Nolla
- Orthopedic & Neuroscience UnitsHospital de la Santa Creu i Sant PauBarcelonaSpain
| | | | - Sergio Verd
- Department of Primary CareBalearic Health Authority, La Vileta surgeryMajorcaSpain
| | - Gemma Ginovart
- Neonatal Intensive Care UnitHospital Germans TriasBarcelonaSpain
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Adynski H, Propper C, Beeber L, Gilmore JH, Zou B, Santos HP. The role of social adversity on emotional dysregulation during infancy and early childhood. J Pediatr Nurs 2023; 72:26-35. [PMID: 37037102 PMCID: PMC10560316 DOI: 10.1016/j.pedn.2023.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 03/21/2023] [Accepted: 03/22/2023] [Indexed: 04/12/2023]
Abstract
PURPOSE The purpose of this study was to investigate if social adversity is associated with mother reported emotional dysregulation behaviors and trajectories during infancy and early childhood. DESIGN & METHODS A secondary data analysis from the Durham Child Health and Development study study included 206 child-mother dyads. Three models were used to explore the relationship between social adversity and mother reported emotional dysregulation during infancy (Infant Behavior Questionnaire-Revised) and early childhood (Child Behavior Checklist - Dysregulation Profile). Linear mixed effects models were adopted to investigate if social adversity was associated with mother reported emotional dysregulation longitudinally. Regression analysis was conducted to explore if social adversity was associated with maternal reported emotional dysregulation trajectory slope scores and maternal reported emotional dysregulation trajectory class. Maternal psychological distress and the child's sex assigned at birth were included as covariates in each analysis. RESULTS Infants with greater social adversity scores had significantly higher maternal reported fear responses across the first year of life. Social adversity was associated with maternal reported distress to limitations trajectory, dysregulated recovery class, and dysregulated distress to limitations class. During early childhood social adversity was significantly associated with maternal reported emotional dysregulation but not trajectories which showed little variability. CONCLUSION & PRACTICAL IMPLICATIONS Our results indicate that social adversity is associated with maternal reported emotional dysregulation during infancy and early childhood. Nursing and other professionals can participate in early screening to determine risk and provide intervention.
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Affiliation(s)
- Harry Adynski
- School of Nursing, University of North Carolina at Chapel Hill, NC, United States.
| | - Cathi Propper
- School of Nursing, University of North Carolina at Chapel Hill, NC, United States
| | - Linda Beeber
- School of Nursing, University of North Carolina at Chapel Hill, NC, United States
| | - John H Gilmore
- Department of Psychiatry, University of North Carolina at Chapel Hill, NC, United States
| | - Baiming Zou
- Department of Biostatistics, University of North Carolina at Chapel Hill, NC, United States
| | - Hudson P Santos
- The University of Miami School of Nursing and Health Studies, Florida, United States
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Romanowska J, Nustad HE, Page CM, Denault WRP, Lee Y, Magnus MC, Haftorn KL, Gjerdevik M, Novakovic B, Saffery R, Gjessing HK, Lyle R, Magnus P, Håberg SE, Jugessur A. The X-factor in ART: does the use of assisted reproductive technologies influence DNA methylation on the X chromosome? Hum Genomics 2023; 17:35. [PMID: 37085889 PMCID: PMC10122315 DOI: 10.1186/s40246-023-00484-6] [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: 01/09/2023] [Accepted: 04/10/2023] [Indexed: 04/23/2023] Open
Abstract
BACKGROUND Assisted reproductive technologies (ART) may perturb DNA methylation (DNAm) in early embryonic development. Although a handful of epigenome-wide association studies of ART have been published, none have investigated CpGs on the X chromosome. To bridge this knowledge gap, we leveraged one of the largest collections of mother-father-newborn trios of ART and non-ART (natural) conceptions to date to investigate sex-specific DNAm differences on the X chromosome. The discovery cohort consisted of 982 ART and 963 non-ART trios from the Norwegian Mother, Father, and Child Cohort Study (MoBa). To verify our results from the MoBa cohort, we used an external cohort of 149 ART and 58 non-ART neonates from the Australian 'Clinical review of the Health of adults conceived following Assisted Reproductive Technologies' (CHART) study. The Illumina EPIC array was used to measure DNAm in both datasets. In the MoBa cohort, we performed a set of X-chromosome-wide association studies ('XWASs' hereafter) to search for sex-specific DNAm differences between ART and non-ART newborns. We tested several models to investigate the influence of various confounders, including parental DNAm. We also searched for differentially methylated regions (DMRs) and regions of co-methylation flanking the most significant CpGs. Additionally, we ran an analogous model to our main model on the external CHART dataset. RESULTS In the MoBa cohort, we found more differentially methylated CpGs and DMRs in girls than boys. Most of the associations persisted after controlling for parental DNAm and other confounders. Many of the significant CpGs and DMRs were in gene-promoter regions, and several of the genes linked to these CpGs are expressed in tissues relevant for both ART and sex (testis, placenta, and fallopian tube). We found no support for parental DNAm-dependent features as an explanation for the observed associations in the newborns. The most significant CpG in the boys-only analysis was in UBE2DNL, which is expressed in testes but with unknown function. The most significant CpGs in the girls-only analysis were in EIF2S3 and AMOT. These three loci also displayed differential DNAm in the CHART cohort. CONCLUSIONS Genes that co-localized with the significant CpGs and DMRs associated with ART are implicated in several key biological processes (e.g., neurodevelopment) and disorders (e.g., intellectual disability and autism). These connections are particularly compelling in light of previous findings indicating that neurodevelopmental outcomes differ in ART-conceived children compared to those naturally conceived.
