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Suonpera E, Gallagher K, Marlow N, Lanceley A. 'I don't want him to always be so far behind': Parental perceptions of child independence in the context of extreme prematurity; a qualitative study. J Child Health Care 2024:13674935241256545. [PMID: 38798176 DOI: 10.1177/13674935241256545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
This study addresses the paucity of research on parents of extremely preterm adolescents (born <27 weeks of gestation) and their experiences within the framework of parental determinism. We conducted semi-structured interviews with twenty-two mothers and one father. Data were analysed thematically, revealing three overarching themes and eight subthemes shaping parental accounts. These themes centred on parental ambitions for their children, their perceptions of their child's abilities, and the parenting behaviours employed to support parental aspirations. Parents' actions were influenced by their ambitions and the belief that they could impact their child's future independence. While some parents adopted 'trusting', non-intensive parenting behaviours, those anticipating challenges for their child's future independence resorted to intensive parenting practices. These findings align with the concept of parental determinism, emphasising the perceived causal link between present parental actions and future child outcomes. In the context of extreme prematurity, a nuanced understanding of parental perceptions regarding their child's future independence aligned with a delicate balance between hope and realistic aspiration is crucial for enhancing parental support and well-being.
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Affiliation(s)
- Emmi Suonpera
- UCL EGA Institute for Women's Health, University College London, London, UK
| | - Katie Gallagher
- UCL EGA Institute for Women's Health, University College London, London, UK
| | - Neil Marlow
- UCL EGA Institute for Women's Health, University College London, London, UK
| | - Anne Lanceley
- UCL EGA Institute for Women's Health, University College London, London, UK
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2
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Ataman-Devrim M, Quigley J, Nixon E. Preterm toddlers' joint attention characteristics during dyadic interactions with their mothers and fathers compared to full-term toddlers at age 2 years. Infant Behav Dev 2024; 74:101915. [PMID: 38159501 DOI: 10.1016/j.infbeh.2023.101915] [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: 05/19/2023] [Revised: 10/27/2023] [Accepted: 12/02/2023] [Indexed: 01/03/2024]
Abstract
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.
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Affiliation(s)
| | - Jean Quigley
- School of Psychology, Trinity College Dublin, Ireland
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Cheng TC, Lo CC. Factors Contributing to the Health of 0- to 5-Year-Old Low-Birth-Weight Children in the United States: Application of the Multiple Disadvantage Model. Eur J Investig Health Psychol Educ 2024; 14:203-214. [PMID: 38248133 PMCID: PMC10814834 DOI: 10.3390/ejihpe14010013] [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: 11/08/2023] [Revised: 01/02/2024] [Accepted: 01/05/2024] [Indexed: 01/23/2024] Open
Abstract
This secondary data analysis of 1731 low-birth-weight children and their parents in the United States investigated children's health and its associations with social disorganization, social structural factors, social relationships, health/mental health, and access to health insurance/services. The study drew on data from the 2021 National Survey of Children's Health. Logistic regression yielded results showing low-birth-weight children's excellent/very good/good health to be associated positively with parents' education and health. In turn, child health was associated negatively with being Black, having a family income at or below the 100% federal poverty level, difficulty parenting the child, child chronic health condition(s), parent mental health, and substance use in the family. The implications of the present findings in terms of interventions promoting maternal and child health as well as participation in government assistance programs for low-income families are discussed.
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Affiliation(s)
- Tyrone C. Cheng
- School of Social Work, University of Alabama, Little Hall, Tuscaloosa, AL 35401, USA
| | - Celia C. Lo
- Peraton, Defense Personnel and Security Research Center, Seaside, CA 93955, USA;
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Molloy MF, Yu EJ, Mattson WI, Hoskinson KR, Taylor HG, Osher DE, Nelson EE, Saygin ZM. Effect of Extremely Preterm Birth on Adolescent Brain Network Organization. Brain Connect 2023; 13:394-409. [PMID: 37312515 DOI: 10.1089/brain.2022.0077] [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: 06/15/2023] Open
Abstract
Introduction: Extremely preterm (EPT) birth, defined as birth at a gestational age (GA) <28 weeks, can have a lasting impact on cognition throughout the life span. Previous investigations reveal differences in brain structure and connectivity between infants born preterm and full-term (FT), but how does preterm birth impact the adolescent connectome? Methods: In this study, we investigate how EPT birth can alter broadscale network organization later in life by comparing resting-state functional magnetic resonance imaging connectome-based parcellations of the entire cortex in adolescents born EPT (N = 22) to age-matched adolescents born FT (GA ≥37 weeks, N = 28). We compare these parcellations to adult parcellations from previous studies and explore the relationship between an individual's network organization and behavior. Results: Primary (occipital and sensorimotor) and frontoparietal networks were observed in both groups. However, there existed notable differences in the limbic and insular networks. Surprisingly, the connectivity profile of the limbic network of EPT adolescents was more adultlike than the same network in FT adolescents. Finally, we found a relationship between adolescents' overall cognition score and their limbic network maturity. Discussion: Overall, preterm birth may contribute to the atypical development of broadscale network organization in adolescence and may partially explain the observed cognitive deficits.
