Outcome studies of low birth weight infants published in the last decade: a metaanalysis

Adenomyosis among patients undergoing postpartum hysterectomy for uncontrollable uterine bleeding: A multicenter, observational, retrospective, cohort study on histologically-based prevalence and clinical characteristics

OBJECTIVE

To assess the prevalence of adenomyosis at pathologic examination, and its association with obstetric complications, peripartum maternal clinical characteristics and neonatal birth weight in patients undergoing postpartum hysterectomy due to postpartum hemorrhage (PPH).

METHODS

A multicenter, observational, retrospective, cohort study was carried out including all women who underwent postpartum hysterectomy due to PPH at gestational week 23+0 or later, between January 2010 and May 2023. Patients were categorized into two groups based on the presence of adenomyosis at pathologic examination, and were compared for obstetric complications, peripartum maternal clinical characteristics, and neonatal birth weight.

RESULTS

The histologically-based prevalence of adenomyosis in patients undergoing postpartum hysterectomy due to PPH was 39.4%. Adenomyosis was associated with a longer hospitalization time (regression coefficient: 4.43 days, 95% CI: 0.34-8.52, P = 0.034) and a higher risk of hypertensive disorders (OR: 5.82, 95% CI: 1.38-24.46, P = 0.016), threatened preterm labor (OR: 3.34, 95% CI: 1.08-10.31, P = 0.036), urgent/emergency C-section (OR: 24.15, 95% CI: 2.60-223.96, P = 0.005), postpartum maternal complications (OR: 4.96, 95% CI: 1.48-16.67, P = 0.012), maternal intensive care unit admission (OR: 3.56, 95% CI: 1.05-12.05, P = 0.041), and low birth weight neonates (OR: 3.8, 95% CI: 1.32-11.02, P = 0.013).

CONCLUSION

In patients undergoing postpartum hysterectomy due to PPH, adenomyosis is a highly prevalent condition among, and is associated with adverse obstetric, maternal, and neonatal outcomes.

Effects of size at birth on health, growth and developmental outcomes in children up to age 18: an umbrella review

BACKGROUND

Size at birth, an indicator of intrauterine growth, has been studied extensively in relation to subsequent health, growth and developmental outcomes. Our umbrella review synthesises evidence from systematic reviews and meta-analyses on the effects of size at birth on subsequent health, growth and development in children and adolescents up to age 18, and identifies gaps.

METHODS

We searched five databases from inception to mid-July 2021 to identify eligible systematic reviews and meta-analyses. For each meta-analysis, we extracted data on the exposures and outcomes measured and the strength of the association.

FINDINGS

We screened 16 641 articles and identified 302 systematic reviews. The literature operationalised size at birth (birth weight and/or gestation) in 12 ways. There were 1041 meta-analyses of associations between size at birth and 67 outcomes. Thirteen outcomes had no meta-analysis.Small size at birth was examined for 50 outcomes and was associated with over half of these (32 of 50); continuous/post-term/large size at birth was examined for 35 outcomes and was consistently associated with 11 of the 35 outcomes. Seventy-three meta-analyses (in 11 reviews) compared risks by size for gestational age (GA), stratified by preterm and term. Prematurity mechanisms were the key aetiologies linked to mortality and cognitive development, while intrauterine growth restriction (IUGR), manifesting as small for GA, was primarily linked to underweight and stunting.

INTERPRETATION

Future reviews should use methodologically sound comparators to further understand aetiological mechanisms linking IUGR and prematurity to subsequent outcomes. Future research should focus on understudied exposures (large size at birth and size at birth stratified by gestation), gaps in outcomes (specifically those without reviews or meta-analysis and stratified by age group of children) and neglected populations.

PROSPERO REGISTRATION NUMBER

CRD42021268843.

Over-reaching with causality language in neurodevelopmental infant research: A methodological literature review

BACKGROUND

A methodological review of 78 empirical articles focusing on the neurodevelopmental outcomes of at-risk infants was conducted.

AIMS

To examine ways language and terminology are used to describe methods, present results, and/or state conclusions in studies published during 1994-2005, a decade reflecting major advances in neurodevelopmental research and in medical intervention. More specifically, to investigate to what extent the design of the study and the language in the results section aligned in regard to causality.

METHODS

A process of search and selection of studies published in pediatric journals was conducted through Google Scholar. Criteria of inclusion and exclusion, following PRISMA, were used. Selected studies reported neurodevelopmental outcomes of infants and young children considered at-risk, and were further categorized accordingly to their study designs. Language use in regard to whether the presentation and interpretation of results may convey causal relationships between birth risk factors and neurodevelopmental outcomes was examined following two analytical steps.

RESULTS

Forty out of 78 studies, (51.28 %) used causality-implying language (e.g., effect, predict, influence) notwithstanding that the study design was non-causal.

CONCLUSIONS

Anticipating the next generation of neurodevelopmental-outcomes research, a framework that aims to raise awareness of the importance of language use and the impact of causality-related terms often used in longitudinal studies is proposed. The objective is to avoid ambiguities and misunderstandings around causal or non-causal connections between birth risk factors and developmental outcomes across diverse audiences, including early intervention practitioners working directly with infants and their families.

Testing a cascade model linking prenatal inflammation to child executive function

Inflammation during pregnancy is beginning to be understood as a risk factor predicting poor infant health and neurodevelopmental outcomes. The long-term sequelae associated with exposure to prenatal inflammation are less well established. The current study examined associations between maternal inflammation during pregnancy, markers of infant neurodevelopment (general cognitive ability, negative affect, and sleep quality), and preschool executive function (EF) in a longitudinal sample of 40 African American mother-infant dyads. Mothers completed a blood draw in the third trimester of pregnancy to measure plasma levels of C-reactive protein (CRP) and pro-inflammatory cytokines (e.g., interleukin 6 [IL-6], tumor necrosis factor-alpha [TNF-α]). When infants were 6 months of age, we assessed general cognitive ability via the Bayley-III, negative affect via the Still-Face Paradigm, and sleep quality via actigraphy monitoring. When children were 4 years of age, we assessed their EF ability using four tasks from the EF Touch battery. Elevated levels of maternal CRP, IL-6, and TNF-α were associated with poorer infant general cognitive ability. Although there were no direct effects of prenatal inflammation on preschool EF, we observed an indirect relationship between IL-6 and preschool EF ability via infant general cognitive ability. Our findings suggest that prenatal inflammation may have long-lasting, cascading implications for child neurodevelopment. Implications of these findings for health disparities in women and children of color are discussed.