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Affiliation(s)
- Julia Romanowska
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway.
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
| | - Haakon E Nustad
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
- DeepInsight, 0154, Oslo, Norway
| | - Christian M Page
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
- Department of Mathematics, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
| | - William R P Denault
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
- Department of Human Genetics, University of Chicago, Chicago, IL, USA
| | - Yunsung Lee
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Maria C Magnus
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Kristine L Haftorn
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Miriam Gjerdevik
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
- Department of Computer Science, Electrical Engineering and Mathematical Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Boris Novakovic
- Murdoch Children's Research Institute, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Richard Saffery
- Murdoch Children's Research Institute, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Håkon K Gjessing
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Robert Lyle
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
- Department of Medical Genetics, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Per Magnus
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Siri E Håberg
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Astanand Jugessur
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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Chalfun G, Araújo Brasil AD, Paravidino VB, Soares-Lima SC, Souza Almeida Lopes MD, Santos Salú MD, Barbosa E Dos Santos PV, P da Cunha Trompiere AC, Vieira Milone LT, Rodrigues-Santos G, Genuíno de Oliveira MB, Robaina JR, Lima-Setta F, Reis MM, Ledo Alves da Cunha AJ, Prata-Barbosa A, de Magalhães-Barbosa MC. NR3C1 gene methylation and cortisol levels in preterm and healthy full-term infants in the first 3 months of life. Epigenomics 2022; 14:1545-1561. [PMID: 36861354 DOI: 10.2217/epi-2022-0444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023] Open
Abstract
Aim: To describe NR3C1 exon-1F methylation and cortisol levels in newborns. Materials & methods: Preterm ≤1500 g and full-term infants were included. Samples were collected at birth and at days 5, 30 and 90 (or at discharge). Results: 46 preterm and 49 full-term infants were included. Methylation was stable over time in full-term infants (p = 0.3116) but decreased in preterm infants (p = 0.0241). Preterm infants had higher cortisol levels on the fifth day, while full-term infants showed increasing levels (p = 0.0177) over time. Conclusion: Hypermethylated sites in NR3C1 at birth and higher cortisol levels on day 5 suggest that prematurity, reflecting prenatal stress, affects the epigenome. Methylation decrease over time in preterm infants suggests that postnatal factors may modify the epigenome, but their role needs to be clarified.
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Affiliation(s)
- Georgia Chalfun
- Department of Pediatrics, D'Or Institute for Research & Education (IDOR), Rio de Janeiro, RJ, 22281-100, Brazil
- Department of Neonatology, Maternity School, Federal University of Rio de Janeiro (UFRJ), RJ, 22240-000, Brazil
| | - Aline de Araújo Brasil
- Department of Pediatrics, D'Or Institute for Research & Education (IDOR), Rio de Janeiro, RJ, 22281-100, Brazil
| | - Vitor Barreto Paravidino
- Department of Epidemiology, Institute of Social Medicine, University of the State of Rio de Janeiro (UERJ), 20550-013, Brazil
- Department of Physical Education & Sports, Naval Academy, Brazilian Navy, Rio de Janeiro, RJ, 20021-010, Brazil
| | - Sheila Coelho Soares-Lima
- Molecular Carcinogenesis Program, Brazilian National Cancer Institute, Rio de Janeiro, RJ, 20230-130, Brazil
| | | | - Margarida Dos Santos Salú
- Department of Pediatrics, D'Or Institute for Research & Education (IDOR), Rio de Janeiro, RJ, 22281-100, Brazil
| | | | | | - Leo Travassos Vieira Milone
- Department of Pediatrics, D'Or Institute for Research & Education (IDOR), Rio de Janeiro, RJ, 22281-100, Brazil
| | - Gustavo Rodrigues-Santos
- Department of Pediatrics, D'Or Institute for Research & Education (IDOR), Rio de Janeiro, RJ, 22281-100, Brazil
| | | | - Jaqueline Rodrigues Robaina
- Department of Pediatrics, D'Or Institute for Research & Education (IDOR), Rio de Janeiro, RJ, 22281-100, Brazil
| | - Fernanda Lima-Setta
- Department of Pediatrics, D'Or Institute for Research & Education (IDOR), Rio de Janeiro, RJ, 22281-100, Brazil
| | - Marcelo Martins Reis
- Department of Pediatrics, D'Or Institute for Research & Education (IDOR), Rio de Janeiro, RJ, 22281-100, Brazil
| | - Antônio José Ledo Alves da Cunha
- Department of Pediatrics, D'Or Institute for Research & Education (IDOR), Rio de Janeiro, RJ, 22281-100, Brazil
- Postgraduate Program in Perinatal Health, Maternity School, Federal University of Rio de Janeiro (UFRJ), RJ, 22240-000, Brazil
| | - Arnaldo Prata-Barbosa
- Department of Pediatrics, D'Or Institute for Research & Education (IDOR), Rio de Janeiro, RJ, 22281-100, Brazil
- Postgraduate Program in Perinatal Health, Maternity School, Federal University of Rio de Janeiro (UFRJ), RJ, 22240-000, Brazil
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NICU-based stress response and preterm infant neurobehavior: exploring the critical windows for exposure. Pediatr Res 2022; 92:1470-1478. [PMID: 35173301 PMCID: PMC9378765 DOI: 10.1038/s41390-022-01983-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 11/10/2021] [Accepted: 01/16/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Exposure to maternal stress in utero negatively impacts cognitive and behavioral outcomes of children born at term. The neonatal intensive care unit (NICU) can be stressful for preterm infants during a developmental period corresponding to the third trimester of gestation. It is unknown whether stress in the NICU contributes to adverse neurodevelopment among NICU graduates. The aim was to examine the association between salivary cortisol and early neurodevelopment in preterm infants. METHODS We examined the association between cortisol levels during the NICU hospitalization and subsequent performance on the NICU Network Neurobehavioral Scales (NNNS), estimating time-specific associations and considering sex differences. RESULTS Eight hundred and forty salivary cortisol levels were measured from 139 infants. Average cortisol levels were inversely associated with NNNS Regulation scores for both male and female infants (β = -0.19; 95% CI: -0.44, -0.02). Critical developmental windows based on postmenstrual age were identified, with cortisol measured <30 weeks PMA positively associated with Habituation and Lethargy scores (β = 0.63-1.04). Critical developmental windows based on chronological age were identified, with cortisol measured in the first week of life inversely associated with Attention score (β = -1.01 for females; -0.93 for males). CONCLUSIONS Stress in the NICU at specific developmental time points may impact early preterm infant neurodevelopment. IMPACT Stress in the neonatal intensive care unit can impact the neurodevelopmental trajectory of premature infants. The impact of stress is different at different points in development. The impact of stress is sexually dimorphic.
