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Alenius S, Kajantie E, Sund R, Nurhonen M, Haaramo P, Näsänen-Gilmore P, Lemola S, Räikkönen K, Schnitzlein DD, Wolke D, Gissler M, Hovi P. School grades and educational attainments of adolescents and young adults born preterm. Sci Rep 2023; 13:231. [PMID: 36604570 PMCID: PMC9816170 DOI: 10.1038/s41598-022-27295-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 12/29/2022] [Indexed: 01/07/2023] Open
Abstract
Attendance in special education (SE) is more common among individuals born preterm than among those born at term. Less is known about school grades of those born preterm in mainstream education (ME), and how these grades predict later educational attainment. This population-based register-linkage study assessed (1) attendance in SE, and then focused on those in ME by assessing (2) school grades at 16 year, (3) completed educational level at 25 year, and (4) school grades as predictors for completed education by gestational age (GA) with full-term birth (39-41 completed weeks) as reference. The sample comprised 223,744 individuals (10,521 preterm, 4.7%) born in Finland (1/1987-9/1990). Of the sample, 4.9% attended SE. Those born preterm had up to 5.5-fold rates for SE. In ME, those born extremely preterm (EPT) had marginally lower mathematics grades compared with full-term counterparts, whilst those born late preterm or early term had slightly higher grades. Those born EPT or very preterm had lower physical education grades in ME. However, the minor differences in school grades according to GA appear not to translate into educational differences in young adulthood. The associations between school grades at 16 year and completed education at 25 year did not vary by GA.
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Affiliation(s)
- Suvi Alenius
- Finnish Institute for Health and Welfare, Mannerheimintie 166, P.O. Box 30, 00271, Helsinki, Finland. .,Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
| | - Eero Kajantie
- Finnish Institute for Health and Welfare, Mannerheimintie 166, P.O. Box 30, 00271, Helsinki, Finland.,Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Faculty of Medicine, PEDEGO Research Unit, MRC Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.,Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Reijo Sund
- Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Markku Nurhonen
- Finnish Institute for Health and Welfare, Mannerheimintie 166, P.O. Box 30, 00271, Helsinki, Finland
| | - Peija Haaramo
- Finnish Institute for Health and Welfare, Mannerheimintie 166, P.O. Box 30, 00271, Helsinki, Finland
| | - Pieta Näsänen-Gilmore
- Finnish Institute for Health and Welfare, Mannerheimintie 166, P.O. Box 30, 00271, Helsinki, Finland.,Tampere Center for Child, Adolescent, and Maternal Health Research: Global Health Group, Faculty of Medicine, and Health Technology, Tampere University, Tampere, Finland
| | - Sakari Lemola
- Department of Psychology, Bielefeld University, Bielefeld, Germany.,Department of Psychology, University of Warwick, Coventry, UK
| | - Katri Räikkönen
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Daniel D Schnitzlein
- Institute of Labour Economics, Leibniz University, Hannover, Germany.,Institute of Labor Economics (IZA), Bonn, Germany
| | - Dieter Wolke
- Department of Psychology, University of Warwick, Coventry, UK
| | - Mika Gissler
- Finnish Institute for Health and Welfare, Mannerheimintie 166, P.O. Box 30, 00271, Helsinki, Finland.,Region Stockholm, Academic Primary Health Care Centre, Stockholm, Sweden & Karolinska Institute, Department of Molecular Medicine and Surgery, Stockholm, Sweden
| | - Petteri Hovi
- Finnish Institute for Health and Welfare, Mannerheimintie 166, P.O. Box 30, 00271, Helsinki, Finland.,Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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2
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Kallankari H, Taskila HL, Heikkinen M, Hallman M, Saunavaara V, Kaukola T. Microstructural alterations in association tracts and language abilities in schoolchildren born very preterm and with poor fetal growth. Pediatr Radiol 2023; 53:94-103. [PMID: 35773359 PMCID: PMC9816217 DOI: 10.1007/s00247-022-05418-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 05/07/2022] [Accepted: 06/02/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND Prematurity and perinatal risk factors may influence white matter microstructure. In turn, these maturational changes may influence language development in this high-risk population of children. OBJECTIVE To evaluate differences in the microstructure of association tracts between preterm and term children and between preterm children with appropriate growth and those with fetal growth restriction and to study whether the diffusion tensor metrics of these tracts correlate with language abilities in schoolchildren with no severe neurological impairment. MATERIALS AND METHODS This study prospectively followed 56 very preterm children (mean gestational age: 28.7 weeks) and 21 age- and gender-matched term children who underwent diffusion tensor imaging at a mean age of 9 years. We used automated probabilistic tractography and measured fractional anisotropy in seven bilateral association tracts known to belong to the white matter language network. Both groups participated in language assessment using five standardised tests at the same age. RESULTS Preterm children had lower fractional anisotropy in the right superior longitudinal fasciculus 1 compared to term children (P < 0.05). Preterm children with fetal growth restriction had lower fractional anisotropy in the left inferior longitudinal fasciculus compared to preterm children with appropriate fetal growth (P < 0.05). Fractional anisotropy in three dorsal tracts and in two dorsal and one ventral tract had a positive correlation with language assessments among preterm children and preterm children with fetal growth restriction, respectively (P < 0.05). CONCLUSION There were some microstructural differences in language-related tracts between preterm and term children and between preterm children with appropriate and those with restricted fetal growth. Children with better language abilities had a higher fractional anisotropy in distinct white matter tracts.
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Affiliation(s)
- Hanna Kallankari
- PEDEGO Research Unit and Medical Research Center Oulu, University of Oulu, Oulu, Finland. .,Department of Child Neurology, Oulu University Hospital, University of Oulu, P.O. Box 5000, FIN-90014, Oulu, Finland.
| | - Hanna-Leena Taskila
- PEDEGO Research Unit and Medical Research Center Oulu, University of Oulu, Oulu, Finland ,Department of Neonatology, Oulu University Hospital, Oulu, Finland
| | - Minna Heikkinen
- PEDEGO Research Unit and Medical Research Center Oulu, University of Oulu, Oulu, Finland ,Child Language Research Center, Faculty of Humanities, University of Oulu, Oulu, Finland
| | - Mikko Hallman
- PEDEGO Research Unit and Medical Research Center Oulu, University of Oulu, Oulu, Finland
| | - Virva Saunavaara
- PET Center, Turku University Hospital, Turku, Finland ,Department of Medical Physics, Turku University Hospital, Turku, Finland
| | - Tuula Kaukola
- PEDEGO Research Unit and Medical Research Center Oulu, University of Oulu, Oulu, Finland ,Department of Neonatology, Oulu University Hospital, Oulu, Finland
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Taskila HL, Heikkinen M, Yliherva A, Välimaa T, Hallman M, Kaukola T, Kallankari H. Antenatal and neonatal risk factors in very preterm children were associated with language difficulties at nine years of age. Acta Paediatr 2022; 111:2100-2107. [PMID: 35896181 DOI: 10.1111/apa.16501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 07/21/2022] [Accepted: 07/26/2022] [Indexed: 11/28/2022]
Abstract
AIM This Finnish study compared language and reading abilities between schoolchildren born at a very low gestational age (VLGA) of <32 weeks and at term and analysed any associations between antenatal and neonatal risk factors and language skills in the VLGA group. METHODS We prospectively followed 76 children born at a VLGA and 50 children born at term when they reached a mean age of 9.0 (8.1-10.0) years. They attended mainstream schools and had no severe neurosensory disabilities. Receptive language ability, rapid naming and word reading were evaluated using standardised tests. RESULTS Children in the VLGA group had lower scores for receptive language abilities (median 55.0 versus 57.0, p = 0.01) and word reading (mean 4.4 versus 5.1, p = 0.03) than the children in the term group. In the VLGA group, foetal growth restriction was associated with lower scores for rapid naming, early intraventricular haemorrhage was associated with poor word reading and respiratory distress syndrome was associated with poor rapid naming (p < 0.05). CONCLUSION Schoolchildren born at a VLGA had more difficulties with receptive language abilities and word reading than children born at term. Foetal growth restriction and early neonatal morbidities were associated with language difficulties.
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Affiliation(s)
- Hanna-Leena Taskila
- PEDEGO Research Unit and Medical Research Center Oulu, University of Oulu, Oulu, Finland.,Department of Children and Adolescents, Oulu University Hospital, Oulu, Finland
| | - Minna Heikkinen
- PEDEGO Research Unit and Medical Research Center Oulu, University of Oulu, Oulu, Finland.,Research Unit of Logopedics and Child Language Research Center, University of Oulu, Oulu, Finland
| | - Anneli Yliherva
- Research Unit of Logopedics and Child Language Research Center, University of Oulu, Oulu, Finland.,Logopedics, Faculty of Social Sciences, University of Tampere, Tampere, Finland
| | - Taina Välimaa
- Research Unit of Logopedics and Child Language Research Center, University of Oulu, Oulu, Finland
| | - Mikko Hallman
- PEDEGO Research Unit and Medical Research Center Oulu, University of Oulu, Oulu, Finland
| | - Tuula Kaukola
- PEDEGO Research Unit and Medical Research Center Oulu, University of Oulu, Oulu, Finland.,Department of Children and Adolescents, Oulu University Hospital, Oulu, Finland
| | - Hanna Kallankari
- PEDEGO Research Unit and Medical Research Center Oulu, University of Oulu, Oulu, Finland.,Department of Children and Adolescents, Oulu University Hospital, Oulu, Finland
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Chand K, Nano R, Wixey J, Patel J. OUP accepted manuscript. Stem Cells Transl Med 2022; 11:372-382. [PMID: 35485440 PMCID: PMC9052430 DOI: 10.1093/stcltm/szac005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 12/12/2021] [Indexed: 11/25/2022] Open
Abstract
Fetal growth restriction (FGR) occurs when a fetus is unable to grow normally due to inadequate nutrient and oxygen supply from the placenta. Children born with FGR are at high risk of lifelong adverse neurodevelopmental outcomes, such as cerebral palsy, behavioral issues, and learning and attention difficulties. Unfortunately, there is no treatment to protect the FGR newborn from these adverse neurological outcomes. Chronic inflammation and vascular disruption are prevalent in the brains of FGR neonates and therefore targeted treatments may be key to neuroprotection. Tissue repair and regeneration via stem cell therapies have emerged as a potential clinical intervention for FGR babies at risk for neurological impairment and long-term disability. This review discusses the advancement of research into stem cell therapy for treating neurological diseases and how this may be extended for use in the FGR newborn. Leading preclinical studies using stem cell therapies in FGR animal models will be highlighted and the near-term steps that need to be taken for the development of future clinical trials.