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Affiliation(s)
- M Fiona Molloy
- Department of Psychology, The Ohio State University, Columbus, Ohio, USA
| | - Emily J Yu
- Department of Psychology, The Ohio State University, Columbus, Ohio, USA
| | - Whitney I Mattson
- Center for Biobehavioral Health, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Kristen R Hoskinson
- Center for Biobehavioral Health, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - H Gerry Taylor
- Center for Biobehavioral Health, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio, USA
- Department of Pediatrics, Ohio State University College of Medicine, Columbus, Ohio, USA
| | - David E Osher
- Department of Psychology, The Ohio State University, Columbus, Ohio, USA
| | - Eric E Nelson
- Center for Biobehavioral Health, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio, USA
- Department of Pediatrics, Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Zeynep M Saygin
- Department of Psychology, The Ohio State University, Columbus, Ohio, USA
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Fitzallen GC, Taylor HG, Liley HG, Bora S. Within- and between-twin comparisons of risk for childhood behavioral difficulties after preterm birth. Pediatr Res 2023:10.1038/s41390-023-02579-1. [PMID: 37041209 DOI: 10.1038/s41390-023-02579-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 01/27/2023] [Accepted: 02/17/2023] [Indexed: 04/13/2023]
Abstract
BACKGROUND Preterm birth and multiple gestation are independently associated with adverse neurodevelopmental outcomes. The objective of this study was to describe risks of screening positive for attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), and anxiety in preterm-born twin children by zygosity (monozygotic, dizygotic) and birth order (first-born, second-born). METHODS Caregivers of 349 preterm-born twin pairs (42% monozygotic) aged 3-18 years reported child behavioral outcomes on Strengths and Weaknesses of ADHD Symptoms and Normal Behavior; Social Responsiveness Scale, Second Edition; and Preschool Anxiety Scale or Screen for Child Anxiety and Related Emotional Disorders. RESULTS Concordance for behavioral outcomes in twin pairs ranged from 80.06 to 89.31% for ADHD, 61.01 to 84.23% for ASD, and 64.76 to 73.35% for anxiety. Monozygotic twins had a greater risk than dizygotic of screening positive for inattention (risk ratio = 2.91, 95% CI = 1.48-5.72) and social anxiety (1.79, 1.23-2.61). Relative to first-born, second-born twins had a greater risk of screening positive for hyperactivity/impulsivity (1.51, 1.06-2.16); overall ASD (2.38, 1.62-3.49); difficulties with social awareness (2.68, 1.94-3.71), social cognition (4.45, 3.06-6.46), and social communication (2.36, 1.56-3.57); restricted/repetitive behavior (1.91, 1.30-2.81); overall anxiety (1.34, 1.10-1.64); generalized anxiety (1.34, 1.11-1.60); and social anxiety (1.32, 1.06-1.64). CONCLUSION The current findings emphasize considering zygosity and birth order in preterm and multiple birth outcomes research, and highlight clinical implications for discharge planning, neurodevelopmental surveillance, and facilitating parenting and family support. IMPACT Zygosity and birth order are important determinants of behavioral and socioemotional outcomes in preterm-born twins. Among 349 preterm-born twin pairs aged 3-18 years (42% monozygotic), 61-89% demonstrated concordance for behavioral and socioemotional outcomes. Monozygosity had greater risks than dizygosity for positive screening of inattention and social anxiety. Second-born twins had greater risks than first-born for hyperactivity/impulsivity, social difficulties (awareness, cognition, communication), restricted/repetitive behavior, and anxiety (generalized, social). These findings have implications for discharge planning, neurodevelopmental surveillance, and facilitating parenting and family support.
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Affiliation(s)
- Grace C Fitzallen
- School of Psychological Sciences, College of Health and Medicine, University of Tasmania, Launceston, TAS, Australia
- School of Psychology, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, QLD, Australia
- Mater Research Institute, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - H Gerry Taylor
- Center for Biobehavioral Health, Abigail Wexner Research Institute at Nationwide Children's Hospital, and Department of Pediatrics, The Ohio State University, Columbus, OH, USA
| | - Helen G Liley
- Mater Research Institute, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Samudragupta Bora
- Mater Research Institute, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.
