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Oluwafemi O, Manoharan S, Xie L, Pro G, Patel RS, Delclos GL, Gelfand A, Messiah SE, Lopez DS, Patel J. Assessing the Role of Asthma on the Relationship between Neurodevelopmental Disabilities and Adverse Birth Outcomes. Pediatr Neurol 2024; 156:131-138. [PMID: 38776595 DOI: 10.1016/j.pediatrneurol.2024.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 03/07/2024] [Accepted: 04/24/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Investigating asthma as an effect modifier between adverse birth outcomes and neurodevelopmental disabilities (NDDs) across different races is crucial for tailored interventions and understanding variable susceptibility among diverse populations. METHODS Data were collected through the National Survey of Children's Health. This cross-sectional study included 131,774 children aged 0 to 17 years. Study exposures comprised adverse birth outcomes including preterm birth and low birth weight. Weighted prevalence estimates and odds ratios with 95% confidence intervals (CIs) among children with and without adverse birth outcomes were calculated for NDDs including attention-deficit/hyperactivity disorder, autism spectrum disorder, cerebral palsy, seizure, and several others including behavior problems. Adjusted odds ratios were stratified by asthma status and separate interactions were assessed for each outcome. RESULTS Of 131,774 participants, 10,227 were born low birth weight (9.12%; 95% CI: 8.77% to 9.49%), 14,058 were born preterm (11.35%; 95% CI: 10.94% to 11.76%), and 16,166 participants had asthma (11.97%; 95% CI: 11.58% to 12.37%). There were 68,100 males (51.11%), 63,674 females (48.89%), 102,061 non-Hispanic Whites (NHW) (66.92%), 8,672 non-Hispanic Blacks (NHB) (13.97%), and 21,041 participants (19.11%) categorized as other. NHB children with adverse birth outcomes had higher prevalence of several NDDs compared to NHW children. CONCLUSIONS Asthma was not shown to be an effect modifier of the association between adverse birth outcomes and NDDs. Nevertheless, these results suggest that NDDs are more prevalent within US children with adverse birth outcomes, with higher rates among NHB compared to NHW children. These findings support screening for NDDs in pediatric health care settings among patients with adverse birth outcomes, particularly among those from ethnic minority backgrounds.
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Affiliation(s)
- Omobola Oluwafemi
- Center for Pediatric Population Health, UTHealth Houston School of Public Health, Dallas, Texas; Department of Epidemiology, Human Genetics and Environmental Sciences, UTHealth Houston School of Public Health, Dallas, Texas; Department of Epidemiology, Human Genetics and Environmental Sciences, Southwest Center for Occupational and Environmental Health, UTHealth Houston School of Public Health, Houston, Texas
| | - Sneha Manoharan
- Center for Pediatric Population Health, UTHealth Houston School of Public Health, Dallas, Texas; The University of North Texas Health Science Center, Fort Worth, Texas
| | - Luyu Xie
- Center for Pediatric Population Health, UTHealth Houston School of Public Health, Dallas, Texas; Department of Epidemiology, Human Genetics and Environmental Sciences, UTHealth Houston School of Public Health, Dallas, Texas
| | - George Pro
- Department of Health Behavior and Health Education, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas; Southern Public Health and Criminal Justice Research Center at University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Rikinkumar S Patel
- Department of Child and Adolescent Psychiatry, Duke University School of Medicine, Durham, North Carolina
| | - George L Delclos
- Department of Epidemiology, Human Genetics and Environmental Sciences, UTHealth Houston School of Public Health, Dallas, Texas; Department of Epidemiology, Human Genetics and Environmental Sciences, Southwest Center for Occupational and Environmental Health, UTHealth Houston School of Public Health, Houston, Texas
| | - Andrew Gelfand
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Sarah E Messiah
- Center for Pediatric Population Health, UTHealth Houston School of Public Health, Dallas, Texas; Department of Epidemiology, Human Genetics and Environmental Sciences, UTHealth Houston School of Public Health, Dallas, Texas
| | - David S Lopez
- Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, Texas
| | - Jenil Patel
- Center for Pediatric Population Health, UTHealth Houston School of Public Health, Dallas, Texas; Department of Epidemiology, Human Genetics and Environmental Sciences, UTHealth Houston School of Public Health, Dallas, Texas; Department of Epidemiology, Human Genetics and Environmental Sciences, Southwest Center for Occupational and Environmental Health, UTHealth Houston School of Public Health, Houston, Texas.
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Ward VC, Lee AC, Hawken S, Otieno NA, Mujuru HA, Chimhini G, Wilson K, Darmstadt GL. Overview of the Global and US Burden of Preterm Birth. Clin Perinatol 2024; 51:301-311. [PMID: 38705642 DOI: 10.1016/j.clp.2024.02.015] [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: 05/07/2024]
Abstract
Preterm birth (PTB) is the leading cause of morbidity and mortality in children globally, yet its prevalence has been difficult to accurately estimate due to unreliable methods of gestational age dating, heterogeneity in counting, and insufficient data. The estimated global PTB rate in 2020 was 9.9% (95% confidence interval: 9.1, 11.2), which reflects no significant change from 2010, and 81% of prematurity-related deaths occurred in Africa and Asia. PTB prevalence in the United States in 2021 was 10.5%, yet with concerning racial disparities. Few effective solutions for prematurity prevention have been identified, highlighting the importance of further research.
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Affiliation(s)
- Victoria C Ward
- Department of Pediatrics, Stanford University School of Medicine, 291 Campus Drive, Li Ka Shing Building, Stanford, CA 94305, USA.
| | - Anne Cc Lee
- Department of Pediatrics, Global Advancement of Infants and Mothers, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115, USA; Department of Pediatrics, Harvard Medical School, 77 Avenue Louis Pasteur, Boston, MA 02115, USA
| | - Steven Hawken
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Center for Practice Changing Research, 501 Smyth Road, Box 201-B, Ottawa, Ontario K1H 8L6, Canada
| | - Nancy A Otieno
- Kenya Medical Research Institute (KEMRI), Centre for Global Health Research, Division of Global Health Protection, Box 1578 Kisumu 40100, Kenya
| | - Hilda A Mujuru
- Department of Child Adolescent and Women's Health, Faculty of Medicine and Health Sciences, University of Zimbabwe, MP 167, Mount Pleasant, Harare, Zimbabwe
| | - Gwendoline Chimhini
- Department of Child Adolescent and Women's Health, Faculty of Medicine and Health Sciences, University of Zimbabwe, MP 167, Mount Pleasant, Harare, Zimbabwe
| | - Kumanan Wilson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Center for Practice Changing Research, 501 Smyth Road, Box 201-B, Ottawa, Ontario K1H 8L6, Canada; Department of Medicine, University of Ottawa, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada; Bruyère Research Institute, 43 Bruyère Street, Ottawa, ON K1N 5C8, Canada
| | - Gary L Darmstadt
- Department of Pediatrics, Stanford University School of Medicine, 453 Quarry Road, Palo Alto, CA 94304, USA
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Jenni F, Konzett K, Gang S, Sparr V, Simma B. Psychomotor and Cognitive Outcome in Very Preterm Infants in Vorarlberg, Austria, 2007-2019. Neuropediatrics 2024; 55:90-96. [PMID: 38158208 DOI: 10.1055/a-2236-4003] [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] [Indexed: 01/03/2024]
Abstract
AIM The aim of this study was to analyze neurodevelopmental outcome of very and extremely preterm infants in Vorarlberg, Austria, accessed with neurodevelopmental testing, at the corrected age of 24 months. This article also compared these results with (inter)national data and analyzed the impact of perinatal parameters. METHODS Population-based, retrospective multicenter study with data on very and extremely preterm infants born in Vorarlberg from 2007 to 2019 assessed with Bayley Scales of Infant Development (BSID-II/Bayley-III). RESULTS Included were 264 infants with a mean age of 29.0 (± 2.1) weeks of gestational age and a mean birth weight of 1177 (± 328.26) g; 172 infants underwent a BSID-II, 92 a Bayley-III assessment. The psychomotor developmental index (PDI) and mental developmental index (MDI) showed mean scores of 99.6 (± 14.4) and 91 (± 20.4), respectively. Adverse outcomes (scores <70) were assessed in 4.2% for PDI and 15.5% for MDI. In the extremely preterm group (n = 79), results for mean PDI were 100.1 (± 16.8) and for mean MDI 88.4 (± 22.4). Accordingly, adverse outcomes were assessed in 5.1% for PDI and in 20.3% for MDI. In addition to bronchopulmonary dysplasia and intraventricular hemorrhage Grade 3-4, head circumference at birth and patent ductus arteriosus were also identified as risk factors for poor outcome. CONCLUSION This study showed a remarkably good neurodevelopmental outcome in preterm infants with low rates of adverse outcome, similar to (inter)national reports, especially in the group of extremely preterm infants. Research is needed to explore the role of social factors and infants' environment, especially cognitive outcome and language skills.
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Affiliation(s)
- Fabio Jenni
- Department of Pediatrics, Academic Teaching Hospital, Landeskrankenhaus Feldkirch, Feldkirch, Austria
| | - Karin Konzett
- Department of Pediatrics, Academic Teaching Hospital, Landeskrankenhaus Feldkirch, Feldkirch, Austria
| | - Stefanie Gang
- Department of Pediatrics, Academic Teaching Hospital, Landeskrankenhaus Feldkirch, Feldkirch, Austria
| | - Verena Sparr
- Department of Pediatrics, Academic Teaching Hospital, Landeskrankenhaus Feldkirch, Feldkirch, Austria
| | - Burkhard Simma
- Department of Pediatrics, Academic Teaching Hospital, Landeskrankenhaus Feldkirch, Feldkirch, Austria
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Papadakis AE, Giannakaki V, Hatzidaki E, Damilakis J. The effect of added filtration on radiation dose and image quality in digital radiography of newborns. Pediatr Radiol 2023; 53:2060-2068. [PMID: 37310445 DOI: 10.1007/s00247-023-05698-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/24/2023] [Accepted: 05/24/2023] [Indexed: 06/14/2023]
Abstract
BACKGROUND Repeated chest and/or abdomen radiographs are needed on mobile digital radiography (DR) units to assess infants' health status. Optimization of DR tube peak kilovoltage (kVp) and tube current time product (mAs) to derive images of diagnostic quality at as low as reasonably achievable radiation dose has been a challenging task. OBJECTIVE To investigate the effect of exposure parameters and additional filtration on entrance skin dose and image quality in newborn DR imaging. MATERIALS AND METHODS A physical anthropomorphic phantom that simulates the average full-term neonate was used. Chest and chest/abdomen DR images were acquired at the manufacturer's recommended kVp/mAs exposure parameters followed by a series of image acquisitions at different kVp/mAs and beam filtration combinations. Entrance skin dose (ESD) and signal difference to noise ratio (SdNR) for soft tissue, bone and feeding gastric tube were estimated in raw unprocessed images. A figure of merit (FOM) analysis provided the kVp/mAs and filtration that generated images of adequate quality at the lowest ESD. RESULTS Signal difference increased with kVp and progressively decreased with increasing filtration. Compared to the manufacturer's recommended 53 kVp/1.6 mAs exposure parameters, ESD was reduced by 76% (47.61 μGy versus 11.3 μGy) in the chest and 66% (47.61 μGy versus 16.14 μGy) in the chest/abdomen when the exposure parameters and additional beam filtration provided by the FOM analysis were used. CONCLUSION The results derived from this phantom study suggest that additional beam filtration along with the appropriate leverage of exposure parameters can lower ESD while maintaining image quality in full-term newborns.
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Affiliation(s)
- Antonios E Papadakis
- Medical Physics Department, University General Hospital of Heraklion, 71110, Stavrakia, Crete, Greece.
| | - Vasiliki Giannakaki
- Medical Physics Department, University General Hospital of Heraklion, 71110, Stavrakia, Crete, Greece
| | - Eleftheria Hatzidaki
- Department of Neonatology and Neonatal Intensive Care Unit, University of Crete, 71110, Stavrakia, Crete, Greece
| | - John Damilakis
- Medical Physics Department, University of Crete, 71110, Stavrakia, Crete, Greece
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Martin-Herz SP, Otieno P, Laanoi GM, Moshi V, Olieng'o Okoth G, Santos N, Walker D. Growth and neurodevelopmental outcomes of preterm and low birth weight infants in rural Kenya: a cross-sectional study. BMJ Open 2023; 13:e064678. [PMID: 37652593 PMCID: PMC10476111 DOI: 10.1136/bmjopen-2022-064678] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 07/19/2023] [Indexed: 09/02/2023] Open
Abstract
OBJECTIVE Data on long-term outcomes of preterm (PT) and low birth weight (LBW) infants in countries with high rates of neonatal mortality and childhood stunting are limited, especially from community settings. The current study sought to explore growth and neurodevelopmental outcomes of PT/LBW infants from a rural community-based setting of Kenya up to 18 months adjusted age. DESIGN Cross-sectional study. SETTING Migori County, Kenya. PARTICIPANTS Three hundred and eighty-two PT/LBW infants (50.2% of those identified as eligible) from a cluster randomised control trial evaluating a package of facility-based intrapartum quality of care interventions for newborn survival consented for follow-up. OUTCOME MEASURES Caregiver interviews and infant health, growth and neurodevelopmental assessments were completed at 6, 12 or 18 months±2 weeks. Data included sociodemographic information, medical history, growth measurements and neurodevelopmental assessment using the Ten Questions Questionnaire, Malawi Developmental Assessment Tool and Hammersmith Infant Neurological Examination. Analyses were descriptive and univariate regression models. No alterations were made to planned data collection. RESULTS The final sample included 362 PT/LBW infants, of which 56.6% were moderate to late PT infants and 64.4% were LBW. Fewer than 2% of parents identified their child as currently malnourished, but direct measurement revealed higher proportions of stunting and underweight than in national demographic and health survey reports. Overall, 22.7% of caregivers expressed concern about their child's neurodevelopmental status. Neurodevelopmental delays were identified in 8.6% of infants based on one or more standardised tools, and 1.9% showed neurological findings indicative of cerebral palsy. CONCLUSIONS Malnutrition and neurodevelopmental delays are common among PT/LBW infants in this setting. Close monitoring and access to early intervention programmes are needed to help these vulnerable infants thrive. TRIAL REGISTRATION NUMBER NCT03112018.