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Affiliation(s)
- Kirat Chand
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia
| | - Rachel Nano
- Cancer and Ageing Research Program, School of Biomedical Sciences, Queensland University of Technology, Brisbane, QLD, Australia
| | - Julie Wixey
- Julie Wixey, Faculty of Medicine, Royal Brisbane and Women’s Hospital, The University of Queensland Centre for Clinical Research, Herston 4029 QLD, Australia.
| | - Jatin Patel
- Corresponding authors: Jatin Patel, Translational Research Institute, Queensland University of Technology, 37 Kent Street, Woolloongabba 4102 QLD, Australia.
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Sacchi C, O'Muircheartaigh J, Batalle D, Counsell SJ, Simonelli A, Cesano M, Falconer S, Chew A, Kennea N, Nongena P, Rutherford MA, Edwards AD, Nosarti C. Neurodevelopmental Outcomes following Intrauterine Growth Restriction and Very Preterm Birth. J Pediatr 2021; 238:135-144.e10. [PMID: 34245768 DOI: 10.1016/j.jpeds.2021.07.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 06/23/2021] [Accepted: 07/01/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To evaluate whether intrauterine growth restriction (IUGR) adds further neurodevelopmental risk to that posed by very preterm birth alone in terms of alterations in brain growth and poorer toddlerhood outcomes. STUDY DESIGN Participants were 314 infants of very preterm birth enrolled in the Evaluation of Preterm Imaging Study (e-Prime) who were subsequently followed up in toddlerhood. IUGR was identified postnatally from discharge records (n = 49) and defined according to prenatal evaluation of growth restriction confirmed by birth weight <10th percentile for gestational age and/or alterations in fetal Doppler. Appropriate for gestational age (AGA; n = 265) was defined as birth weight >10th percentile for gestational age at delivery. Infants underwent magnetic resonance imaging at term-equivalent age (median = 42 weeks); T2-weighted images were obtained for voxelwise gray matter volumes. Follow-up assessments were conducted at corrected median age of 22 months using the Bayley Scales of Infant and Toddler Development III and the Modified-Checklist for Autism in Toddlers. RESULTS Infants of very preterm birth with IUGR displayed a relative volumetric decrease in gray matter in limbic regions and a relative increase in frontoinsular, temporal-parietal, and frontal areas compared with peers of very preterm birth who were AGA. At follow-up, toddlers born very preterm with IUGR had significantly lower cognitive (effect size = 0.42) and motor (effect size = 0.41) scores and were more likely to have a positive Modified-Checklist for Autism in Toddlers screening for autism (OR = 2.12) compared with peers of very preterm birth who were AGA. CONCLUSIONS IUGR might confer a neurodevelopmental risk that is greater than that posed by very preterm alone, in terms of both alterations in brain growth and poorer toddlerhood outcomes.
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Affiliation(s)
- Chiara Sacchi
- Department of Developmental and Social Psychology, University of Padova, Padua, Italy
| | - Jonathan O'Muircheartaigh
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom; Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Dafnis Batalle
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom; Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Serena Jane Counsell
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Alessandra Simonelli
- Department of Developmental and Social Psychology, University of Padova, Padua, Italy
| | - Michela Cesano
- Department of Developmental and Social Psychology, University of Padova, Padua, Italy
| | - Shona Falconer
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Andrew Chew
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Nigel Kennea
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Phumza Nongena
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Mary Ann Rutherford
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Anthony David Edwards
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Chiara Nosarti
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom; Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.
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Heikkinen M, Kallankari H, Partanen L, Korkalainen N, Kaukola T, Yliherva A. Children born before 32 weeks of gestation displayed impaired reading fluency, comprehension and spelling skills at 9 years of age. Acta Paediatr 2021; 110:521-527. [PMID: 32609898 DOI: 10.1111/apa.15456] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 06/16/2020] [Accepted: 06/25/2020] [Indexed: 12/01/2022]
Abstract
AIM Our aim was to study whether prematurity, associated with prenatal and neonatal risk factors, affects specific literacy skills among school children born at a very low gestational age (VLGA) of <32 weeks. METHODS The study group comprised 76 prospectively followed VLGA children born between November 1998 and November 2002 at Oulu University Hospital, Finland, and 51 term controls. The median gestational age of the VLGA children was 29.0 (24.1-31.9) weeks. All children were examined at a median age of 8.9 (8.0-9.9) years in Oulu between November 2007 and November 2011. Reading fluency, comprehension and spelling skills were evaluated using standardised tests for Finnish-speaking children. RESULTS Very low gestational age children had significantly poorer test results in reading comprehension (median 6.9 vs 8.3, P = .014) and spelling (median 35.7 vs 38.0, P = .013) than term children. Furthermore, VLGA children more often performed below the 10th percentile normal values in spelling (P = .012) compared with term controls. Foetal growth restriction was associated with lower scoring in reading fluency (P = .023) and spelling (P = .004) among VLGA children. CONCLUSION Very low gestational age school children performed poorer in reading comprehension and spelling than term children. In addition, poor foetal growth in VLGA children was associated with literacy problems.
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Affiliation(s)
- Minna Heikkinen
- Faculty of Humanities Child Language Research Center University of Oulu Oulu Finland
| | - Hanna Kallankari
- PEDEGO Research Unit and Medical Research Center Oulu University of Oulu Oulu Finland
- Department of Child Neurology Oulu University Hospital Oulu Finland
| | - Lea Partanen
- Faculty of Humanities Child Language Research Center University of Oulu Oulu Finland
| | - Noora Korkalainen
- PEDEGO Research Unit and Medical Research Center Oulu University of Oulu Oulu Finland
| | - Tuula Kaukola
- PEDEGO Research Unit and Medical Research Center Oulu University of Oulu Oulu Finland
- Department of Neonatology Oulu University Hospital Oulu Finland
| | - Anneli Yliherva
- Faculty of Humanities Child Language Research Center University of Oulu Oulu Finland
- Logopedics, Faculty of Social Sciences University of Tampere Tampere Finland
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Kallankari H, Saunavaara V, Parkkola R, Haataja L, Hallman M, Kaukola T. Diffusion tensor imaging in frontostriatal tracts is associated with executive functioning in very preterm children at 9 years of age. Pediatr Radiol 2021; 51:112-118. [PMID: 32870358 PMCID: PMC7796865 DOI: 10.1007/s00247-020-04802-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 05/27/2020] [Accepted: 08/05/2020] [Indexed: 01/26/2023]
Abstract
BACKGROUND Very preterm birth can disturb brain maturation and subject these high-risk children to neurocognitive difficulties later. OBJECTIVE The aim of the study was to evaluate the impact of prematurity on microstructure of frontostriatal tracts in children with no severe neurologic impairment, and to study whether the diffusion tensor imaging metrics of frontostriatal tracts correlate to executive functioning. MATERIALS AND METHODS The prospective cohort study comprised 54 very preterm children (mean gestational age 28.8 weeks) and 20 age- and gender-matched term children. None of the children had severe neurologic impairment. The children underwent diffusion tensor imaging and neuropsychological assessments at a mean age of 9 years. We measured quantitative diffusion tensor imaging metrics of frontostriatal tracts using probabilistic tractography. We also administered five subtests from the Developmental Neuropsychological Assessment, Second Edition, to evaluate executive functioning. RESULTS Very preterm children had significantly higher fractional anisotropy and axial diffusivity values (P<0.05, corrected for multiple comparison) in dorsolateral prefrontal caudate and ventrolateral prefrontal caudate tracts as compared to term-born children. We found negative correlations between the diffusion tensor imaging metrics of frontostriatal tracts and inhibition functions (P<0.05, corrected for multiple comparison) in very preterm children. CONCLUSION Prematurity has a long-term effect on frontostriatal white matter microstructure that might contribute to difficulties in executive functioning.
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Affiliation(s)
- Hanna Kallankari
- PEDEGO Research Unit and Medical Research Center Oulu, University of Oulu, Oulu, Finland. .,Department of Child Neurology, Oulu University Hospital, P.O. Box 23, FIN-90029 OYS, Oulu, Finland.
| | - Virva Saunavaara
- PET Center, Turku University Hospital, Turku, Finland ,Department of Medical Physics, Turku University Hospital, Turku, Finland
| | - Riitta Parkkola
- Department of Radiology, University of Turku and Turku University Hospital, Turku, Finland
| | - Leena Haataja
- Department of Child Neurology, Children and Adolescents, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Mikko Hallman
- PEDEGO Research Unit and Medical Research Center Oulu, University of Oulu, Oulu, Finland
| | - Tuula Kaukola
- PEDEGO Research Unit and Medical Research Center Oulu, University of Oulu, Oulu, Finland ,Department of Neonatology, Oulu University Hospital, Oulu, Finland
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Paul R, Singh A. Does early childhood adversities affect physical, cognitive and language development in indian children? Evidence from a panel study. SSM Popul Health 2020; 12:100693. [PMID: 33294583 PMCID: PMC7695919 DOI: 10.1016/j.ssmph.2020.100693] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 11/09/2020] [Accepted: 11/09/2020] [Indexed: 01/17/2023] Open
Abstract
Early childhood adversities are known to impair the development potential of children, however, there is limited evidence for the same in the Indian context. This study provides evidence of the effect of relevant biological and social risk factors during early childhood on the physical, cognitive and language development of Indian children. Panel data from two rounds of the India Human Development Survey (IHDS) was used to examine these associations among the Indian children. Using multivariable ordered logistic regression models, our study examined the association between the risk factors and the four indicators of development potential - stunting status, mathematical skill, reading skill, and writing skill. The results show that malnutrition and hostile community environment during early childhood impairs the physical development of children. The results also reveal that malnutrition, indoor air pollution, poor household sanitation condition, hostile community environment, lack of education among household adults, domestic violence on women in the community, and lack of autonomy among women in the household are the major biological and social risk factors that affect the cognitive and language development of Indian children.