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Jensen ET, Yi J, Jackson W, Singh R, Joseph RM, Kuban KCK, Msall ME, Washburn L, Fry R, South AM, O’Shea TM. Analysis of Neurodevelopment in Children Born Extremely Preterm Treated With Acid Suppressants Before Age 2 Years. JAMA Netw Open 2022; 5:e2241943. [PMID: 36378311 PMCID: PMC9667324 DOI: 10.1001/jamanetworkopen.2022.41943] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
IMPORTANCE Children born preterm are at increased risk of adverse neurodevelopmental outcomes and may be particularly vulnerable to the effects of gastric acid suppression during infancy. OBJECTIVE To assess whether early acid suppressant use in infants born extremely preterm is associated with poorer neurodevelopmental outcomes. DESIGN, SETTING, AND PARTICIPANTS The Extremely Low Gestational Age Newborn study was a multicenter, longitudinal cohort study of infants born before 28 weeks' gestational age between March 22, 2002, and August 31, 2004. The current analyses were performed from September 12, 2020, through September 22, 2022. Of the 1506 infants enrolled, 284 died before discharge and 22 died before 24 months of age. An additional 2 died before age 10 years, leaving 1198 (79.5%) eligible for a visit. Of these, 889 (74%) participated in the visit at age 10. At age 10 years, the association of early-life acid suppressant use with neurocognitive, neurodevelopmental, and psychiatric symptomatology was assessed. EXPOSURES Acid suppressant use before 24 months of age was determined from medical records and from questionnaires administered to mothers. MAIN OUTCOMES AND MEASURES Neurodevelopmental assessments at age 10 years included the School-Age Differential Ability Scales-II, the Developmental Neuropsychological Assessment-II, the Autism Diagnostic Observation Schedule-2, the Social Responsiveness Scale-2, and the Child Symptom Inventory-4 for attention-deficit/hyperactivity disorder (ADHD), depression, and anxiety. RESULTS Of the 889 participants assessed at age 10 years (mean [SD] age, 9.97 [0.67] years; mean [SD] gestational age at birth, 26.1 [1.3] weeks; 455 [51.2%] male), 368 (41.4%) had received acid suppressants by 24 months of age. Associations were observed between acid suppressant use and decreased full-scale IQ z score (adjusted β, -0.29; 95% CI, -0.45 to -0.12), verbal IQ z score (adjusted β, -0.34; 95% CI, -0.52 to -0.15), nonverbal IQ z score (adjusted β, -0.22; 95% CI to -0.39 to -0.05), working memory z score (adjusted β, -0.26; 95% CI to -0.45, -0.08), autism spectrum disorder (adjusted relative risk, 1.84; 95% CI, 1.15-2.95), and epilepsy (adjusted relative risk, 2.07; 95% CI, 1.31 to 3.35). Results were robust to multiple sensitivity analyses. Use of acid suppressants was not associated with inhibitory control, ADHD, anxiety, or depression. CONCLUSIONS AND RELEVANCE The results of this cohort study suggest that early-life use of acid suppressants in extremely preterm infants may be associated with poorer neurodevelopmental outcomes and add to evidence indicating caution in use of these agents.
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Affiliation(s)
- Elizabeth T. Jensen
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Joe Yi
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill
| | - Wesley Jackson
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill
| | - Rachana Singh
- Department of Pediatrics, Tufts University School of Medicine, Boston, Massachusetts
| | - Robert M. Joseph
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, Massachusetts
| | | | - Michael E. Msall
- Kennedy Research Center on Intellectual and Neurodevelopmental Disabilities, University of Chicago Pritzker School of Medicine, Chicago, Illinois
| | - Lisa Washburn
- Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Rebecca Fry
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill
| | - Andrew M. South
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, North Carolina
- Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - T. Michael O’Shea
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill
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Alvares Bíscaro R. Epigenetics and the return to the great mother archetype. THE JOURNAL OF ANALYTICAL PSYCHOLOGY 2022; 67:445-454. [PMID: 35856535 DOI: 10.1111/1468-5922.12783] [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: 11/29/2022]
Abstract
Epigenetics is the study of how signals from the environment can change gene expression through the creation of molecules and chemical bonds that can last a lifetime and, therefore, determine the phenotype (the characteristics of the individual resulting from the interaction of their genotype [genes] with their environment). Research in this field began at McGill University, Canada, where it was observed that rats' mothers who were more nurturing raised more resilient pups. Since then, many studies have been carried out with animals and humans, showing the link between epigenetic changes and the experience of the great mother archetype - with potential consequences for the emotional life of the individual and for society.