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Affiliation(s)
- Susanne P Martin-Herz
- Department of Pediatrics, University of California San Francisco, San Francisco, California, USA
| | - Phelgona Otieno
- Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Grace M Laanoi
- Department of Paediatrics and Child Health, Maseno University, Maseno, Kenya
- Paediatric & Child Health, Jaramogi Oginga Odinga Teaching and Referral Hospital, Kisumu, Kenya
| | - Vincent Moshi
- Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | | | - Nicole Santos
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, California, USA
| | - Dilys Walker
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, California, USA
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, San Francisco, California, USA
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Fisher M, Marro L, Arbuckle TE, Potter BK, Little J, Weiler H, Morisset AS, Lanphear B, Oulhote Y, Braun JM, Kumarathasan P, Walker M, Borghese MM, Ashley-Martin J, Shutt R, Fraser WD. Association between toxic metals, vitamin D and preterm birth in the Maternal-Infant research on environmental chemicals study. Paediatr Perinat Epidemiol 2023. [PMID: 36864001 DOI: 10.1111/ppe.12962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
BACKGROUND Toxic metals, like lead, are risk factors for preterm birth (PTB), but few studies have examined low levels found in most Canadians. Vitamin D, which may have antioxidant activity, protects against PTB. OBJECTIVES In this study, we investigated the impact of toxic metals (lead, mercury, cadmium and arsenic) on PTB and examined if maternal plasma vitamin D concentrations modify these associations. METHODS We investigated whether concentrations of metals in whole blood measured in early and late pregnancy were associated with PTB (<37 weeks) and spontaneous PTB in 1851 live births from the Maternal-Infant Research on Environmental Chemicals Study using discrete time survival analysis. We also investigated whether the risk of PTB was modified by first-trimester plasma 25-hydroxyvitamin D (25OHD) concentrations. RESULTS Of 1851 live births, 6.1% (n = 113) were PTBs and 4.9% (n = 89) were spontaneous PTB. A 1 μg/dL increase in blood lead concentrations during pregnancy was associated with an increased risk of PTB (relative risk [RR] 1.48, 95% confidence interval [CI] 1.00, 2.20) and spontaneous PTB (RR 1.71, 95% CI 1.13, 2.60). The risk was higher in women with insufficient vitamin D concentrations (25OHD <50 nmol/L) for both PTB (RR 2.42, 95% CI 1.01, 5.79) and spontaneous PTB (RR 3.04, 95% CI 1.15, 8.04). However, an interaction on the additive scale was not present. Arsenic was associated with a higher risk of PTB (RR 1.10, 95% CI 1.02, 1.19) and spontaneous PTB (RR 1.11, 95% CI 1.03, 1.20) per 1 μg/L. CONCLUSIONS Gestational exposure to low levels of lead and arsenic may increase the risk of PTB and spontaneous PTB; individuals with insufficient vitamin D may be more susceptible to the adverse effects of lead. Given our relatively small number of cases, we encourage testing of this hypothesis in other cohorts, especially those with vitamin D-deficient populations.
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Affiliation(s)
- Mandy Fisher
- Environmental Health Science and Research Bureau, Health Canada, Ottawa, Ontario, Canada.,University of Ottawa, School of Epidemiology and Public Health (SEPH), Ottawa, Ontario, Canada
| | - Leonora Marro
- Environmental Health Science and Research Bureau, Health Canada, Ottawa, Ontario, Canada
| | - Tye E Arbuckle
- Environmental Health Science and Research Bureau, Health Canada, Ottawa, Ontario, Canada
| | - Beth K Potter
- University of Ottawa, School of Epidemiology and Public Health (SEPH), Ottawa, Ontario, Canada
| | - Julian Little
- University of Ottawa, School of Epidemiology and Public Health (SEPH), Ottawa, Ontario, Canada
| | - Hope Weiler
- Nutrition Research Division, Health Products and Food Branch, Health Canada, Ottawa, Ontario, Canada
| | | | - Bruce Lanphear
- Simon Fraser University. Vancouver, British Columbia Canada, Vancouver, British Columbia, Canada
| | - Youssef Oulhote
- Department of Epidemiology and Biostatistics, School of Public Health and Health Sciences, University of Massachusetts Amherst, Boston, Massachusetts, USA
| | - Joseph M Braun
- Department of Epidemiology, Brown University, Providence, Rhode Island, USA
| | | | - Mark Walker
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Michael M Borghese
- Environmental Health Science and Research Bureau, Health Canada, Ottawa, Ontario, Canada
| | - Jillian Ashley-Martin
- Environmental Health Science and Research Bureau, Health Canada, Ottawa, Ontario, Canada
| | - Robin Shutt
- Environmental Health Science and Research Bureau, Health Canada, Ottawa, Ontario, Canada
| | - William D Fraser
- Centre de Recherche du CHUS, and Department of Obstetrics and gynecology, University of Sherbrooke, Sherbrooke, Québec, Canada
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Brew BK, Donnolley N, Henry A, Dahlen H, Jalaludin B, Chambers GM. Double jeopardy-pregnancy and birth during a catastrophic bushfire event followed by a pandemic lockdown, a natural experiment. ENVIRONMENTAL RESEARCH 2022; 214:113752. [PMID: 35777439 DOI: 10.1016/j.envres.2022.113752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 06/01/2022] [Accepted: 06/19/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND From November 2019 to January 2020, eastern Australia experienced the worst bushfires in recorded history. Two months later, Sydney and surrounds were placed into lockdown for six weeks due to the COVID-19 pandemic, followed by ongoing restrictions. Many pregnant women at this time were exposed to both the bushfires and COVID-19 restrictions. OBJECTIVE To assess the impact of exposure to bushfires and pandemic restrictions on perinatal outcomes. METHODS The study included 60 054 pregnant women who gave birth between November 2017 and December 2020 in South Sydney. Exposure cohorts were based on conception and birthing dates: 1) bushfire late pregnancy, born before lockdown; 2) bushfires in early-mid pregnancy, born during lockdown or soon after; 3) conceived during bushfires, lockdown in second trimester; 4) conceived after bushfires, pregnancy during restrictions. Exposure cohorts were compared with pregnancies in the matching periods in the two years prior. Associations between exposure cohorts and gestational diabetes, preeclampsia, hypertension, stillbirth, mode of birth, birthweight, preterm birth and small for gestational age were assessed using generalised estimating equations, adjusting for covariates. RESULTS A decrease in low birth weight was observed for cohort 1 (aOR 0.81, 95%CI 0.69, 0.95). Conversely, cohort 2 showed an increase in low birth weight, and increases in prelabour rupture of membranes, and caesarean sections (aOR 1.18, 95%CI 1.03, 1.37; aOR 1.21, 95%CI 1.07, 1.37; aOR 1.10 (1.02, 1.18) respectively). Cohort 3 showed an increase in unplanned caesarean sections and high birth weight babies (aOR 1.15, 95%CI 1.04, 1.27 and aOR 1.16, 95%CI 1.02, 1.31 respectively), and a decrease in gestational diabetes mellitus was observed for both cohorts 3 and 4. CONCLUSION Pregnancies exposed to both severe climate events and pandemic disruptions appear to have increased risk of adverse perinatal outcomes beyond only experiencing one event, but further research is needed.
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Affiliation(s)
- Bronwyn K Brew
- National Perinatal Epidemiology and Statistics Unit, Centre for Big Data Research in Health & School of Clinical Medicine, UNSW, Australia.
| | - Natasha Donnolley
- National Perinatal Epidemiology and Statistics Unit, Centre for Big Data Research in Health & School of Clinical Medicine, UNSW, Australia
| | - Amanda Henry
- Discipline of Women's Health, School of Clinical Medicine, UNSW, Australia; Department of Women's and Children's Health, St George Hospital, Kogarah, NSW, Australia
| | - Hannah Dahlen
- School of Nursing and Midwifery, Western Sydney University, Australia
| | - Bin Jalaludin
- Ingham Institute for Applied Medical Research, UNSW Sydney, Australia
| | - Georgina M Chambers
- National Perinatal Epidemiology and Statistics Unit, Centre for Big Data Research in Health & School of Clinical Medicine, UNSW, Australia
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Fitzpatrick KE, Quigley MA, Kurinczuk JJ. Planned mode of birth after previous cesarean section: A structured review of the evidence on the associated outcomes for women and their children in high-income setting. Front Med (Lausanne) 2022; 9:920647. [PMID: 36148449 PMCID: PMC9486480 DOI: 10.3389/fmed.2022.920647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 08/08/2022] [Indexed: 12/05/2022] Open
Abstract
In many high-income settings policy consensus supports giving pregnant women who have had a previous cesarean section a choice between planning an elective repeat cesarean section (ERCS) or planning a vaginal birth after previous cesarean (VBAC), provided they have no contraindications to VBAC. To help women make an informed decision regarding this choice, clinical guidelines advise women should be counseled on the associated risks and benefits. The most recent and comprehensive review of the associated risks and benefits of planned VBAC compared to ERCS in high-income settings was published in 2010 by the US Agency for Healthcare Research and Quality (AHRQ). This paper describes a structured review of the evidence in high-income settings that has been published since the AHRQ review and the literature in high-income settings that has been published since 1980 on outcomes not included in the AHRQ review. Three databases (MEDLINE, EMBASE, and PsycINFO) were searched for relevant studies meeting pre-specified eligible criteria, supplemented by searching of reference lists. Forty-seven studies were identified as meeting the eligibility criteria and included in the structured review. The review suggests that while planned VBAC compared to ERCS is associated with an increased risk of various serious birth-related complications for both the mother and her baby, the absolute risk of these complications is small for either birth approach. The review also found some evidence that planned VBAC compared to ERCS is associated with benefits such as a shorter length of hospital stay and a higher likelihood of breastfeeding. The limited evidence available also suggests that planned mode of birth after previous cesarean section is not associated with the child’s subsequent risk of experiencing adverse neurodevelopmental or health problems in childhood. This information can be used to manage and counsel women with previous cesarean section about their subsequent birth choices. Collectively, the evidence supports existing consensus that there are risks and benefits associated with both planned VBAC and ERCS, and therefore women without contraindications to VBAC should be given an informed choice about planned mode of birth after previous cesarean section. However, further studies into the longer-term effects of planned mode of birth after previous cesarean section are needed along with more research to address the other key limitations and gaps that have been highlighted with the existing evidence.
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A Systematic Review of the Effects of Skin-to-Skin Contact on Biomarkers of Stress in Preterm Infants and Parents. Adv Neonatal Care 2022; 22:223-230. [PMID: 34054011 PMCID: PMC9150851 DOI: 10.1097/anc.0000000000000905] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Premature infants and their parents experience significant stress related to separation and lifesaving procedures. While evidence suggests that skin-to-skin contact (SSC) is a stress-reducing intervention for both neonates and parents, the mechanisms that underlie its efficacy are not well understood. OBJECTIVE Purpose of this systematic review is to summarize the current state of knowledge on changes in biomarkers (ie, oxytocin [OT], cortisol, hypoxanthine, xanthine, uric acid, and allantoin), associated with SSC in premature infants and parents, that may reflect physiologic responses to stress. METHODS A comprehensive literature search was conducted from 1990 to 2020. Studies were selected using prespecified inclusion and exclusion criteria. RESULTS Of the 175 studies identified, only 19 are included in this review. Ten studies evaluated only infants, 2 evaluated only parents, and 7 evaluated for changes in biomarkers in both infants and parents. Cortisol was the most common biomarker evaluated. While changes in infants' cortisol levels were highly variable, in 55% of the parent studies, parent cortisol levels decreased following SSC. In both parents and infants, OT levels decreased following SSC. Only 1 study found that allantoin levels were significantly lower in infants who received SSC. IMPLICATIONS FOR PRACTICE AND RESEARCH While evidence suggests the numerous benefits of SSC, additional research is needed to identify the optimal biomarker to determine the mechanisms that underlie these effects. The use of novel biomarkers (eg, gene expression changes microbiome) may provide new insights into the mechanisms that underlie the efficacy of SSC.Video Abstract available at:https://journals.lww.com/advancesinneonatalcare/Pages/videogallery.aspx?autoPlay=false&videoId=48.
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Yoo YM, Park JE, Park MS, Lee JH. Implementation of the Feed and Swaddle Technique as a Non-Pharmacological Strategy to Conduct Brain Magnetic Resonance Imaging in Very Low Birth Weight Infants. NEONATAL MEDICINE 2021. [DOI: 10.5385/nm.2021.28.3.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Purpose: Magnetic resonance imaging (MRI) is a useful tool for evaluating brain injury and maturation in preterm infants and often requires sedation to acquire images of sufficient quality. Infant sedation is often associated with adverse events, despite extreme precautions. In this study, the swaddling technique was investigated as an alternative non-pharmacological strategy to obtain brain MRIs of sufficient quality.Methods: We applied the feed and swaddle technique during routine brain MRI as a quality improvement project and compared its morbidity with that of sedation in a historic age-matched group. Seventy-nine very low birth weight infants in the neonatal intensive care unit of Ajou University Hospital (Suwon, Korea) were enrolled. Thirty-two (40.5%) infants were in the feed and swaddling group, and 47 (59.5%) were in the sedation group.Results: The morbidity associated with the cardiopulmonary system (swaddling group vs. sedation group: 53.13% [n=17] vs. 63.83% [n=30], P=0.723) and central nervous system (40.63% [n=13] vs. 29.79% [n=14], P=0.217) were not significantly different between groups. The MRI failure rate was not significantly different (swaddling group vs. sedation group: 12.5% [n=4] vs. 4.3% [n=2], P=0.174). The MRI scanning time was longer in the swaddling group than in the sedation group (76.5±20.3 minutes vs. 61.5±13.6 minutes, P=0.001). Cardiopulmonary adverse events were significantly less common in the swaddling group than in the sedation group (3.13% [n=1] vs. 34.04% [n=16], P=0.002).Conclusion: The success rate of MRI was comparable between the swaddling technique and sedation. Furthermore, despite the drawback of prolonged scan time, cardiopulmonary adverse events are fewer with swaddling than with sedative agents. Therefore, swaddling can be an alternative to sedation or anesthesia when performing neonatal MRI scans.
