Preterm children have unfavorable motor, cognitive, and functional performance when compared to term children of preschool age

Is neurodevelopment impaired in Brazilian children with intestinal failure on prolonged parenteral nutrition? A single center study

PURPOSE

To assess the neurodevelopment outcomes of children younger than 42 months of age with intestinal failure (IF) using prolonged parenteral nutrition (PN) followed by a Pediatric Multidisciplinary Intestinal Rehabilitation Program from a public tertiary hospital in Brazil.

METHODS

Bayley III scale was administered in children aged 2 to 42 months with IF and receiving PN for more than 60 days. Composite scores in cognitive, motor, and language domains were analyzed. Developmental delay was defined as a performance 2 standard deviations (SD) below the average at the 3 domains. Association between Bayley III composite scores and clinical variables related to IF were tested.

RESULTS

Twenty-four children with median (IQR) age of 17.5 months (9-28.5) were studied, 58.3% were male. Developmental delay was found in 34%, 33% and 27% of the patients in cognitive, motor, and language domains, respectively. There was no significant association between the Bayley-III composite scores and length of hospitalization, prematurity, and number of surgical procedures with anesthesia.

CONCLUSION

The study demonstrated impairments in the cognitive, motor and language domains in approximately one-third of young patients with IF on prolonged PN.

Preterm toddlers' joint attention characteristics during dyadic interactions with their mothers and fathers compared to full-term toddlers at age 2 years

The current study investigates Joint Attention (JA) characteristics (duration, frequency, source of initiation, type of JA, agent of termination, missed and unsuccessful episodes) in preterm and full-term toddlers' interactions with their mothers and fathers, separately. Thirty-one singleton full-term (Mage = 24.07 months, SD = 1.45; 13 boys) and 17 singleton preterm toddlers (Madjustedage = 24.72 months, SD = 3.39; 12 boys) participated in the study with both parents. JA episodes were examined during dyadic five-minute free play sessions, were coded second-by-second, and were analysed using two-way mixed ANOVAs. Although the total amount of time spent in JA was not significantly different between the preterm and the full-term groups, JA episodes were more frequent, specifically supported JA episodes, and were more often terminated by the child during parent-preterm toddler interactions. Moreover, preterm toddlers missed their fathers' attempts for JA more often than their mothers' and more often than full-term toddlers missed their fathers' and mothers' bids for JA. Further, regardless of the birth status, toddlers initiated more JA with mothers than fathers, and fathers redirected their child's attention to initiate JA more than mothers. Findings indicate that preterm toddlers may struggle to respond to JA bids, especially with their fathers, and to sustain their attention on a specific object or event during interactions. Preterm toddlers may need more support to engage in JA relative to their full-term peers, and redirecting attention strategy may not be optimal for them. Also, toddlers' JA interactions may be different with their mothers and fathers. Findings contribute to the literature by demonstrating preterm toddlers' JA characteristics with both parents compared to full-term toddlers at age two.

Does the Degree of Prematurity Relate to the Bayley-4 Scores Earned by Matched Samples of Infants and Toddlers across the Cognitive, Language, and Motor Domains?