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Affiliation(s)
- Ronak Paul
- Department of Public Health and Mortality Studies, International Institute for Population Sciences, Mumbai, 400088, India
| | - Abhishek Singh
- Department of Public Health and Mortality Studies, International Institute for Population Sciences, Mumbai, 400088, India
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Partanen L, Korkalainen N, Mäkikallio K, Olsén P, Heikkinen H, Yliherva A. Foetal growth restriction has negative influence on narrative skills in 8-10-year-old children. Acta Paediatr 2020; 109:1595-1602. [PMID: 31869483 DOI: 10.1111/apa.15146] [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] [Received: 10/14/2019] [Revised: 12/11/2019] [Accepted: 12/19/2019] [Indexed: 11/27/2022]
Abstract
AIM The risk for neurocognitive difficulties is increased in children born with foetal growth restriction (FGR), but no data exist yet on their narrative skills. The narrative skills of 8- to 10-year-old children born with FGR between 24 and 40 weeks were compared with those of children born with appropriate growth for gestational age (AGA). METHODS A prospectively collected cohort of 36 children with FGR was recruited prenatally at a Finnish tertiary hospital from 1998-2001, and 31 children with AGA served as controls. Narrative skills were assessed using a standardised test, and correlations between narrative, communication, reading and spelling skills were studied. RESULTS Children born with FGR produced significantly less information and shorter utterances in their narratives than the AGA group. Children born preterm with FGR performed significantly more poorly in their narratives than the preterm AGA group. Poor narrative skills correlated with poor communication, reading and spelling skills. CONCLUSION Children born with FGR had poorer narrative skills compared with their AGA peers at the age of 8-10 years, and narrative skills were linked to other language-based skills, which underlines the importance of early detection and preventive measures to optimise the educational outcome of children born with FGR.
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Affiliation(s)
- Lea Partanen
- Faculty of Humanities Child Language Research Centre University of Oulu Oulu Finland
| | - Noora Korkalainen
- Faculty of Humanities Child Language Research Centre University of Oulu Oulu Finland
- Department of Obstetrics and Gynaecology University Hospital of Oulu Oulu Finland
| | - Kaarin Mäkikallio
- Department of Obstetrics and Gynaecology University Hospital of Turku Turku Finland
- Department of Clinical Medicine University of Turku Turku Finland
| | - Päivi Olsén
- PEDEGO Research Unit University of Oulu Oulu Finland
- Department of Paediatrics University Hospital of Oulu Oulu Finland
| | - Hanna Heikkinen
- Research Unit of Mathematical Sciences University of Oulu Oulu Finland
| | - Anneli Yliherva
- Faculty of Humanities Child Language Research Centre University of Oulu Oulu Finland
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10
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Zavadenko NN, Davydova LA. [Neurological and neurodevelopmental disorders in preterm-born children (with extremely low, very low or low body weight)]. Zh Nevrol Psikhiatr Im S S Korsakova 2020; 119:12-19. [PMID: 31994509 DOI: 10.17116/jnevro201911912112] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
AIM To evaluate the incidence of neurological diseases and neurodevelopmental disorders in preterm-born children, aged 5-8 years, with extremely low (ELBW), very low (VLBW) or low body weight (LBW) at birth. MATERIAL AND METHODS One hundred and twenty-two preterm-born children, including 36 born with ELBW, 36 born with VLBW and 50 born with LBW, were examined in the age from 5 years 0 months to 8 years 0 months. Presenting complaints were assessed by means of the structured parents' questionnaire. Diagnosis of the nervous system diseases was based on the criteria of ICD-10 and DSM-V. RESULTS AND CONCLUSION Based on the assessment results, there was no any neurological or neurodevelopmental disorder in 8.3% (n=3) of children with ELBW, 16.7% (n=6) with VLBW, 22.0% (n=11) with LBW at birth. Compared to the general pediatric population, more preterm-born children with ELBW, VLBW or LBW, aged 5-8 years, had developmental dyspraxia, chronic motor tics, tension type headaches and enuresis. Moreover, the higher incidence was found for neurodevelopmental disorders, including attention deficit hyperactivity disorder, autism spectrum disorders, specific learning disabilities, compared with population rates. All conditions were more prevalent in boys than in girls, with the exception of tension type headaches. The frequency of disorders was inversely correlated with gestational age and body weight. However, the results demonstrate reserve capacities of the developing brain in children born preterm and suffered early brain damage.
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Affiliation(s)
- N N Zavadenko
- Pirogov Russian National Research Medical University, Ministry of Healthcare of RF, Moscow, Russia
| | - L A Davydova
- Pirogov Russian National Research Medical University, Ministry of Healthcare of RF, Moscow, Russia
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11
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Lind A, Nyman A, Lehtonen L, Haataja L. Predictive value of psychological assessment at five years of age in the long-term follow-up of very preterm children. Child Neuropsychol 2019; 26:312-323. [DOI: 10.1080/09297049.2019.1674267] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Annika Lind
- Department of Psychology, University of Turku, Turku, Finland
- Turku Institute for Advanced Studies (TIAS), University of Turku, Turku, Finland
| | - Anna Nyman
- Department of Psychology, University of Turku, Turku, Finland
| | - Liisa Lehtonen
- Department of Pediatrics, University of Turku and Turku University Hospital, Turku, Finland
| | - Leena Haataja
- Children’s Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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12
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Korkalainen N, Partanen L, Räsänen J, Yliherva A, Mäkikallio K. Fetal hemodynamics and language skills in primary school-aged children with fetal growth restriction: A longitudinal study. Early Hum Dev 2019; 134:34-40. [PMID: 31170674 DOI: 10.1016/j.earlhumdev.2019.05.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 04/29/2019] [Accepted: 05/24/2019] [Indexed: 10/26/2022]
Abstract
AIM Long-term follow-up studies on children born with fetal growth restriction (FGR) have revealed a specific profile of neurocognitive difficulties, including problems with speech, language and literacy skills. We hypothesized that problems with communication skills, including language use and literacy skills of FGR children at primary school age are associated with prenatal circulatory changes. METHODS Ultrasonographic assessment of fetoplacental hemodynamics was performed prenatally in 77 fetuses. After a follow-up period of 8-10 years, assessment of reading and spelling skills using standardized tests and the Children's Communication Questionnaire (CCC-2) was performed to measure different language skills in 37 FGR children and 31 appropriately grown (AGA) controls, matched for gestational age. RESULTS Increased blood flow resistance in the umbilical artery (UA PI >2 SD) during fetal life showed odds ratios of 3.5-19.1 for poor literacy and communication skills and need for speech and language therapy. Furthermore, FGR children with prenatal cerebral vasodilatation (cerebroplacental ratio (CPR) < -2 SD) had significantly poorer literacy and communication skills, at primary school age compared to the AGA controls. Abnormal CPR demonstrated odds ratios of 4.2-28.1 for poor literacy and communication skills and need for speech and language therapy. CONCLUSION Increased blood flow resistance in the umbilical artery and cerebral vasodilatation are associated with poor communication, language, and literacy skills at early school age in children born with FGR. These findings indicate the need for continuous follow-up of this group and timely targeted support to ensure optimal academic outcomes.
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Affiliation(s)
- Noora Korkalainen
- Department of Obstetrics and Gynecology, University Hospital of Oulu, Oulu, Finland; PEDEGO Research Unit, University of Oulu, Oulu, Finland.
| | - Lea Partanen
- Child Language Research Center, Logopedics, University of Oulu, Oulu, Finland
| | - Juha Räsänen
- Department of Obstetrics and Gynecology, University Hospital of Helsinki, University of Helsinki, Helsinki, Finland
| | - Anneli Yliherva
- Child Language Research Center, Logopedics, University of Oulu, Oulu, Finland
| | - Kaarin Mäkikallio
- Department of Obstetrics and Gynecology, University Hospital of Oulu, Oulu, Finland; PEDEGO Research Unit, University of Oulu, Oulu, Finland; Department of Obstetrics and Gynecology, University Hospital of Turku, University of Turku, Turku, Finland
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13
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Nist MD, Pickler RH. An Integrative Review of Cytokine/Chemokine Predictors of Neurodevelopment in Preterm Infants. Biol Res Nurs 2019; 21:366-376. [PMID: 31142128 PMCID: PMC6794666 DOI: 10.1177/1099800419852766] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Preterm infants are at risk of brain injury and poor neurodevelopmental outcomes including impairments in cognition, behavioral functioning, sensory perception, and motor performance. Systemic inflammation has been identified as an important, potentially modifiable precursor of neurologic and neurodevelopmental impairments. Inflammation is typically measured by quantifying circulating cytokines and chemokines. However, it is unclear which specific cytokines/chemokines most consistently predict neurodevelopment in preterm infants. In this integrative review, we evaluated and analyzed the literature (N = 37 publications) to determine the cytokines/chemokines most predictive of neurodevelopment in preterm infants, the optimal timing for these measurements, and the ideal source for collecting cytokines/chemokines. Synthesis of the findings of these studies revealed that interleukin (IL)-6, IL-1β, IL-8, and tumor necrosis factor (TNF)-α collected during the first 3 weeks of life are most predictive of subsequent neurodevelopment. Methodological variation among studies hinders more specific analysis, including the evaluation of cytokine thresholds and meta-analyses, that would allow for the use of cytokines/chemokines to predict neurodevelopment. Future research should focus on identifying explicit cytokine values, specifically for IL-6, IL-1β, IL-8, and TNF-α, that are most predictive for identifying preterm infants most at risk of impairment, keeping in mind that longitudinal measures of cytokines/chemokines may be more predictive of future outcomes than single-time point measures.
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Affiliation(s)
| | - Rita H. Pickler
- Nursing Science Programs, The Ohio State University College of Nursing,
Columbus, OH, USA
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14
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Zavadenko NN, Davydova LA, Zavadenko AN. [Neurodevelopment of children born very preterm with extremely low and very low body weight]. Zh Nevrol Psikhiatr Im S S Korsakova 2019; 118:49-55. [PMID: 30585604 DOI: 10.17116/jnevro201811811149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
AIM To evaluate the characteristics of neurodevelopment by the age of 5-8 years in children who were born very preterm with extremely low body weight (ELBW) and very low body weight (VLBW). MATERIAL AND METHODS Seventy-two patients, aged from 5 years to 8 years were examined. Patients were divided into group I (36 patients born preterm with ELBW (16 boys, 20 girls)) and group II (36 patients born with VLBW (16 boys, 20 girls)). The control group included 30 healthy peers (16 boys, 14 girls). All children were assessed by means of the Griffiths Mental Development Scales, Extended Revised: 2 to 8 years (GMDS-ER 2-8). RESULTS The value of general quotient (GQ) in patients born with ELBW (73.4±2.1) was significantly lower compared to their healthy peers (80.9±2.1; p=0.036). The same tendency was found in patients born with VLBW who's GQ was decreased by 73.1±3.0 (p=0.101). Concurrently the patients demonstrated lower scores on all six scales, which achieved significant difference with the controls for the 'Locomotor' and 'Performance' scales in group I, and for the 'Performance' and 'Practical reasoning' scales in group II. The boys born with ELBW tended to demonstrate lower results on all six scales and received significantly lower scores on the 'Locomotor' and 'Language' scales. The boys born with VLBW demonstrated significantly lower scores on the 'Language', 'Eye and hand co-ordination' and 'Practical reasoning' scales. In girls significantly lower score on the 'Performance' scale only was shown for those, who were born with ELBW. CONCLUSION Early diagnosis and characterization of developmental delays in children born very preterm determine the effectiveness of therapeutic measures based on the individual approach and comprehensive medical-psychological-pedagogical support.