- Department of Pediatrics, University Hospitals Rainbow Babies & Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
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Taylor HG, Hoskinson KR, Vrantsidis DM, Minich NM, Busch T, Horn T, Mattson WI, Nelson EE. Quality of Social Relationships with Parents and Peers in Adolescents Born Extremely Preterm. J Dev Behav Pediatr 2023; 44:e218-e224. [PMID: 36943202 DOI: 10.1097/dbp.0000000000001165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 12/05/2022] [Indexed: 03/23/2023]
Abstract
OBJECTIVE Adolescents born extremely preterm (EPT, gestational age [GA] <28 weeks) are at higher risk for problems in peer socialization than those born full-term (FT, GA >36 weeks). This study was designed to examine the possibility that adolescents born EPT may also have difficulty in transitioning from parents to peers for socialization, a process referred to as "social reorienting." A secondary aim was to investigate associations of social reorienting with other neurodevelopmental characteristics. METHODS The Network of Relationships Inventory, Relationship Quality Version was administered to 24 adolescents (ages 11-16 years) born EPT and 29 born FT to obtain self-ratings of closeness and discord with parents and peers. Measures of other neurodevelopmental characteristics included tests of cognitive and social skills, adolescent self-ratings of adjustment and victimization, and parent ratings of youth behavior and adaptive skills. Mixed model analyses controlling for sex, socioeconomic status, and race were conducted to examine group differences in measures of relationship quality and their associations with other neurodevelopmental characteristics. RESULTS The EPT group had higher ratings of closeness with parents than the FT group. For adolescents from lower socioeconomic backgrounds, those born EPT had lower closeness with peers. Higher closeness with parents was associated with lower test scores. Lower closeness and more discord with peers were associated with more behavior problems. CONCLUSION Findings suggest that adolescents born EPT have difficulties in social reorientation toward peers and identify factors related to these difficulties. Results imply a need for interventions to improve peer socialization in youth born EPT.
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Affiliation(s)
- H Gerry Taylor
- Center for Biobehavioral Health, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH
- Department of Pediatrics, The Ohio State University, Columbus, OH
| | - Kristen R Hoskinson
- Center for Biobehavioral Health, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH
- Department of Pediatrics, The Ohio State University, Columbus, OH
| | - Daphne M Vrantsidis
- Center for Biobehavioral Health, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH
- Department of Pediatrics, The Ohio State University, Columbus, OH
| | | | - Tyler Busch
- Department of Pediatrics, Case Western Reserve University, Cleveland, OH
| | - Timothy Horn
- Center for Biobehavioral Health, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH
| | - Whitney I Mattson
- Center for Biobehavioral Health, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH
| | - Eric E Nelson
- Center for Biobehavioral Health, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH
- Department of Pediatrics, The Ohio State University, Columbus, OH
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Dell'Aversana V, Tofani M, Valente D. Emotional Regulation Interventions on Developmental Course for Preterm Children: A Systematic Review of Randomized Control Trials. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10030603. [PMID: 36980161 PMCID: PMC10047217 DOI: 10.3390/children10030603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/14/2023] [Accepted: 03/20/2023] [Indexed: 03/30/2023]
Abstract
Children born preterm (<37 weeks of gestation) are at increased risk of socio-emotional difficulties. This study aims to determine the effects of rehabilitation intervention on the emotional regulation of children born preterm through a systematic review. We conducted a systematic review according to PRISMA guidelines. The literature screening was carried out on PUBMED, SCOPUS and WEB OF SCIENCE in August 2022. An author identified eligible studies based on predefined inclusion criteria and extracted the data. RCT quality was assessed using the JADAD and PEDro scales. We selected five RCTs for qualitative synthesis, having the common objective of evaluating the changes in emotional regulation after a rehabilitation intervention. Evidence of benefits was found after parent training intervention (PCIT; p < 0.05). Moreover, there was an improvement in day-to-day executive life and fewer behavioral problems after mindfulness intervention. Clinical, but not statistical, efficacy was found for the group-based physiotherapy intervention. In conclusion, parent training and mindfulness interventions can be helpful rehabilitation techniques, but the relatively small sample limited statistical power, so the discovery needs to be interpreted cautiously. Further research on these aspects is recommended.
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Affiliation(s)
- Vincenza Dell'Aversana
- MSc in Rehabilitaiton Sciences for Healthcare Professions, Sapienza University of Rome, 00185 Rome, Italy
| | - Marco Tofani
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy
| | - Donatella Valente
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy
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8
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Ittyerah M. Handedness in low-birthweight children: Insights in lateralization. Front Psychol 2023; 13:1018913. [PMID: 36710785 PMCID: PMC9874154 DOI: 10.3389/fpsyg.2022.1018913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 12/15/2022] [Indexed: 01/13/2023] Open
Abstract
Low-birthweight (LBW) children (n = 96) weighing less than 2.5 kg at birth and normal birthweight (NBW) children (n = 96) from Delhi, India, between the ages of 5 and 12 years were assessed for intelligence with Ravens Colored Progressive Matrices (RCPM), their handedness and hand proficiency for unimanual and bimanual performance. The objective was to know if there is a relation between birthweight and the development of handedness. Compared with NBW children, the LBW group had lower percentile scores for the RCPM. The LBW children were less lateralized than the NBW children in the hand preference test. The LBW children were faster than the NBW for sorting objects with each hand separately, but they were slower in the bimanual envelope task. This indicates a delay in interhemispheric transfer and the development of the corpus callosum that connects the cerebral hemispheres to enable bimanual coordination. In the absence of more direct evidence, hand skill was used as an index of the extent of lateralized control for performance. Findings indicate a relation between birthweight and lateralization in children tested for hand preference.