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Multi-level hypothalamic neuromodulation of self-regulation and cognition in preterm infants: Towards a control systems model. COMPREHENSIVE PSYCHONEUROENDOCRINOLOGY 2022; 9:100109. [PMID: 35755927 PMCID: PMC9216652 DOI: 10.1016/j.cpnec.2021.100109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 12/28/2021] [Indexed: 11/21/2022] Open
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Brandon DH, Hatch D, Barnes A, Vance AJ, Harney J, Voigtman B, Younge N. Impact of diaper change frequency on preterm infants' vital sign stability and skin health: A RCT. Early Hum Dev 2022; 164:105510. [PMID: 34896732 PMCID: PMC8886570 DOI: 10.1016/j.earlhumdev.2021.105510] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 11/05/2021] [Accepted: 11/17/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND Bundling nurse caregiving interventions are promoted to minimize infant stress. PURPOSE To evaluate impact of bundled nursing care and diaper change frequency on vital sign stability and skin health of preterm infants born ≤32 weeks gestation. METHOD Stable preterm infants on a 3-hour feeding schedule were randomly assigned to 3- vs. 6-hour diaper changes. Diapers were changed prior to 6 h if stool was present. Direct observation of bundled care events (BCE) identify caregiving activities during each BCE. Skin pH, transepidermal water loss (TEWL), and neonatal skin condition scores (NSCS) were obtained. Vital sign data (HR, RR, O2 saturation) was downloaded from bedside monitors. RESULTS Forty-six infants contributed to 605 BCEs. BCEs lasted on average 28 min and included nine different activities (e.g., vital signs, feeding). Significant increases in heart rate during BCEs occurred in approximately half of the observations. Among observations with a diaper change increases in heart rate during diapering occurred in over 74% of observations Infants who were awake at the beginning of BCEs had 48% lower odds of having a change in heart rate than infants who were sleeping (p = .02). There were no group differences (3- vs. 6-hour diaper change) in skin health outcomes (TEWL, pH, NSCS). CONCLUSION Reducing diaper change frequency without stool present should be considered to minimize caregiving stress in preterm infants. Additional research should evaluate the intrusiveness and clusters of activities that significantly impact physiologic stability to better individualize the timing of routine yet intrusive activities. Clinicaltrials.gov registry # NCT03370757.
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Affiliation(s)
- Debra H. Brandon
- Duke University School of Nursing, DUMC 3322, 307 Trent Drive, Durham, NC 27710,Duke University School of Medicine, Department of Pediatrics, DUMC 2739, Duke University Hospital, Durham, NC 27710
| | - Daniel Hatch
- Duke University School of Nursing, DUMC 3322, 307 Trent Drive, Durham, NC 27710, United States of America.
| | - Angel Barnes
- Duke University School of Nursing, DUMC 3322, 307 Trent Drive, Durham, NC 27710, United States of America.
| | - Ashlee J. Vance
- Duke University School of Nursing, DUMC 3322, 307 Trent Drive, Durham, NC 27710
| | - Jane Harney
- Duke University School of Nursing, DUMC 3322, 307 Trent Drive, Durham, NC 27710, United States of America.
| | - Barbara Voigtman
- Kimberly Clark Corporation South Office, 2001 Marathon Avenue, Neenah, WI 54956, United States of America.
| | - Noelle Younge
- Duke University School of Medicine, Department of Pediatrics, Duke University Hospital, DUMC 2739, Durham, NC 27710, United States of America.
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12
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Oliveira DJD, Medeiros KS, Sarmento ACA, Oliveira FJD, Costa APF, Souza NL, Gonçalves AK, Silva MDLC. Use of glucose for pain management in premature neonates: a systematic review and meta-analysis protocol. BMJ Open 2021; 11:e052901. [PMID: 34887278 PMCID: PMC8663090 DOI: 10.1136/bmjopen-2021-052901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 09/24/2021] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Therapeutic management of neonatal pain is essential to reduce changes in initial and subsequent development. Although glucose has been shown to be effective in relieving pain, concentrations and dosages remain to be standardised. The objective of this systematic review and meta-analysis is to identify the efficacy of glucose as an analgesic in preterm infants. METHODS AND ANALYSIS The Web of Science, Science Direct, Scopus, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, PubMed, Medline, Latin American and Caribbean Health Sciences Literature and Embase databases will be researched for randomised studies published until December 2021. This systematic review and meta-analysis will include studies investigating the use of glucose for pain control in premature neonates. The primary outcome will be pain relief. Three independent reviewers will select the studies and extract the data from original publications. The risk of bias was assessed using the Cochrane risk of bias tool. Data synthesis will be performed using the Review Manager software (RevMan V.5.2.3). We will evaluate heterogeneity based on I2 statistics. In addition, quantitative synthesis will be performed if the included studies are sufficiently homogeneous. ETHICS AND DISSEMINATION Ethical approval for the research will not be required for this systematic review. The results of this study will be published in an international journal. TRIAL REGISTRATION NUMBER This protocol was submitted to the International Prospective Register of Systematic Reviews (PROSPERO, number CRD42021236217).