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Affiliation(s)
- N N Zavadenko
- Neurology, Neurosurgery and Medical Genetics Department of the Pediatric Faculty, N.I. Pirogov Russian National Research Medical University of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - L A Davydova
- Neurology, Neurosurgery and Medical Genetics Department of the Pediatric Faculty, N.I. Pirogov Russian National Research Medical University of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - A N Zavadenko
- Neurology, Neurosurgery and Medical Genetics Department of the Pediatric Faculty, N.I. Pirogov Russian National Research Medical University of the Ministry of Health of the Russian Federation, Moscow, Russia
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15
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Groom KM, McCowan LM, Mackay LK, Lee AC, Gardener G, Unterscheider J, Sekar R, Dickinson JE, Muller P, Reid RA, Watson D, Welsh A, Marlow J, Walker SP, Hyett J, Morris J, Stone PR, Baker PN. STRIDER NZAus: a multicentre randomised controlled trial of sildenafil therapy in early-onset fetal growth restriction. BJOG 2019; 126:997-1006. [PMID: 30779295 DOI: 10.1111/1471-0528.15658] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To assess the effect of maternal sildenafil therapy on fetal growth in pregnancies with early-onset fetal growth restriction. DESIGN A randomised placebo-controlled trial. SETTING Thirteen maternal-fetal medicine units across New Zealand and Australia. POPULATION Women with singleton pregnancies affected by fetal growth restriction at 22+0 to 29+6 weeks. METHODS Women were randomised to oral administration of 25 mg sildenafil citrate or visually matching placebo three times daily until 32+0 weeks, birth or fetal death (whichever occurred first). MAIN OUTCOME MEASURES The primary outcome was the proportion of pregnancies with an increase in fetal growth velocity. Secondary outcomes included live birth, survival to hospital discharge free of major neonatal morbidity and pre-eclampsia. RESULTS Sildenafil did not affect the proportion of pregnancies with an increase in fetal growth velocity; 32/61 (52.5%) sildenafil-treated, 39/57 (68.4%) placebo-treated [adjusted odds ratio (OR) 0.49, 95% CI 0.23-1.05] and had no effect on abdominal circumference Z-scores (P = 0.61). Sildenafil use was associated with a lower mean uterine artery pulsatility index after 48 hours of treatment (1.56 versus 1.81; P = 0.02). The live birth rate was 56/63 (88.9%) for sildenafil-treated and 47/59 (79.7%) for placebo-treated (adjusted OR 2.50, 95% CI 0.80-7.79); survival to hospital discharge free of major neonatal morbidity was 42/63 (66.7%) for sildenafil-treated and 33/59 (55.9%) for placebo-treated (adjusted OR 1.93, 95% CI 0.84-4.45); and new-onset pre-eclampsia was 9/51 (17.7%) for sildenafil-treated and 14/55 (25.5%) for placebo-treated (OR 0.67, 95% CI 0.26-1.75). CONCLUSIONS Maternal sildenafil use had no effect on fetal growth velocity. Prospectively planned meta-analyses will determine whether sildenafil exerts other effects on maternal and fetal/neonatal wellbeing. TWEETABLE ABSTRACT Maternal sildenafil use has no beneficial effect on growth in early-onset FGR, but also no evidence of harm.
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Affiliation(s)
- K M Groom
- Liggins Institute, University of Auckland, Auckland, New Zealand.,National Women's Health, Auckland City Hospital, Auckland, New Zealand
| | - L M McCowan
- National Women's Health, Auckland City Hospital, Auckland, New Zealand.,Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - L K Mackay
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - A C Lee
- Section of Epidemiology and Biostatistics, University of Auckland, Auckland, New Zealand
| | - G Gardener
- Mater Centre for Maternal Fetal Medicine, Mater Research Institute, Mater Mother's Hospital, University of Queensland, Brisbane, Qld, Australia
| | - J Unterscheider
- Department of Maternal Fetal Medicine, Royal Women's Hospital, Melbourne, Vic, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Vic, Australia
| | - R Sekar
- Department of Maternal Fetal Medicine, Royal Brisbane and Women's Hospital, Brisbane, Qld, Australia
| | - J E Dickinson
- King Edward Memorial Hospital, Perth, WA, Australia.,Division of Obstetrics and Gynaecology, University of Western Australia, Perth, WA, Australia
| | - P Muller
- Director Maternal Fetal Medicine Service, Women's and Children's Hospital Adelaide, North Adelaide, SA, Australia
| | - R A Reid
- Christchurch Women's Hospital, Christchurch, New Zealand.,Department of Obstetrics and Gynaecology, University of Otago, Christchurch, New Zealand
| | - D Watson
- Women's and Children's Service, Townsville Hospital, Townsville, Qld, Australia
| | - A Welsh
- Royal Hospital for Women, Sydney, NSW, Australia.,School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia
| | - J Marlow
- Maternal Fetal Medicine, Wellington Hospital, Wellington, New Zealand
| | - S P Walker
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Vic, Australia.,Mercy Hospital for Women, Melbourne, Vic, Australia
| | - J Hyett
- RPA Women and Babies, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Discipline of Obstetrics, Gynaecology and Neonatology, Faculty of Medicine, University of Sydney, Sydney, NSW, Australia
| | - J Morris
- Perinatal Research, Faculty of Medicine and Health, The Kolling Institute, The University of Sydney, Sydney, NSW, Australia
| | - P R Stone
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - P N Baker
- Liggins Institute, University of Auckland, Auckland, New Zealand.,College of Life Sciences, University of Leicester, Leicester, UK
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16
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Vollmer B, Edmonds CJ. School Age Neurological and Cognitive Outcomes of Fetal Growth Retardation or Small for Gestational Age Birth Weight. Front Endocrinol (Lausanne) 2019; 10:186. [PMID: 30984109 PMCID: PMC6447606 DOI: 10.3389/fendo.2019.00186] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 03/06/2019] [Indexed: 01/30/2023] Open
Abstract
Children who were growth restricted in utero (FGR) and are born small for gestational age (SGA) may experience poorer long term neurological and cognitive outcomes. Those also born preterm may have particular difficulties. The objective of this paper was to review the literature on school age neurocognitive outcome for term and preterm children that was published in the last 15 years. Considering term born children first, there is evidence that these children are at higher risk for Cerebral Palsy (CP) than those born appropriate for gestational age (AGA); information on neuromotor function in the absence of CP is somewhat contradictory. With regards to cognitive outcome, the most common finding was that being born SGA and/or FGR at term does not impact negatively on general intellectual functioning, commonly assessed by IQ scores. There was some indication that they may experience particular problems with attention. With regards to children born preterm, the risk of CP appears not to be increased compared to those preterms born AGA. For preterm children who do not develop CP, motor outcome is more affected by post-natal and post-neonatal brain growth than intrauterine growth. In contrast to term born children, preterm SGA and/or FGR children are at increased risk of cognitive and behavioral difficulties, and in common with term born children, are at higher risk than their AGA counterparts of difficulties with attentional control. In conclusion, preterm born SGA and/or FGR children are at higher risk of neurodevelopmental problems in the school years. It is important to continue to follow up children into the school age years because these difficulties may take time to emerge, and may be more visible in the more demanding school environment.
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Affiliation(s)
- Brigitte Vollmer
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- Paediatric and Neonatal Neurology, Southampton Children's Hospital, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
- *Correspondence: Brigitte Vollmer
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17
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Nist MD, Harrison TM, Steward DK. The biological embedding of neonatal stress exposure: A conceptual model describing the mechanisms of stress-induced neurodevelopmental impairment in preterm infants. Res Nurs Health 2018; 42:61-71. [PMID: 30499161 DOI: 10.1002/nur.21923] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 10/27/2018] [Indexed: 12/15/2022]
Abstract
The biological embedding of early life stress exposure may result in life-long neurodevelopmental impairment in preterm infants. Infants hospitalized in the neonatal intensive care unit are exposed to significant experiential, environmental, and physiologic stressors over the course of their extended hospitalization. Stress exposure during the sensitive period of brain development may alter biological processes, including functioning of the immune system, the autonomic nervous system, and the hypothalamic-pituitary-adrenal axis as well as gene expression. These alterations may subsequently affect brain structure and function. Changes to these processes may mediate the relationship between neonatal stress exposure and neurodevelopment in preterm infants and represent potential therapeutic targets to improve long-term outcomes. The purpose of this paper is to introduce a conceptual model, based on published research, that describes the mechanisms mediating stress exposure and neurodevelopment impairment in preterm infants and to provide the theoretical foundation on which to base future descriptive research, intervention studies, and clinical care.
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18
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Chandra I, Sun L. Preterm and term preeclampsia: differences in biochemical parameter and pregnancy outcomes. Postgrad Med 2018; 130:703-707. [PMID: 30246594 DOI: 10.1080/00325481.2018.1527169] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To analyze the similarities and differences in the clinical parameters, laboratory biomarkers, and pregnancy outcomes between preterm and term preeclampsia (PE). METHODS Data on 185 women diagnosed with PE were collected from a Jiangsu Province Hospital from January 2017 to December 2017 and analyzed. 74 (40%) patients were diagnosed with preterm PE, of which 70 (94.6%) patients with PE with severe features (PEs) and the rest with PE. 111 (60%) patients were diagnosed with term PE, of which 54 (48.6%) patients with PEs and the rest with PE. RESULTS Preterm PE group had significantly higher blood pressure than that of term PE, with mean delivery at gestational age of 34.3[Formula: see text]2.1 weeks for preterm PE and 39[Formula: see text]1.2 weeks for term PE. Preterm PE group was associated with previous cesarean section and PE history, fetal growth restriction (FGR), non-reassuring fetal status (NRFS), and fetal umbilical artery (UA) systolic velocity/diastolic velocity ratio (S/D R) abnormality, neonatal lower birth weight, lower APGAR score, and higher NICU transfer rate. 74.3% of pregnant women from preterm PE group had proteinuria of +2 to +4, whilst only 37.8% pregnant women from term PE group developed that condition. Liver and renal function, also serum Ca and K were significantly higher in preterm PE. CONCLUSION Our study found that preterm PE significantly correlated with higher incidence of PEs, neonatal morbidities, also higher liver and kidney function compared to term PE. These results may be helpful for obstetricians to make accurate quantification of risk regarding every result of antenatal check-up, and perform close follow up if any abnormalities were found on blood pressure, ultrasound, or blood tests.