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Siffredi V, Liverani MC, Freitas LGA, Tadros D, Farouj Y, Borradori Tolsa C, Van De Ville D, Hüppi PS, Ha-Vinh Leuchter R. Large-scale brain network dynamics in very preterm children and relationship with socio-emotional outcomes: an exploratory study. Pediatr Res 2022:10.1038/s41390-022-02342-y. [PMID: 36329223 DOI: 10.1038/s41390-022-02342-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 08/30/2022] [Accepted: 09/24/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Children born very preterm (VPT; <32 weeks' gestation) are at high risk of neurodevelopmental and behavioural difficulties associated with atypical brain maturation, including socio-emotional difficulties. The analysis of large-scale brain network dynamics during rest allows us to investigate brain functional connectivity and its association with behavioural outcomes. METHODS Dynamic functional connectivity was extracted by using the innovation-driven co-activation patterns framework in VPT and full-term children aged 6-9 to explore changes in spatial organisation, laterality and temporal dynamics of spontaneous large-scale brain activity (VPT, n = 28; full-term, n = 12). Multivariate analysis was used to explore potential biomarkers for socio-emotional difficulties in VPT children. RESULTS The spatial organisation of the 13 retrieved functional networks was comparable across groups. Dynamic features and lateralisation of network brain activity were also comparable for all brain networks. Multivariate analysis unveiled group differences in associations between dynamical functional connectivity parameters with socio-emotional abilities. CONCLUSION In this exploratory study, the group differences observed might reflect reduced degrees of maturation of functional architecture in the VPT group in regard to socio-emotional abilities. Dynamic features of functional connectivity could represent relevant neuroimaging markers and inform on potential mechanisms through which preterm birth leads to neurodevelopmental and behavioural disorders. IMPACT Spatial organisation of the retrieved resting-state networks was comparable between school-aged very preterm and full-term children. Dynamic features and lateralisation of network brain activity were also comparable across groups. Multivariate pattern analysis revealed different patterns of association between dynamical functional connectivity parameters and socio-emotional abilities in the very preterm and full-term groups. Findings suggest a reduced degree of maturation of the functional architecture in the very preterm group in association with socio-emotional abilities.
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Affiliation(s)
- Vanessa Siffredi
- Division of Development and Growth, Department of Paediatrics, Gynaecology and Obstetrics, Geneva University Hospitals, Geneva, Switzerland. .,Institute of Bioengineering, Center for Neuroprosthetics, Ecole Polytechnique Fédérale de Lausanne, Écublens, Switzerland. .,Department of Radiology and Medical Informatics, Faculty of Medicine, University of Geneva, Geneva, Switzerland.
| | - Maria Chiara Liverani
- Division of Development and Growth, Department of Paediatrics, Gynaecology and Obstetrics, Geneva University Hospitals, Geneva, Switzerland.,SensoriMotor, Affective and Social Development Laboratory, Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland
| | - Lorena G A Freitas
- Division of Development and Growth, Department of Paediatrics, Gynaecology and Obstetrics, Geneva University Hospitals, Geneva, Switzerland.,Institute of Bioengineering, Center for Neuroprosthetics, Ecole Polytechnique Fédérale de Lausanne, Écublens, Switzerland.,Department of Radiology and Medical Informatics, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - D Tadros
- Division of Development and Growth, Department of Paediatrics, Gynaecology and Obstetrics, Geneva University Hospitals, Geneva, Switzerland.,Institute of Bioengineering, Center for Neuroprosthetics, Ecole Polytechnique Fédérale de Lausanne, Écublens, Switzerland.,Department of Radiology and Medical Informatics, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Y Farouj
- Institute of Bioengineering, Center for Neuroprosthetics, Ecole Polytechnique Fédérale de Lausanne, Écublens, Switzerland.,Department of Radiology and Medical Informatics, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Cristina Borradori Tolsa
- Division of Development and Growth, Department of Paediatrics, Gynaecology and Obstetrics, Geneva University Hospitals, Geneva, Switzerland
| | - Dimitri Van De Ville
- Division of Development and Growth, Department of Paediatrics, Gynaecology and Obstetrics, Geneva University Hospitals, Geneva, Switzerland.,Institute of Bioengineering, Center for Neuroprosthetics, Ecole Polytechnique Fédérale de Lausanne, Écublens, Switzerland.,Department of Radiology and Medical Informatics, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Petra Susan Hüppi
- Division of Development and Growth, Department of Paediatrics, Gynaecology and Obstetrics, Geneva University Hospitals, Geneva, Switzerland
| | - Russia Ha-Vinh Leuchter
- Division of Development and Growth, Department of Paediatrics, Gynaecology and Obstetrics, Geneva University Hospitals, Geneva, Switzerland
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Stedall PM, Spencer-Smith MM, Mainzer RM, Treyvaud K, Burnett AC, Doyle LW, Spittle AJ, Anderson PJ. Thirteen-Year Outcomes of a Randomized Clinical Trial of Early Preventive Care for Very Preterm Infants and Their Parents. J Pediatr 2022; 246:80-88.e4. [PMID: 35304169 DOI: 10.1016/j.jpeds.2022.03.