Effect of Childhood Developmental Coordination Disorder on Adulthood Physical Activity; Arvo Ylppö Longitudinal Study

Individuals at risk of Developmental Coordination Disorder (DCD) have low levels of physical activity in childhood due to impaired motor competence; however, physical activity levels in adulthood have not been established. This study sought to determine the impact of DCD risk on physical activity levels in adults using accelerometry measurement. Participants (n = 656) from the Arvo Ylppö Longitudinal Study cohort had their motor competence assessed at the age of five years, and their physical activity quantified via device assessment at the age of 25 years. Between group differences were assessed to differentiate physical activity measures for individuals based on DCD risk status, with general linear modeling performed to control for the effects of sex, body mass index (BMI), and maternal education. Participants at risk of DCD were found to have a lower total number of steps (d = 0.3, p = 0.022) than those not at risk. Statistical modeling indicated that DCD risk status increased time spent in sedentary light activity (β = 0.1, 95% CI 0.02 to 0.3, p = 0.026) and decreased time spent in vigorous physical activity via interaction with BMI (β = 0.04, 95% CI 0.001 to 0.1, p = 0.025). Sensitivity analysis found that visuomotor impairment did not significantly impact physical activity but did increase the role of DCD risk status in some models. This 20‐year‐longitudinal study indicated that DCD risk status continues to negatively impact on levels of physical activity into early adulthood.

The efficacy and safety of hydroxychloroquine in pregnant patients with IgA nephropathy: A retrospective cohort study

AIM

Hydroxychloroquine (HCQ) is used to control proteinuria in IgA Nephropathy (IgAN) However, its efficacy and safety in pregnant IgAN patients remains unknown. This study aimed to verify the safety of HCQ in pregnant IgAN patients and compare renal function and pregnancy outcomes with those of patients not treated with HCQ.

METHODS

We retrospectively reviewed medical records of all pregnant IgAN patients and singleton gestations at Peking University First Hospital from 2003-2021. Patients who did and did not receive HCQ treatment during pregnancy were compared.

RESULTS

We found no significant pre- or post-pregnancy differences in proteinuria or renal function between the two groups. However, the HCQ (+) group had higher proteinuria at the time of kidney biopsy (2.04 [1.26, 2.56] g/d vs. 0.80 [0.44, 1.11] g/d, P < .001); the proteinuria level at HCQ therapy initiation was also higher than that at the beginning of pregnancy (1.87 [1.30, 2.59] g/d vs. 1.08 [0.75, 1.50] g/d, P = .001). Despite no difference in preterm birth, birth weight, preeclampsia or postpartum haemorrhage, the proportion of patients with a previous history of spontaneous abortion was higher in the HCQ (+) group than in the HCQ (-) group (48.0% vs. 20.6%, P = .010). The eGFR (regression coefficient, 0.981; 95%CI 0.964-0.998) was a predictive factor for obstetrical complications.

CONCLUSION

HCQ is safe for IgAN treatment during pregnancy with effective reduction of proteinuria. HCQ might also be helpful in patients with a history of spontaneous abortion.

Trends of proximate low birth weight and associations among children under-five years of age: Evidence from the 2016 Ethiopian demographic and health survey data

BACKGROUND

Low birth weight puts a newborn at increased risk of death and illness, and limits their productivity in the adulthood period later. The incidence of low birth weight has been selected as an important indicator for monitoring major health goals by the World Summit for Children. The 2014 World Health Organization estimation of child death indicated that 4.53% of total deaths in Ethiopia were due to low birth weight. The aim of this study was to assess trends of proximate low birth weight and associations of low birth weight with potential determinants from 2011 to 2016.

METHODS

This study used the 2016 Ethiopian Demographic and Health Survey data (EDHS) as data sources. According to the 2016 EDHS data, all the regions were stratified into urban and rural areas. The variable "size of child" measured according to the report of mothers before two weeks of the EDHS takes placed. The study sample refined from EDHS data and used for this further analysis were 7919 children. A logistic regression model was used to assess the association of proximate low birth weight and potential determinates of proximate low birth weight. But, the data were tested to model fitness and were fitted to Hosmer-Lemeshow-goodness of fit.

RESULTS

The prevalence of proximate low birth weight in Ethiopia was 26.9% (2132), (95%CI = 25.4, 27.9). Of the prevalence of child size in year from 2011 to 2016, 17.1% was very small, and 9.8% was small. In the final multivariate logistic regression model, region (AOR = xx), (955%CI = xx), Afar (AOR = 2.44), (95%CI = 1.82, 3.27), Somalia (AOR = 0.73), (95%CI = 0.55, 0.97), Benishangul-Gumz (AOR = 0.48), (95%CI = 0.35, 0.67), SNNPR (AOR = 0.67), (95%CI = 0.48, 0.93), religion, Protestant (AOR = 0.76), (95%CI = 0.60, 0.95), residence, rural (AOR = 1.39), (95%CI = 1.07, 1.81), child sex, female (AOR = 1.43), (95%CI = 1.29, 1.59), birth type, multiple birth during first parity (AOR = 2.18), (95%CI = 1.41, 3.37), multiple birth during second parity (AOR = 2.92), (95%CI = 1.86, 4.58), preparedness for birth, wanted latter child (AOR = 1.26), (95%CI = 1.09, 1.47), fast and rapid breathing (AOR = 1.22), (95%CI = 1.02, 1.45), maternal education, unable to read and write (AOR = 1.46), (95%CI = 1.56, 2.17), and maternal age, 15-19 years old (AOR = 1.86), (95%CI = 1.19, 2.92) associated with proximate low birth weight.

CONCLUSIONS

The proximate LBW prevalence as indicated by small child size is high. Region, religion, residence, birth type, preparedness for birth, fast and rapid breathing, maternal education, and maternal age were associated with proximate low birth weight. Health institutions should mitigating measures on low birth weight with a special emphasis on factors identified in this study.

Prenatal Risk Predicts Preschooler Executive Function: A Cascade Model

Little research has considered whether prenatal experience contributes to executive function (EF) development above and beyond postnatal experience. This study tests direct, mediated, and moderated associations between prenatal risk factors and preschool EF and IQ in a longitudinal sample of 1,292 children from the Family Life Project. A composite of prenatal risk factors (i.e., low birth weight, prematurity, maternal emotional problems, maternal prepregnancy obesity, and obstetric complications) significantly predicted EF and IQ at age 3, above quality of the postnatal environment. This relationship was indirect, mediated through infant general cognitive abilities. Quality of the postnatal home and child-care environments did not moderate the cascade model. These findings highlight the role of prenatal experience as a contributor to individual differences in cognitive development.

Midterm eGFR and Adverse Pregnancy Outcomes: The Clinical Significance of Gestational Hyperfiltration

BACKGROUND AND OBJECTIVES

Although hemodynamic adaptation plays a crucial role in maintaining gestation, the clinical significance of midterm renal hyperfiltration (MRH) on pregnancy outcomes is unknown.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS

This was an observational cohort study. Women with a singleton pregnancy and a serum creatinine measurement during their second trimester were followed at two university hospitals in Korea between 2001 and 2015. Those with substantial renal function impairment or who delivered during the second trimester were not considered. MRH was represented by the highest eGFR, which was calculated using the Chronic Kidney Disease Epidemiology Collaboration method. An adverse pregnancy event was defined by the composition of preterm birth (gestational age <37 weeks), low birth weight (<2.5 kg), and preeclampsia.