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Affiliation(s)
- Ivana Chandra
- a Department of Obstetrics and Gynecology , The First Affiliated Hospital of Nanjing Medical University , Nanjing , Jiangsu , China
| | - Lizhou Sun
- a Department of Obstetrics and Gynecology , The First Affiliated Hospital of Nanjing Medical University , Nanjing , Jiangsu , China
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19
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Amplitude-Integrated EEG and Brain Sparing in Preterm Small-for-Gestational-Age Infants. J Clin Neurophysiol 2018; 34:456-460. [PMID: 28873072 DOI: 10.1097/wnp.0000000000000399] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Preterm small-for-gestational-age (SGA) infants are at risk for a high mortality rate and impaired cognitive development. Only a few studies have focused on amplitude-integrated EEG (aEEG) in preterm SGA infants. They have been shown to have a slower rate of brain maturation, but these findings have not consistently been related to neurodevelopmental outcomes. The aim of our study was to evaluate early aEEG monitoring in SGA compared with adequate-for-gestational-age preterms. METHODS This prospective cohort study enrolled infants with very low birth weight who were admitted to the neonatal intensive care unit at Hospital Puerta del Mar, Cádiz, Spain, from June 2009 to September 2012. This study was a subanalysis of SGA from the global cohort previously described by our group. Adverse outcome included severe intraventricular hemorrhage and/or death. Cerebral function was monitored using aEEG recordings during the first 72 hours of life. RESULTS Preterm SGA infants (18 SGA in the global cohort of 92 patients) had lower 1- and 5-minute Apgar scores, higher score for neonatal acute physiology perinatal extension II scores, and higher proportion of adverse outcomes. When comparing preterm adequate-for-gestational-age infants with SGA infants with good prognosis, those with SGA had more mature and continuous aEEG patterns. Low margin amplitude depression was not as severe in these patients, and a higher proportion of these patients developed sleep-wake cycles. CONCLUSIONS The results of our study suggest that SGA infants with a good prognosis have a more mature aEEG pattern than preterm adequate-for-gestational-age patients with the same outcome. These findings support the brain sparing theory in SGA infants.
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20
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Neuromotor Development of Children Aged 6 and 7 Years Born before the 30th Week Gestation. BIOMED RESEARCH INTERNATIONAL 2018; 2018:2820932. [PMID: 29888253 PMCID: PMC5985120 DOI: 10.1155/2018/2820932] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 02/19/2018] [Accepted: 03/13/2018] [Indexed: 11/18/2022]
Abstract
Introduction The aim of this study was to evaluate and compare the level of neuromotor function and somatic development in 6- and 7-year-old children born before the 30th week gestation with that in full-term children at the same age, as well as the correlation between prematurity and motor development. Material and Methods The study group consisted of prematurely born 40 children. Their mean gestational age at birth was 27.8 ± 1.6 weeks (range 24–30 weeks). The control group consisted of 40 healthy children born with normal birth weight (>2500 g). The neuromotor function was assessed using Touwen neurological examination criteria. During the examination, the attention was focused on the hand preference, laterality, synkinesis, and asymmetry. In addition, children's weight, height, and BMI index were measured. Results Premature children showed much worse results than full-term ones in hand function (p < 0,001). They obtained the best results in paper tearing while crossing the body midline turned out to be the most difficult. Considering the quality of walking, the biggest difficulty for the premature children was to walk backwards along the straight line while during normal walking they showed the best results. The results for the muscle tone subcategory in the study group were also significantly worse than those in control group (p < 0,001), as well as the total outcome for the movement coordination and diadochokinesis subcategories (p < 0,001). Conclusion The nondisabled, prematurely born children have significantly lower average outcomes regarding hand function, quality of walking, muscle tone, coordination, and diadochokinesis at age of six to seven, compared to the full-term peers.
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21
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Hyodo R, Sato Y, Ito M, Sugiyama Y, Ogawa C, Kawai H, Nakane T, Saito A, Hirakawa A, Kidokoro H, Natsume J, Hayakawa M. Magnetic resonance spectroscopy in preterm infants: association with neurodevelopmental outcomes. Arch Dis Child Fetal Neonatal Ed 2018; 103:F238-F244. [PMID: 28724545 DOI: 10.1136/archdischild-2016-311403] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Revised: 05/30/2017] [Accepted: 06/07/2017] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To compare magnetic resonance spectroscopy (MRS) metabolite ratios in preterm infants at term-equivalent age with those in term infants and to evaluate the association between MRS metabolites and neurodevelopmental outcomes at 18 months corrected age in preterm infants. DESIGN We studied infants born at a gestational age <37 weeks and weighing <1500 g during 2009-2013 using MRS at term-equivalent age. Infants with major brain abnormalities were excluded. The ratios of N-acetylaspartate (NAA) to creatine (Cre), NAA to choline-containing compounds (Cho) and Cho to Cre in the frontal white matter and thalamus were measured using multivoxel point-resolved proton spectroscopy sequence. Neurodevelopmental outcomes were assessed at 18 months corrected age. RESULTS Thirty-three preterm infants and 16 term infants were enrolled in this study. Preterm infants with normal development at 18 months showed significantly lower NAA/Cho ratios in the frontal white matter than term infants. There were no differences in the Cre/Cho ratios between preterm and term infants. At 18 months corrected age, 9 preterm infants with a mild developmental delay showed significantly lower NAA/Cho ratios in the thalamus than 24 preterm infants with normal development. CONCLUSIONS Preterm infants at term-equivalent age showed reduced MRS metabolites (NAA/Cho) compared with term infants. Decreased NAA/Cho ratios in the thalamus were associated with neurodevelopmental delay at 18 months corrected age in preterm infants.
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Affiliation(s)
- Reina Hyodo
- Division of Neonatology, Center for Maternal-Neonatal Care, Nagoya University Hospital, Nagoya, Japan
| | - Yoshiaki Sato
- Division of Neonatology, Center for Maternal-Neonatal Care, Nagoya University Hospital, Nagoya, Japan
| | - Miharu Ito
- Division of Neonatology, Center for Maternal-Neonatal Care, Nagoya University Hospital, Nagoya, Japan
| | - Yuichiro Sugiyama
- Division of Neonatology, Center for Maternal-Neonatal Care, Nagoya University Hospital, Nagoya, Japan
| | - Chikako Ogawa
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hisashi Kawai
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Toshiki Nakane
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Akiko Saito
- Division of Neonatology, Center for Maternal-Neonatal Care, Nagoya University Hospital, Nagoya, Japan
| | - Akihiro Hirakawa
- Department of Biostatistics and Bioinformatics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroyuki Kidokoro
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Brain and Mind Research Center, Nagoya University, Nagoya, Japan
| | - Jun Natsume
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Brain and Mind Research Center, Nagoya University, Nagoya, Japan
| | - Masahiro Hayakawa
- Division of Neonatology, Center for Maternal-Neonatal Care, Nagoya University Hospital, Nagoya, Japan
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22
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Groom KM, David AL. The role of aspirin, heparin, and other interventions in the prevention and treatment of fetal growth restriction. Am J Obstet Gynecol 2018; 218:S829-S840. [PMID: 29229321 DOI: 10.1016/j.ajog.2017.11.565] [Citation(s) in RCA: 103] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 10/20/2017] [Accepted: 11/08/2017] [Indexed: 11/24/2022]
Abstract
Fetal growth restriction and related placental pathologies such as preeclampsia, stillbirth, and placental abruption are believed to arise in early pregnancy when inadequate remodeling of the maternal spiral arteries leads to persistent high-resistance and low-flow uteroplacental circulation. The consequent placental ischaemia, reperfusion injury, and oxidative stress are associated with an imbalance in angiogenic/antiangiogenic factors. Many interventions have centered on the prevention and/or treatment of preeclampsia with results pertaining to fetal growth restriction and small-for-gestational-age pregnancy often included as secondary outcomes because of the common pathophysiology. This renders the study findings less reliable for determining clinical significance. For the prevention of fetal growth restriction, a recent large-study level meta-analysis and individual patient data meta-analysis confirm that aspirin modestly reduces small-for-gestational-age pregnancy in women at high risk (relative risk, 0.90, 95% confidence interval, 0.81-1.00) and that a dose of ≥100 mg should be recommended and to start at or before 16 weeks of gestation. These findings support national clinical practice guidelines. In vitro and in vivo studies suggest that low-molecular-weight heparin may prevent fetal growth restriction; however, evidence from randomized control trials is inconsistent. A meta-analysis of multicenter trial data does not demonstrate any positive preventative effect of low-molecular-weight heparin on a primary composite outcome of placenta-mediated complications including fetal growth restriction (18% vs 18%; absolute risk difference, 0.6%; 95% confidence interval, 10.4-9.2); use of low-molecular-weight heparin for the prevention of fetal growth restriction should remain in the research setting. There are even fewer treatment options once fetal growth restriction is diagnosed. At present the only management option if the risk of hypoxia, acidosis, and intrauterine death is high is iatrogenic preterm birth, with the use of peripartum maternal administration of magnesium sulphate for neuroprotection and corticosteroids for fetal lung maturity, to prevent adverse neonatal outcomes. The pipeline of potential therapies use different strategies, many aiming to increase fetal growth by improving poor placentation and uterine blood flow. Phosphodiesterase type 5 inhibitors that potentiate nitric oxide availability such as sildenafil citrate have been extensively researched both in preclinical and clinical studies; results from the Sildenafil Therapy In Dismal Prognosis Early-Onset Intrauterine Growth Restriction consortium of randomized control clinical trials are keenly awaited. Targeting the uteroplacental circulation with novel therapeutics is another approach, the most advanced being maternal vascular endothelial growth factor gene therapy, which is being translated into the clinic via the doEs Vascular endothelial growth factor gene therapy safEly impRove outcome in seveRe Early-onset fetal growth reSTriction consortium. Other targeting approaches include nanoparticles and microRNAs to deliver drugs locally to the uterine arterial endothelium or trophoblast. In vitro and in vivo studies and animal models have demonstrated effects of nitric oxide donors, dietary nitrate, hydrogen sulphide donors, statins, and proton pump inhibitors on maternal blood pressure, uteroplacental resistance indices, and angiogenic/antiangiogenic factors. Data from human pregnancies and, in particular, pregnancies with fetal growth restriction remain very limited. Early research into melatonin, creatine, and N-acetyl cysteine supplementation in pregnancy suggests they may have potential as neuro- and cardioprotective agents in fetal growth restriction.