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11
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Sanefuji M, Sonoda Y, Ito Y, Ogawa M, Tocan V, Inoue H, Ochiai M, Shimono M, Suga R, Senju A, Honjo S, Kusuhara K, Ohga S. Physical growth and neurodevelopment during the first year of life: a cohort study of the Japan Environment and Children's Study. BMC Pediatr 2021; 21:360. [PMID: 34433439 PMCID: PMC8385793 DOI: 10.1186/s12887-021-02815-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 07/19/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The association between a slower physical growth and poorer neurodevelopment has been established in infants born preterm or small for gestational age. However, this association is inconsistent in term-born infants, and detailed investigations in infancy, when intervention is most beneficial for improving outcomes, are lacking. We therefore examined this association separately by sex during the first year of life in term-born infants. METHODS Using data collected until children reached 12 months old in an ongoing prospective cohort of the Japan Environment and Children's Study, we analyzed 44,264 boys and 42,541 girls with singleton term-birth. The exposure variables were conditional variables that disentangle linear growth from weight gain relative to linear growth, calculated from the length and weight at birth and 4, 7 and 10 months old. Neurodevelopmental delay was identified using the Japanese-translated version of Ages & Stages Questionnaires, third edition. RESULTS A reduced risk of neurodevelopmental delay at 6 months old was observed in children with a higher birth weight (adjusted relative risks [aRRs]: 0.91 and 0.93, 95 % confidence intervals [95 % CIs]: 0.87-0.96 and 0.88-0.98 in boys and girls, respectively) and increased linear growth between 0 and 4 months old (aRRs: 0.85 and 0.87, 95 % CIs: 0.82-0.88 and 0.83-0.91 in boys and girls, respectively). A reduced risk at 12 months was found in children with an increased linear growth between 0 and 4 months (aRRs: 0.92 and 0.90, 95 % CIs: 0.87-0.98 and 0.84-0.96 in boys and girls, respectively), boys with an increased relative weight gain between 0 and 4 months (aRR: 0.90, 95 % CI: 0.84-0.97), and girls with a higher birth weight (aRR: 0.89, 95 % CI: 0.83-0.96). CONCLUSIONS These results suggest that a slow physical growth by four months old may be a predictor of neurodevelopmental delay during infancy.
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Affiliation(s)
- Masafumi Sanefuji
- Research Center for Environment and Developmental Medical Sciences, Kyushu University, Fukuoka, Japan. .,Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
| | - Yuri Sonoda
- Research Center for Environment and Developmental Medical Sciences, Kyushu University, Fukuoka, Japan.,Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoshiya Ito
- Japanese Red Cross Hokkaido College of Nursing, Kitami, Japan
| | - Masanobu Ogawa
- Research Center for Environment and Developmental Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Vlad Tocan
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hirosuke Inoue
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masayuki Ochiai
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masayuki Shimono
- Department of Pediatrics, University of Occupational and Environmental Health, Kitakyushu, Japan.,Regional Center for Japan Environment and Children's Study, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Reiko Suga
- Regional Center for Japan Environment and Children's Study, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Ayako Senju
- Department of Pediatrics, University of Occupational and Environmental Health, Kitakyushu, Japan.,Regional Center for Japan Environment and Children's Study, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Satoshi Honjo
- Department of Pediatrics, National Hospital Organization Fukuoka National Hospital, Fukuoka, Japan
| | - Koichi Kusuhara
- Department of Pediatrics, University of Occupational and Environmental Health, Kitakyushu, Japan.,Regional Center for Japan Environment and Children's Study, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Shouichi Ohga
- Research Center for Environment and Developmental Medical Sciences, Kyushu University, Fukuoka, Japan.,Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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12
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Joaquino SM, Lee HC, Abrams B. Pre-pregnancy body mass index, gestational weight gain and postnatal growth in preterm infants. J Perinatol 2021; 41:1825-1834. [PMID: 34012052 DOI: 10.1038/s41372-021-01087-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 03/30/2021] [Accepted: 04/29/2021] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To evaluate associations between pre-pregnancy body mass index (BMI), gestational weight gain (GWG), and postnatal growth in preterm infants. DESIGN A cohort study of 14,962 births < 32 weeks' gestation. We used multivariable linear regression to assess associations between maternal BMI or GWG (models stratified by BMI) and infant postnatal growth, defined as the difference between discharge and birth weight Z-scores based on Fenton or INTERGROWTH-21st growth charts. RESULT For BMI, obesity class 2 was positively associated with postnatal growth using the Fenton chart. Using INTERGROWTH-21st, inadequate or excessive GWG in women with underweight or obesity class 3 were associated with postnatal growth in different directions. Excessive GWG in women with normal weight was negatively associated with postnatal growth defined by Fenton. CONCLUSION Some categories of BMI and GWG were modestly associated with postnatal growth in preterm infants. Results were inconsistent within and between the INTERGROWTH-21st standard and Fenton growth reference.
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Affiliation(s)
- Svea Milet Joaquino
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, CA, USA.,California Perinatal Quality Care Collaborative, Stanford, CA, USA
| | - Henry C Lee
- California Perinatal Quality Care Collaborative, Stanford, CA, USA. .,Pediatrics, Stanford University, Stanford, CA, USA.
| | - Barbara Abrams
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, CA, USA
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13
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Darmstadt GL, Khan NZ, Rosenstock S, Muslima H, Parveen M, Mahmood W, Ahmed ASMNU, Chowdhury MAKA, Zeger S, Saha SK. Impact of emollient therapy for preterm infants in the neonatal period on child neurodevelopment in Bangladesh: an observational cohort study. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2021; 40:24. [PMID: 34039435 PMCID: PMC8152128 DOI: 10.1186/s41043-021-00248-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 04/29/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Topical treatment with sunflower seed oil (SSO) or Aquaphor® reduced sepsis and neonatal mortality in hospitalized preterm infants <33 weeks' gestational age in Bangladesh. We sought to determine whether the emollient treatments improved neurodevelopmental outcomes during early childhood. METHODS 497 infants were randomized to receive SSO, Aquaphor®, or neither through the neonatal period or hospital discharge. 159 infant survivors were enrolled in the longitudinal follow-up study using a validated Rapid Neurodevelopmental Assessment tool and the Bayley Scales of Infant Development II (BSID II) administered at three-monthly intervals for the first year and thereafter at six-monthly intervals. Lowess smoothing was used to display neurodevelopmental status across multiple domains by age and treatment group, and Generalized Estimating Equations (GEE) were used to compare treatment groups across age points. RESULTS 123 children completed at least one follow-up visit. Lowess graphs suggest that lower proportions of children who received massage with either SSO or Aquaphor® had neurodevelopmental delays than control infants in a composite outcome of disabilities. In GEE analysis, infants receiving SSO showed a significant protective effect on the development of fine motor skills [odds ratio (OR) 0.92, 95% confidence interval (CI) 0.86-0.98, p=0.006]. The Psychomotor Development Index (PDI) in the BSID II showed significantly lower disability rates in the Aquaphor group (23.6%) compared to the control (55.2%) (OR 0.21, 95% CI 0.06-0.72, p=0.004). CONCLUSIONS Emollient massage of very preterm, hospitalized newborn infants improved some child neurodevelopmental outcomes over the first 2 years of follow-up. Findings warrant further confirmatory research. TRIAL REGISTRATION ClinicalTrials.gov (98-04-21-03-2) under weblink https://clinicaltrials.gov/ct2/show/NCT00162747.
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Affiliation(s)
- Gary L Darmstadt
- Prematurity Research Center, Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, 1701 Page Mill Road, Palo Alto, CA, 94304, USA.
| | - Naila Z Khan
- Clinical Neurosciences Center, Bangladesh Protibondhi Foundation, Dhaka, Bangladesh
| | - Summer Rosenstock
- Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Humaira Muslima
- Clinical Neurosciences Center, Bangladesh Protibondhi Foundation, Dhaka, Bangladesh
| | - Monowara Parveen
- Clinical Neurosciences Center, Bangladesh Protibondhi Foundation, Dhaka, Bangladesh
| | - Wajeeha Mahmood
- Prematurity Research Center, Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, 1701 Page Mill Road, Palo Alto, CA, 94304, USA
| | - A S M Nawshad Uddin Ahmed
- Department of Neonatology, Bangladesh Institute of Child Health, Dhaka Shishu Hospital, Dhaka, Bangladesh
| | - M A K Azad Chowdhury
- Department of Neonatology, Bangladesh Institute of Child Health, Dhaka Shishu Hospital, Dhaka, Bangladesh
| | - Scott Zeger
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Samir K Saha
- Department of Microbiology, Bangladesh Institute of Child Health, Dhaka Shishu Hospital, Dhaka, Bangladesh
- Child Health Research Foundation , Dhaka, Bangladesh
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14
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Dibble M, Ang JZ, Mariga L, Molloy EJ, Bokde ALW. Diffusion Tensor Imaging in Very Preterm, Moderate-Late Preterm and Term-Born Neonates: A Systematic Review. J Pediatr 2021; 232:48-58.e3. [PMID: 33453200 DOI: 10.1016/j.jpeds.2021.01.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 12/31/2020] [Accepted: 01/07/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To examine white matter abnormalities, measured by diffusion tensor imaging, in very preterm (<32 weeks) and moderate-late preterm neonates (32-37 weeks) at term-equivalent age, compared with healthy full-term controls (≥37 weeks). STUDY DESIGN A search of Medline (PubMed) was conducted to identify studies with diffusion data collected on very preterm, moderate-late preterm and full-term neonates, using the guidelines from the Meta-analysis of Observational Studies in Epidemiology and PRISMA statements. RESULTS Eleven studies were included with diffusion tensor imaging data from 554 very preterm, 575 moderate-late preterm, and 318 full-term neonates. Widespread statistically significant diffusion measures were found in all preterm subgroups at term-equivalent age compared with full-term neonates, and this difference was more marked for the very preterm group. These abnormalities are suggestive of changes in the white matter microstructure in the preterm groups. The corpus callosum was a region of interest in both early and moderate-late preterm groups, which showed statistically significant diffusion measures in all 11 studies. CONCLUSIONS Microstructural white matter changes may underpin the increased risk of neurodevelopmental disability seen in preterm infants in later life. diffusion tensor imaging may therefore be a useful prognostic tool for neuro-disability in preterm neonates.
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Affiliation(s)
- Megan Dibble
- Cognitive Systems Group, Discipline of Psychiatry, School of Medicine, Trinity College Dublin, Dublin, Ireland; Trinity College Institute of Neuroscience (TCIN), Trinity College Dublin, Dublin, Ireland.
| | - Jin Zhe Ang
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Liam Mariga
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Eleanor J Molloy
- Pediatrics and Child Health, Trinity College Dublin, Dublin, Ireland; Neonatologist and Pediatrician, CHI at Crumlin and Tallaght, Coombe Women and Infants University Hospital, Dublin, Ireland; Trinity Translational Medicine Institute (TTMI) & Trinity Research in Childhood Centre (TRICC), Trinity College Dublin, Dublin, Ireland
| | - Arun L W Bokde
- Cognitive Systems Group, Discipline of Psychiatry, School of Medicine, Trinity College Dublin, Dublin, Ireland; Trinity College Institute of Neuroscience (TCIN), Trinity College Dublin, Dublin, Ireland
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15
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Mehrkanoon S, Boashash B, Colditz P. Identifying Emergent Mesoscopic-Macroscopic Functional Brain Network Dynamics in Infants at Term-Equivalent Age with Electric Source Neuroimaging. Brain Connect 2021; 11:663-677. [PMID: 33764807 DOI: 10.1089/brain.2020.0965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Aim: To identify and characterize the functional brain networks at the time when the brain is yet to develop higher order functions in term-born and preterm infants at term-equivalent age. Introduction: Although functional magnetic resonance imaging (fMRI) data have revealed the existence of spatially structured resting-state brain activity in infants, the temporal information of fMRI data limits the characterization of fast timescale brain oscillations. In this study, we use infants' high-density electroencephalography (EEG) to characterize spatiotemporal and spectral functional organizations of brain network dynamics. Methods: We used source-reconstructed EEG and graph theoretical analyses in 100 infants (84 preterm, 16 term born) to identify the rich-club topological organization, temporal dynamics, and spectral fingerprints of dynamic functional brain networks. Results: Five dynamic functional brain networks are identified, which have rich-club topological organizations, distinctive spectral fingerprints (in the delta and low-alpha frequency), and scale-invariant temporal dynamics (<0.1 Hz): The default mode, primary sensory-limbic system, thalamo-frontal, thalamo-sensorimotor, and visual-limbic system. The temporal dynamics of these networks are correlated in a hierarchically leading-following organization, showing that infant brain networks arise from long-range synchronization of band-limited cortical oscillation based on interacting fast- and slow-coherent cortical oscillations. Conclusion: Dynamic functional brain networks do not solely depend on the maturation of cognitive networks; instead, the brain network dynamics exist in infants at term age well before the childhood and adulthood, and hence, it offers a quantitative measurement of neurotypical development in infants. Clinical Trial Registration Number: ACTRN12615000591550. Impact statement Our work offers novel functional insights into the brain network characterization in infants, providing a new functional basis for future deployable prognostication approaches.