RESULTS

Data from 1931 pregnancies were included. The relationship between midterm eGFR and adverse pregnancy outcomes, which occurred in 538 mothers, was defined by a nonlinear U-shaped curve. The adjusted odds ratio and associated 95% confidence interval (95% CI) of an adverse pregnancy outcome for eGFR levels below and above the reference level of 120-150 ml/min per 1.73 m2 were 1.97 (95% CI, 1.34 to 2.89; P<0.001) for ≥150 ml/min per 1.73 m2; 1.57 (95% CI, 1.23 to 2.00; P<0.001) for 90-120 ml/min per 1.73 m2; and 4.93 (95% CI, 1.97 to 12.31; P<0.001) for 60-90 ml/min per 1.73 m2. Moreover, among mothers without baseline CKD, women with adverse pregnancy outcomes had less prominent MRH than those without (P<0.001).

CONCLUSIONS

We identified a unique U-shaped relationship between midterm eGFR and adverse pregnancy outcomes, and the optimal range of midterm eGFR levels was 120-150 ml/min per 1.73 m2. In those without evident functional renal impairment, the absence of prominent MRH might be a significant risk factor for poor pregnancy outcomes.

Risk factors for low birth weight and preterm birth: A population-based case-control study in Wuhan, China

Low birth weight (LBW) and preterm birth (PB) are associated with newborn mortality and diseases in adulthood. We explored factors related to LBW and PB by conducting a population-based case-control study from January 2011 to December 2013 in Wuhan, China. A total of 337 LBW newborn babies, 472 PB babies, and 708 babies with normal birth weights and born from term pregnancies were included in this study. Information of newborns and their parents was collected by trained investigators using questionnaires and referring to medical records. Univariate and logistic regression analyses with the stepwise selection method were used to determine the associations of related factors with LBW and PB. Results showed that maternal hypertension (OR=6.78, 95% CI: 2.27-20.29, P=0.001), maternal high-risk pregnancy (OR=1.53, 95% CI: 1.06-2.21, P=0.022), and maternal fruit intake ≥300 g per day during the first trimester (OR=1.70, 95% CI: 1.17-2.45, P=0.005) were associated with LBW. BMI ≥24 kg/m² of mother prior to delivery (OR=0.48, 95% CI: 0.32-0.74, P=0.001) and gestation ≥37 weeks (OR=0.01, 95% CI: 0.00-0.02, P<0.034) were protective factors for LBW. Maternal hypertension (OR=3.36, 95% CI: 1.26-8.98, P=0.016), maternal high-risk pregnancy (OR=4.38, 95% CI: 3.26-5.88, P<0.001), maternal meal intake of only twice per day (OR=1.88, 95% CI: 1.10-3.20, P=0.021), and mother liking food with lots of aginomoto and salt (OR=1.60, 95% CI: 1.02-2.51, P=0.040) were risk factors for PB. BMI ≥24 kg/m² of mother prior to delivery (OR=0.66, 95% CI: 0.47-0.93, P=0.018), distance of house from road ≥36 meters (OR=0.72, 95% CI: 0.53-0.97, P=0.028), and living in rural area (OR= 0.60, 95% CI: 0.37-0.99, P=0.047) were protective factors for PB. Our study demonstrated some risk factors and protective factors for LBW and PB, and provided valuable information for the prevention of the conditions among newborns.

A Brief Measure of Language Skills at 3 Years of Age and Special Education Use in Middle Childhood

OBJECTIVE

To test whether a language screener administered during early childhood predicts special education referrals and placement in middle childhood.

STUDY DESIGN

A series of logistic regressions was conducted in a longitudinal study of 731 children. Predictor variables included scores on the early language screener (Fluharty Preschool Speech and Language Screening Test-Second Edition [Fluharty-2]) at ages 3 and 4 years, a standardized measure of academic achievement at age 5 years, and parent report of special education services at ages 7.5, 8.5, and 9.5 years.

RESULTS

Results showed that higher scores on the Fluharty-2 predicted a reduced likelihood of having an individualized education program (OR 0.48), being referred for special education (OR 0.55), and being held back a grade (OR 0.37). These findings did not vary by sex, race, or ethnicity, and remained significant after controlling for male sex, behavior problems, parental education, and family income. The Fluharty-2 remained predictive of special education outcomes even after controlling for children's academic skills at age 5 years.

CONCLUSIONS

Results suggest that structured, brief assessments of language in early childhood are robust predictors of children's future engagement in special education services and low academic achievement. Primary care physicians may use a multipronged developmental surveillance and monitoring protocol designed to identify children who may need comprehensive evaluation and intervention. Early intervention may reduce the need for costly special education services in the future and reduce comorbid conditions.

Twenty-year Follow-up of Kangaroo Mother Care Versus Traditional Care

BACKGROUND AND OBJECTIVES

Kangaroo mother care (KMC) is a multifaceted intervention for preterm and low birth weight infants and their parents. Short- and mid-term benefits of KMC on survival, neurodevelopment, breastfeeding, and the quality of mother-infant bonding were documented in a randomized controlled trial (RCT) conducted in Colombia from 1993 to 1996. The aim of the present study was to evaluate the persistence of these results in young adulthood.

METHODS

From 2012 to 2014, a total of 494 (69%) of the 716 participants of the original RCT known to be alive were identified; 441 (62% of the participants in the original RCT) were re-enrolled, and results for the 264 participants weighing ≤1800 g at birth were analyzed. The KMC and control groups were compared for health status and neurologic, cognitive, and social functioning with the use of neuroimaging, neurophysiological, and behavioral tests.

RESULTS

The effects of KMC at 1 year on IQ and home environment were still present 20 years later in the most fragile individuals, and KMC parents were more protective and nurturing, reflected by reduced school absenteeism and reduced hyperactivity, aggressiveness, externalization, and socio-deviant conduct of young adults. Neuroimaging showed larger volume of the left caudate nucleus in the KMC group.

CONCLUSIONS

This study indicates that KMC had significant, long-lasting social and behavioral protective effects 20 years after the intervention. Coverage with this efficient and scientifically based health care intervention should be extended to the 18 million infants born each year who are candidates for the method.

Effects of Health and Nutrition on Cognitive and Behavioural Development in Children in the First Three Years of Life: Part 1: Low Birthweight, Breastfeeding, and Protein-Energy Malnutrition

The following paper and its accompanying paper (Grantham-McGregor SM, et al. Effects of health and nutrition on cognitive and behavioural development in children in the first three years of life. Part 2: Infections and micronutrient deficiencies: iodine, iron, and zinc. Food Nutr Bull 1999;20:76–99) review the literature on the conditions that are prevalent and considered to be likely to affect child development and are therefore of public health importance. the reviews are selective, and we have generally focused on recent work, particularly in areas that remain controversial. the reviews are restricted to nutritional and health insults that are important in the first three years of life. Where possible, we have discussed the better studies. This paper considers the effects of low birthweight (focusing on small-for-gestational-age babies) and early childhood protein-energy malnutrition on mental, motor, and behavioural development. We have also included a section on breastfeeding because of its importance to child health and nutrition programmes.

Advances in the nutrition of preterm infants

The greatly improved survival rate of infants born both preterm and low birth weight (LBW) has led to the subsequent growth and development of these infants becoming an important focus for research. Preterm infants begin life with, or acquire as a result of their prematurity, greater morbidity than term born babies, growth deficits, an increased risk of developmental delay and an increased risk of later adult diseases compared with appropriate for gestational age (AGA) term born babies.