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13
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Chalfun G, Reis MM, de Oliveira MBG, de Araújo Brasil A, Dos Santos Salú M, da Cunha AJLA, Prata-Barbosa A, de Magalhães-Barbosa MC. Perinatal stress and methylation of the NR3C1 gene in newborns: systematic review. Epigenetics 2021; 17:1003-1019. [PMID: 34519616 DOI: 10.1080/15592294.2021.1980691] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Adverse experiences in the perinatal period have been associated with the methylation of the human glucocorticoid receptor gene (NR3C1) and long-term diseases. We conducted a systematic review on the association between adversities in the perinatal period and DNA methylation in the 1 F region of the NR3C1 gene in newborns. We explored the MEDLINE, Web of Science, Scopus, Scielo, and Lilacs databases without time or language limitations. Two independent reviewers performed the selection of articles and data extraction. A third participated in the methodological quality assessment and consensus meetings at all stages. Finally, ten studies were selected. Methodological quality was considered moderate in six and low in four. Methylation changes were reported in 41 of the 47 CpG sites of exon 1 F. Six studies addressed maternal conditions during pregnancy: two reported methylation changes at the same sites (CpG 10, 13, 20, 21 and 47), and four at one or more sites from CpG 35 to 39. Four studies addressed neonatal parameters and morbidities: methylation changes at the same sites 4, 8, 10, 16, 25, and 35 were reported in two. Hypermethylation associated with stressful conditions prevailed. Hypomethylation was more often associated with protective conditions (maternal-foetal attachment during pregnancy, breast milk intake, higher birth weight or Apgar). In conclusion, methylation changes in several sites of the 1 F region of the NR3C1 gene in newborns and very young infants were associated with perinatal stress, but more robust and comparable results are needed to corroborate site-specific associations.
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Affiliation(s)
- Georgia Chalfun
- Department of Pediatrics, D'Or Institute for Research and Education (Idor), Rio de Janeiro, RJ, Brazil.,Federal University of Rio de Janeiro (Ufrj), Rio De Janeiro, RJ, Brazil
| | - Marcelo Martins Reis
- Department of Pediatrics, D'Or Institute for Research and Education (Idor), Rio de Janeiro, RJ, Brazil
| | | | - Aline de Araújo Brasil
- Department of Pediatrics, D'Or Institute for Research and Education (Idor), Rio de Janeiro, RJ, Brazil
| | - Margarida Dos Santos Salú
- Department of Pediatrics, D'Or Institute for Research and Education (Idor), Rio de Janeiro, RJ, Brazil
| | - Antônio José Ledo Alves da Cunha
- Department of Pediatrics, D'Or Institute for Research and Education (Idor), Rio de Janeiro, RJ, Brazil.,Federal University of Rio de Janeiro (Ufrj), Rio De Janeiro, RJ, Brazil
| | - Arnaldo Prata-Barbosa
- Department of Pediatrics, D'Or Institute for Research and Education (Idor), Rio de Janeiro, RJ, Brazil.,Federal University of Rio de Janeiro (Ufrj), Rio De Janeiro, RJ, Brazil
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14
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Schroder JD, de Araújo JB, de Oliveira T, de Moura AB, Fries GR, Quevedo J, Réus GZ, Ignácio ZM. Telomeres: the role of shortening and senescence in major depressive disorder and its therapeutic implications. Rev Neurosci 2021; 33:227-255. [PMID: 34388328 DOI: 10.1515/revneuro-2021-0070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 07/17/2021] [Indexed: 11/15/2022]
Abstract
Major depressive disorder (MDD) is one of the most prevalent and debilitating psychiatric disorders, with a large number of patients not showing an effective therapeutic response to available treatments. Several biopsychosocial factors, such as stress in childhood and throughout life, and factors related to biological aging, may increase the susceptibility to MDD development. Included in critical biological processes related to aging and underlying biological mechanisms associated with MDD is the shortening of telomeres and changes in telomerase activity. This comprehensive review discusses studies that assessed the length of telomeres or telomerase activity and function in peripheral blood cells and brain tissues of MDD individuals. Also, results from in vitro protocols and animal models of stress and depressive-like behaviors were included. We also expand our discussion to include the role of telomere biology as it relates to other relevant biological mechanisms, such as the hypothalamic-pituitary-adrenal (HPA) axis, oxidative stress, inflammation, genetics, and epigenetic changes. In the text and the discussion, conflicting results in the literature were observed, especially considering the size of telomeres in the central nervous system, on which there are different protocols with divergent results in the literature. Finally, the context of this review is considering cell signaling, transcription factors, and neurotransmission, which are involved in MDD and can be underlying to senescence, telomere shortening, and telomerase functions.