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 02/22/2022] [Accepted: 03/09/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To evaluate 13-year outcomes of a randomized controlled trial of preventive care (VIBeS Plus) for infants born very preterm and their parents and examine whether possible effects of intervention varied by family social risk. STUDY DESIGN Families were randomized to an intervention arm (n = 61) or a standard care arm (n = 59). The intervention was delivered at home by psychologists and physiotherapists over the infants' first year, focusing on infant development and parental mental health. At 13 years corrected age, cognitive, motor, and behavioral outcomes, and parental mental health were assessed. Primary estimands were between-group mean differences, estimated using multiple imputed regression models. RESULTS Follow-up included 81 surviving children (69%). There was little evidence of benefits of the intervention for IQ, attention, executive functioning, working memory, and academic skills regardless of level of social risk. Specifically, mean differences in adolescent cognitive outcomes ranged from -2.0 units (95% CI, -9.9 to 5.9) in favor of standard treatment to 5.1 units (95% CI, -2.3 to 12.5) favoring the intervention. A group-by-social risk interaction was observed only for adolescent motor outcomes, with mean differences favoring the intervention for those at higher social risk (balance, 4.9; 95% CI, 1.3-8.5; total motor, 3.2; 95% CI, 0.3-6.2), but not those at lower social risk (balance, -0.3; 95% CI, -2.4 to 1.9; total motor, 0.03; 95% CI, -1.9 to 2.0). Mean differences in adolescent behavior and parental mental health ranged from -6.6 (95% CI -13.8, 0.5) to -0.2 (95% CI, -1.9 to 1.4) and -1.8 (95% CI, -4.1 to 0.6) to -1.7 (95% CI, -4.3 to 1.0), respectively, indicating a pattern of fewer symptoms in the intervention group. CONCLUSIONS Benefits of the intervention persisted for adolescent behavior, with better motor outcomes observed in those from socially disadvantaged families. Replication with larger samples, multiple informant reports, and assessment of quality of life-related outcomes is warranted. TRIAL REGISTRATION http://www.anzctr.org.au/: ACTRN12605000492651.
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Affiliation(s)
- Paulina M Stedall
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia; Department of Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
| | - Megan M Spencer-Smith
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia; Department of Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
| | - Rheanna M Mainzer
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Melbourne, Australia
| | - Karli Treyvaud
- Department of Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia; Department of Psychology and Counselling, La Trobe University, Melbourne, Australia
| | - Alice C Burnett
- Department of Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia; Premature Infant Follow-up Program, Royal Women's Hospital, Parkville, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; Neonatal Medicine, Royal Children's Hospital, Parkville, Australia
| | - Lex W Doyle
- Department of Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia; Premature Infant Follow-up Program, Royal Women's Hospital, Parkville, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; Department of Obstetrics and Gynaecology, Royal Women's Hospital, Parkville, Australia
| | - Alicia J Spittle
- Department of Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia; Newborn Research, Royal Women's Hospital, Parkville, Australia; Department of Physiotherapy, University of Melbourne, Melbourne, Australia
| | - Peter J Anderson
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia; Department of Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia.
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11
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Grannis C, Hung A, French RC, Mattson WI, Fu X, Hoskinson KR, Gerry Taylor H, Nelson EE. Multimodal classification of extremely preterm and term adolescents using the fusiform gyrus: A machine learning approach. Neuroimage Clin 2022; 35:103078. [PMID: 35687994 PMCID: PMC9189188 DOI: 10.1016/j.nicl.2022.103078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 06/02/2022] [Accepted: 06/03/2022] [Indexed: 10/31/2022]
Abstract
OBJECTIVE Extremely preterm birth has been associated with atypical visual and neural processing of faces, as well as differences in gray matter structure in visual processing areas relative to full-term peers. In particular, the right fusiform gyrus, a core visual area involved in face processing, has been shown to have structural and functional differences between preterm and full-term individuals from childhood through early adulthood. The current study used multiple neuroimaging modalities to build a machine learning model based on the right fusiform gyrus to classify extremely preterm birth status. METHOD Extremely preterm adolescents (n = 20) and full-term peers (n = 24) underwent structural and functional magnetic resonance imaging. Group differences in gray matter density, measured via voxel-based morphometry (VBM), and blood-oxygen level-dependent (BOLD) response to face stimuli were explored within the right fusiform. Using group difference clusters as seed regions, analyses investigating outgoing white matter streamlines, regional homogeneity, and functional connectivity during a face processing task and at rest were conducted. A data driven approach was utilized to determine the most discriminative combination of these features within a linear support vector machine classifier. RESULTS Group differences in two partially overlapping clusters emerged: one from the VBM analysis showing less density in the extremely preterm cohort and one from BOLD response to faces showing greater activation in the extremely preterm relative to full-term youth. A classifier fit to the data from the cluster identified in the BOLD analysis achieved an accuracy score of 88.64% when BOLD, gray matter density, regional homogeneity, and functional connectivity during the task and at rest were included. A classifier fit to the data from the cluster identified in the VBM analysis achieved an accuracy score of 95.45% when only BOLD, gray matter density, and regional homogeneity were included. CONCLUSION Consistent with previous findings, we observed neural differences in extremely preterm youth in an area that plays an important role in face processing. Multimodal analyses revealed differences in structure, function, and connectivity that, when taken together, accurately distinguish extremely preterm from full-term born youth. Our findings suggest a compensatory role of the fusiform where less dense gray matter is countered by increased local BOLD signal. Importantly, sub-threshold differences in many modalities within the same region were informative when distinguishing between extremely preterm and full-term youth.