Research in recent decades has confirmed that there are marked differences in the nutritional requirements of preterm LBW infants compared with their AGA term born counterparts, both in the neonatal period and probably for all of infancy. In addition to the increased requirement for energy and protein, preterm LBW infants demonstrate a greatly increased requirement for some of the mineral elements, particularly iron, zinc and calcium, when compared with the needs of term AGA infants. In the UK, feeding practices for preterm infants in neonatal units and throughout infancy after hospital discharge are variable and many questions remain as to the optimal nutritional regimen for preterm LBW infants (and for subgroups of these infants) at different stages of infancy. There is some concern that the 2002 World Health Organization recommendations on infant feeding may be applied to all infants, including preterm infants, without consideration of their special nutritional needs, which may further compromise their growth and development.

A brief résumé of the work of prominent researchers in the field of preterm infant nutrition in the UK, notably Lucas, Cooke and Fewtrell, is included in the review, together with information from papers published by the authors of the review. The review concludes with a summary of the generally accepted recommendations on feeding preterm LBW infants after hospital discharge and information on some practical help available to the parents of these children and to health workers in the field.

The Social Behaviour of 11- to 12-year-old Children Born as Low Birthweight and/or Premature Infants

Two studies (Study 1 and Study 2) were carried out to compare the social behaviour of school-aged children born as premature and/or low birthweight infants, with that of children born as healthy fullterm infants. Participants in Study 1 were 147 11-year-olds of whom 49 (29 females and 20 males) were reported by their parents to have been born prematurely. Participants in Study 2 were 84 11-year-old boys, 28 of whom were born with a birthweight less than 2000 grams. These at-risk subjects were followed for a period of two years. Subgroups within both study groups were matched with control groups using gender, age, and the school environment as common factors. Children in the target classes of Study 1 were classified using the Revised Class Play (Masten, Morison, & Pelligrini, 1985) and the Peer Nomination Inventory (Perry, Kusel, & Perry, 1988). In Study 2, the children completed the Pupil Evaluation Inventory (PEI) (Pekarik, Prinz, Liebert, Weintraub, & Neale, 1976). Findings suggest that aggressive behaviour is not related to birth status and that birth status is not linked to prosocial behaviour associated with sociability and likeability. However, both studies showed that children (boys and girls alike) born as premature or low birthweight infants, expressed greater levels of internalised social behaviour. These findings suggest that infants born premature and/or with a low birthweight may be less socially competent with their peers during their school-age years.

Influence of Low Birth Weight on the Intellectual Performance of Children at Entry to First Year of School

Influence of low birth weight (LBW) on children at entry to school was studied by comparing a group of LBW children with a group of normal birth weight (NBW) children. A wide variety of study instruments was used to obtain required information and steps were taken to ensure quality of data. Influence of LBW on competency at entry to school was examined while accounting for the possible confounders of the relevant association.

LBW group was found to have a lower level of intellectual performance at the time of school entry. The significant factors influencing this association were: poor socio-economic status, lower duration of pre-school education, lack of availability of reading material and lower nutritional status. However the influence of LBW on performance at entry to school remained significant once the above confounders were controlled. This highlights the need to prevent LBW and to maximize the intellectual ability of LBW survivors by appropriate interventions.

The Course of Intellectual Development in Preterm and Fullterm Children: An 8-year Longitudinal Study

A total of 55 preterm children born at low to moderate risk and a comparison group of 100 healthy fullterm children were studied until they reached 8 years of age. Perinatal biomedical data and environmental data were considered as potential contributors to developmental outcome. The Budapest Binet intelligence quotients (IQs) were used as outcome measures. The mean IQs for both groups fell within the normal range at each measurement point. However, the differential patterns of IQ development in the preterm and term group underscore the significance of the age variable. Instead of a gradually declining impact of prematurity, the age effect resulted in a complex pattern. The considerable intra-group variability within the preterm group and the correlates of outcome suggest that biological hazards related to birth may have subtle long-term influences. Variables tapping the quality of home environment, however, clearly outweighed the perinatal risk factors in their ability to predict long-term outcomes. The results suggest a transaction between the two spheres of contributing factors. Long-term follow-up studies with multiple measurement points are essential if we are to understand the developmental implications of premature birth.

Migrationshintergrund als Risikofaktor für die Entwicklung Frühgeborener im Alter von zwei Jahren

Zusammenfassung. Im Rahmen der Aachener Frühgeborenennachsorge wurden N = 199 Frühgeborene (< 32 SSW und/oder < 1500 g) der Geburtsjahrgänge 2007 bis 2011 im Alter von korrigiert zwei Jahren entwicklungsneurologisch nachuntersucht und ihr MDI mit dem Bayley II ermittelt. Die Daten wurden retrospektiv analysiert, um herauszufinden, ob der Migrationshintergrund die kognitive Leistungsfähigkeit zum Untersuchungszeitpunkt beeinflusst. Es zeigten sich keine Unterschiede hinsichtlich des Geschlechts, medizinischer Komplikationen und der Inanspruchnahme von Therapie zwischen Kindern mit (42 %) und ohne (58 %) Migrationshintergrund. In Übereinstimmung mit der Literatur lag die gesamte Aachener Stichprobe mit einem mittleren MDI von 83,3 (SD 17,4) eine Standardabweichung unter dem Durchschnitt der Referenzpopulation. Kinder mit Migrationshintergrund lagen im kognitiven Outcome 10 Punkte unter Kindern ohne diesen, was entscheidend durch das Vorliegen familiärer Risikofaktoren bedingt wurde. Im regressionsanalytischen Modell hatten familiäre Risikofaktoren und das Geburtsgewicht den größten Einfluss auf den kognitiven Outcome; aber auch das Vorliegen eines Migrationshintergrundes leistete einen zusätzlichen Beitrag zur Vorhersage. Frühgeborene mit Migrationshintergrund sollten daher als besondere Risikogruppe erkannt werden, insbesondere wenn sie zusätzlich familiäre Risikofaktoren aufweisen, um sie frühzeitig differenzierter fördern zu können.

The role of pragmatics in mediating the relationship between social disadvantage and adolescent behavior

OBJECTIVE

The relationship between social disadvantage, behavior, and communication in childhood is well established. Less is known about how these 3 interact across childhood and specifically whether pragmatic language skills act as a mediator between early social disadvantage and adolescent behavior.

METHOD

The sample was the Avon Longitudinal Study of Parents and Children, a representative birth cohort initially recruited in England in 1991/1992 and followed through to adolescence and beyond. Of the original 13,992 live births, data were available for 2926 children at 13 years. Univariable analysis was first used to identify sociodemographic and other predictors of the Strengths and Difficulties Questionnaire (SDQ) at 13 years. The mediational role of the pragmatics scale of the Children's Communication Checklist (CCC) at 9 years was then tested, controlling for age, gender, and IQ.

RESULTS

There was evidence of both a direct effect from social disadvantage (path C') to SDQ Total Behavior Score at 13 years (-.205; p < .001) and an indirect effect from social disadvantage to SDQ Total (-.225; p < .001) after adjusting for the CCC pragmatics scale as a mediator. The latter represents a reduction in the magnitude of the unadjusted effect or "total effect" (-.430), demonstrating that the pragmatics scale partially mediates the relationship of early social disadvantage and adolescent behavior (even after controlling for other covariates). The same relationship held for all but the pro-social subscale of the SDQ.