The literature on children born prematurely has consistently shown that full-term babies outperform preterm babies by about 12 IQ points, even when tested as adolescents, and this advantage for full-term infants extends to the language and motor domains as well. The results of comprehensive meta-analyses suggest that the degree of prematurity greatly influences later test performance, but these inferences are based on data from an array of separate studies with no control of potential confounding variables such as age. This study analyzed Bayley-4 data for 66 extremely premature infants and toddlers (<32 weeks), 70 moderately premature children (32-36 weeks), and 133 full-term children. All groups were carefully matched on key background variables by the test publisher during the standardization of the Bayley-4. This investigation analyzed data on the five subtests: cognitive, expressive communication, receptive communication, fine motor, and gross motor. A multivariate analysis of covariance (MANCOVA) assessed for group mean differences across the three subsamples, while controlling for the children's age. Extremely premature children scored significantly lower than moderately premature children on all subtests, and both preterm groups were significantly outscored by the full-term sample across all domains. In each set of comparisons, the cognitive and motor subtests yielded the largest differences, whereas language development, both expressive and receptive, appeared the least impacted by prematurity. A follow-up MANOVA was conducted to examine full-term versus preterm discrepancies on the five subtests for infants (2-17 months) vs. toddlers (18-42 months). For that analysis, the two preterm groups were combined into a single preterm sample, and a significant interaction between the age level and group (full-term vs. preterm) was found. Premature infants scored lower than premature toddlers on receptive communication, fine motor, and cognitive. Neither expressive communication nor gross motor produced significant discrepancies between age groups The findings of this study enrich the preterm literature on the degree of prematurity; the age-based interactions have implications for which abilities are most likely to improve as infants grow into toddlerhood.

Meaningful everyday life situations from the perspective of children born preterm: A photo-elicitation interview study with six-year-old children

AIM

The aim of the study was to explore meaningful everyday life situations as perceived by six-year-old children born preterm.

MATERIALS AND METHODS

The study had a descriptive qualitative design with an inductive approach. Ten, six-year-old children born preterm, not diagnosed with any disabilities, participated. Data was collected by photo-elicitation interviews to stimulate and help the children to describe their meaningful everyday life situations. A qualitative content analysis according to Elo and Kyngäs was applied.

RESULTS

The children's descriptions of meaningful everyday life situations can be understood as being in an active and dynamic process, representing the core category. The analysis resulted in three generic categories, as the children described the significance of having significant circumstances and doing things. The experiences the children gain when they do things create their desire for further development.

DISCUSSION

The results reveal that children born preterm are able to reflect on and give detailed descriptions of situations of importance to them. The study suggests that if six-year-old children born preterm are given the opportunity to share their views they can take an active role e.g. in planning and carrying through of interventions by health care services.

NICU music therapy effects on maternal mental health and preterm infant's emotional arousal

In recent decades, music therapy in the Neonatal Intensive Care Unit (NICU) has been shown to regulate preterm infant's physiological responses and improve maternal mental health. This study investigated the effects of the music therapy intervention for the mother-preterm infant dyad (MUSIP) for maternal anxiety, postnatal depression, and stress, and preterm infants' weight gain, length of hospitalization, heart rate (HR), and oxygen saturation (So₂ ). A pre-experimental design was used with 33 mother-preterm infant dyads in a Brazilian NICU: 16 dyads in the Music Therapy Group (MTG) and 17 dyads in the Control Group (CG). The MTG took part in the MUSIP, aimed at supporting maternal singing with the preterm baby. Infants' HR and So₂ were recorded at each minute from 10 min before to 10 min after sessions 1, 3, and 6. Before infants' discharge, maternal anxiety and depression scores were lower in the MTG compared to the CG. Anxiety, depression, and stress levels decreased significantly after the intervention in the MTG. With regard to infants, HR and So₂ ranges were higher during music therapy, compared to before and after sessions. MUSIP improved maternal mental health and affected preterm infants' emotional arousal, with positive trends in decreasing HR, stabilizing So₂ , and reducing length of hospitalization.

Sazonalidade e fatores de risco associados ao desenvolvimento motor de lactentes nascidos a termo