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Calderon J, Willaime M, Lelong N, Bonnet D, Houyel L, Ballon M, Goffinet F, Khoshnood B. Population-based study of cognitive outcomes in congenital heart defects. Arch Dis Child 2018; 103:49-56. [PMID: 28780508 DOI: 10.1136/archdischild-2016-310830] [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: 03/06/2016] [Revised: 07/04/2017] [Accepted: 07/18/2017] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To characterise and compare cognitive outcomes in children with operated (open-heart surgery) and non-operated (catheter-based interventions only or no intervention) congenital heart defects (CHD) and to determine associated risk factors. DESIGN This prospective population-based study reports outcomes of 3-year-old children with CHD with or without open-heart surgery. MAIN OUTCOME MEASURES Standardised cognitive scores (mean scores and proportions below normative values) were assessed with the Kaufman Assessment Battery for Children II. We analysed demographic, perinatal and operative variables as predictors of cognitive outcomes. RESULTS 419 children participated (154 with open-heart surgery; 265 without surgery). Global cognitive scores did not differ between the groups. Compared with the non-operated group, children who underwent surgery obtained lower scores in expressive language (p=0.03) and logical reasoning (p=0.05). When compared with test norms, the frequency of global cognitive scores >1 SDs below the expected mean was higher in the surgical group (25% vs 16% in the general population) (p=0.03). A higher-than-expected proportion of children in the non-operated group scored >2 SDs below the expected mean (7% vs 2%) (p=0.05). Being small for gestational age (SGA) significantly increased the risk of cognitive impairment in the surgical group, after adjustments for multiple covariates including maternal education, complexity of the CHD and operative-related variables (adjusted OR=5.9; 95% CI (1.7 to 20.1)). CONCLUSIONS Despite mean scores within the normative range, a high proportion of preschool children with CHD with or without surgery are at early cognitive risk. SGA is a strong predictor of the neurodevelopmental prognosis in CHD.
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Affiliation(s)
- Johanna Calderon
- Department of Psychiatry, Harvard Medical School, Boston Children's Hospital, Boston, Massachusetts, USA.,Inserm, UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Research Center for Epidemiology and Biostatistics Sorbonne Paris Cité (CRESS), Paris Descartes University, Paris, France
| | - Marion Willaime
- Department of Psychiatry, Harvard Medical School, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Nathalie Lelong
- Department of Psychiatry, Harvard Medical School, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Damien Bonnet
- Centre de référence M3C, Necker, Assistance Publique, Hôpitaux de Paris, Université Paris Descartes, Paris, France
| | - Lucile Houyel
- Service de chirurgie des cardiopathies congénitales, Hôpital Marie Lannelongue, Paris, France
| | - Morgane Ballon
- Department of Psychiatry, Harvard Medical School, Boston Children's Hospital, Boston, Massachusetts, USA
| | - François Goffinet
- Department of Psychiatry, Harvard Medical School, Boston Children's Hospital, Boston, Massachusetts, USA.,Maternité Port Royal, Paris, France
| | - Babak Khoshnood
- Department of Psychiatry, Harvard Medical School, Boston Children's Hospital, Boston, Massachusetts, USA
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Partanen L, Korkalainen N, Mäkikallio K, Olsén P, Laukkanen-Nevala P, Yliherva A. Foetal growth restriction is associated with poor reading and spelling skills at eight years to 10 years of age. Acta Paediatr 2018; 107:79-85. [PMID: 28763117 DOI: 10.1111/apa.14005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 07/12/2017] [Accepted: 07/27/2017] [Indexed: 11/28/2022]
Abstract
AIM Foetal growth restriction (FGR) is associated with communication problems, which might lead to poor literacy skills. The reading and spelling skills of eight- to 10-year-old FGR children born at 24-40 gestational weeks were compared with those of their gestational age-matched, appropriately grown (AGA) peers. METHODS A prospectively collected cohort of 37 FGR and 31 AGA children was recruited prenatally at a Finnish tertiary care centre during 1998-2001. The children's reading and spelling skills were assessed using standardised tests for Finnish-speaking second and third graders. RESULTS Significantly more children performed below the 10th percentile normal values for reading and spelling skills in the FGR group than in the AGA group. At nine years of age, the FGR children had significantly poorer performance in word reading skills and reading fluency, reading accuracy and reading comprehension than the AGA controls. No between-group differences were detected at eight years of age. CONCLUSION FGR is associated with poor performance in reading and spelling skills. A third of the FGR children performed below the 10th percentile normal values at nine years of age. These results indicate a need to continuously evaluate linguistic and literacy skills as FGR children age to ensure optimal support.
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Affiliation(s)
- Lea Partanen
- Child Language Research Center; Faculty of Humanities; University of Oulu; Oulu Finland
| | - Noora Korkalainen
- PEDEGO Research Unit; Institute of Clinical Medicine; University of Oulu; Oulu Finland
- Department of Obstetrics and Gynaecology; Oulu University Hospital; Oulu Finland
| | - Kaarin Mäkikallio
- PEDEGO Research Unit; Institute of Clinical Medicine; University of Oulu; Oulu Finland
- Department of Obstetrics and Gynaecology; Oulu University Hospital; Oulu Finland
- Department of Obstetrics and Gynaecology; Turku University Hospital; Turku Finland
| | - Päivi Olsén
- PEDEGO Research Unit; Institute of Clinical Medicine; University of Oulu; Oulu Finland
- Department of Paediatrics; Oulu University Hospital; Oulu Finland
| | | | - Anneli Yliherva
- Child Language Research Center; Faculty of Humanities; University of Oulu; Oulu Finland
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Korzeniewski SJ, Allred EN, Joseph RM, Heeren T, Kuban KC, O’Shea TM, Leviton A. Neurodevelopment at Age 10 Years of Children Born <28 Weeks With Fetal Growth Restriction. Pediatrics 2017; 140:peds.2017-0697. [PMID: 29030525 PMCID: PMC5654396 DOI: 10.1542/peds.2017-0697] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/21/2017] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES We sought to evaluate the relationships between fetal growth restriction (FGR) (both severe and less severe) and assessments of cognitive, academic, and adaptive behavior brain function at age 10 years. METHODS At age 10 years, the Extremely Low Gestational Age Newborns Cohort Study assessed the cognitive function, academic achievement, social-communicative function, psychiatric symptoms, and overall quality of life of 889 children born before 28 weeks' gestation. A pediatric epileptologist also interviewed parents as part of a seizure evaluation. The 52 children whose birth weight z scores were <-2 were classified as having severe FGR, and the 113 whose birth weight z scores were between -2 and -1 were considered to have less severe FGR. RESULTS The more severe the growth restriction in utero, the lower the level of function on multiple cognitive and academic achievement assessments performed at age 10 years. Growth-restricted children were also more likely than their extremely preterm peers to have social awareness impairments, autistic mannerisms, autism spectrum diagnoses, difficulty with semantics and speech coherence, and diminished social and psychosocial functioning. They also more frequently had phobias, obsessions, and compulsions (according to teacher, but not parent, report). CONCLUSIONS Among children born extremely preterm, those with severe FGR appear to be at increased risk of multiple cognitive and behavioral dysfunctions at age 10 years, raising the possibility that whatever adversely affected their intrauterine growth also adversely affected multiple domains of cognitive and neurobehavioral development.
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Affiliation(s)
- Steven J. Korzeniewski
- Department of Obstetrics and Gynecology, School of Medicine, Wayne State University, Detroit, Michigan;,Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan
| | - Elizabeth N. Allred
- Department of Neurology, Boston Children’s Hospital, Boston, Massachusetts;,Department of Neurology, Harvard Medical School, Harvard University, Boston, Massachusetts
| | | | - Tim Heeren
- Department of Biostatistics, School of Public Health
| | - Karl C.K. Kuban
- Boston University, Boston, Massachusetts;,Departments of Pediatrics, Boston Medical Center, Boston, Massachusetts; and
| | - T. Michael O’Shea
- Department of Pediatrics, Wake Forest University, Winston-Salem, North Carolina
| | - Alan Leviton
- Department of Neurology, Boston Children’s Hospital, Boston, Massachusetts;,Department of Neurology, Harvard Medical School, Harvard University, Boston, Massachusetts
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26
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Saunavaara V, Kallankari H, Parkkola R, Haataja L, Olsén P, Hallman M, Kaukola T. Very preterm children with fetal growth restriction demonstrated altered white matter maturation at nine years of age. Acta Paediatr 2017. [PMID: 28626859 DOI: 10.1111/apa.13954] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
AIM This study evaluated the role of preterm birth and fetal growth restriction on white matter maturation in schoolchildren without any severe neurodevelopmental impairment. METHODS The study group comprised 56 very preterm children and 21 term children born between November 1998 and November 2002 at Oulu University Hospital, Finland. The mean gestational age of the preterm children was 28.7 (24.1-31.9) weeks. All children underwent diffusion tensor imaging at a mean age of 9.0 (8.6-9.6) years. Voxel-wise statistical analyses of the imaging data were carried out using tract-based spatial statistics. RESULTS Preterm children with fetal growth restriction had lower fractional anisotropy and higher radial diffusivity than term controls (p < 0.05), bilaterally in several white matter areas. Preterm children without fetal growth restriction had higher mean diffusivity and axial diffusivity than term controls (p < 0.05) in analogous areas, but more asymmetrically. CONCLUSION Preterm children had microstructural differences in white matter, compared to term-born children at a mean age of nine, and those with poor fetal growth showed widespread changes in white matter maturation compared to term-born children. Fetal growth and prematurity seemed to affect white matter maturation in a way that was still visible at that age.