CONCLUSION

The results provide evidence to suggest that there maybe a causal relationship between these variables, suggesting that interventions targeting pragmatic skills have the potential to reduce adolescent behavioral symptoms.

Low birth weight at term and its determinants in a tertiary hospital of Nepal: a case-control study

Birth weight of a child is an important indicator of its vulnerability for childhood illness and chances of survival. A large number of infant deaths can be averted by appropriate management of low birth weight babies and prevention of factors associated with low birth weight. The prevalence of low birth weight babies in Nepal is estimated to be about 12-32%.Our study aimed at identifying major determinants of low birth weight among term babies in Nepal. A hospital-based retrospective case control study was conducted in maternity ward of Tribhuvan University Teaching Hospital from February to July 2011. A total of 155 LBW babies and 310 controls were included in the study. Mothers admitted to maternity ward during the study period were interviewed, medical records were assessed and anthropometric measurements were done. Risk factors, broadly classified into proximal and distal factors, were assessed for any association with birth of low-birth weight babies. Regression analysis revealed that a history of premature delivery (adjusted odds ratio; aOR5.24, CI 1.05-26.28), hard physical work during pregnancy (aOR1.48, CI 0.97-2.26), younger age of mother (aOR1.98, CI 1.15-3.41), mothers with haemoglobin level less than 11gm/dl (aOR0.51, CI0.24-1.07) and lack of consumption of nutritious food during pregnancy (aOR1.99, CI 1.28-3.10) were significantly associated with the birth of LBW babies. These factors should be addressed with appropriate measures so as to decrease the prevalence of low birth weight among term babies in Nepal.

Child and family characteristics associated with age of diagnosis of an autism spectrum disorder in a tertiary care setting

OBJECTIVE

To identify child and family characteristics associated with age of diagnosis of autism spectrum disorder (ASD) in a tertiary care setting using objective, standardized assessments ensuring diagnostic validity and timing.

METHODS

The authors conducted a chart review of children who received their initial ASD diagnosis from 2007 to 2011. Child variables included gender, birth order, cognitive functioning, and for children ≤36 months, language and adaptive assessments. Family variables included insurance, maternal age, maternal education, sibling or family member with ASD, and number of children in the house. Primary outcome was age of ASD diagnosis. The authors ran multiple regression models evaluating the impact of child and family variables on the total sample and on the subsample of children ≤36 months.

RESULTS

Median age of diagnosis was 2.9 years (range, 15 mo-13.8 yr; n = 591). In the total sample, significant predictors of earlier age of diagnosis were later birth order, higher maternal education, fewer children in the house, and a sibling with ASD. In a separate analysis of children ≤36 months of age (n = 315) with additional data for language and adaptive assessments, significant predictors of younger age of diagnosis were higher cognitive and adaptive functioning, lower receptive and expressive language, and having a sibling with ASD.

CONCLUSIONS

This study suggests that both family and child characteristics play an important role in the early identification of ASD and that predictive variables may vary based on a child's age. Future research should help to elucidate this finding so that screening measures and policies aimed at early identification can target the most predictive factors.

Environment as a risk factor in delayed development in premature, low-birthweight and mild asphyxia children

BACKGROUND

Premature infants with low birthweight (LBW) and asphyxia are at high risk of delay of language and visual-motor development. Environmental risk factors contributing to the delay include parents' education, family income, number of children in the family, exclusive breast-feeding, and the mother's parenting time. Lack of research in Indonesia on premature, LBW and mild asphyxia children minimizes information to parents on the importance of an optimal environment. The aim of this study was to observe the role of the environment as a risk factor for delay in language and visual-motor development.

METHODS

A cross-sectional study was carried out from June to December 2011 of 12-24-month-old children born premature, with LBW and mild asphyxia at the Hasan Sadikin, Bandung City, and Muhammadiyah Hospitals. Language and visual-motor development were measured by Capute scales. Risk factors were analyzed using chi-squared test and multivariate logistic regression analysis.

RESULTS

Of the 70 subjects, 49% had language and visual-motor delay. Environmental factors related to the delay were low parental education, low family income, non-exclusive breast-feeding (P < 0.001) and full-time maternal parenting (P < 0.05). On multivariate analysis non-exclusive breast-feeding was associated with a 175-fold risk (prevalence rate [PR], 174.756; 95% confidence interval [CI]: 10.407-2934.516, P < 0.001), and low family income, a 0.042-fold risk (PR 0.042; 95%CI: 0.005-0.321, P < 0.05).

CONCLUSION

Low family income and non-exclusive breast-feeding are risk factors for delay in language and visual-motor development in 12-24-month-old children born premature, with LBW and mild asphyxia.

Neurodevelopmental outcomes of infants born prematurely

Long-term follow-up of infants born prematurely is necessary to determine neurodevelopmental outcomes, particularly with the expansion of interest from major disabilities to high prevalence/low severity dysfunctions. Models of pathogenesis include changes due to developmental disruptions and to injury, the magnitude and type of change influenced by the infant's age, and central nervous system recovery and reorganization. Alterations in neurogenesis, migration, myelination, cell death, and synaptogenesis occur even in the absence of insult. Despite increased knowledge regarding these processes, the functional significance of brain abnormalities is unclear. Because of methodologic problems in follow-up studies, it is difficult to characterize outcome definitively. Nonetheless, an acceptable degree of agreement across studies is found with regard to specific neurodevelopmental outcomes: motor/neurologic function, visuomotor integrative skills, IQ, academic achievement, language, executive function, and attention-deficit hyperactivity disorder/behavioral issues. In general, children born prematurely have more problems in these areas than do their normal birth weight counterparts. Suggestions for improved analyses and clarification of outcomes include use of cluster analysis, structural equation modeling, growth curve analysis, developmental epidemiologic approaches, and better control of background variables using risk indexes and factor scores. Better assessment techniques measuring functions documented to be at higher risk of problems are discussed.

Parental concerns about their premature infants' health after discharge from the neonatal intensive care unit: a questionnaire survey for anticipated guidance in a neonatal follow-up clinic

Purpose

The aim of this study was to develop an appropriate nursing information guideline according to corrected age, after investigating parents' concerns about the growth, development, and diseases of their premature infants after discharge from the neonatal intensive care unit (NICU).

Methods

The parents of premature infants (birth weight, <2,500 g; gestational age, <37 weeks) who went to a neonatal follow-up clinic after NICU discharge at Seoul St. Mary's Hospital from January 2005 to December 2009, were asked with regard to their concerns about their infants through a questionnaire survey. The results of physical examinations, including body measurements and neurodevelopmental status at 4, 8, 12, and 18 months of corrected age, were retrospectively reviewed in 390 infants.

Results

The most common parental concerns were developmental delay, poor growth, and feeding and nutritional problems. Parental concerns about developmental delay, growth failure in improvement in body weight and length, and overweightness were high in specificity but very low in sensitivity. After NICU discharge, 30% of premature infants experienced infectious diseases before 18 months of corrected age, the most common of which was respiratory tract infection.