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Affiliation(s)
- Connor Grannis
- Center for Biobehavioral Health, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, United States.
| | - Andy Hung
- Center for Biobehavioral Health, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, United States
| | - Roberto C French
- Center for Biobehavioral Health, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, United States
| | - Whitney I Mattson
- Center for Biobehavioral Health, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, United States
| | - Xiaoxue Fu
- College of Education, University of South Carolina, Columbia, SC, United States
| | - Kristen R Hoskinson
- Center for Biobehavioral Health, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, United States; Department of Pediatrics, Ohio State University Wexner College of Medicine, Columbus, OH, United States
| | - H Gerry Taylor
- Center for Biobehavioral Health, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, United States; Department of Pediatrics, Ohio State University Wexner College of Medicine, Columbus, OH, United States
| | - Eric E Nelson
- Center for Biobehavioral Health, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, United States; Department of Pediatrics, Ohio State University Wexner College of Medicine, Columbus, OH, United States
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12
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Fu X, Hung A, de Silva AD, Busch T, Mattson WI, Hoskinson KR, Taylor HG, Nelson EE. Development of the mentalizing network structures and theory of mind in extremely preterm youth. Soc Cogn Affect Neurosci 2022; 17:977-985. [PMID: 35428893 PMCID: PMC9629469 DOI: 10.1093/scan/nsac027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 03/10/2022] [Accepted: 04/15/2022] [Indexed: 01/12/2023] Open
Abstract
Adolescents born preterm (<37 weeks of gestation) are at elevated risk for deficits in social cognition and peer relationships. Theory of Mind (ToM) is a complex form of social cognition important for regulating social interactions. ToM and the underlying mentalizing network continue to develop across adolescence. The present study recruited 48 adolescents (12-17 years old) who were either born extremely preterm (EPT; <28 weeks of gestation) or full-term (FT) at birth. Cortical thickness, gray matter volume and surface area were measured in four regions of the mentalizing network: the temporoparietal junction, anterior temporal cortex, posterior superior temporal sulcus and frontal pole (mBA10). We also assessed the adolescents' performance on a ToM task. Findings revealed both group differences and group-by-age interaction effects in the gray matter indices within the temporal lobe regions of the mentalizing network. The EPT group also performed significantly worse than the FT group on the ToM task. The cortical structural measures that discriminated the EPT and FT groups were not related to ToM performance. These results highlight altered developmental changes in brain regions underlying mentalizing functions in EPT adolescents relative to FT controls.
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Affiliation(s)
- Xiaoxue Fu
- Correspondence should be addressed to Xiaoxue Fu, Department of Psychology, University of South Carolina, 129 Institute for Mind and Brain, 1800 Gervais Street, Columbia, SC 29201, USA. E-mail:
| | - Andy Hung
- Center for Biobehavioral Health, Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus, OH 43205, USA
| | - Aryanne D de Silva
- Center for Biobehavioral Health, Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus, OH 43205, USA
| | - Tyler Busch
- Center for Biobehavioral Health, Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus, OH 43205, USA
| | - Whitney I Mattson
- Center for Biobehavioral Health, Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus, OH 43205, USA
| | - Kristen R Hoskinson
- Center for Biobehavioral Health, Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus, OH 43205, USA,Department of Pediatrics, Ohio State University College of Medicine, Columbus, OH 43210, USA
| | - Hudson Gerry Taylor
- Center for Biobehavioral Health, Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus, OH 43205, USA,Department of Pediatrics, Ohio State University College of Medicine, Columbus, OH 43210, USA
| | - Eric E Nelson
- Center for Biobehavioral Health, Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus, OH 43205, USA,Department of Pediatrics, Ohio State University College of Medicine, Columbus, OH 43210, USA
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Taylor HG, Vrantsidis DM, Neel ML, Benkart R, Busch TA, de Silva A, Udaipuria S, Maitre NL. School Readiness in 4-Year-Old Very Preterm Children. CHILDREN 2022; 9:children9030323. [PMID: 35327695 PMCID: PMC8947581 DOI: 10.3390/children9030323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 02/10/2022] [Accepted: 02/21/2022] [Indexed: 11/22/2022]
Abstract
The aims of this study were to identify the aspects of school readiness that best distinguish very preterm (VPT) preschoolers from full-term (FT) controls, determine the extent to which readiness problems in the VPT group reflected global cognitive weaknesses or more specific deficits, and identify distinct profiles of readiness problems. Fifty-three VPT (gestational age ≤ 30 weeks) 4-year-olds were compared to 38 FT (gestational age ≥ 37 weeks) controls on measures of global cognitive ability, executive function, motor skills, early literacy and numeracy, and psychosocial functioning. Latent class analysis (LCA) was also conducted to identify individual readiness profiles. The VPT group had the most pronounced difficulties on tests of spatial and nonverbal cognitive abilities, executive function, motor skills, phonological processing, and numeracy. The VPT group also had sex-related difficulties in processing speed, social functioning, and emotion regulation. These differences were evident in analyses of both continuous scores and rates of deficits. The VPT group’s difficulties in motor skills, and VPT females’ difficulties in social functioning and emotion regulation, were evident even when controlling for global cognitive ability. LCA suggested four profiles of readiness, with the majority of the VPT group assigned to profiles characterized by relative weaknesses in either cognitive abilities or psychosocial functioning or by more global readiness problems. The findings support the need to evaluate multiple aspects of school readiness in VPT preschoolers and inform efforts to design more targeted early educational interventions.