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Affiliation(s)
- Steve Mehrkanoon
- University of Queensland Centre for Clinical Research, The University of Queensland, Herston, Brisbane, Queensland, Australia.,Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Herston, Queensland, Australia.,University of Queensland Perinatal Research Centre, Saint Lucia, Queensland, Australia
| | - Boualem Boashash
- University of Queensland Centre for Clinical Research, The University of Queensland, Herston, Brisbane, Queensland, Australia.,Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Herston, Queensland, Australia
| | - Paul Colditz
- University of Queensland Centre for Clinical Research, The University of Queensland, Herston, Brisbane, Queensland, Australia.,Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Herston, Queensland, Australia.,University of Queensland Perinatal Research Centre, Saint Lucia, Queensland, Australia
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16
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The Association between Early-Life Gut Microbiota and Long-Term Health and Diseases. J Clin Med 2021; 10:jcm10030459. [PMID: 33504109 PMCID: PMC7865818 DOI: 10.3390/jcm10030459] [Citation(s) in RCA: 96] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/12/2021] [Accepted: 01/21/2021] [Indexed: 12/14/2022] Open
Abstract
Early life gut microbiota have been increasingly recognized as major contributors to short and/or long-term human health and diseases. Numerous studies have demonstrated that human gut microbial colonization begins at birth, but continues to develop a succession of taxonomic abundances for two to three years until the gut microbiota reaches adult-like diversity and proportions. Several factors, including gestational age (GA), delivery mode, birth weight, feeding types, antibiotic exposure, maternal microbiome, and diet, influence the diversity, abundance, and function of early life gut microbiota. Gut microbial life is essential for assisting with the digestion of food substances to release nutrients, exerting control over pathogens, stimulating or modulating the immune system, and influencing many systems such as the liver, brain, and endocrine system. Microbial metabolites play multiple roles in these interactions. Furthermore, studies provide evidence supporting that imbalances of the gut microbiota in early life, referred to as dysbiosis, are associated with specific childhood or adult disease outcomes, such as asthma, atopic dermatitis, diabetes, allergic diseases, obesity, cardiovascular diseases (CVD), and neurological disorders. These findings support that the human gut microbiota may play a fundamental role in the risk of acquiring diseases that may be programmed during early life. In fact, it is critical to explore the role of the human gut microbiota in early life.
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17
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Dawood FS, Kittikraisak W, Patel A, Rentz Hunt D, Suntarattiwong P, Wesley MG, Thompson MG, Soto G, Mundhada S, Arriola CS, Azziz-Baumgartner E, Brummer T, Cabrera S, Chang HH, Deshmukh M, Ellison D, Florian R, Gonzales O, Kurhe K, Kaoiean S, Rawangban B, Lindstrom S, Llajaruna E, Mott JA, Saha S, Prakash A, Mohanty S, Sinthuwattanawibool C, Tinoco Y. Incidence of influenza during pregnancy and association with pregnancy and perinatal outcomes in three middle-income countries: a multisite prospective longitudinal cohort study. THE LANCET. INFECTIOUS DISEASES 2021; 21:97-106. [PMID: 33129424 PMCID: PMC10563867 DOI: 10.1016/s1473-3099(20)30592-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 05/22/2020] [Accepted: 07/02/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Influenza vaccination during pregnancy prevents influenza among women and their infants but remains underused among pregnant women. We aimed to quantify the risk of antenatal influenza and examine its association with perinatal outcomes. METHODS We did a prospective cohort study in pregnant women in India, Peru, and Thailand. Before the 2017 and 2018 influenza seasons, we enrolled pregnant women aged 18 years or older with expected delivery dates 8 weeks or more after the season started. We contacted women twice weekly until the end of pregnancy to identify illnesses with symptoms of myalgia, cough, runny nose or nasal congestion, sore throat, or difficulty breathing and collected mid-turbinate nasal swabs from symptomatic women for influenza real-time RT-PCR testing. We assessed the association of antenatal influenza with preterm birth, late pregnancy loss (≥13 weeks gestation), small for gestational age (SGA), and birthweight of term singleton infants using Cox proportional hazards models or generalised linear models to adjust for potential confounders. FINDINGS Between March 13, 2017, and Aug 3, 2018, we enrolled 11 277 women with a median age of 26 years (IQR 23-31) and gestational age of 19 weeks (14-24). 1474 (13%) received influenza vaccines. 310 participants (3%) had influenza (270 [87%] influenza A and 40 [13%] influenza B). Influenza incidences weighted by the population of women of childbearing age in each study country were 88·7 per 10 000 pregnant woman-months (95% CI 68·6 to 114·8) during the 2017 season and 69·6 per 10 000 pregnant woman-months (53·8 to 90·2) during the 2018 season. Antenatal influenza was not associated with preterm birth (adjusted hazard ratio [aHR] 1·4, 95% CI 0·9 to 2·0; p=0·096) or having an SGA infant (adjusted relative risk 1·0, 95% CI 0·8 to 1·3, p=0·97), but was associated with late pregnancy loss (aHR 10·7, 95% CI 4·3 to 27·0; p<0·0001) and reduction in mean birthweight of term, singleton infants (-55·3 g, 95% CI -109·3 to -1·4; p=0·0445). INTERPRETATION Women had a 0·7-0·9% risk of influenza per month of pregnancy during the influenza season, and antenatal influenza was associated with increased risk for some adverse pregnancy outcomes. These findings support the added value of antenatal influenza vaccination to improve perinatal outcomes. FUNDING US Centers for Disease Control and Prevention. TRANSLATIONS For the Thai, Hindi, Marathi and Spanish translations of the abstract see Supplementary Materials section.
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Affiliation(s)
- Fatimah S Dawood
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Wanitchaya Kittikraisak
- Thailand Ministry of Public Health-US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Archana Patel
- Lata Medical Research Foundation, Nagpur, India; Datta Meghe Institute of Medical Sciences, Wardha, India
| | | | - Piyarat Suntarattiwong
- Queen Sirikit National Institute of Child Health, Thailand Ministry of Public Health, Bangkok, Thailand
| | - Meredith G Wesley
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA; Abt Associates, Atlanta, GA, USA
| | - Mark G Thompson
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Giselle Soto
- US Naval Medical Research Unit No 6, Bellavista, Peru
| | | | - Carmen S Arriola
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | | | - Howard H Chang
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | | | - Damon Ellison
- Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | | | | | - Kunal Kurhe
- Lata Medical Research Foundation, Nagpur, India
| | | | | | - Stephen Lindstrom
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Joshua A Mott
- Thailand Ministry of Public Health-US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Siddhartha Saha
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Sarita Mohanty
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Yeny Tinoco
- US Naval Medical Research Unit No 6, Bellavista, Peru
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18
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Kim S, Choi Y, Lee S, Ahn MB, Kim SH, Cho WK, Cho KS, Jung MH, Suh BK. Growth patterns over 2 years after birth according to birth weight and length percentiles in children born preterm. Ann Pediatr Endocrinol Metab 2020; 25:163-168. [PMID: 32871654 PMCID: PMC7538305 DOI: 10.6065/apem.1938180.090] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 02/20/2020] [Indexed: 01/22/2023] Open
Abstract
PURPOSE To analyze growth patterns over 2 years after birth according to preterm infant birth weight and length percentiles. METHODS Anthropometric measurements of 82 preterm infants were retrospectively reviewed. Preterm infants with birth weight or length below the 10th percentile were classified as small for gestational age (SGA) (n=19) and those between the 10th and 89th percentile as appropriate for gestational age (AGA) (n=63). The association between the length standard deviation score (SDS) at 2 years of corrected age and clinical factors were analyzed. RESULTS The length SDS of the SGA group was significantly increased at 6 months (-1.30±1.71) and 24 months (-0.97±1.06) of corrected age. The length SDS was lower in the SGA group than those in the AGA group at 6 months (-1.30±1.71 vs. -0.25±1.15, P=0.004), 18 months (-0.97±1.39 vs. -0.03±1.29, P=0.015), and 24 months (-0.97±1.06 vs. -0.29±1.12, P=0.022,). The percentage of children with a length SDS of <-2 (growth failure) at 24 months was 15.8% in the SGA group and 4.8% in the AGA group (P=0.108). Multiple linear regression analysis demonstrated that length at 24 months of corrected age was negatively correlated with birth length below the 10th percentile (coefficient β=-0.91, P=0.001) and duration of stay in the neonatal intensive care unit (NICU) (coefficient β=-0.01, P=0.001). CONCLUSION Despite the fact that catch-up growth occurs during the early period of infancy in a large portion of preterm SGA infants, a significant portion of these infants show growth failure at 24 months of age. Growth over 2 years after birth is affected by birth length and duration of stay in the NICU in preterm children.
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Affiliation(s)
- Seulki Kim
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yujung Choi
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seonhwa Lee
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Moon Bae Ahn
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Shin Hee Kim
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Won Kyung Cho
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kyung Soon Cho
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Min Ho Jung
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea,Address for correspondence: Min Ho Jung, MD Department of Pediatrics, Ajou Department of Pediatrics, The Catholic University of Korea, Yeouido St. Mary's Hospital, 62 Yeouido-dong, Yeongdeungpo-gu, Seoul 07345, Korea Tel: +82-2-3779-1131 Fax: +82-2-783-2589 E-mail:
| | - Byung Kyu Suh
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
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19
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Sunny DE, Hammer E, Strempel S, Joseph C, Manchanda H, Ittermann T, Hübner S, Weiss FU, Völker U, Heckmann M. Nup133 and ERα mediate the differential effects of hyperoxia-induced damage in male and female OPCs. Mol Cell Pediatr 2020; 7:10. [PMID: 32844334 PMCID: PMC7447710 DOI: 10.1186/s40348-020-00102-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 08/02/2020] [Indexed: 02/07/2023] Open
Abstract
Background Hyperoxia is a well-known cause of cerebral white matter injury in preterm infants with male sex being an independent and critical risk factor for poor neurodevelopmental outcome. Sex is therefore being widely considered as one of the major decisive factors for prognosis and treatment of these infants. But unfortunately, we still lack a clear view of the molecular mechanisms that lead to such a profound difference. Hence, using mouse-derived primary oligodendrocyte progenitor cells (OPCs), we investigated the molecular factors and underlying mechanisms behind the differential response of male and female cells towards oxidative stress. Results We demonstrate that oxidative stress severely affects cellular functions related to energy metabolism, stress response, and maturation in the male-derived OPCs, whereas the female cells remain largely unaffected. CNPase protein level was found to decline following hyperoxia in male but not in female cells. This impairment of maturation was accompanied by the downregulation of nucleoporin and nuclear lamina proteins in the male cells. We identify Nup133 as a novel target protein affected by hyperoxia, whose inverse regulation may mediate this differential response in the male and female cells. Nup133 protein level declined following hyperoxia in male but not in female cells. We show that nuclear respiratory factor 1 (Nrf1) is a direct downstream target of Nup133 and that Nrf1 mRNA declines following hyperoxia in male but not in female cells. The female cells may be rendered resistant due to synergistic protection via the estrogen receptor alpha (ERα) which was upregulated following hyperoxia in female but not in male cells. Both Nup133 and ERα regulate mitochondrial function and oxidative stress response by transcriptional regulation of Nrf1. Conclusions These findings from a basic cell culture model establish prominent sex-based differences and suggest a novel mechanism involved in the differential response of OPCs towards oxidative stress. It conveys a strong message supporting the need to study how complex cellular processes are regulated differently in male and female brains during development and for a better understanding of how the brain copes up with different forms of stress after preterm birth.
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Affiliation(s)
- Donna Elizabeth Sunny
- Department of Neonatology and Pediatric Intensive Care, University of Medicine Greifswald, Ferdinand-Sauerbruchstrasse, 17475, Greifswald, Germany.
| | - Elke Hammer
- Department of Functional Genomics, University of Medicine Greifswald, Greifswald, Germany
| | | | - Christy Joseph
- Department of Pharmacology, Center of Drug Absorption and Transport (C_DAT), University of Medicine Greifswald, Greifswald, Germany
| | - Himanshu Manchanda
- Department of Bioinformatics, University of Medicine Greifswald, Greifswald, Germany
| | - Till Ittermann
- Institute for Community Medicine, University of Medicine Greifswald, Greifswald, Germany
| | - Stephanie Hübner
- Department of Neonatology and Pediatric Intensive Care, University of Medicine Greifswald, Ferdinand-Sauerbruchstrasse, 17475, Greifswald, Germany
| | - Frank Ulrich Weiss
- Department of Internal Medicine A, University of Medicine Greifswald, Greifswald, Germany
| | - Uwe Völker
- Department of Functional Genomics, University of Medicine Greifswald, Greifswald, Germany
| | - Matthias Heckmann
- Department of Neonatology and Pediatric Intensive Care, University of Medicine Greifswald, Ferdinand-Sauerbruchstrasse, 17475, Greifswald, Germany
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Do developmental and temperamental characteristics mediate the association between preterm birth and the quality of mother-child interaction? Infant Behav Dev 2020; 58:101421. [PMID: 32135402 DOI: 10.1016/j.infbeh.2020.101421] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 12/05/2019] [Accepted: 01/18/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND The current study aims to evaluate the association between preterm birth and the quality of mother-child interaction of very preterm-, moderate preterm-, and full-term-born children at 18 and 36 months and to determine whether developmental and behavioral characteristics mediate the association between preterm birth and the quality of mother-child interaction. METHOD Participants included 110 preterm-born children and 39 full-term-born children assessed at ages 18 and 36 months. Mother-child free play interactions, the Mullen Scales of Early Learning, the Infant Behavior Questionnaire, and the Early Childhood Behavior Questionnaire were administered. RESULTS Significant associations between preterm birth and the quality of mother-child interaction were found at 18 and 36 months. The mother-child interaction quality was less optimal for the preterm-born children compared with the full-term-born children, mainly so for the very preterm-born children. Unlike behavioral characteristics, cognitive development was found to mediate the association between the gestational age-based group and the quality of mother-child interaction. CONCLUSIONS Intervention programs for preterm-born children and their families, should consider maternal and children's behaviors during mother-child interactions, in addition to cognitive, language, motor and emotional regulation abilities, and particularly so with very preterm-born children, who exhibit slower cognitive development.