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Affiliation(s)
- Virva Saunavaara
- PET Center; Turku University Hospital; Turku Finland
- Department of Medical physics; Turku University Hospital; Turku Finland
| | - Hanna Kallankari
- Department of Child Neurology; PEDEGO Research Unit; University of Oulu and Oulu University Hospital; Oulu Finland
| | | | - Leena Haataja
- Department of Child Neurology, Children and adolescents; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| | - Päivi Olsén
- Department of Child Neurology; PEDEGO Research Unit; University of Oulu and Oulu University Hospital; Oulu Finland
| | - Mikko Hallman
- PEDEGO Research Unit; Medical Research Center Oulu; Oulu Finland
| | - Tuula Kaukola
- Department of Neonatology; PEDEGO Research Unit; University of Oulu and Oulu University Hospital; Oulu Finland
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27
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Ribeiro CDC, Pachelli MRDO, Amaral NCDO, Lamônica DAC. Development skills of children born premature with low and very low birth weight. Codas 2017; 29:e20160058. [PMID: 28146204 DOI: 10.1590/2317-1782/20162016058] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 05/23/2016] [Indexed: 11/22/2022] Open
Abstract
Purpose To compare the performance of children born premature with low birth weight (LBW) and very low birth-weight (VLBW) with that of children born at term, within the age range of one to three years, regarding child development in the gross motor, fine motor-adaptive, personal-social and language domains. Methods This is a cross-sectional study in a cohort of 150 infants born premature (experimental group) and at term (control group) divided into eight groups with respect to weight (low birth weight: <2500 grams and very low birth weight: <1500 grams) and age range (aged 12 to 24 and 25 to 36 months). The control groups were paired with the experimental groups as for gender, chronological age, and socioeconomic level. Assessment comprised the application of anamnesis protocol, socioeconomic classification, and Denver Developmental Screening Test (DDST-II). Corrected age was calculated for premature children up to 24 months of age. Descriptive statistical analysis and the Student's t-test were used. Results No statistically significant difference was found in the comparison between the groups of infants born premature and at term for all domains evaluated. Conclusion The performance of infants born premature was lower than that of infants born at term regarding the gross motor, fine motor-adaptive, personal-social and language domains. In this study, the preterm groups presented different performances, i.e., normative, average, and below average performances were observed within the same group.
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Affiliation(s)
| | | | - Natalie Camillo de Oliveira Amaral
- Universidade de São Paulo - USP - Bauru (SP), Brasil.,Hospital de Reabilitação de Anomalias Craniofaciais - Bauru (SP), Brasil.,Unimed Bauru - Bauru (SP), Brasil.,Fundação para o Desenvolvimento Médico Hospitalar - Bauru (SP), Brasil
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28
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Sicard M, Nusinovici S, Hanf M, Muller JB, Guellec I, Ancel PY, Gascoin G, Rozé JC, Flamant C. Fetal and Postnatal Head Circumference Growth: Synergetic Factors for Neurodevelopmental Outcome at 2 Years of Age for Preterm Infants. Neonatology 2017; 112:122-129. [PMID: 28482345 DOI: 10.1159/000464272] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Accepted: 02/20/2017] [Indexed: 11/19/2022]
Abstract
UNLABELLED Preterm infants present higher risk of non-optimal neurodevelopmental outcome. Fetal and postnatal growth, in particular head circumference (HC), is associated with neurodevelopmental outcome. OBJECTIVES We aimed to calculate the relationship between HC at birth, HC delta Z-score (between birth and hospital discharge), and non-optimal neurodevelopmental outcome at 2 years of corrected age in preterm infants. METHODS Surviving infants born ≤34 weeks of gestation were included in the analysis. The relationship between the risk of being non-optimal at 2 years and both HC at birth and HC growth was assessed. The 2 Z-scores were considered first independently and then simultaneously to investigate their effect on the risk of non-optimality using a generalized additive model. RESULTS A total of 4,046 infants with both HC measures at birth and hospital discharge were included. Infants with small HC at birth (Z-score <-2 SD), or presenting suboptimal HC growth (dZ-score <-2 SD), are at higher risk of non-optimal neurodevelopmental outcome at 2 years (respectively OR 1.7 [95% CI 1.4-2] and OR 1.4 [95% CI 1.2-1.8]). Interestingly, patients cumulating small HC Z-score at birth (-2 SD) and presenting catch-down growth (HC dZ-score [-2 SD]) have a significantly increased risk for neurocognitive impairment (OR >2) while adjusting for gestational age, twin status, sex, and socioeconomic information. CONCLUSIONS HC at birth and HC dZ-score between birth and hospital discharge are synergistically associated to neurodevelopmental outcome at 2 years of corrected age, in a population-based prospective cohort of preterm infants born ≤34 weeks of gestation.
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Affiliation(s)
- Mélanie Sicard
- Department of Neonatal Medicine, Nantes University Hospital, Nantes, France
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29
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Korpela S, Nyman A, Munck P, Ahtola A, Matomäki J, Korhonen T, Parkkola R, Haataja L. Working memory in very-low-birthweight children at the age of 11 years. Child Neuropsychol 2016; 24:338-353. [PMID: 27907284 DOI: 10.1080/09297049.2016.1260101] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The aim of this study is to investigate the working memory (WM) of very-low-birthweight (VLBW, ≤ 1500 g) children at the age of 11 years using Baddeley's WM model. A regional cohort of 95 VLBW children was assessed for the domains of the WM model (central executive [CE], visuospatial sketchpad [VS], and phonological loop [PL]) using subtests from the Working Memory Test Battery for Children (WMTB-C) and the Wechsler Intelligence Scale for Children - Fourth Edition (WISC-IV). VLBW children were categorized into three groups according to their degree of brain pathology (normal, minor, or major) in neonatal brain magnetic resonance imaging at the term age, and the WM performance was compared between groups to test norms. The structure of the WM model was studied by analyzing correlations among domains. Even VLBW children with normal cognitive development (general ability index ≥ 85) performed worse compared to the test norms (M = 100, SD = 15) on CE (M = 87.64, SD = 20.54, p < .001) and VS (M = 91.65, SD = 11.03, p < .001), but their performance on PL was above the norm (M = 110.79, SD = 13.79, p < .001). VLBW children with major brain pathology performed significantly worse on VS and PL compared to the other groups. The correlations among the WM domains of the VLBW children differ from earlier findings in normative populations. To conclude, the WM of the VLBW children in the study differ-especially in the CE and VS subtest scores-from the normative population irrespective of the degree of brain pathology and level of cognitive development.
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Affiliation(s)
- Satu Korpela
- a Department of Psychology , University of Turku , Finland.,b Helsinki University Hospital , Child Neurology , Finland
| | - Anna Nyman
- a Department of Psychology , University of Turku , Finland.,c Turku University Hospital , Child Neurology , Finland
| | - Petriina Munck
- a Department of Psychology , University of Turku , Finland.,c Turku University Hospital , Child Neurology , Finland
| | | | - Jaakko Matomäki
- d Clinical Research Center , Turku University Hospital , Finland
| | - Tapio Korhonen
- a Department of Psychology , University of Turku , Finland
| | - Riitta Parkkola
- e Department of Radiology, Turku PET Center , Turku University Hospital , Finland.,f Department of Medicine , University of Turku , Finland
| | - Leena Haataja
- b Helsinki University Hospital , Child Neurology , Finland.,g Department of Pediatric Neurology, Children's Hospital , University of Helsinki , Finland
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30
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El Ayoubi M, Patkai J, Bordarier C, Desfrere L, Moriette G, Jarreau PH, Zeitlin J. Impact of fetal growth restriction on neurodevelopmental outcome at 2 years for extremely preterm infants: a single institution study. Dev Med Child Neurol 2016; 58:1249-1256. [PMID: 27520849 DOI: 10.1111/dmcn.13218] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/24/2016] [Indexed: 01/28/2023]
Abstract
AIM We evaluated the impact of fetal growth restriction on neurodevelopmental outcomes at 2 years corrected age for infants born before 27 weeks gestational age. METHOD Data on infants born before 27 weeks gestational age between 1999 and 2008 (n=463), admitted to a tertiary neonatal unit in Paris, were used to compare neurological outcomes at 2 years for infants with birthweight lower than the 10th centile and birthweight of at least the 10th centile, using intrauterine reference curves. Outcomes were cerebral palsy (CP) and the Brunet-Lézine assessment of cognitive development, which provides age-corrected overall and domain-specific (global and fine motor skills, language and social interaction) developmental quotients. Models were adjusted for perinatal and social factors. RESULTS Seventy-two percent of infants were discharged alive. Eighty-three percent (n=268) were evaluated at 2 years. Six percent had CP. Fetal growth restriction was not associated with the risk of CP. After adjustment, children with a birthweight lower than the 10th centile had a global developmental quotient 4.7 points lower than those with birthweight of at least the 10th centile (p<0.001); differences were greatest for fine motor and social skills (-4.7, p=0.053 and -7.3, p<0.001 respectively). INTERPRETATION In extremely preterm children, fetal growth restriction was associated with poorer neurodevelopmental outcomes at 2 years, but not with CP.