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Affiliation(s)
- H. Gerry Taylor
- Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus, OH 43215, USA; (D.M.V.); (M.L.N.); (R.B.); (T.A.B.); (A.d.S.)
- Department of Pediatrics, The Ohio State University, Columbus, OH 43210, USA
- Correspondence: ; Tel.: +1-614-722-3184
| | - Daphne M. Vrantsidis
- Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus, OH 43215, USA; (D.M.V.); (M.L.N.); (R.B.); (T.A.B.); (A.d.S.)
| | - Mary Lauren Neel
- Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus, OH 43215, USA; (D.M.V.); (M.L.N.); (R.B.); (T.A.B.); (A.d.S.)
- Department of Pediatrics, The Ohio State University, Columbus, OH 43210, USA
| | - Rebekah Benkart
- Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus, OH 43215, USA; (D.M.V.); (M.L.N.); (R.B.); (T.A.B.); (A.d.S.)
| | - Tyler A. Busch
- Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus, OH 43215, USA; (D.M.V.); (M.L.N.); (R.B.); (T.A.B.); (A.d.S.)
| | - Aryanne de Silva
- Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus, OH 43215, USA; (D.M.V.); (M.L.N.); (R.B.); (T.A.B.); (A.d.S.)
- Department of Pediatrics, The Ohio State University, Columbus, OH 43210, USA
| | - Shivika Udaipuria
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA;
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Bindt C. [Preterm birth: a risk for mental health?]. PSYCHOTHERAPEUT 2021; 67:28-33. [PMID: 34744317 PMCID: PMC8557705 DOI: 10.1007/s00278-021-00552-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/06/2021] [Indexed: 10/30/2022]
Abstract
One in 12 children is born before 37 completed weeks of gestation and during the last decades survival rates and developmental outcomes of even very premature children have significantly improved. As a result, mental health sequelae of preterm birth are more frequently addressed. The manifestation of a distinct psychopathological profile with co-occurrence of symptoms associated with attention deficit/hyperactivity, autism spectrum and anxiety disorders has been recognized and discussed as "preterm behavioral phenotype", mainly affecting high-risk children with very low birth weights. Current research findings on parental psychological distress and early childhood developmental conditions after preterm birth indicate contextual factors that are of relevance, also for clinicians in psychotherapeutic practice.
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Affiliation(s)
- Carola Bindt
- Klinik für Kinder- und Jugendpsychiatrie, -psychotherapie und -psychosomatik, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, W 35, 20246 Hamburg, Deutschland
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15
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Aho L, Metsäranta M, Lönnberg P, Wolford E, Lano A. Newborn Neurobehavior Is Related to Later Neurodevelopment and Social Cognition Skills in Extremely Preterm-Born Children: A Prospective Longitudinal Cohort Study. Front Psychol 2021; 12:710430. [PMID: 34552532 PMCID: PMC8450593 DOI: 10.3389/fpsyg.2021.710430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 08/09/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: The aim of this study was to evaluate the ability of the neonatal neurobehavioral characteristics to act as an indicator for later neurodevelopment and neurocognitive performance. Methods: Sixty-six infants born extremely preterm (<28 gestational weeks) were followed until 6.5 years. Neurobehavior at term age was assessed by the behavior subscale of the Hammersmith Neonatal Neurological Examination (HNNE) using dichotomic rating, optimal, and non-optimal. The Griffiths Mental Developmental Scales (GMDS) at 2 years, and the Wechsler Intelligence Scales at 6.5 years, and a Neuropsychological Assessment at 6.5 years were used to assess neurodevelopment and neurocognitive performance including social cognition skills. Results: An optimal auditory orientation at term age was associated with better developmental quotients (DQ) in Personal–Social, and Hearing–Language GMDS subscale at 2 years (p < 0.05). An optimal visual alertness was associated with better Total (p < 0.01), Locomotor (p < 0.001), and Eye–Hand Coordination (p < 0.01) DQs at 2 years, and with sensorimotor function (p < 0.001) and social perception (p < 0.01) tests at 6.5 years. Conclusion: The neurobehavioral characteristics of newborns might serve as a precursor of social cognition skills and the HNNE behavior subscale offers a tool to identify infants at risk for later deficits in neurodevelopment and social cognition.