Resumo Introdução Diferentes fatores afetam o desenvolvimento motor no primeiro ano de vida, tendo sido pouco estudada a interferência da variação sazonal. Objetivo Investigar a influência da sazonalidade e de fatores de risco e proteção para o desenvolvimento motor de lactentes nascidos a termo, aos 7 e 10 meses de idade. Método Foram incluídos no estudo lactentes a termo (N=174) que vivenciaram os marcos de desenvolvimento referentes ao 2º e 3º trimestres no período de verão ou de inverno. Prontuários, entrevistas, e a Alberta Infant Motor Scale foram utilizados. Resultados A aquisição do sentar-se e engatinhar foi mais tardia nos grupos pós-inverno (p < 0,001). Quanto aos grupos de risco e sem risco para o desenvolvimento motor, observou-se, aos 7 meses, menor prevalência de planejamento da gravidez (p=0,015), menor tempo de aleitamento materno exclusivo (p=0,004) e de amamentação (p=0,012) no grupo com risco. Aos 10 meses, os lactentes do grupo de risco se caracterizaram pela menor idade gestacional (p=0,040), por serem filhos de mães mais velhas (p=0,020), maior número de irmãos (p=0,002), níveis mais elevados de pobreza (p=0,002) e maiores restrições de movimento (p=0,000). A regressão logística evidenciou que, aos 7 meses, o aleitamento materno foi a variável associada ao desenvolvimento motor, enquanto aos 10 meses, o número de filhos, a pobreza e a restrição de movimento do lactente explicaram a variação no desenvolvimento motor. Conclusão O clima frio não se mostrou um determinante isolado para o risco de atraso motor, variáveis ambientais foram mais influentes no modelo.

Instrumentos de avaliação da terapia ocupacional para crianças e adolescentes no Brasil: uma revisão da literatura

Resumo Introdução Observa-se um interesse crescente na utilização de métodos para avaliar a efetividade das práticas desenvolvidas por terapeutas ocupacionais, contudo, quando se trata de instrumentos de avaliação próprios da terapia ocupacional, ainda que o uso seja visto como positivo e vantajoso, parecem ser pouco utilizados e difundidos no Brasil. Objetivo Identificar e analisar estudos originais desenvolvidos em território brasileiro que utilizaram instrumentos sistematizados de avaliação criados por terapeutas ocupacionais para a população infantojuvenil. Método Trata-se de uma pesquisa de revisão sistemática da literatura, sendo as buscas realizadas nas bases de dados: PubMed, Scopus, SciELO e BVS, além dos periódicos: Cadernos Brasileiros de Terapia Ocupacional, Revista de Terapia Ocupacional da Universidade de São Paulo, Revista Interinstitucional Brasileira de Terapia Ocupacional e Revista Baiana de Terapia Ocupacional, atendendo aos critérios de seleção adotados. Resultados Foram incluídos 37 estudos, contemplando 15 instrumentos criados por terapeutas ocupacionais para a avaliação de crianças e adolescentes. Quatro categorias de instrumentos emergiram da análise dos resultados, a saber: desempenho funcional; participação e desempenho ocupacional; comportamento lúdico e atividade sensorial. A maioria dos instrumentos apresentou boas evidências de adequação psicométrica no contexto brasileiro, embora alguns ainda necessitem de maiores investigações. Conclusão Diante dos instrumentos e de suas principais características apresentadas neste estudo, pôde-se apreender um panorama diverso, podendo potencializar os processos de cuidado em infância e adolescência no campo da terapia ocupacional. Há a recomendação para que futuros estudos se debrucem em investigar ferramentas avaliativas confiáveis para compor a produção científica nacional.

Neonatal Adverse Outcomes, Neonatal Birth Risks, and Socioeconomic Status: Combined Influence on Preterm Infants' Cognitive, Language, and Motor Development in Brazil

BACKGROUND

This study extended previous research by investigating the combined effects of neonatal birth risks, neonatal adverse outcomes, and socioeconomic status on preterm neurodevelopment.

METHOD

A total of 184 preterm infants were assessed using the Bayley Scales of Infant Development III in a follow-up clinic in southern Brazil. Structural equation modeling was conducted with 3 latent variables (neonatal birth risks, neonatal adverse outcomes, and socioeconomic status) and 3 outcomes (cognitive, language, and motor development).