Conclusion

For guiding of premature infants in outpatient day clinics after NICU discharge, it is necessary to identify the parents' highest concerns, to educate them about the possibilities of growth and neurodevelopmental disabilities in their infants and to provide them with handouts containing guidelines on the management of infectious diseases, especially respiratory infections.

What helps the mother of a preterm infant become securely attached, responsive and well-adjusted?

OBJECTIVE

To investigate the relationship between the predictor variables of experiential avoidance, relationship satisfaction, prenatal expectations (compared to postnatal experience) and postpartum support, and the criterion variables of maternal attachment, maternal psychological symptoms and maternal responsiveness, after controlling for birth weight.

DESIGN

A quantitative survey study.

METHOD

The participants were 127 mothers of preterm infants (delivery prior to 37 weeks gestation, <24 months corrected age) recruited through parent support organisations. The web-based survey included measures of: demographics, postpartum support and prenatal expectations (compared to postnatal experience)-all designed for this study, as well as maternal attachment, (MPAS) maternal responsiveness (MIRI), experiential avoidance (AAQ), maternal psychological symptoms (DASS-21) and relationship satisfaction (RQI). Three standard multiple regression analyses were conducted.

RESULTS

The combined effects of experiential avoidance, relationship satisfaction, prenatal expectations (compared to postnatal experience) and postpartum support accounted for a significant 21% of variance in maternal attachment, Fch (4,121)=8.01, p<.001, a significant 38% of variance in maternal psychological symptoms Fch (4,121)=18.38, p<.001, and a significant 11% of variance in maternal responsiveness, Fch (4,121)=3.78, p=.013 after controlling for birth weight.

CONCLUSION

The four predictor variables predicted maternal attachment, psychological symptoms and responsiveness after controlling for birth weight, with experiential avoidance being the most important predictor, followed by prenatal expectations (compared to postnatal experience), relationship satisfaction, then postpartum support. This has implications for designing interventions to optimise attachment and responsiveness, and minimise psychological symptoms, in mothers of infants born preterm.

Perinatal and neonatal risk factors for autism: a comprehensive meta-analysis

BACKGROUND

The etiology of autism is unknown, although perinatal and neonatal exposures have been the focus of epidemiologic research for over 40 years.

OBJECTIVE

To provide the first review and meta-analysis of the association between perinatal and neonatal factors and autism risk.

METHODS

PubMed, Embase, and PsycInfo databases were searched for studies that examined the association between perinatal and neonatal factors and autism through March 2007. Forty studies were eligible for the meta-analysis. For each exposure, a summary effect estimate was calculated using a random-effects model. Heterogeneity in effect estimates across studies was examined, and, if found, a meta-regression was conducted to identify measured methodological factors that could explain between-study variability.

RESULTS

Over 60 perinatal and neonatal factors were examined. Factors associated with autism risk in the meta-analysis were abnormal presentation, umbilical-cord complications, fetal distress, birth injury or trauma, multiple birth, maternal hemorrhage, summer birth, low birth weight, small for gestational age, congenital malformation, low 5-minute Apgar score, feeding difficulties, meconium aspiration, neonatal anemia, ABO or Rh incompatibility, and hyperbilirubinemia. Factors not associated with autism risk included anesthesia, assisted vaginal delivery, postterm birth, high birth weight, and head circumference.

CONCLUSIONS

There is insufficient evidence to implicate any 1 perinatal or neonatal factor in autism etiology, although there is some evidence to suggest that exposure to a broad class of conditions reflecting general compromises to perinatal and neonatal health may increase the risk. Methodological variations were likely sources of heterogeneity of risk factor effects across studies.

Recém-nascido pequeno para a idade gestacional: repercussão nas habilidades motoras finas

OBJETIVO: Comparar as habilidades motoras finas de lactentes nascidos a termo pequenos para a idade gestacional (PIG) com as habilidades dos nascidos adequados para a idade gestacional (AIG) no terceiro mês de vida. MÉTODOS: Realizou-se um estudo observacional de corte transversal. Avaliaram-se 67 lactentes (21 PIG e 46 AIG) no terceiro mês de vida. Portadores de síndromes genéticas, malformações congênitas, infecções congênitas e aqueles que necessitaram de unidade de terapia intensiva neonatal foram excluídos. As Escalas Bayley II de Desenvolvimento Infantil foram utilizadas, com ênfase nos itens que avaliam as habilidades motoras finas. RESULTADOS: Não se observaram diferenças entre os grupos na escala motora (p=0,21) e mental (p=0,45) no terceiro mês de vida. No item "Alcança o Aro Suspenso", houve diferença significativa (teste Exato de Fisher; p=0,02), demonstrando maior frequência de execução para o grupo PIG no terceiro mês de vida. CONCLUSÕES: Supõe-se que a diferença encontrada no item "Alcança o Aro Suspenso" possa ser atribuída à grande ocorrência de movimentos dos braços observada no grupo PIG e não a uma condição melhor de desenvolvimento desse grupo.

Estimating the effects of cigarette taxes on birth outcomes

Employing provincial data from 1979 to 2004 allows us to exploit the significant (45 percent to 60 percent) reduction in excise taxes in Eastern Canada enacted in February 1994 to estimate the impacts of cigarette taxes on birth outcomes. Empirical estimates suggest that an increase in cigarette taxes is significantly associated with lower infant mortalities. However, we also find some evidence of a counter-intuitive positive correlation between taxes and fetal deaths. Overall, conditional on methodology, we find increased lagged per capita health expenditures and the number of physicians to be significantly associated with improvements in birth outcomes.

Effect of psychosocial stress and physical activity on low birthweight: a cohort study

AIM

To determine the effect of physical activity and psychosocial stress on low birthweight (LBW).

METHODS

A prospective study was carried out in a district of Sri Lanka between May 2001 and April 2002. A total of 885 pregnant mothers were recruited at < or = 16 weeks of gestation and followed up until partus. Trimester-specific exposure statuses along with potential confounding factors were gathered on average at the 12th, 28th, and 36th weeks of gestation. Physical activities were assessed by inquiring about the duration of specific postures adopted per day by housewives during each trimester at home and both at home and during working hours for those who were engaged in paid employment. Psychosocial stress was assessed using the Modified Life Events Inventory and the General Health Questionnaire 30. LBW was defined as a birthweight of less than 2500 g. Multiple logistic regression analysis was applied for controlling confounders and the results were expressed as adjusted odds ratios (OR) and 95% confidence intervals (95%CI).

RESULTS

Standing > 2.5 h/day (OR 2.26; 95%CI 1.10, 4.69) during the second trimester and sleeping 8 h or less/day (OR 2.84; 95%CI 1.49, 5.40) either during the second, third or both trimesters together, an increase in maternal age in years (OR 0.92; 95%CI 0.87, 0.98), and body mass index < 19.8 kg/m(2) (OR 2.2; 95%CI 1.17, 4.22) had a statistically significant association with LBW. Psychosocial stress was not associated with LBW.

CONCLUSIONS

Standing > 2.5 h/day and sleeping < or = 8 h/day were risk factors for LBW, whereas psychosocial stress was not.