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Absorption of Polyunsaturated Fatty Acid (PUFA) Is Related to IgG Blood Levels of Neonatal Pigs during the First 48 Hours Postpartum. J Immunol Res 2020; 2020:3813250. [PMID: 32090128 PMCID: PMC7026738 DOI: 10.1155/2020/3813250] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 01/07/2020] [Accepted: 01/28/2020] [Indexed: 01/14/2023] Open
Abstract
The current study is aimed at highlighting the impact of enterally or parenterally applied immunoglobulins (Igs) on polyunsaturated fatty acid (PUFA) absorption in newborn pigs. Piglets were chosen as the appropriate model since they are born agammaglobulinemic and any effects of Ig addition can thus be easily monitored. Twenty-one, new born piglets were used in the study. Plasma levels of PUFAs, ARA, DHA, and EPA dropped (similarly to that seen in human infants) by between 40 and 50% in newborn, unsuckled piglets fed an infant formula for 48 h. However, piglets fed the same infant formula but supplied with immunoglobulins (Igs) either orally, by feeding piglets with swine or bovine colostrum, or intravenously, by i.u.a. (intraumbilical artery) infusion of swine or human Ig preparations or swine serum, demonstrated improved growth and PUFA levels similar to those observed at birth. The significant positive correlation was found between the body weight gain, as well as levels of ARA and EPA, and plasma immunoglobulins concentration. These results indicate the importance of the presence of Ig in the blood for appropriate absorption of dietary PUFAs and probably other nutrients in newborn piglets. This may have an impact on the dietary guidelines for human neonates, especially those born prematurely with low plasma Ig levels, since PUFAs are important factors for brain development in early life.
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22
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Forde D, Deming DD, Tan JC, Phillips RM, Fry-Bowers EK, Barger MK, Bahjri K, Angeles DM, Boskovic DS. Oxidative Stress Biomarker Decreased in Preterm Neonates Treated With Kangaroo Mother Care. Biol Res Nurs 2020; 22:188-196. [PMID: 31973579 DOI: 10.1177/1099800419900231] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Due to physiological and metabolic immaturity, prematurely born infants are at increased risk because of maternal separation in many neonatal intensive care units (NICUs). The stress induced from maternal-infant separation can lead to well-documented short-term physiologic instability and potentially lifelong neurological, sociological, or psychological sequelae. Based on previous studies of kangaroo mother care (KMC) that demonstrated improvement in physiologic parameters, we examined the impact of KMC on physiologic measures of stress (abdominal temperature, heart rate, oxygen saturation, perfusion index, near-infrared spectrometry), oxidative stress, and energy utilization/conservation in preterm infants. METHODS In this randomized, stratified study of premature neonates, we compared the effects on urinary concentrations of biomarkers of energy utilization and oxidative stress of 1 hr of KMC versus incubator care on Day 3 of life in intervention-group babies (n = 26) and control-group babies (n = 25), respectively. On Day 4, both groups received 1 hr of KMC. Urinary samples were collected 3 hr before and 3 hr after intervention/incubator care on both days. Energy utilization was assessed by measures of adenosine triphosphate (ATP) degradation (i.e., hypoxanthine, xanthine, and uric acid). Oxidative stress was assessed using urinary allantoin. Mixed-models analysis was used to assess differences in purine/allantoin. RESULTS Mean allantoin levels over Days 3 and 4 were significantly lower in the KMC group than in the control group (p = .026). CONCLUSIONS Results provide preliminary evidence that KMC reduces neonatal oxidative stress processes and that urinary allantoin could serve as an effective noninvasive marker for future studies.
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Affiliation(s)
- Dorothy Forde
- Hahn School of Nursing, University of San Diego, CA, USA
- School of Nursing, University of California, San Francisco, CA, USA
| | - Douglas D Deming
- Department of Pediatrics, Division of Neonatology, School of Medicine, Loma Linda University, Loma, CA, USA
| | - John C Tan
- Department of Basic Sciences, Division of Biomedical Engineering Sciences, School of Medicine, Loma Linda University, Loma Linda, CA, USA
| | - Raylene M Phillips
- Department of Pediatrics, Division of Neonatology, School of Medicine, Loma Linda University, Loma, CA, USA
| | | | - Mary K Barger
- Hahn School of Nursing, University of San Diego, CA, USA
| | - Khaled Bahjri
- School of Pharmacy, Loma Linda University, Loma Linda, CA, USA
| | - Danilyn M Angeles
- Department of Pediatrics, Division of Neonatology, School of Medicine, Loma Linda University, Loma, CA, USA
- Department of Basic Sciences, Division of Physiology, School of Medicine, Loma Linda University, Loma Linda, CA, USA
| | - Danilo S Boskovic
- Department of Basic Sciences, Division of Biochemistry, School of Medicine, Loma Linda University, Loma Linda, CA, USA
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Wadon M, Modi N, Wong HS, Thapar A, O'Donovan MC. Recent advances in the genetics of preterm birth. Ann Hum Genet 2019; 84:205-213. [PMID: 31853956 PMCID: PMC7187167 DOI: 10.1111/ahg.12373] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 11/20/2019] [Accepted: 11/20/2019] [Indexed: 02/06/2023]
Abstract
Preterm birth is associated with short- and long-term impairments affecting physical, cognitive, and neuropsychiatric health. These sequelae, together with a rising preterm birth rate and increased survival, make prematurity a growing public health issue because of the increased number of individuals with impaired health throughout the life span. Although a major contribution to preterm birth comes from environmental factors, it is also modestly heritable. Little is known about the architecture of this genetic contribution. Studies of common and of rare genetic variation have had limited power, but recent findings implicate variation in both the maternal and fetal genome. There is some evidence risk alleles in mothers may be enriched for processes related to immunity and inflammation, and in the preterm infant, processes related to brain development. Overall genomic discoveries for preterm birth lag behind progress for many other multifactorial diseases and traits. Investigations focusing on gene-environment interactions may also provide insights, but these studies still have a number of limitations. Adequately sized genetic studies of preterm birth are a priority for the future especially given the breadth of its negative health impacts across the life span and the current interest in newborn genome sequencing.
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Affiliation(s)
- Megan Wadon
- MRC Centre for Neuropsychiatric Genetics and Genomics, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, Wales
| | - Neena Modi
- Section of Neonatal Medicine, Department of Medicine, Chelsea and Westminster Hospital Campus, Imperial College, London, United Kingdom
| | - Hilary S Wong
- Department of Paediatrics, University of Cambridge, Cambridge, United Kingdom
| | - Anita Thapar
- MRC Centre for Neuropsychiatric Genetics and Genomics, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, Wales
| | - Michael C O'Donovan
- MRC Centre for Neuropsychiatric Genetics and Genomics, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, Wales
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Individualised developmental care for babies and parents in the NICU: Evidence-based best practice guideline recommendations. Early Hum Dev 2019; 139:104840. [PMID: 31445697 DOI: 10.1016/j.earlhumdev.2019.104840] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Advances in neonatal care have improved survival of premature and critically ill infants; and while rates of some long-term neurodevelopmental problems in survivors have improved, such as cerebral palsy, there are others such as learning and behavioural difficulties that have not. The goal of improving long term neurodevelopmental morbidity has led to an increased focus on improving developmental care not only in neonatal long term follow- up clinics but within the NICU itself to capture the period of earliest brain neuroplasticity. The application of a systematic approach to improve practice is considered the most effective strategy for implementing neuroprotective developmentally supportive care. The content of this paper incorporates evidence-based systematic reviews to guide clinicians in the application of developmentally supportive interventions.
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Ahn YM, Lee S. [Cognitive Ability and Related Factors in Preschoolers Born Prematurely]. CHILD HEALTH NURSING RESEARCH 2019; 25:468-476. [PMID: 35004438 PMCID: PMC8650994 DOI: 10.4094/chnr.2019.25.4.468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 07/18/2019] [Accepted: 07/22/2019] [Indexed: 11/14/2022] Open
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Palazzi A, Meschini R, Piccinini CA. INTERVENÇÃO MUSICOTERÁPICA PARA MÃE-BEBÊ PRÉ-TERMO: UMA PROPOSTA DE INTERVENÇÃO NA UTI NEONATAL. PSICOLOGIA EM ESTUDO 2019. [DOI: 10.4025/psicolestud.v24i0.41123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
O presente relato de experiência descreve a Intervenção musicoterápica para mãe-bebê pré-termo – IMUSP, que visa sensibilizar a mãe a cantar para seu bebê pré-termo, durante a internação na Unidade de Terapia Intensiva Neonatal. A IMUSP está prevista para oito sessões, alternadas entre sessões individuais com a mãe e sessões com mãe-bebê. Na implementação da IMUSP, a musicoterapeuta realizou a intervenção na UTINeo de um hospital público com nove mães e bebês prematuros. Foram encontrados vários desafios relativos à disponibilidade das famílias atendidas e às exigências do hospital. Em função disso, foi necessário adaptar a IMUSP, flexibilizando o número de sessões, o tipo de atividades propostas, bem como a alternância entre sessões com a mãe e com mãe-bebê. Evidências sugerem que a IMUSP contribuiu para o ‘empoderamento’ da mãe e do bebê, e para a ‘musicalidade comunicativa’ da díade, fortalecendo a interação mãe-bebê pré-termo. A IMUSP é uma intervenção de baixo custo com grande potencial de impacto a longo prazo, uma vez que, além de oferecer apoio à díade na UTINeo, orienta a mãe para que possa cantar autonomamente para seu bebê durante a internação e após a alta hospitalar. Futuros estudos são necessários para ampliar a aplicação da IMUSP e verificar os seus benefícios a curto e longo prazo para a mãe, o bebê pré-termo e a interação mãe-bebê.
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Parent-Infant Interaction during the First Year of Life in Infants at High Risk for Cerebral Palsy: A Systematic Review of the Literature. Neural Plast 2019; 2019:5759694. [PMID: 31178902 PMCID: PMC6501141 DOI: 10.1155/2019/5759694] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 01/18/2019] [Accepted: 02/04/2019] [Indexed: 01/26/2023] Open
Abstract
Introduction Perinatal adverse events put neonates at high risk for short and long-term disabilities, including cerebral palsy (CP). The most recent guidelines about early intervention in infants with brain damage have emphasized the importance of family involvement from the very first phases of development. Early parent-infant interactions are pivotal in promoting infant cognitive and social developmental trajectories. However, little is known about the extent to which severe adverse perinatal events can affect the quality of early parent-infant interactions. Patients and Methods We systematically searched five databases (PubMed, PsycINFO, EMBASE, CINAHL, and Cochrane Library) for the publications assessing parent-infant interactions in infants at high neurological risk within 1 year of age. Articles were selected if they involved direct comparison between high-risk populations and healthy controls or low-risk populations, and if quantitative or semiquantitative tools were used to assess the parent-infant interaction. Measures of parent-infant interaction included infant interactive behaviors, parental interactive behaviors, and dyadic interactive patterns. Results The search yielded 18 publications that met the inclusion criteria. The articles represent a high level of heterogeneity in terms of infant neurological risk, infant age, and tools assessing interactive behaviors. Both infant and maternal behaviors within the investigated interactive exchanges were reported to be compromised, leading to subsequent overall impairment of the dyadic patterns. Conclusion While the studies reviewed here provide general and important information, the review did not yield a clear picture of early dyadic interactions in high-risk infant populations. Further observational studies are warranted in order to provide a more accurate knowledge of the early dyadic exchanges between infants at high neurological risk and their parents, as they might provide a critical opportunity for early family centered habilitative interventions.
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Postnatal growth in preterm infants during the first year of life: A population-based cohort study in China. PLoS One 2019; 14:e0213762. [PMID: 30973951 PMCID: PMC6459511 DOI: 10.1371/journal.pone.0213762] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 02/28/2019] [Indexed: 11/19/2022] Open
Abstract
In preterm infants (i.e. the gestational age less than 37 weeks), postnatal growth remains a concern. This study used multicenter longitudinal data from China's Under 5 Child Nutrition and Health Surveillance System to investigate the postnatal growth in the weight and length of preterm infants. Gender-stratified differences in weight and length were assessed between preterm and term infants. 1221 preterm infants and 1221 matched term infants were included. The rates of growth in weight and length in preterm infants was greater than those in term infants, especially from the first to sixth month. The rates were higher in males compared to females in the first 3 months. The differences of weight and length between preterm and term infants decreased with increasing age, however, these measurements did not reach the level of their term peers until 12 months before adjusting for gestational age. The median values of weight and length were even larger in preterm infants in the first month after adjusting for gestational age.
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29
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Perinatal factors affect the gut microbiota up to four years after birth. Nat Commun 2019; 10:1517. [PMID: 30944304 PMCID: PMC6447568 DOI: 10.1038/s41467-019-09252-4] [Citation(s) in RCA: 150] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 02/28/2019] [Indexed: 12/16/2022] Open
Abstract
Perinatal factors impact gut microbiota development in early life, however, little is known on the effects of these factors on microbes in later life. Here we sequence DNA from faecal samples of children over the first four years and reveal a perpetual evolution of the gut microbiota during this period. The significant impact of gestational age at birth and delivery mode on gut microbiota progression is evident in the first four years of life, while no measurable effects of antibiotics are found in the first year. Microbiota profiles are also characteristic in children dependant on gestational age and maturity. Full term delivery is characterised by Bacteroides (year one), Parabacteroides (year two) and Christensenellaceae (year four). Preterm delivery is characterised by Lactobacillus (year one), Streptococcus (year two) and Carnobacterium (year four). This study reveals that the gut retains distinct microbial profiles of perinatal factors up to four years of age. Early life microbiome is affected by factors such as mode of delivery, gestational age at birth and feeding regime. Here, the authors show that gestational age at birth still imprints on the microbiome at four years of age, suggesting a link between altered microbiome in prematurity and long term health implications.