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Affiliation(s)
- Leena Aho
- Department of Paediatrics, Children's Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Marjo Metsäranta
- Department of Paediatrics, Children's Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Piia Lönnberg
- Department of Paediatrics, Children's Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Elina Wolford
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
| | - Aulikki Lano
- Department of Paediatrics, Children's Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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F. Kaul Y, Johansson M, Månsson J, Stjernqvist K, Farooqi A, Serenius F, B. Thorell L. Cognitive profiles of extremely preterm children: Full-Scale IQ hides strengths and weaknesses. Acta Paediatr 2021; 110:1817-1826. [PMID: 33486812 DOI: 10.1111/apa.15776] [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] [Received: 11/06/2020] [Revised: 12/22/2020] [Accepted: 01/21/2021] [Indexed: 12/21/2022]
Abstract
AIM To study whether a specific cognitive profile can be identified for children born extremely preterm (EPT) by investigating: 1) strengths and weaknesses not revealed by Full-Scale IQ, 2) overlap between different cognitive deficits and 3) proportion of EPT children with multiple deficits. METHODS We analysed data from the 4th version of Wechsler Intelligence Scales for Children in EPT children (n = 359) and matched controls (n = 367), collected within the 6.5-year follow-up of a population-based prospective cohort study. RESULTS Extremely preterm children performed worse than controls on all measures. Group differences were the largest in Perceptual Reasoning (PRI) and Working Memory (WMI), but differences between indices were small. However, when conducting categorical analyses, deficits in PRI and/or WMI were not more common than other combinations. Many EPT children had no or mild cognitive deficits, although often in multiple domains. CONCLUSION Extremely preterm children had greater weaknesses in working memory and perceptual abilities. However, detailed analyses of cognitive subscales showed large heterogeneity and provided no support for a specific cognitive profile. In conclusion, Full-Scale IQ scores hide strengths and weaknesses and individual profiles for EPT children need to be considered in order to provide appropriate support.
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Affiliation(s)
- Ylva F. Kaul
- Department of Women's and Children's Health Uppsala University Uppsala Sweden
| | - Martin Johansson
- Department of Women's and Children's Health Uppsala University Uppsala Sweden
| | - Johanna Månsson
- Department of Clinical Sciences, Pediatric Section Lund University Lund Sweden
- Department of Neonatal care and Pediatric Surgery Skåne University Hospital Lund Sweden
| | - Karin Stjernqvist
- Department of Clinical Sciences, Pediatric Section Lund University Lund Sweden
- Department of Neonatal care and Pediatric Surgery Skåne University Hospital Lund Sweden
| | - Aijaz Farooqi
- Department of Pediatrics Umeå University Umeå Sweden
| | - Fredrik Serenius
- Department of Women's and Children's Health Uppsala University Uppsala Sweden
- Department of Pediatrics Umeå University Umeå Sweden
| | - Lisa B. Thorell
- Department of Clinical Neuroscience Karolinska Institutet Stockholm Sweden
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Scher MS. "The First Thousand Days" Define a Fetal/Neonatal Neurology Program. Front Pediatr 2021; 9:683138. [PMID: 34408995 PMCID: PMC8365757 DOI: 10.3389/fped.2021.683138] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 05/27/2021] [Indexed: 01/11/2023] Open
Abstract
Gene-environment interactions begin at conception to influence maternal/placental/fetal triads, neonates, and children with short- and long-term effects on brain development. Life-long developmental neuroplasticity more likely results during critical/sensitive periods of brain maturation over these first 1,000 days. A fetal/neonatal program (FNNP) applying this perspective better identifies trimester-specific mechanisms affecting the maternal/placental/fetal (MPF) triad, expressed as brain malformations and destructive lesions. Maladaptive MPF triad interactions impair progenitor neuronal/glial populations within transient embryonic/fetal brain structures by processes such as maternal immune activation. Destructive fetal brain lesions later in pregnancy result from ischemic placental syndromes associated with the great obstetrical syndromes. Trimester-specific MPF triad diseases may negatively impact labor and delivery outcomes. Neonatal neurocritical care addresses the symptomatic minority who express the great neonatal neurological syndromes: encephalopathy, seizures, stroke, and encephalopathy of prematurity. The asymptomatic majority present with neurologic disorders before 2 years of age without prior detection. The developmental principle of ontogenetic adaptation helps guide the diagnostic process during the first 1,000 days to identify more phenotypes using systems-biology analyses. This strategy will foster innovative interdisciplinary diagnostic/therapeutic pathways, educational curricula, and research agenda among multiple FNNP. Effective early-life diagnostic/therapeutic programs will help reduce neurologic disease burden across the lifespan and successive generations.
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Affiliation(s)
- Mark S Scher
- Division of Pediatric Neurology, Department of Pediatrics, Fetal/Neonatal Neurology Program, Emeritus Scholar Tenured Full Professor in Pediatrics and Neurology, Case Western Reserve University School of Medicine, Cleveland, OH, United States
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18
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Marlow N, Johnson S. Introduction. Semin Fetal Neonatal Med 2020; 25:101124. [PMID: 32534907 DOI: 10.1016/j.siny.2020.101124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Neil Marlow
- Institute for Women's Health, University College London, London, WC1E 6AU, UK.
| | - Samantha Johnson
- Department of Health Sciences, George Davis Centre, University of Leicester, Leicester, LE1 7RH, UK
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