Endowments and parental investments in infancy and early childhood

This article tests whether parents reinforce or compensate for child endowments. We estimate how the difference in birth weight across siblings impacts specific parental investments: breast-feeding, well-baby visits, immunizations, and preschool attendance. Our results indicate that normal-birthweight children are 5%-11% more likely to receive early childhood parental investments than their low-birth-weight siblings. Moreover, the presence of additional low-birth-weight siblings in the household increases the likelihood of investments such as well-baby visits and immunizations for normal-birth-weight children. These results suggest that parental investments in early childhood tend to reinforce endowment differences.

Birth weight effects on children's mental, motor, and physical development: evidence from twins data

OBJECTIVE

To determine the effect of very low birth weight (VLBW; <1500 g) and moderately low birth weight (MLBW; 1500-2499 g) on children's mental and motor development and physical growth during the first 2 years of life and whether VLBW and MLBW babies catch up to normal birth weight (NBW; > or =2500 g) children by age 2.

METHODS

We use data on dizygotic (DZ) and monozygotic (MZ) twins and singleton births from the first two waves of the Early Childhood Longitudinal Study-Birth Cohort (ECLS-B), a nationally representative dataset of children born in the US in 2001. We estimate the effects of VLBW and MLBW on children's mental and motor development scores, weight-for-age, weight-for-length, weight-for-height, and length-for-age z-scores at 9 months and 2 years. We examine whether differences in outcomes within twin pairs are related to differences in their birth weights. The within-twins analysis is conducted on samples of DZ and MZ twins. For comparison, we also estimate birth weight effects on child outcomes from multivariate linear regression models using the full singleton and twins' sample. We also estimate the effect of being small-for-gestational age (SGA; birth weight <10th percentile for gestation) using the same set of models in order to separate out the effects of fetal growth restriction from prematurity.

RESULTS

Evaluation of all births showed that VLBW and MLBW have large negative effects on mental development, motor development, and growth at 9 months and 2 years of age. However, results from within-twin models with DZ twins that control for shared maternal and environmental factors showed much less effect of birth weight on mental or motor development, but continued large effects on growth for the VLBW group. Within-twin models with MZ twins that control for shared maternal, environmental, and genetic factors showed statistically insignificant effects of birth weight on mental and motor development, but continued effects on growth. Similar patterns were found when examining the effects of SGA.

CONCLUSIONS

After controlling for the influence of maternal, environmental, and genetic factors, low birth weight has at most a small negative effect on children's mental and motor development in their first 2 years of life. However, low birth weight is a major risk factor for children's physical growth in the early years and there is no evidence of catch-up by age 2.

Early diet and general cognitive outcome at adolescence in children born at or below 30 weeks gestation

OBJECTIVE

To test the hypothesis that effects of early diet on cognition observed at age 8 years persist in adolescents born preterm at < or = 30 weeks gestational age.

STUDY DESIGN

A subgroup from a preterm infant cohort recruited for a randomized trial studying the effects of early dietary intervention was assessed at age 16 years. IQ scores were compared between those assigned a high-nutrient diet (n = 49) or standard-nutrient diet (n = 46) in infancy at both 8 and 16 years.

RESULTS

At age 8 years, the high-nutrient group had higher mean Verbal IQ (VIQ; P = .03), Performance IQ (P = .01), and Full-Scale IQ (P = .02) scores compared with the standard-nutrient group; the VIQ difference persisted at adolescence (P = .02). This effect was accounted for principally by a significant difference in the mean Verbal Comprehension Index score (P < .008).

CONCLUSIONS

A brief period of dietary intervention after preterm birth, principally between 26 and 34 weeks of gestation, affected IQ at age 16 years. A standard-nutrient diet was associated with lower VIQ, accounted for mainly by differences in verbal comprehension, which persisted after control of social factors.

Unimpaired outcomes for extremely low birth weight infants at 18 to 22 months

OBJECTIVE

The goal was to identify, among extremely low birth weight (

METHODS

Unimpaired outcome was defined as Bayley Scales of Infant Development II scores of >or=85, normal neurologic examination findings, and normal vision, hearing, swallowing, and walking. Outcomes were determined for 5250 (86%) of 6090 extremely low birth weight inborn infants.

RESULTS

Of the 5250 infants whose outcomes were known at 18 months, 850 (16%) were unimpaired, 1153 (22%) had mild impairments, 1147 (22%) had moderate/severe neurodevelopmental impairments, and 2100 (40%) had died. Unimpaired survival rates varied according to birth weight, from <1% for infants

CONCLUSIONS

Although <1% of live-born infants of Collapse

Key Words

• extremely low birth weight
• outcomes
• neurodevelopmental impairment

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MESH Headings

• Child Development
• Female
• Follow-Up Studies
• Gestational Age
• Humans
• Infant, Extremely Low Birth Weight
• Infant, Newborn
• Infant, Newborn, Diseases/epidemiology
• Male
• Regression Analysis
• Risk Factors
• Social Class

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Grants

• U10 HD27851 NICHD NIH HHS
• U10 HD021385 NICHD NIH HHS
• U10 HD021364 NICHD NIH HHS
• U10 HD53109 NICHD NIH HHS
• KL2 RR24149 NCRR NIH HHS
• M01 RR2635 NCRR NIH HHS
• M01 RR16587 NCRR NIH HHS
• U10 HD027856 NICHD NIH HHS
• U10 HD40689 NICHD NIH HHS
• U10 HD021373 NICHD NIH HHS
• UL1 RR024139 NCRR NIH HHS
• U10 HD40492 NICHD NIH HHS
• U10 HD53119 NICHD NIH HHS
• M01 RR59 NCRR NIH HHS
• M01RR80 NCRR NIH HHS
• U10 HD053124 NICHD NIH HHS
• U10 HD053119 NICHD NIH HHS
• U10 HD53124 NICHD NIH HHS
• U10 HD21364 NICHD NIH HHS
• U10 HD34216 NICHD NIH HHS
• U01 HD036790 NICHD NIH HHS
• M01 RR6022 NCRR NIH HHS
• U10 HD027880 NICHD NIH HHS
• U10 HD040521 NICHD NIH HHS
• M01RR54 NCRR NIH HHS
• M01 RR002172 NCRR NIH HHS
• U10 HD053109 NICHD NIH HHS
• U10 HD40521 NICHD NIH HHS
• M01 RR2172 NCRR NIH HHS
• U10 HD27880 NICHD NIH HHS
• M01 RR008084 NCRR NIH HHS
• M01 RR125 NCRR NIH HHS
• U10 HD27904 NICHD NIH HHS
• M01 RR2588 NCRR NIH HHS
• U10 HD040461 NICHD NIH HHS
• U10 HD40498 NICHD NIH HHS
• M01 RR016587 NCRR NIH HHS
• M01 RR1032 NCRR NIH HHS
• M01 RR002635 NCRR NIH HHS
• U10 HD53089 NICHD NIH HHS
• U10 HD27871 NICHD NIH HHS
• UL1 RR024128 NCRR NIH HHS
• M01 RR7122 NCRR NIH HHS
• U10 HD040689 NICHD NIH HHS
• U10 HD040492 NICHD NIH HHS
• M01 RR001032 NCRR NIH HHS
• U10 HD027853 NICHD NIH HHS
• U10 HD027904 NICHD NIH HHS
• UL1 RR24148 NCRR NIH HHS
• U10 HD021397 NICHD NIH HHS
• U10 HD27856 NICHD NIH HHS
• KL2 RR024149 NCRR NIH HHS
• M01RR64 NCRR NIH HHS
• U10 HD034167 NICHD NIH HHS
• U10 HD40461 NICHD NIH HHS
• M01RR39 NCRR NIH HHS
• U10 HD27853 NICHD NIH HHS
• M01RR44 NCRR NIH HHS
• M01 RR30 NCRR NIH HHS
• UL1 TR000454 NCATS NIH HHS
• U10 HD027871 NICHD NIH HHS
• UL1 RR024148 NCRR NIH HHS
• M01 RR007122 NCRR NIH HHS
• U10 HD027851 NICHD NIH HHS
• U10 HD21397 NICHD NIH HHS
• U01 HD36790 NICHD NIH HHS
• M01 RR750 NCRR NIH HHS
• M01 RR8084 NCRR NIH HHS
• U10 HD21415 NICHD NIH HHS
• U10 HD21373 NICHD NIH HHS
• UL1RR24128 NCRR NIH HHS
• M01 RR997 NCRR NIH HHS
• M01RR70 NCRR NIH HHS
• UL1 RR025008 NCRR NIH HHS
• U10 HD21385 NICHD NIH HHS
• M01RR633 NCRR NIH HHS
• M01 RR32 NCRR NIH HHS
• U10 HD034216 NICHD NIH HHS
• UL1 RR24139 NCRR NIH HHS
• U10 HD040498 NICHD NIH HHS
• U10 HD27881 NICHD NIH HHS
• M01 RR006022 NCRR NIH HHS
• U10 HD053089 NICHD NIH HHS