RESULTS

The analyses showed that neonatal adverse outcomes were associated with infants' cognitive (b = -0.45, P < .001), language (b = -0.23, P = .001), and motor (b = -0.51, P < .001) development. Socioeconomic status also explained the variances (cognitive: b = 0.20, P = .006; language: b = 0.28, P = .001; and motor: b = 0.21, P = .004), whereas neonatal birth risks remained significant only in the motor development (b = 0.15, P = .040).

CONCLUSION

This study suggests that the most evident contributors to poor neurodevelopment were adverse outcomes and socioeconomic risk factors.

Disruption and Compensation of Sulcation-based Covariance Networks in Neonatal Brain Growth after Perinatal Injury

Perinatal brain injuries in preterm neonates are associated with alterations in structural neurodevelopment, leading to impaired cognition, motor coordination, and behavior. However, it remains unknown how such injuries affect postnatal cortical folding and structural covariance networks, which indicate functional parcellation and reciprocal brain connectivity. Studying 229 magnetic resonance scans from 158 preterm neonates (n = 158, mean age = 28.2), we found that severe injuries including intraventricular hemorrhage, periventricular leukomalacia, and ventriculomegaly lead to significantly reduced cortical folding and increased covariance (hyper-covariance) in only the early (<31 weeks) but not middle (31-35 weeks) or late stage (>35 weeks) of the third trimester. The aberrant hyper-covariance may drive acceleration of cortical folding as a compensatory mechanism to "catch-up" with normal development. By 40 weeks, preterm neonates with/without severe brain injuries exhibited no difference in cortical folding and covariance compared with healthy term neonates. However, graph theory-based analysis showed that even after recovery, severely injured brains exhibit a more segregated, less integrated, and overall inefficient network system with reduced integration strength in the dorsal attention, frontoparietal, limbic, and visual network systems. Ultimately, severe perinatal injuries cause network-level deviations that persist until the late stage of the third trimester and may contribute to neurofunctional impairment.

Modelling the dynamics of children's gross motor coordination

This study modelled children's gross motor coordination, investigated sex-differences and identified the effects of fixed and dynamic correlates on motor coordination development. A total of 344 Portuguese children (170 girls), from 6 age cohorts (5 to 9 years of age), were followed consecutively for three years (age range 5 to 11 years) using a mixed-longitudinal cohort design. Birth weight, hand dominance and socioeconomic status (SES) were identified. Gross motor coordination, body mass index, physical fitness (PF) and physical activity (PA) were assessed annually. A sequence of multilevel hierarchical linear models were developed. Model 1 found that age, age², sex, sex-by-age and sex-by-age² were significant predictors (p < 0.05) of gross motor coordination. Boys outperformed girls from 6 years of age onwards. Model 2 found a cohort effect (p < 0.05). Model 3 found that right handers were more coordinated (p < 0.05). When the confounders of body mass index, PF and PA were added to the model (Model 4) it was found that boys and girls had parallel trajectories in their gross motor coordination development. In conclusion children with increasing body mass index were less coordinated, while those who were stronger and more agile had steeper trajectories of gross motor coordination with age.

The relationship between exclusive breastfeeding and infant development: A 6- and 12-month follow-up study

BACKGROUND

Breastfeeding offers several advantages for infants with research suggesting that it benefits development, including cognitive and language development. However, limited research has examined the benefits in infants under one year.

AIMS

To investigate the association between breastfeeding duration and infant development.

STUDY DESIGN

A longitudinal study conducted over 12 months.

SUBJECTS

Two hundred fifty-five mothers and their infants living in South Korea were seen at three time-points based on infants' age (4, 6, and 12 months).

OUTCOME MEASURES

Breastfeeding data were collected at 4 and 6 months. The Korea-Developmental Screening Test for Infants & Children was administered at 6 and 12 months to measure developmental milestones. We analyzed the relationship between breastfeeding duration in the first 6 months and infant development at 6 and 12 months using logistic regression analysis.