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30
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Medina-Alva P, Duque KR, Zea-Vera A, Bellomo S, Cárcamo C, Guillen-Pinto D, Rivas M, Tori A, Zegarra J, Cam L, Castañeda A, Villavicencio A, Ochoa TJ. Combined predictors of neurodevelopment in very low birth weight preterm infants. Early Hum Dev 2019; 130:109-115. [PMID: 30743197 PMCID: PMC6478608 DOI: 10.1016/j.earlhumdev.2019.01.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 01/13/2019] [Accepted: 01/26/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To evaluate the combined prognostic value of neurological examination, head circumference and cranial ultrasound for neurodevelopmental delay (NDD) in very low birth weight (VLBW, <1500 g) preterm infants. METHODS Prospective follow-up study. Preterm infants with VLWB were assessed for NDD using the Mullen Scales of Early Learning test at 24 months of corrected age. Abnormal neurological examination (≥2 deviant items of Hammersmith neurological examination), microcephaly and major ultrasound abnormalities, each performed at term age, were evaluated as predictors of NDD in a multivariable Poisson model. RESULTS 35/132 infants (26.5%) had NDD. In the multivariable analysis, microcephaly (RR, 3.2; 95% CI, 1.6-6.7) and major ultrasound abnormalities (RR, 2.7; 95% CI, 1.3-5.7) were associated to NDD. The combination of the two tests showed the highest positive predictive value (100%; 95% CI, 51%-100%), while the combination of normal neurological examination, no major US findings and normal head size at term showed the highest negative predictive value (89%; 95% CI, 78%-95%). The maximum under receiver operating characteristic curve area was for microcephaly or major ultrasound abnormalities (AUC 0.74 (0.65-0.83)). CONCLUSION The combination of head circumference, cranial ultrasound and neurological examination at term age is useful to predict NDD in VLBW preterm infants.
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Affiliation(s)
- Pilar Medina-Alva
- School of Medicine, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, San Martin de Porres, Lima 15102, Peru; Instituto Nacional Materno Perinatal, Jr Santa Rosa 941, Cercado de Lima, Lima 15001, Peru.
| | - Kevin R Duque
- School of Medicine, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, San Martin de Porres, Lima 15102, Peru.
| | - Alonso Zea-Vera
- School of Medicine, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, San Martin de Porres, Lima 15102, Peru
| | - Sicilia Bellomo
- School of Medicine, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, San Martin de Porres, Lima 15102, Peru; Hospital Nacional Cayetano Heredia, Av Honorio Delgado 262, San Martin de Porres, Lima 15102, Peru
| | - César Cárcamo
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, San Martin de Porres, Lima 15102, Peru.
| | - Daniel Guillen-Pinto
- School of Medicine, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, San Martin de Porres, Lima 15102, Peru; Hospital Nacional Cayetano Heredia, Av Honorio Delgado 262, San Martin de Porres, Lima 15102, Peru
| | - Maria Rivas
- Hospital Nacional Madre Niño San Bartolome, Av Alfonso Ugarte 825, Lima 15001, Peru
| | - Alfredo Tori
- Hospital Nacional Guillermo Almenara, Av. Miguel Grau 800, La Victoria 15033, Lima, Peru
| | - Jaime Zegarra
- School of Medicine, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, San Martin de Porres, Lima 15102, Peru; Hospital Nacional Cayetano Heredia, Av Honorio Delgado 262, San Martin de Porres, Lima 15102, Peru.
| | - Luis Cam
- Hospital Nacional Alberto Sabogal Sologuren, Jr. Colina 1081, Bellavista 07011, Callao, Peru
| | - Anne Castañeda
- Hospital Nacional Guillermo Almenara, Av. Miguel Grau 800, La Victoria 15033, Lima, Peru
| | - Aasith Villavicencio
- School of Medicine, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, San Martin de Porres, Lima 15102, Peru.
| | - Theresa J Ochoa
- School of Medicine, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, San Martin de Porres, Lima 15102, Peru; Instituto de Medicina Tropical "Alexander von Humboldt", Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, San Martin de Porres, Lima 15102, Peru; Center for Infectious Diseases, University of Texas Health Science Center at Houston, Houston, TX, United States.
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31
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Clark RE, Weinreb L, Flahive JM, Seifert RW. Homelessness Contributes To Pregnancy Complications. Health Aff (Millwood) 2019; 38:139-146. [DOI: 10.1377/hlthaff.2018.05156] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Robin E. Clark
- Robin E. Clark is a professor of family medicine and community health, University of Massachusetts Medical School, in Worcester
| | - Linda Weinreb
- Linda Weinreb is a professor of family medicine and community health, University of Massachusetts Medical School, and vice president and medical director for Medicaid at Fallon Health, in Worcester
| | - Julie M. Flahive
- Julie M. Flahive is a biostatistician in the Department of Quantitative Health Sciences, University of Massachusetts Medical School
| | - Robert W. Seifert
- Robert W. Seifert is interim director of the Center for Health Law and Economics, University of Massachusetts Medical School
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Li H, He Z, Gao D, Lv Y, Zhou Q, Xiao B, Huang W. Characteristics of the Intestinal Microbiota in Very Low Birth Weight Infants With Extrauterine Growth Restriction. Front Pediatr 2019; 7:99. [PMID: 30972313 PMCID: PMC6443964 DOI: 10.3389/fped.2019.00099] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 03/04/2019] [Indexed: 12/15/2022] Open
Abstract
Objective: Very low birth weight (VLBW) infants, which experience significant postnatal growth restriction at the time of discharge, are at high risk of later growth failure and long-term consequences. This study aims to characterize the structure of intestinal microbiome community in VLBW infants with extrauterine growth restriction (EUGR). Methods: Twenty-three VLBW infants appropriate for gestational age (GA) hospitalized at the neonatal intensive care unit of the BaoAn Maternal and Child Care Hospital (Shenzhen, China) were enrolled in this study, which were divided into the growth restriction group (EUGR; n = 12) and the normal growth group (AGA; n = 11). Meconium and fecal samples at postnatal day 28 were collected respectively during hospitalization. Total bacterial DNA was extracted and sequenced using the Illumina MiSeq Sequencing System based on the V3-V4 hyper-variable regions of the 16S rRNA gene. Results: The intestinal bacterial communities of preterm infants were dominated by the phylum Proteobacteria. Compared with the AGA group, the relative abundances of the genera Aeromicrobium and Serratia in meconium samples significantly decreased, whereas genera Parabacteroides, Ruminococcus, Blautia, and Aeromonas were more prevalent in the EUGR group. On postnatal day 28, the relative abundances of the genera Parabacteroides, Bacteroides, Eubacterium, Granulicatella, and Salinivibrio were significantly different between the two groups, where genus Salinivibrio decreased significantly in the EUGR samples. Among them, genus Parabacteroides was more abundant on both postnatal day 1 and 28. Further KEGG prediction analysis showed that there were many differences in functional genes and pathways between the two groups on postnatal day 28, but not on day 1, the majority of which were related to energy metabolism. And no statistical differences were observed in the clinical characteristics of infants. Conclusions: Overall, these findings showed that a distinct gut microbiota profile presented in preterm infants with EUGR. The role of intestinal microbiome in the extrauterine growth of preterm infants during hospitalization should be further investigated.
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Affiliation(s)
- Hongping Li
- Shenzhen Children's Hospital, Shenzhen, China
| | - Zhijiang He
- Shenzhen University General Hospital, Shenzhen, China
| | - Di Gao
- Shenzhen Children's Hospital, Shenzhen, China
| | - Yuanhong Lv
- Shenzhen Children's Hospital, Shenzhen, China
| | - Queyun Zhou
- Shenzhen Children's Hospital, Shenzhen, China
| | - Bin Xiao
- Shenzhen Children's Hospital, Shenzhen, China
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Takahashi N, Li F, Fushima T, Oyanagi G, Sato E, Oe Y, Sekimoto A, Saigusa D, Sato H, Ito S. Vitamin B 3 Nicotinamide: A Promising Candidate for Treating Preeclampsia and Improving Fetal Growth. TOHOKU J EXP MED 2018; 244:243-248. [PMID: 29563389 DOI: 10.1620/tjem.244.243] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Up to 8% of pregnant women suffer from preeclampsia (PE), a deadly disease characterized by high blood pressure (BP), blood vessel damage, called endotheliosis (vascular endothelial swelling with narrowing of capillary lumen), and high levels of protein in the urine. PE is often associated with premature delivery, which is a risk factor of cardiovascular and metabolic diseases among the offspring. Accordingly, establishing drug treatments of PE is in immediate needs. Currently, many of anti-hypertensive drugs cause malformation of the fetuses and are contraindicated for pregnant women. Anti-hypertensive drugs that are allowed to be used for treating pregnant women could lower BP of the mothers and reduce the risk of maternal death due to cardiovascular diseases such as cerebral hemorrhage. However, these anti-hypertensives do not improve endotheliosis and proteinuria. In fact, they reduce blood supply to the placentae and fetuses, which could lead to fetal growth restriction (FGR) and fetal and neonatal death. Until now, the only treatment for preeclamptic women has been delivery of the baby and placenta. Using three mechanistically different mouse models of PE, we have found that vitamin B3 nicotinamide (Nam) is the first safe drug that alleviates PE, and that Nam also alleviates or prevents miscarriage, prolongs pregnancy period, and improves the growth of the fetuses in mice with PE. Importantly, Nam has been used for pregnant and nursing women who have difficulty in taking sufficient meal. Nam could help treat or prevent PE and FGR associated with PE, if the treatment works in humans.
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Affiliation(s)
- Nobuyuki Takahashi
- Division of Clinical Pharmacology and Therapeutics, Tohoku University Graduate School of Pharmaceutical Sciences.,Department of Medicine, Division of Nephrology, Endocrinology, and Vascular Medicine, Tohoku University.,Department of Pathology and Laboratory Medicine, The University of North Carolina
| | - Feng Li
- Department of Pathology and Laboratory Medicine, The University of North Carolina
| | - Tomofumi Fushima
- Division of Clinical Pharmacology and Therapeutics, Tohoku University Graduate School of Pharmaceutical Sciences
| | - Gen Oyanagi
- Tohoku University Hospital Pharmaceutical Department
| | - Emiko Sato
- Division of Clinical Pharmacology and Therapeutics, Tohoku University Graduate School of Pharmaceutical Sciences.,Department of Medicine, Division of Nephrology, Endocrinology, and Vascular Medicine, Tohoku University
| | - Yuji Oe
- Division of Feto-Maternal Medical Science, Tohoku Medical Megabank Organization, Tohoku University
| | - Akiyo Sekimoto
- Division of Clinical Pharmacology and Therapeutics, Tohoku University Graduate School of Pharmaceutical Sciences.,Department of Medicine, Division of Nephrology, Endocrinology, and Vascular Medicine, Tohoku University
| | - Daisuke Saigusa
- Department of Integrative Genomics, Tohoku Medical Megabank Organization, Tohoku University
| | - Hiroshi Sato
- Division of Clinical Pharmacology and Therapeutics, Tohoku University Graduate School of Pharmaceutical Sciences.,Department of Medicine, Division of Nephrology, Endocrinology, and Vascular Medicine, Tohoku University
| | - Sadayoshi Ito
- Department of Medicine, Division of Nephrology, Endocrinology, and Vascular Medicine, Tohoku University
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Harel-Gadassi A, Friedlander E, Yaari M, Bar-Oz B, Eventov-Friedman S, Mankuta D, Yirmiya N. Developmental assessment of preterm infants: Chronological or corrected age? RESEARCH IN DEVELOPMENTAL DISABILITIES 2018; 80:35-43. [PMID: 29906778 DOI: 10.1016/j.ridd.2018.06.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Revised: 02/19/2018] [Accepted: 06/07/2018] [Indexed: 06/08/2023]
Abstract
The aim of this study is to examine the effect of age correction on the developmental assessment scores of preterm infants, using for the first time, the Mullen scales of early learning (MSEL) test. Participants included 110 preterm infants (born at a gestational age of ≤ 34 weeks) at ages 1, 4, 8, 12, 18, 24 and 36 months. The corrected age-based MSEL composite score and each of the five MSEL scale scores were significantly higher than chronological age-based scores at all ages. These corrected scores were significantly higher than the chronological scores regardless of gestational age whether weight was, or adequate or small for gestational age. Larger differences between corrected and chronological age-based scores significantly correlated with earlier gestational age and with lower birth weight between 1 and 24 months but not at 36 months. Using chronological age-based scores yielded significantly more infants identified with developmental delays than using corrected age-based scores. The findings indicate that clinicians and researchers, as well as family members, should be aware of and acknowledge the distinction between corrected and chronological ages when evaluating preterm infants in research and clinical practices.
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Affiliation(s)
- Ayelet Harel-Gadassi
- School of Education, The Hebrew University of Jerusalem, Mount Scopus, Jerusalem, 9190501, Israel
| | - Edwa Friedlander
- Department of Psychology, The Hebrew University of Jerusalem, Mount Scopus, Jerusalem, 9190501, Israel
| | - Maya Yaari
- Department of Psychology, The Hebrew University of Jerusalem, Mount Scopus, Jerusalem, 9190501, Israel
| | - Benjamin Bar-Oz
- Department of Neonatology, Hadassah University Hospital, Jerusalem, 91120, Israel
| | | | - David Mankuta
- Department of Obstetrics & Gynecology, Hadassah University Hospital, Jerusalem, 91120, Israel
| | - Nurit Yirmiya
- Department of Psychology, The Hebrew University of Jerusalem, Mount Scopus, Jerusalem, 9190501, Israel.
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35
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Zuckerman KE, Chavez AE, Murillo CR, Lindly OJ, Reeder JA. Disparities in Familiarity With Developmental Disabilities Among Low-Income Parents. Acad Pediatr 2018; 18:944-951. [PMID: 29981380 PMCID: PMC7456571 DOI: 10.1016/j.acap.2018.06.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 06/20/2018] [Accepted: 06/27/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Parent knowledge about developmental disabilities (DDs) may facilitate access to DD care; however, parents may vary in their knowledge and familiarity with common DDs. This study aimed to assess racial/ethnic and language differences in low-income families' familiarity, knowledge, and personal experience with DDs. METHODS We conducted a child development survey among 539 low-income parents of young children attending visits at the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in 6 Oregon counties in 2015. Survey items assessed parent familiarity with early signs of DDs, self-reported knowledge about DDs, and personal experience with a friend or family member with a DD. Bivariable and multivariable analyses assessed differences in outcomes among non-Latino white (white), Latino English-proficient (Latino-EP), Latino limited-English-proficient (Latino-LEP), and non-Latino other race English-proficient (other race) parents. RESULTS Overall, parent participants correctly identified 64.7% of early signs of DDs. White parents correctly identified the most early signs, even after adjustment for sociodemographic factors. Compared with white parents, Latino-LEP, Latino-EP, and other race parents were less likely to have heard of prevalent DDs, such as attention-deficit/hyperactivity disorder and autism, and less likely to have a friend or family member with a DD. CONCLUSIONS Low-income Latino-LEP and other race parents have less familiarity or personal experience with DDs and are less aware of early signs of DDs compared to low-income white parents. Study findings suggest that interventions to reduce disparities in DD diagnosis and treatment should include increasing information transfer to parents in racial/ethnic and language minority communities.