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Affiliation(s)
- Jessica Daniela Schroder
- Laboratory of Physiology Pharmacology and Psychopathology, Graduate Program in Biomedical Sciences, Federal University of the Southern Frontier, Rodovia SC 484 - Km 02, Fronteira Sul, Postal Code: 89815-899Chapecó, SC, Brazil
| | - Julia Beatrice de Araújo
- Laboratory of Physiology Pharmacology and Psychopathology, Graduate Program in Biomedical Sciences, Federal University of the Southern Frontier, Rodovia SC 484 - Km 02, Fronteira Sul, Postal Code: 89815-899Chapecó, SC, Brazil
| | - Tacio de Oliveira
- Laboratory of Physiology Pharmacology and Psychopathology, Graduate Program in Biomedical Sciences, Federal University of the Southern Frontier, Rodovia SC 484 - Km 02, Fronteira Sul, Postal Code: 89815-899Chapecó, SC, Brazil
| | - Airam Barbosa de Moura
- Laboratory of Translational Psychiatry, Graduate Program in Health Sciences, University of Southern Santa Catarina, Av. Universitária, 1105 - Bairro Universitário Postal Code: 88806-000Criciúma, SC, Brazil
| | - Gabriel Rodrigo Fries
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, Translational Psychiatry Program, The University of Texas Health Science Center at Houston (UTHealth), 1941 East Road BBSB 3142, Houston77054, TX, USA.,Neuroscience Graduate Program, Graduate School of Biomedical Sciences, The University of Texas Health Science Center at Houston (UTHealth), 1941 East Road, BBSB 3142, Houston77054, TX, USA.,Center for Precision Health, School of Biomedical Informatics, The University of Texas Health Science Center at Houston, 1941 East Road, BBSB 3142, Houston77054, TX, USA
| | - João Quevedo
- Laboratory of Translational Psychiatry, Graduate Program in Health Sciences, University of Southern Santa Catarina, Av. Universitária, 1105 - Bairro Universitário Postal Code: 88806-000Criciúma, SC, Brazil.,Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, Translational Psychiatry Program, The University of Texas Health Science Center at Houston (UTHealth), 1941 East Road BBSB 3142, Houston77054, TX, USA.,Neuroscience Graduate Program, Graduate School of Biomedical Sciences, The University of Texas Health Science Center at Houston (UTHealth), 1941 East Road, BBSB 3142, Houston77054, TX, USA.,Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, Center of Excellence on Mood Disorders, The University of Texas Health Science Center at Houston (UTHealth), 1941 East Road, BBSB 3142, Houston77054, TX, USA
| | - Gislaine Zilli Réus
- Laboratory of Translational Psychiatry, Graduate Program in Health Sciences, University of Southern Santa Catarina, Av. Universitária, 1105 - Bairro Universitário Postal Code: 88806-000Criciúma, SC, Brazil
| | - Zuleide Maria Ignácio
- Laboratory of Physiology Pharmacology and Psychopathology, Graduate Program in Biomedical Sciences, Federal University of the Southern Frontier, Rodovia SC 484 - Km 02, Fronteira Sul, Postal Code: 89815-899Chapecó, SC, Brazil.,Laboratory of Translational Psychiatry, Graduate Program in Health Sciences, University of Southern Santa Catarina, Av. Universitária, 1105 - Bairro Universitário Postal Code: 88806-000Criciúma, SC, Brazil
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15
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Identifying the Critical Threshold for Long-Term Pediatric Neurological Hospitalizations of the Offspring in Preterm Delivery. J Clin Med 2021; 10:jcm10132919. [PMID: 34209950 PMCID: PMC8269302 DOI: 10.3390/jcm10132919] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 06/15/2021] [Accepted: 06/28/2021] [Indexed: 12/16/2022] Open
Abstract
We opted to investigate whether a critical threshold exists for long-term pediatric neurological morbidity, and cerebral palsy (CP), in preterm delivery, via a population-based cohort analysis. Four study groups were classified according to their gestational age at birth: 24–27.6, 28–31.6, 32–36.6 weeks and term deliveries, evaluating the incidence of long-term hospitalizations of the offspring due to neurological morbidity. Cox proportional hazard models were performed to control for confounders. A Kaplan–Meier survival curve was used to compare the cumulative neurological morbidity incidence for each group. A total of 220,563 deliveries were included: 0.1% (118) occurred at 24–27.6 weeks of gestation, 0.4% (776) occurred at 28–31.6 weeks of gestation, 6% (13,308) occurred at 32–36.6 weeks of gestation and 93% (206,361) at term. In a Cox model, while adjusting for confounders, delivery before 25 weeks had a 3.9-fold risk for long-term neurological morbidity (adjusted HR (hazard ratio) = 3.9, 95% CI (confidence interval) 2.3–6.6; p < 0.001). The Kaplan–Meier survival curve demonstrated a linear association between long-term neurological morbidity and decreasing gestational age. In a second Cox model, adjusted for confounders, infants born before 25 weeks of gestation had increased rates of CP (adjusted HR = 62.495% CI 25.6–152.4; p < 0.001). In our population, the critical cut-off for long-term neurological complications is delivery before 25 weeks gestation.
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16
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Telomere length shortening in hospitalized preterm infants: A pilot study. PLoS One 2021; 16:e0243468. [PMID: 33471805 PMCID: PMC7817026 DOI: 10.1371/journal.pone.0243468] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 11/21/2020] [Indexed: 12/18/2022] Open
Abstract
Leukocyte telomere length is a biomarker of aging-related health risks. Hospitalized preterm infants frequently experience elevated oxidative stress and inflammation, both of which contribute to telomere shortening. Our aim was to examine changes in telomere length during neonatal intensive care unit (NICU) hospitalization in a cohort of preterm infants <32 weeks' gestation. We conducted a longitudinal study of 10 infants (mean gestational age 27 weeks, range 23.5 to 29, at birth). We isolated DNA from dried blood spots and used Real Time Quantitative PCR to measure relative leukocyte telomere length in triplicate at three time points for each participant. From birth to discharge, infants experienced an average decline in relative telomere length of 0.021 units per week (95% CI -0.040, -0.0020; p = 0.03), after adjustment for gestational age at birth. Our results suggest a measurable decline in telomere length during NICU hospitalization. We speculate that telomere length change may convey information about NICU exposures that carry short- and long-term health risks.