RESULTS

Compared to infants who did not breastfeed at all, infants who were exclusively breastfed until 4 months of age followed by mixed breastfeeding had a better communication and social interaction at 6 months, and better cognition, communication, and social interaction at 12 months. Exclusive breastfeeding until 6 months of age had no apparent impact on the outcomes at 6 and 12 months.

CONCLUSIONS

Exclusive breastfeeding up to 4 months of age followed by mixed breastfeeding might maximize the effects of infant development in their first year after birth. Breastfeeding programs should effectively communicate that exclusive breastfeeding for at least 4 months benefits infant development.

Body Structure, Function, Activity, and Participation in 3- to 6-Year-Old Children Born Very Preterm: An ICF-Based Systematic Review and Meta-Analysis

BACKGROUND

The World Health Organization's International Classification of Functioning, Disability, and Health framework, Children and Youth Version (ICF-CY), provides a valuable method of conceptualizing the multidomain difficulties experienced by children born very preterm (VP). Reviews investigating motor outcomes at preschool age across ICF-CY domains are lacking.

PURPOSE

The purpose of this review is to identify and compare motor outcomes of 3- to 6-year-old children born VP and children born full-term (FT) within the ICF-CY framework.

DATA SOURCES

Four electronic databases and reference lists of included and key articles were searched.

STUDY SELECTION

Studies comparing motor outcomes of 3- to 6-year-old children born VP (<32 weeks' gestation or birth weight <1500 g) with peers born FT were included.

DATA EXTRACTION

Two independent authors extracted data and completed quality assessments.

DATA SYNTHESIS

Thirty-six studies were included. Activity motor performance of children born VP was consistently poorer compared with peers born FT: standardized mean difference (SMD) was -0.71 (95% CI = -0.80 to -0.61; 14 studies, 2056 participants). Furthermore, children born VP had higher relative risk (RR) of motor impairment (RR = 3.39; 95% CI = 2.68 to 4.27; 9 studies, 3466 participants). Body structure and function outcomes were largely unable to be pooled because assessment tools varied too widely. However, children born VP had higher RR of any neurological dysfunction (Touwen Neurological Examination) (RR = 4.55; 95% CI = 1.20 to 17.17; 3 studies, 1363 participants). There were no participation outcome data.

LIMITATIONS

Limitations include the lack of consistent assessment tools used in VP follow-up at preschool age and the quality of the evidence.

CONCLUSIONS

Children born VP experience significant motor impairment across ICF-CY activity and body structure and function domains at preschool age compared with peers born FT. Evidence investigating participation in VP preschool-age populations relative to children born at term is sparse, requiring further research.

A gradient relationship between low birth weight and IQ: A meta-analysis

Multiple studies have reported that individuals with low birth weights (LBW, <2500 g) have a lower intelligence quotient (IQ) than those with normal birth weights (NBW, ≥2500 g). Based on 57 eligible individual studies including 12,137 participants, we performed a meta-analysis to estimate the association between low birth weight and individuals' IQ scores (IQs). The pooled weight mean difference (WMD) in IQs between NBW and LBW individuals was 10 (95% CI 9.26-11.68). The WMD was stable regardless of age. No publication bias was detected. The mean IQs of the extremely low birth weight (ELBW, <1000 g), very low birth weight (VLBW, 1000-1499 g), moderately low birth weight (MLBW, 1500-2499 g) and NBW individuals were 91, 94, 99 and 104, respectively. Additionally, the WMD in IQs with NBW were 14, 10 and 7 for ELBW, VLBW, and MLBW individuals, respectively. Two studies permitted estimates of the influence of social determinants of health to the discrepancy in IQs, which was 13%. Since IQ is inherited and influenced by environmental factors, parental IQs and other factors contribute to residual confounding of the results. As the conclusion was based on population studies, it may not be applicable to a single individual.