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Affiliation(s)
- Katharine E. Zuckerman
- Division of General Pediatrics, Doernbecher Children’s Hospital, Oregon Health & Science University, 707 SW Gaines St, Mail Code CDRC-P, Portland, OR, 97239.,Oregon Health & Science University – Portland State University School of Public Health, 3181 SW Sam Jackson Park Road, Mail Code GH-230, Portland, OR, 97239
| | - Alison E. Chavez
- Division of General Pediatrics, Doernbecher Children’s Hospital, Oregon Health & Science University, 707 SW Gaines St, Mail Code CDRC-P, Portland, OR, 97239.,Department of Psychology, University of Massachusetts Boston, 100 William T. Morrissey Blvd., Boston, MA, 02125
| | - Carolina Regalado Murillo
- Division of General Pediatrics, Doernbecher Children’s Hospital, Oregon Health & Science University, 707 SW Gaines St, Mail Code CDRC-P, Portland, OR, 97239
| | - Olivia J. Lindly
- Division of General Pediatrics, Doernbecher Children’s Hospital, Oregon Health & Science University, 707 SW Gaines St, Mail Code CDRC-P, Portland, OR, 97239.,Massachusetts General Hospital for Children, Division of General Academic Pediatrics, 55 Fruit St., Boston, MA, 02114
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36
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Palazzi A, Nunes CC, Piccinini CA. Music therapy and musical stimulation in the context of prematurity: A narrative literature review from 2010-2015. J Clin Nurs 2017; 27:e1-e20. [DOI: 10.1111/jocn.13893] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Ambra Palazzi
- Federal University of Rio Grande do Sul - Psychology Institute; Porto Alegre Brazil
| | - Camila Canani Nunes
- Federal University of Rio Grande do Sul - Psychology Institute; Porto Alegre Brazil
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37
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Cheng L, Zhang B, Huo W, Cao Z, Liu W, Liao J, Xia W, Xu S, Li Y. Fetal exposure to lead during pregnancy and the risk of preterm and early-term deliveries. Int J Hyg Environ Health 2017; 220:984-989. [DOI: 10.1016/j.ijheh.2017.05.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 05/16/2017] [Accepted: 05/16/2017] [Indexed: 01/29/2023]
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Lefmann T, Combs-Orme T, Orme JG. Examining the inter-correlated effects of low income, life stress, and race on birth outcomes: A representative state study. SOCIAL WORK IN HEALTH CARE 2017; 56:450-469. [PMID: 28486063 DOI: 10.1080/00981389.2017.1316811] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Programming of the stress response system during gestation has lifelong effects that put the infant at risk for multiple stress-related pathologies. Populations most vulnerable to prenatal stress are African-Americans and individuals of low socioeconomic status. The Pregnancy Risk Assessment Monitoring System (PRAMS) research project, a collaboration between the Centers for Disease Control and Prevention and individual state health departments, was employed for this study. Tennessee data from 2009 were compiled from individual birth certificates and PRAMS questionnaire responses to examine the influence of maternal stressors, race and low income on birth outcomes. The number of stressors was only a significant predictor of having an infant small for gestational age when moderated by Medicaid status. Medicaid status was a positive predictor of both problematic birth and preterm delivery, but did not predict small or large for gestational age. The relationship between race and birth outcomes overall was moderated by age, with young African-American mothers less likely than European-Americans and older African-American mothers to have adverse birth outcomes.
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Affiliation(s)
- Tess Lefmann
- a Department of Social Work, School of Applied Sciences , The University of Mississippi, University , Mississipi , USA
| | - Terri Combs-Orme
- b College of Social Work , The University of Tennessee , Knoxville , Tennessee , USA
| | - John G Orme
- b College of Social Work , The University of Tennessee , Knoxville , Tennessee , USA
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Goncharova K, Lozinska L, Arevalo Sureda E, Woliński J, Weström B, Pierzynowski S. Importance of neonatal immunoglobulin transfer for hippocampal development and behaviour in the newborn pig. PLoS One 2017; 12:e0180002. [PMID: 28658291 PMCID: PMC5489200 DOI: 10.1371/journal.pone.0180002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 06/07/2017] [Indexed: 01/02/2023] Open
Abstract
Neurological disorders are among the main clinical problems affecting preterm children and often result in the development of communication and learning disabilities later in life. Several factors are of importance for brain development, however the role of immunoglobulins (passive immunity transfer) has not yet been investigated. Piglets are born agammaglobulinemic, as a result of the lack of transfer of maternal immunoglobulins in utero, thus, they serve as an ideal model to mimic the condition of immunoglobulin deficiency in preterm infants. Thirty six, unsuckled newborn piglets were fed an infant formula or colostrum and supplemented orally or intravenously with either species-specific or foreign immunoglobulin and then compared to both newborn and sow-reared piglets. Two days after the piglets were born behavioural tests (novel recognition and olfactory discrimination of conspecifics scent) were performed, after which the piglets were sacrificed and blood, cerebrospinal fluid and hippocampi samples were collected for analyses. Both parameters of neuronal plasticity (neuronal maturation and synapse-associated proteins) and behavioural test parameters appeared to be improved by the appearance of species-specific porcine immunoglulin in the circulation and cerebrospinal fluid of the piglets. In conclusion, we postulate possible positive clinical effects following intravenous infusion of human immunoglobulin in terms of neuronal plasticity and cognitive function in preterm infants born with low blood immunoglobulin levels.
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Affiliation(s)
- Kateryna Goncharova
- Department of Biology, Lund University, Lund, Sweden
- R&D Anara AB, Trelleborg, Sweden
- Department of Animal Physiology, The Kielanowski Institute of Animal Physiology and Nutrition, Polish Academy of Sciences, Jabłonna, Poland
- * E-mail: ,
| | - Liudmyla Lozinska
- Department of Biology, Lund University, Lund, Sweden
- R&D Anara AB, Trelleborg, Sweden
| | | | - Jarosław Woliński
- Department of Animal Physiology, The Kielanowski Institute of Animal Physiology and Nutrition, Polish Academy of Sciences, Jabłonna, Poland
| | - Björn Weström
- Department of Biology, Lund University, Lund, Sweden
| | - Stefan Pierzynowski
- Department of Biology, Lund University, Lund, Sweden
- R&D Anara AB, Trelleborg, Sweden
- Department of Medical Biology, Institute of Rural Health, Lublin, Poland
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40
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Abstract
PURPOSE OF REVIEW This review summarizes the recent epidemiologic literature examining health outcomes in communities living close to unconventional natural gas development (UNGD) and identifies areas requiring further study. RECENT FINDINGS To date, these studies have been primarily retrospective in design and used self-report of health symptoms or electronic health databases to obtain outcome information. Proximity to UNGD is often used as a surrogate for exposure. There is preliminary evidence linking respiratory outcomes, including asthma exacerbations, and birth outcomes, such as reduced fetal growth and preterm birth, to UNGD; however, results differ across study populations and regions. SUMMARY Although small, the current body of literature suggests that living near UNGD may have negative health consequences for surrounding communities, but additional work using more granular estimates of exposure or personalized monitoring is urgently needed.
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Affiliation(s)
- Shaina L. Stacy
- Department of Epidemiology, Brown University School of Public Health, Box G-S121-2, Providence, Rhode Island 02912
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41
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Joseph RA. Prolonged Mechanical Ventilation: Challenges to Nurses and Outcome in Extremely Preterm Babies. Crit Care Nurse 2017; 35:58-66. [PMID: 26232802 DOI: 10.4037/ccn2015396] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Worldwide, about 15 million infants are born prematurely each year. Technological advances, including invasive mechanical ventilation, play a major role in the survival of extremely preterm babies. Those who survive may have prolonged morbid conditions that result in long-term sequelae. Nurses face several challenges during the hospitalization of these infants. Vigilant care, monitoring, and careful handling of the infants can prevent infections and long-term complications. Newer, less invasive technologies are promising for improved outcomes in extremely preterm infants.
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Affiliation(s)
- Rachel A Joseph
- Rachel A. Joseph is an assistant professor, West Chester University of Pennsylvania, West Chester, Pennsylvania, and a clinical nurse in the neonatal intensive care unit, Christiana Care Health Systems, Newark, Delaware.
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IMPACT OF PRENATAL MATERNAL FACTORS AND BIRTH ORDER ON THE ANTHROPOMETRIC STATUS OF NEWBORNS IN IRAN. J Biosoc Sci 2016; 49:251-264. [PMID: 27453129 DOI: 10.1017/s0021932016000353] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
This cross-sectional study was carried out to capture possible maternal factors affecting newborns' anthropometric measurements. Data were collected from eight public health centres and referral university hospital records in Tabriz and Heriss districts, north-west Iran, for 807 mother-neonate pairs delivering live singleton births and their offspring during the two years up to August 2014. The incidence of low birth weight (LBW) was 5.1%. A close correlation was found between maternal anthropometry and birth order with neonatal anthropometric data. Birth order and maternal height and body mass index (BMI) positively affected neonates' birth size (weight, length and head circumference). The rate of LBW was significantly higher for older (≥35 years), taller (≥170 cm), underweight (BMI<18.5) and non-iron-taking women and in the first-born babies. The odds of having LBW newborns in older, taller, underweight, obese and irregular iron-taking women were 3.82, 4.00, 9.07, 3.50 and 2.50 times those of mid-age group, middle-height, overweight and regular iron-taking women, respectively. First-born newborns were 5.97 times more likely to be LBW compared with second-birth neonates. The results indicate that maternal anthropometric indices, age, iron intake and birth order influence the risk of LBW in newborns.
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Postnatal growth standards for preterm infants: the Preterm Postnatal Follow-up Study of the INTERGROWTH-21(st) Project. LANCET GLOBAL HEALTH 2016; 3:e681-91. [PMID: 26475015 DOI: 10.1016/s2214-109x(15)00163-1] [Citation(s) in RCA: 214] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 06/23/2015] [Accepted: 07/27/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND Charts of size at birth are used to assess the postnatal growth of preterm babies on the assumption that extrauterine growth should mimic that in the uterus. METHODS The INTERGROWTH-21(st) Project assessed fetal, newborn, and postnatal growth in eight geographically defined populations, in which maternal health care and nutritional needs were met. From these populations, the Fetal Growth Longitudinal Study selected low-risk women starting antenatal care before 14 weeks' gestation and monitored fetal growth by ultrasonography. All preterm births from this cohort were eligible for the Preterm Postnatal Follow-up Study, which included standardised anthropometric measurements, feeding practices based on breastfeeding, and data on morbidity, treatments, and development. To construct the preterm postnatal growth standards, we selected all live singletons born between 26 and before 37 weeks' gestation without congenital malformations, fetal growth restriction, or severe postnatal morbidity. We did analyses with second-degree fractional polynomial regression models in a multilevel framework accounting for repeated measures. Fetal and neonatal data were pooled from study sites and stratified by postmenstrual age. For neonates, boys and girls were assessed separately. FINDINGS From 4607 women enrolled in the study, there were 224 preterm singleton births, of which 201 (90%) were enrolled in the Preterm Postnatal Follow-up Study. Variance component analysis showed that only 0·2% and 4·0% of the total variability in postnatal length and head circumference, respectively, could be attributed to between-site differences, justifying pooling the data from all study sites. Preterm growth patterns differed from those for babies in the INTERGROWTH-21(st) Newborn Size Standards. They overlapped with the WHO Child Growth Standards for term babies by 64 weeks' postmenstrual age. INTERPRETATION Our data have yielded standards for postnatal growth in preterm infants. These standards should be used for the assessment of preterm infants until 64 weeks' postmenstrual age, after which the WHO Child Growth Standards are appropriate. Size-at-birth charts should not be used to measure postnatal growth of preterm infants. FUNDING Bill & Melinda Gates Foundation.