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17
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Boggini T, Pozzoli S, Schiavolin P, Erario R, Mosca F, Brambilla P, Fumagalli M. Cumulative procedural pain and brain development in very preterm infants: A systematic review of clinical and preclinical studies. Neurosci Biobehav Rev 2020; 123:320-336. [PMID: 33359095 DOI: 10.1016/j.neubiorev.2020.12.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 12/05/2020] [Accepted: 12/15/2020] [Indexed: 01/16/2023]
Abstract
Very preterm infants may manifest neurodevelopmental impairments, even in the absence of brain lesions. Pathogenesis is complex and multifactorial. Evidence suggests a role of early adversities on neurodevelopmental outcomes, via epigenetic regulation and changes in brain architecture. In this context, we focused on cumulative pain exposure which preterm neonates experience in neonatal intensive care unit (NICU). We systematically searched for: i) evidence linking pain with brain development and exploring the potential pathogenetic role of epigenetics; ii) preclinical research supporting clinical observational studies. Nine clinical neuroimaging studies, during neonatal or school age, mostly from the same research group, revealed volume reduction of white and gray matter structures in association with postnatal pain exposure. Three controlled animal studies mimicking NICU settings found increased cell death or apoptosis; nevertheless, eligible groups were limited in size. Epigenetic modulation (SLC6A4 promoter methylation) was identified in only two clinical trials. We call for additional research and, although knowledge gaps, we also point out the urgent need of minimizing painful procedures in NICUs.
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Affiliation(s)
- Tiziana Boggini
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, NICU, Milan, Italy.
| | - Sara Pozzoli
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Neurosciences and Mental Health, Milan, Italy
| | - Paola Schiavolin
- University of Milan, Department of Clinical Sciences and Community Health, Milan, Italy
| | - Raffaele Erario
- University of Milan, Department of Pathophysiology and Transplantation, Milan, Italy
| | - Fabio Mosca
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, NICU, Milan, Italy; University of Milan, Department of Clinical Sciences and Community Health, Milan, Italy
| | - Paolo Brambilla
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Neurosciences and Mental Health, Milan, Italy; University of Milan, Department of Pathophysiology and Transplantation, Milan, Italy
| | - Monica Fumagalli
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, NICU, Milan, Italy; University of Milan, Department of Clinical Sciences and Community Health, Milan, Italy
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18
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Griffiths N, Spence K, Galea C, Psaila K, Foureur M, Sinclair L. The effects of education levels of developmental care in Australia: Perceptions and challenges. Aust Crit Care 2020; 34:370-377. [PMID: 33221131 DOI: 10.1016/j.aucc.2020.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 09/28/2020] [Accepted: 10/09/2020] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Developmental care consists of a range of clinical, infant-focused, and family-focused interventions designed to modify the neonatal intensive care environment and caregiving practices to reduce stressors on the developing brain. Since the inception of developmental care in the early 1980s, it has been recommended and adopted globally as a component of routine practice for neonatal care. Despite its application for almost 40 y, little is known of the attitude of neonatal nurses in Australia towards the intervention. AIMS AND OBJECTIVES The objective of this study was to establish Australian neonatal nurse perceptions of developmental care and explore associations between developmental care education levels of the nurses and personal beliefs in the application of developmental care. DESIGN This involves a cross-sectional survey design. METHODS An online questionnaire was completed by 171 neonatal nurses. Participants were members of the Australian College of Neonatal Nursing (n = 783). Covariate associations between key components of developmental care and respondents' geographical location, place of employment, professional qualifications, and developmental care education level were analysed. The reporting of this study is in accordance with the Enhancing the Quality and Transparency of Health Research Checklist for Reporting Results of Internet E-Surveys. RESULTS Differences were observed between groups for geographical location, place of employment, and professional qualification level. Rural nurses were less likely to support the provision of skin-to-skin care (odds ratio [OR]: 0.6, 95% confidence interval [CI]: 0.2-1.8) than nurses in a metropolitsan unit. Nurses working in a neonatal intensive care unit and nurses with postgraduate qualifications were more likely to support parental involvement in care ([OR: 2.3, 95% CI: 0.9-6.2] and [OR: 2.1, 95% CI: 0.6-7.4], respectively). Rural respondents were more likely to have attended off-site education (OR: 3.6, 95% CI: 1.3-9.9) than metropolitan respondents. CONCLUSION The application of developmental care in Australia may be influenced by inadequate resources and inequitable access to educational resources, and similar challenges have been reported in other countries. Overcoming the challenges requires a focused education strategy and support within and beyond the neonatal intensive care unit.