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Affiliation(s)

Regina A. Gargus University of Arkansas Medical Sciences, Little Rock, AR
Betty R. Vohr Women and Infants Hospital The Warren Alpert Medical School of Brown University
Jon E Tyson University of Texas Houston Medical School
Pamela High The Warren Alpert Medical School of Brown University Hasbro Children's Hospitals
Rosemary D. Higgins Neonatal Research Network, National Institute of Child Health and Human Development
Lisa A. Wrage RTI International
Kenneth Poole RTI International

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Collaborators Collapse

Implementation and evaluation of an individualized developmental care program in a neonatal intensive care unit

PURPOSE

This study aims to detect differences in outcomes for very preterm infants after the introduction of developmental care in a neonatal nursery, and to evaluate the effect of developmental care on parental well-being.

DESIGN AND METHODS

Prospective before and after cohort study of very preterm babies, with education for all staff between cohorts.

RESULTS

No significant differences were found between cohorts for short-term outcomes for babies or parental anxiety levels or depression. All infants scored within normal temperament ranges at 4 months.

PRACTICE IMPLICATIONS

Developmental care is a safe practice model. The interdisciplinary study facilitated professional development and increased the knowledge of nurses.

Birth weight and cognitive ability in childhood among siblings and nonsiblings

OBJECTIVES

The purpose of this work was to examine whether the positive association between birth weight and childhood cognitive ability is seen within siblings from the same family, as well as between nonsiblings, and to determine whether these associations vary with age.

METHODS

We compared the association of birth weight with cognitive ability measured at ages 5 to 6, 7 to 9, and 11 to 12 years among a total of 5402 children from different families with that among 2236 to 3083 sibships from the National Longitudinal Study of Youth 1979-Children.

RESULTS

In the whole cohort, there were positive associations between birth weight and cognitive ability at all ages, with the association increasing with age from a 0.81-point increase at ages 5 to 6 years to 1.30 and 1.44 points at ages 7 to 9 and 11 to 12 years, respectively, per 1 SD of gestational age- and gender-adjusted birth weight z score. With adjustment for covariates, there was marked attenuation of these associations. Mean differences were 0.28 points in children aged 5 to 6 years, 0.67 points in those aged 7 to 9 years, and 0.52 points in those aged 11 to 12 years after adjusting for child's gender, race or ethnicity, year of birth, and age at test; maternal age, height, parity, education, smoking during pregnancy, and cognitive ability; and household income. Our family-based analyses that separated within- and between-family effects found that the between-family associations were much stronger than the within-family associations. However, adjustment for potential confounders attenuated the between-family associations, and there was no evidence for a difference in association comparing the between- and within-family associations.

CONCLUSIONS

In these data, the positive association between birth weight and childhood cognitive ability at ages 5 to 12 years is explained largely by family characteristics rather than a specific intrauterine effect.

Perinatal characteristics and parents' perspective of health status of NICU graduates born at term

OBJECTIVE

Long-term outcomes of preterm infants have been extensively studied, but few studies have examined long-term outcomes of term infants who require neonatal intensive care unit (NICU). Our objectives were to assess perinatal characteristics and health status of preschool age term babies using data from a population-based study of NICU graduates.

STUDY DESIGN

Retrospective cross-sectional survey. All babies were born in 1996 to 1997 in BC (Canada). The Health Status Classification System Preschool (HSCS-PS) questionnaire was completed by parents at 42 months of age. HSCS-PS was grouped in four categories (neurosensory, learning, motor and quality of life). Logistic regression was used to identify perinatal risk factors associated with moderate/severe problems at 42 months of age.

RESULT

Completed surveys were received for 261 term NICU survivors and 393 control children. Term infants represent 32% of all NICU admissions. Mean birth weight of NICU graduates was 3458 g (s.d.=600 g). Median length-of-stay in NICU was 5 days. At 42 months, the NICU group had significantly more problems on the HSCS-PS as compared to the full-term healthy infants in neurosensory, motor and learning/remembering. Moderate/severe health status problems were associated with congenital anomalies (odds ratio (OR), 3.2; confidence interval (CI): 1.3 to 7.8); smoking status (OR, 2.7, CI: 1.1 to 6.6) and SNAP score (OR, 1.04; CI: 1.0 to 1.1).

CONCLUSION

Term babies admitted to NICUs may have significant health issues in childhood. Greater attention needs to be paid to long-term outcomes of term NICU graduates. Further study is warranted to address which NICU term survivors warrant secondary and/or tertiary-level neurodevelopmental follow-up.

Motor performance of infants born small or appropriate for gestational age: a comparative study

PURPOSE

To compare the motor performance of infants born small for gestational age (SGA) with those appropriate for gestational age (AGA) at 1, 2, 3, and 6 months.

METHODS

A prospective cross-sectional study was conducted including infants born full-term, with birth weight under the 10th percentile for the SGA group and between the 10th and 90th percentiles for the AGA group. The Motor Scale of Bayley Scales of Infant Development-II was used to document motor performance.

RESULTS

The SGA group presented a mean motor index score lower than the AGA group at 2 and 6 months, with the SGA group presenting fewer infants that successfully accomplished "makes crawling movements," "turns from side to back," "balances head," "sits alone momentarily," and "sits alone for 30 seconds."

CONCLUSIONS

Data analysis suggested that infants who are SGA present greater risk of adverse outcomes that are detectable in motor performance measures at 2 months.