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44
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Kelly CE, Thompson DK, Chen J, Leemans A, Adamson CL, Inder TE, Cheong JLY, Doyle LW, Anderson PJ. Axon density and axon orientation dispersion in children born preterm. Hum Brain Mapp 2016; 37:3080-102. [PMID: 27133221 DOI: 10.1002/hbm.23227] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 04/12/2016] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Very preterm birth (VPT, <32 weeks' gestation) is associated with altered white matter fractional anisotropy (FA), the biological basis of which is uncertain but may relate to changes in axon density and/or dispersion, which can be measured using Neurite Orientation Dispersion and Density Imaging (NODDI). This study aimed to compare whole brain white matter FA, axon dispersion, and axon density between VPT children and controls (born ≥37 weeks' gestation), and to investigate associations with perinatal factors and neurodevelopmental outcomes. METHODS FA, neurite dispersion, and neurite density were estimated from multishell diffusion magnetic resonance images for 145 VPT and 33 control 7-year-olds. Diffusion values were compared between groups and correlated with perinatal factors (gestational age, birthweight, and neonatal brain abnormalities) and neurodevelopmental outcomes (IQ, motor, academic, and behavioral outcomes) using Tract-Based Spatial Statistics. RESULTS Compared with controls, VPT children had lower FA and higher axon dispersion within many major white matter fiber tracts. Neonatal brain abnormalities predicted lower FA and higher axon dispersion in many major tracts in VPT children. Lower FA, higher axon dispersion, and lower axon density in various tracts correlated with poorer neurodevelopmental outcomes in VPT children. CONCLUSIONS FA and NODDI measures distinguished VPT children from controls and were associated with neonatal brain abnormalities and neurodevelopmental outcomes. This study provides a more detailed and biologically meaningful interpretation of white matter microstructure changes associated with prematurity. Hum Brain Mapp 37:3080-3102, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Claire E Kelly
- Murdoch Childrens Research Institute, Melbourne, Australia
| | - Deanne K Thompson
- Murdoch Childrens Research Institute, Melbourne, Australia.,Florey Institute of Neuroscience and Mental Health, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Jian Chen
- Murdoch Childrens Research Institute, Melbourne, Australia.,Department of Medicine, Monash Medical Centre, Monash University, Melbourne, Australia
| | - Alexander Leemans
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | | | - Jeanie L Y Cheong
- Murdoch Childrens Research Institute, Melbourne, Australia.,Royal Women's Hospital, Melbourne, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Australia
| | - Lex W Doyle
- Murdoch Childrens Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Royal Women's Hospital, Melbourne, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Australia
| | - Peter J Anderson
- Murdoch Childrens Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
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Nishimura T, Takei N, Tsuchiya KJ, Asano R, Mori N. Identification of neurodevelopmental trajectories in infancy and of risk factors affecting deviant development: a longitudinal birth cohort study. Int J Epidemiol 2016; 45:543-53. [DOI: 10.1093/ije/dyv363] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2015] [Indexed: 02/06/2023] Open
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Chiu YHM, Hsu HHL, Coull BA, Bellinger DC, Kloog I, Schwartz J, Wright RO, Wright RJ. Prenatal particulate air pollution and neurodevelopment in urban children: Examining sensitive windows and sex-specific associations. ENVIRONMENT INTERNATIONAL 2016; 87:56-65. [PMID: 26641520 PMCID: PMC4691396 DOI: 10.1016/j.envint.2015.11.010] [Citation(s) in RCA: 172] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Revised: 11/11/2015] [Accepted: 11/11/2015] [Indexed: 05/14/2023]
Abstract
BACKGROUND Brain growth and structural organization occurs in stages beginning prenatally. Toxicants may impact neurodevelopment differently dependent upon exposure timing and fetal sex. OBJECTIVES We implemented innovative methodology to identify sensitive windows for the associations between prenatal particulate matter with diameter ≤ 2.5 μm (PM2.5) and children's neurodevelopment. METHODS We assessed 267 full-term urban children's prenatal daily PM2.5 exposure using a validated satellite-based spatio-temporally resolved prediction model. Outcomes included IQ (WISC-IV), attention (omission errors [OEs], commission errors [CEs], hit reaction time [HRT], and HRT standard error [HRT-SE] on the Conners' CPT-II), and memory (general memory [GM] index and its components - verbal [VEM] and visual [VIM] memory, and attention-concentration [AC] indices on the WRAML-2) assessed at age 6.5±0.98 years. To identify the role of exposure timing, we used distributed lag models to examine associations between weekly prenatal PM2.5 exposure and neurodevelopment. Sex-specific associations were also examined. RESULTS Mothers were primarily minorities (60% Hispanic, 25% black); 69% had ≤12 years of education. Adjusting for maternal age, education, race, and smoking, we found associations between higher PM2.5 levels at 31-38 weeks with lower IQ, at 20-26 weeks gestation with increased OEs, at 32-36 weeks with slower HRT, and at 22-40 weeks with increased HRT-SE among boys, while significant associations were found in memory domains in girls (higher PM2.5 exposure at 18-26 weeks with reduced VIM, at 12-20 weeks with reduced GM). CONCLUSIONS Increased PM2.5 exposure in specific prenatal windows may be associated with poorer function across memory and attention domains with variable associations based on sex. Refined determination of time window- and sex-specific associations may enhance insight into underlying mechanisms and identification of vulnerable subgroups.
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Affiliation(s)
- Yueh-Hsiu Mathilda Chiu
- Kravis Children's Hospital, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Hsiao-Hsien Leon Hsu
- Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Brent A Coull
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - David C Bellinger
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Neurology Research, Children's Hospital Boston, Harvard Medical School, Boston, MA, USA
| | - Itai Kloog
- Department of Geography and Environmental Development, Ben-Gurion University of the Negev, Israel
| | - Joel Schwartz
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Robert O Wright
- Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA; The Mindich Child Health & Development Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rosalind J Wright
- Kravis Children's Hospital, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA; The Mindich Child Health & Development Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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Giuliani F, Cheikh Ismail L, Bertino E, Bhutta ZA, Ohuma EO, Rovelli I, Conde-Agudelo A, Villar J, Kennedy SH. Monitoring postnatal growth of preterm infants: present and future. Am J Clin Nutr 2016; 103:635S-47S. [PMID: 26791186 PMCID: PMC6443302 DOI: 10.3945/ajcn.114.106310] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND There is no consensus with regard to which charts are most suitable for monitoring the postnatal growth of preterm infants. OBJECTIVE We aimed to assess the strategies used to develop existing postnatal growth charts for preterm infants and their methodologic quality. DESIGN A systematic review of observational longitudinal studies, having as their primary objective the creation of postnatal growth charts for preterm infants, was conducted. Thirty-eight items distributed in 3 methodologic domains ("study design," "statistical methods," and "reporting methods") were assessed in each study. Each item was scored as a "low" or "high" risk of bias. Two reviewers independently selected the studies, assessed the risk of bias, and extracted data. A total quality score [(number of "low risk" of bias marks/total number of items assessed) × 100%] was calculated for each study. Median (range, IQR) quality scores for each methodologic domain and for all included studies were computed. RESULTS Sixty-one studies met the inclusion criteria. Twenty-seven (44.3%) of the 61 studies scored ≥50%, of which 10 scored >60% and only 1 scored >66%. The median (range, IQR) quality score for the 61 included studies was 47% (26-75%, 34-56%). The scores for the domains study design, statistical methods, and reporting methods were 44% (19-67%, 33-52%), 25% (0-88%, 13-38%), and 33% (0-100%, 0-33%), respectively. The most common shortcomings were observed in items related to anthropometric measures (the main variable of interest), gestational age estimation, follow-up duration, reporting of postnatal care and morbidities, assessment of outliers, covariates, and chart presentation. CONCLUSIONS The overall methodologic quality of existing longitudinal studies was fair to low. To overcome these problems, the Preterm Postnatal Follow-up Study, 1 of the 3 main components of The International Fetal and Newborn Growth Consortium for the 21st Century Project, was designed to construct preterm postnatal growth standards from a prospective cohort of "healthy" pregnancies and preterm newborns without evidence of fetal growth restriction.
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Affiliation(s)
- Francesca Giuliani
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - Leila Cheikh Ismail
- Nuffield Department of Obstetrics & Gynaecology, and Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, United Kingdom
| | - Enrico Bertino
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - Zulfiqar A Bhutta
- Center of Excellence in Women & Child Health, The Aga Khan University, Karachi, Pakistan; Center for Global Child Health, Hospital for Sick Children, Toronto, Canada
| | - Eric O Ohuma
- Nuffield Department of Obstetrics & Gynaecology, and Centre for Statistics in Medicine, University of Oxford Botnar Research Centre, Oxford, United Kingdom
| | - Ilaria Rovelli
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - Agustin Conde-Agudelo
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD; National Institutes of Health/Department of Health and Human Services, Detroit, MI
| | - José Villar
- Nuffield Department of Obstetrics & Gynaecology, and Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, United Kingdom
| | - Stephen H Kennedy
- Nuffield Department of Obstetrics & Gynaecology, and Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, United Kingdom;
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Milner KM, Neal EFG, Roberts G, Steer AC, Duke T. Long-term neurodevelopmental outcome in high-risk newborns in resource-limited settings: a systematic review of the literature. Paediatr Int Child Health 2015; 35:227-42. [PMID: 26138273 DOI: 10.1179/2046905515y.0000000043] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND Improving outcomes beyond survival for high-risk newborns in resource-limited settings is an emerging challenge. Global estimates demonstrate the scale of this challenge and significant gaps in morbidity outcome data in high mortality contexts. A systematic review was conducted to document the prevalence of neurodevelopmental impairment in high-risk newborns who were followed up into childhood in low- and middle-income countries. METHODS High-risk newborns were defined as low, very or extremely low birthweight, preterm infants or those surviving birth asphyxia or serious infections. Electronic databases were searched and articles screened for eligibility. Included articles were appraised according to STROBE criteria. Narrative review was performed and median prevalence of key neurodevelopmental outcomes was calculated where data quality allowed. RESULTS 6959 articles were identified with sixty included in final review. At follow-up in early childhood, median estimated prevalence (inter-quartile range) of overall neurodevelopmental impairment, cognitive impairment and cerebral palsy were: for survivors of prematurity/very low birthweight 21.4% (11.6-30.8), 16.3% (6.3-29.6) and 11.2% (5.9-16.1), respectively, and for survivors of birth asphyxia 34.6% (25.4-51.5), 11.3% (7.7-11.8) and 22.8% (15.7-31.4), respectively. Only three studies reporting outcomes following newborn serious bacterial infections were identified. There was limited reporting of important outcomes such as vision and hearing impairment. Major challenges with standardised reporting of key exposure and developmental outcome variables and lack of control data were identified. CONCLUSION Understanding the limitations of the available data on neurodevelopmental outcome in newborns in resource-limited settings provides clear direction for research and efforts to improve long-term outcome in high-risk newborns in these settings.
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Developmental presentation, medical complexities, and service delivery for a child with 16p11.2 deletion syndrome. Pediatr Phys Ther 2015; 27:90-9. [PMID: 25521272 DOI: 10.1097/pep.0000000000000105] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To discuss the developmental presentation, complicating factors, and delivery of physical therapy services through the Birth to Three System, for 1 child with 16p11.2 deletion syndrome. KEY POINTS History, presenting problems, medical complexities, developmental and behavioral characteristics, interventions, and implications for service delivery are reviewed. CONCLUSIONS The child experienced many difficulties reported in the literature related to the wide phenotype of 16p11.2 deletion syndrome. Focus on caregiver instruction and education to accomplish family-driven, functional outcomes increased carryover and allowed the greatest potential for success. RECOMMENDATIONS FOR CLINICAL PRACTICE Genetic disorders such as 16p11.2 deletion syndrome are increasingly being recognized as etiologic factors in neurodevelopmental conditions. It is critical for physical therapists to be aware of the varied manifestations and effects of this genetic disorder. Advanced problem solving and decision-making, ongoing assessment, and collaboration are required to comprehensively support the family in meeting the child's medical, behavioral, and developmental needs.
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Fernandes M, Stein A, Newton CR, Cheikh-Ismail L, Kihara M, Wulff K, de León Quintana E, Aranzeta L, Soria-Frisch A, Acedo J, Ibanez D, Abubakar A, Giuliani F, Lewis T, Kennedy S, Villar J. The INTERGROWTH-21st Project Neurodevelopment Package: a novel method for the multi-dimensional assessment of neurodevelopment in pre-school age children. PLoS One 2014; 9:e113360. [PMID: 25423589 PMCID: PMC4244160 DOI: 10.1371/journal.pone.0113360] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 10/22/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The International Fetal and Newborn Growth Consortium for the 21st Century (INTERGROWTH-21st) Project is a population-based, longitudinal study describing early growth and development in an optimally healthy cohort of 4607 mothers and newborns. At 24 months, children are assessed for neurodevelopmental outcomes with the INTERGROWTH-21st Neurodevelopment Package. This paper describes neurodevelopment tools for preschoolers and the systematic approach leading to the development of the Package. METHODS An advisory panel shortlisted project-specific criteria (such as multi-dimensional assessments and suitability for international populations) to be fulfilled by a neurodevelopment instrument. A literature review of well-established tools for preschoolers revealed 47 candidates, none of which fulfilled all the project's criteria. A multi-dimensional assessment was, therefore, compiled using a package-based approach by: (i) categorizing desired outcomes into domains, (ii) devising domain-specific criteria for tool selection, and (iii) selecting the most appropriate measure for each domain. RESULTS The Package measures vision (Cardiff tests); cortical auditory processing (auditory evoked potentials to a novelty oddball paradigm); and cognition, language skills, behavior, motor skills and attention (the INTERGROWTH-21st Neurodevelopment Assessment) in 35-45 minutes. Sleep-wake patterns (actigraphy) are also assessed. Tablet-based applications with integrated quality checks and automated, wireless electroencephalography make the Package easy to administer in the field by non-specialist staff. The Package is in use in Brazil, India, Italy, Kenya and the United Kingdom. CONCLUSIONS The INTERGROWTH-21st Neurodevelopment Package is a multi-dimensional instrument measuring early child development (ECD). Its developmental approach may be useful to those involved in large-scale ECD research and surveillance efforts.
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Affiliation(s)
- Michelle Fernandes
- Nuffield Department of Obstetrics & Gynaecology, and Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, United Kingdom
| | - Alan Stein
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom
| | - Charles R. Newton
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
| | - Leila Cheikh-Ismail
- Nuffield Department of Obstetrics & Gynaecology, and Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, United Kingdom
| | - Michael Kihara
- Department of Psychology, United States International University, Nairobi, Kenya
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
| | - Katharina Wulff
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | | | - Luis Aranzeta
- Centro de Tecnología e Innovación, Mexico City, Mexico
| | | | - Javier Acedo
- Neuroscience Business Unit, Starlab Barcelona, SL, Barcelona, Spain
| | - David Ibanez
- Neuroscience Business Unit, Starlab Barcelona, SL, Barcelona, Spain
| | - Amina Abubakar
- Department of Psychology, Lancaster University, Lancaster, United Kingdom
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
| | - Francesca Giuliani
- Dipartimento di Scienze Pediatriche e dell' Adolescenza, SCDU Neonatologia, Università di Torino, Turin, Italy
| | - Tamsin Lewis
- Nuffield Department of Obstetrics & Gynaecology, and Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, United Kingdom
| | - Stephen Kennedy
- Nuffield Department of Obstetrics & Gynaecology, and Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, United Kingdom
| | - Jose Villar
- Nuffield Department of Obstetrics & Gynaecology, and Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, United Kingdom
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