Functionality of children aged 5 to 7 years born prematurely

Abstract Introduction: Preterm birth is one of several risk factors that can compromise child growth and development. Objective: Evaluate the functionality of 5 to 7-year-old schoolchildren born prematurely and compare them to children born full-term. Methods: This was a cross-sectional study with 110 children divided into 2 groups (55 in the preterm group - PTG; 55 in the full-term group - FTG). Sociodemographic data were collected of the families and children and the families were economically classified according to the Brazilian Economic Classification Criteria - CCEB (Brazilian Association of Market Research Companies - ABEP) Functionality was assessed using the Pediatric Evaluation of Disability Inventory (PEDI). Results: With respect to the descriptive variables, significant differences were observed for gestational age (p < 0.001), birth weight (p < 0.001), complications during the perinatal period (p < 0.001), current diseases (p = 0.010) and schooling level of the child (p = 0.023). In regard to functionality, on the Caregiver Assistance scale, a significant difference was recorded for mobility (p = 0.009). Conclusion: The results of this study demonstrate that 5 to 7-year-old schoolchildren born prematurely showed no differences in functional skills when compared to full-term children. However, the caregivers of preterm children provide greater mobility assistance compared to those caring for full-term children.

Reviewing the use of corticosteroids in bronchopulmonary dysplasia

OBJECTIVE

Review the risks and benefits of postnatal corticosteroid use for the treatment of bronchopulmonary dysplasia, considering that there is not a more effective therapy.

DATA SOURCES

The literature review was carried out in the BIREME database, using the terms "bronchopulmonary dysplasia and corticosteroid" in the LILACS, IBECS, MEDLINE, Cochrane Library, and SciELO databases, selecting the most relevant articles on the subject, with emphasis on recent literature published in the last five years.

SUMMARY OF THE DATA

In preterm infants, bronchopulmonary dysplasia is still a common problem and remains without a specific therapy, despite knowledge of the several risk factors. The treatment essentially consists of supportive measures, but in the past, corticosteroids were widely used, as they are the only medications that have an impact on disease progression. However, the emergence of cerebral palsy associated with the indiscriminate use of corticosteroids has prevented the prescription of this drug in the last 15 years. Since then, no new measures have been taken, and the incidence of the disease tended to increase during this period, creating the need for a review of corticosteroid use and, possibly, more restricted indications.

CONCLUSIONS

The association between risks and benefits of corticosteroid use in preterm infants needs to be considered due to the fact that some infant subpopulations may show more benefits than risks, such as those using mechanical ventilation with difficult weaning.

O crescimento e desenvolvimento frente à prematuridade e baixo peso ao nascer

<p>Objetivo: Realizar um levantamento bibliográfico acerca do crescimento e desenvolvimento de prematuros e/ou com baixo peso ao nascer. Metodologia: Utilizaram-se as bases de dados LILACS, MEDLINE e ELO. Foram encontrados 64 trabalhos: 10 publicados em 2005, 10 em 2006, 12 em 2007, 16 em 2008, 8 em 2009 e 8 em 2010. As publicações situaram-se nas áreas da medicina (59,4%), nutrição (7,8%), enfermagem (7,8%), saúde coletiva (7,8%), psicologia (6,2%), epidemiologia (4,7%), fisiologia (3,1%) e fonoaudiologia (3,1%). Resultados: Os textos encontrados permitiram organizar o conhecimento produzido segundo as seguintes categorias de análise: Fatores associados ao baixo peso ao nascer/prematuridade. Repercussões do baixo peso ao nascer/prematuridade para o crescimento e desenvolvimento e medidas de prevenção e Sobrevida dos recém-nascidos prematuros e/ou de baixo peso. Conclusão: As crianças nascidas prematuramente e com baixo peso geralmente apresentam déficit de desenvolvimento. Um acompanhamento pós-natal focado no crescimento e desenvolvimento torna-se essencial.</p>