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Affiliation(s)
- Nadine Griffiths
- Grace Centre for Newborn Intensive Care, The Children's Hospital at Westmead, Locked Bag 4001, Westmead 2145, NSW, Australia; University of Technology Sydney, Centre of Midwifery, Child and Family Health, 15 Broadway, Ultimo, NSW 2007, Australia.
| | - Kaye Spence
- Grace Centre for Newborn Intensive Care, The Children's Hospital at Westmead, Locked Bag 4001, Westmead 2145, NSW, Australia; School of Nursing and Midwifery, Western Sydney University, Parramatta, NSW, Australia
| | - Claire Galea
- Cerebral Palsy Alliance Research Institute, Discipline of Child & Adolescent Health, Faculty of Medicine & Health, The University of Sydney, PO Box 6427, Frenchs Forest, Sydney, NSW 2086, Australia
| | - Kim Psaila
- School of Nursing and Midwifery, Western Sydney University, Parramatta, NSW, Australia
| | - Maralyn Foureur
- University of Technology Sydney, Centre of Midwifery, Child and Family Health, 15 Broadway, Ultimo, NSW 2007, Australia; Nursing and Midwifery Research Centre Hunter New England Local Health District, James Fletcher Hospital Campus, 77 Scott Street, Newcastle 2300, NSW, Australia; Faculty of Health and Medicine, University of Newcastle, Callaghan Campus, 2308 NSW, Australia
| | - Lynn Sinclair
- University of Technology Sydney, Centre of Midwifery, Child and Family Health, 15 Broadway, Ultimo, NSW 2007, Australia; University of New South Wales, School of Women's and Children's Health, Faculty of Medicine, Randwick, NSW 2052, Australia
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19
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Polettini J, da Silva MG. Telomere-Related Disorders in Fetal Membranes Associated With Birth and Adverse Pregnancy Outcomes. Front Physiol 2020; 11:561771. [PMID: 33123024 PMCID: PMC7573552 DOI: 10.3389/fphys.2020.561771] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 09/14/2020] [Indexed: 12/22/2022] Open
Abstract
Telomere disorders have been associated with aging-related diseases, including diabetes, vascular, and neurodegenerative diseases. The main consequence of altered telomere is the induction of the state of irreversible cell cycle arrest. Though several mechanisms responsible for the activation of senescence have been identified, it is still unclear how a cell is indeed induced to become irreversibly arrested. Most tissues in the body will experience senescence throughout its lifespan, but intrinsic and extrinsic stressors, such as chemicals, pollution, oxidative stress (OS), and inflammation accelerate the process. Pregnancy is a state of OS, as the higher metabolic demand of the growing fetus results in increased reactive oxygen species production. As a temporary organ in the mother, senescence in fetal membranes and placenta is expected and linked to term parturition (>37 weeks of gestation). However, a persistent, overwhelming, or premature OS affects placental antioxidant capacity, with consequent accumulation of OS causing damage to lipids, proteins, and DNA in the placental tissues. Therefore, senescence and its main inducer, telomere length (TL) reduction, have been associated with pregnancy complications, including stillbirth, preeclampsia, intrauterine growth restriction, and prematurity. Fetal membranes have a notable role in preterm births, which continue to be a major health issue associated with increased risk of neo and perinatal adverse outcomes and/or predisposition to disease in later life; however, the ability to mediate a delay in parturition during such cases is limited, because the pathophysiology of preterm births and physiological mechanisms of term births are not yet fully elucidated. Here, we review the current knowledge regarding the regulation of telomere-related senescence mechanisms in fetal membranes, highlighting the role of inflammation, methylation, and telomerase activity. Moreover, we present the evidences of TL reduction and senescence in gestational tissues by the time of term parturition. In conclusion, we verified that telomere regulation in fetal membranes requires a more complete understanding, in order to support the development of successful effective interventions of the molecular mechanisms that triggers parturition, including telomere signals, which may vary throughout placental tissues.
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Affiliation(s)
- Jossimara Polettini
- Universidade Federal da Fronteira Sul (UFFS), Programa de Pós Graduação em Ciências Biomédicas, Faculdade de Medicina, Campus Passo Fundo, Brazil
| | - Marcia Guimarães da Silva
- Universidade Estadual Paulista (UNESP), Faculdade de Medicina, Departamento de Patologia, Botucatu, Brazil
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Hematopoietic cellular aging is not accelerated during the first 2 years of life in children born preterm. Pediatr Res 2020; 88:903-909. [PMID: 32170191 PMCID: PMC7086539 DOI: 10.1038/s41390-020-0833-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 02/10/2020] [Accepted: 02/19/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND Prematurity in itself and exposure to neonatal intensive care triggers inflammatory processes and oxidative stress, leading to risk for disease later in life. The effects on cellular aging processes are incompletely understood. METHODS Relative telomere length (RTL) was measured by qPCR in this longitudinal cohort study with blood samples taken at birth and at 2 years of age from 60 children (16 preterm and 44 term). Viral respiratory infections the first year were evaluated. Epigenetic biological DNA methylation (DNAm) age was predicted based on methylation array data in 23 children (11 preterm and 12 term). RTL change/year and DNAm age change/year was compared in preterm and term during the 2 first years of life. RESULTS Preterm infants had longer telomeres than term born at birth and at 2 years of age, but no difference in telomere attrition rate could be detected. Predicted epigenetic DNAm age was younger in preterm infants, but rate of DNAm aging was similar in both groups. CONCLUSIONS Despite early exposure to risk factors for accelerated cellular aging, children born preterm exhibited preserved telomeres. Stress during the neonatal intensive care period did not reflect accelerated epigenetic DNAm aging. Early-life aging was not explained by preterm birth. IMPACT Preterm birth is associated with elevated disease risk later in life. Preterm children often suffer from inflammation early in life. Stress-related telomere erosion during neonatal intensive care has been proposed. Inflammation-accelerated biological aging in preterm is unknown. We find no accelerated aging due to prematurity or infections during the first 2 years of life.
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Bovbjerg ML. Current Resources for Evidence-Based Practice, November 2019. J Obstet Gynecol Neonatal Nurs 2019; 48:693-704. [PMID: 31629697 DOI: 10.1016/j.jogn.2019.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
A review of new resources to support the provision of evidence-based care for women and infants.
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