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Affiliation(s)
- Mayass El Ayoubi
- INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France.,Service de Médecine et Réanimation Néonatales de Port-Royal, Hôpitaux Universitaire Paris Centre Site Cochin, Université Paris V René Descartes and Assistance Publique Hôpitaux de Paris, Paris, France
| | - Juliana Patkai
- Service de Médecine et Réanimation Néonatales de Port-Royal, Hôpitaux Universitaire Paris Centre Site Cochin, Université Paris V René Descartes and Assistance Publique Hôpitaux de Paris, Paris, France
| | - Cécile Bordarier
- Service de Médecine et Réanimation Néonatales de Port-Royal, Hôpitaux Universitaire Paris Centre Site Cochin, Université Paris V René Descartes and Assistance Publique Hôpitaux de Paris, Paris, France
| | - Luc Desfrere
- Service de Médecine et Réanimation Néonatales - Maternité de Louis Mourier, Hôpitaux Universitaires Paris Nord-Val de Seine, Paris, France
| | - Guy Moriette
- Service de Médecine et Réanimation Néonatales de Port-Royal, Hôpitaux Universitaire Paris Centre Site Cochin, Université Paris V René Descartes and Assistance Publique Hôpitaux de Paris, Paris, France
| | - Pierre-Henri Jarreau
- Service de Médecine et Réanimation Néonatales de Port-Royal, Hôpitaux Universitaire Paris Centre Site Cochin, Université Paris V René Descartes and Assistance Publique Hôpitaux de Paris, Paris, France
| | - Jennifer Zeitlin
- INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France
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Faa G, Manchia M, Pintus R, Gerosa C, Marcialis MA, Fanos V. Fetal programming of neuropsychiatric disorders. ACTA ACUST UNITED AC 2016; 108:207-223. [DOI: 10.1002/bdrc.21139] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 09/28/2016] [Indexed: 12/14/2022]
Affiliation(s)
- Gavino Faa
- Division of Pathology, Department of Surgery; University Hospital San Giovanni di Dio; Cagliari Italy
| | - Mirko Manchia
- Section of Psychiatry, Department of Public Health, Clinical and Molecular Medicine; University of Cagliari; Cagliari Italy
- Department of Pharmacology; Dalhousie University; Halifax Nova Scotia Canada
| | - Roberta Pintus
- Neonatal Intensive Care Unit, Neonatal Pathology and Neonatal Section; AOU Cagliari and University of Cagliari; Cagliari Italy
| | - Clara Gerosa
- Division of Pathology, Department of Surgery; University Hospital San Giovanni di Dio; Cagliari Italy
| | - Maria Antonietta Marcialis
- Neonatal Intensive Care Unit, Neonatal Pathology and Neonatal Section; AOU Cagliari and University of Cagliari; Cagliari Italy
| | - Vassilios Fanos
- Neonatal Intensive Care Unit, Neonatal Pathology and Neonatal Section; AOU Cagliari and University of Cagliari; Cagliari Italy
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Ford RM, Griffiths S, Neulinger K, Andrews G, Shum DHK, Gray PH. Impaired prospective memory but intact episodic memory in intellectually average 7- to 9-year-olds born very preterm and/or very low birth weight. Child Neuropsychol 2016; 23:954-979. [PMID: 27539515 DOI: 10.1080/09297049.2016.1216091] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Relatively little is known about episodic memory (EM: memory for personally-experienced events) and prospective memory (PM: memory for intended actions) in children born very preterm (VP) or with very low birth weight (VLBW). This study evaluates EM and PM in mainstream-schooled 7- to 9-year-olds born VP (≤ 32 weeks) and/or VLBW (< 1500 g) and matches full-term children for comparison (n = 35 and n = 37, respectively). Additionally, participants were assessed for verbal and non-verbal ability, executive function (EF), and theory of mind (ToM). The results show that the VP/VLBW children were outperformed by the full-term children on the memory tests overall, with a significant univariate group difference in PM. Moreover, within the VP/VLBW group, the measures of PM, verbal ability and working memory all displayed reliable negative correlations with severity of neonatal illness. PM was found to be independent of EM and cognitive functioning, suggesting that this form of memory might constitute a domain of specific vulnerability for VP/VLBW children.
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Affiliation(s)
- Ruth M Ford
- a Department of Psychology , Anglia Ruskin University , Cambridge , UK
| | - Sarah Griffiths
- b Menzies Health Institute Queensland and School of Applied Psychology , Griffith University , Queensland , Australia
| | - Kerryn Neulinger
- b Menzies Health Institute Queensland and School of Applied Psychology , Griffith University , Queensland , Australia
| | - Glenda Andrews
- b Menzies Health Institute Queensland and School of Applied Psychology , Griffith University , Queensland , Australia
| | - David H K Shum
- b Menzies Health Institute Queensland and School of Applied Psychology , Griffith University , Queensland , Australia
| | - Peter H Gray
- c Mater Research Institute , University of Queensland and Mater Mothers' Hospital , Queensland , Australia
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33
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Manuck TA, Rice MM, Bailit JL, Grobman WA, Reddy UM, Wapner RJ, Thorp JM, Caritis SN, Prasad M, Tita AT, Saade GR, Sorokin Y, Rouse DJ, Blackwell SC, Tolosa JE, Varner M, Hill K, Sowles A, Postma J, Alexander S, Andersen G, Scott V, Morby V, Jolley K, Miller J, Berg B, Talucci M, Zylfijaj M, Reid Z, Leed R, Benson J, Forester S, Kitto C, Davis S, Falk M, Perez C, Dorman K, Mitchell J, Kaluta E, Clark K, Spicer K, Timlin S, Wilson K, Leveno K, Moseley L, Santillan M, Price J, Buentipo K, Bludau V, Thomas T, Fay L, Melton C, Kingsbery J, Benezue R, Simhan H, Bickus M, Fischer D, Kamon T, DeAngelis D, Mercer B, Milluzzi C, Dalton W, Dotson T, McDonald P, Brezine C, McGrail A, Latimer C, Guzzo L, Johnson F, Gerwig L, Fyffe S, Loux D, Frantz S, Cline D, Wylie S, Iams J, Wallace M, Northen A, Grant J, Colquitt C, Rouse D, Andrews W, Mallett G, Ramos-Brinson M, Roy A, Stein L, Campbell P, Collins C, Jackson N, Dinsmoor M, Senka J, Paychek K, Peaceman A, Moss J, Salazar A, Acosta A, Hankins G, Hauff N, Palmer L, Lockhart P, Driscoll D, Wynn L, Sudz C, Dengate D, Girard C, Field S, Breault P, Smith F, Annunziata N, Allard D, Silva J, Gamage M, Hunt J, Tillinghast J, Corcoran N, Jimenez M, Ortiz F, Givens P, Rech B, Moran C, Hutchinson M, Spears Z, Carreno C, Heaps B, Zamora G, Seguin J, Rincon M, Snyder J, Farrar C, Lairson E, Bonino C, Smith W, Beach K, Van Dyke S, Butcher S, Thom E, Zhao Y, McGee P, Momirova V, Palugod R, Reamer B, Larsen M, Williams T, Spangler T, Lozitska A, Spong C, Tolivaisa S, VanDorsten J. Preterm neonatal morbidity and mortality by gestational age: a contemporary cohort. Am J Obstet Gynecol 2016; 215:103.e1-103.e14. [PMID: 26772790 PMCID: PMC4921282 DOI: 10.1016/j.ajog.2016.01.004] [Citation(s) in RCA: 317] [Impact Index Per Article: 39.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 12/28/2015] [Accepted: 01/02/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Although preterm birth <37 weeks' gestation is the leading cause of neonatal morbidity and mortality in the United States, the majority of data regarding preterm neonatal outcomes come from older studies, and many reports have been limited to only very preterm neonates. Delineation of neonatal outcomes by delivery gestational age is needed to further clarify the continuum of mortality and morbidity frequencies among preterm neonates. OBJECTIVE We sought to describe the contemporary frequencies of neonatal death, neonatal morbidities, and neonatal length of stay across the spectrum of preterm gestational ages. STUDY DESIGN This was a secondary analysis of an obstetric cohort of 115,502 women and their neonates who were born in 25 hospitals nationwide, 2008 through 2011. All liveborn nonanomalous singleton preterm (23.0-36.9 weeks of gestation) neonates were included in this analysis. The frequency of neonatal death, major neonatal morbidity (intraventricular hemorrhage grade III/IV, seizures, hypoxic-ischemic encephalopathy, necrotizing enterocolitis stage II/III, bronchopulmonary dysplasia, persistent pulmonary hypertension), and minor neonatal morbidity (hypotension requiring treatment, intraventricular hemorrhage grade I/II, necrotizing enterocolitis stage I, respiratory distress syndrome, hyperbilirubinemia requiring treatment) were calculated by delivery gestational age; each neonate was classified once by the worst outcome for which criteria was met. RESULTS In all, 8334 deliveries met inclusion criteria. There were 119 (1.4%) neonatal deaths. In all, 657 (7.9%) neonates had major morbidity, 3136 (37.6%) had minor morbidity, and 4422 (53.1%) survived without any of the studied morbidities. Deaths declined rapidly with each advancing week of gestation. This decline in death was accompanied by an increase in major neonatal morbidity, which peaked at 54.8% at 25 weeks of gestation. As frequencies of death and major neonatal morbidity fell, minor neonatal morbidity increased, peaking at 81.7% at 31 weeks of gestation. The frequency of all morbidities fell >32 weeks. After 25 weeks, neonatal length of hospital stay decreased significantly with each additional completed week of pregnancy; among babies delivered from 26-32 weeks of gestation, each additional week in utero reduced the subsequent length of neonatal hospitalization by a minimum of 8 days. The median postmenstrual age at discharge nadired around 36 weeks' postmenstrual age for babies born at 31-35 weeks of gestation. CONCLUSION Our data show that there is a continuum of outcomes, with each additional week of gestation conferring survival benefit while reducing the length of initial hospitalization. These contemporary data can be useful for patient counseling regarding preterm outcomes.
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Monteiro-Luperi TI, Befi-Lopes DM, Diniz EMA, Krebs VL, Carvalho WBD. Desempenho linguístico de prematuros de 2 anos, considerando idade cronológica e idade corrigida. Codas 2016; 28:118-22. [DOI: 10.1590/2317-1782/20162015075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 07/11/2015] [Indexed: 11/21/2022] Open
Abstract
RESUMO Introdução O nascimento prematuro acarreta problemas que não se restringem à mortalidade perinatal. Alguns prematuros, mesmo na ausência de lesões cerebrais, apresentam consequências negativas em diversos aspectos do desenvolvimento, como dificuldades em adquirir linguagem. Objetivo O objetivo deste estudo foi verificar o desempenho linguístico de prematuros, na faixa etária de 2 anos, considerando a idade cronológica e a idade corrigida. Métodos Participaram do estudo 23 sujeitos prematuros e para verificar as habilidades linguísticas foi aplicado o Test of Early Language Development – TELD-3. Resultados Os sujeitos prematuros apresentaram desempenho total alterado no TELD-3 em 39,13% dos casos. Os prematuros também foram analisados considerando o atraso para a idade cronológica e a corrigida e não houve diferença no desempenho para os subtestes receptivo (p = 0,250) e expressivo (p = 1,000). Conclusão O grupo de prematuros aos 2 anos de idade constitui população de risco para alterações de linguagem que não podem ser compensadas com a correção da idade.
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Joseph RM, O’Shea TM, Allred EN, Heeren T, Hirtz D, Jara H, Leviton A, Kuban KC. Neurocognitive and Academic Outcomes at Age 10 Years of Extremely Preterm Newborns. Pediatrics 2016; 137:peds.2015-4343. [PMID: 27006473 PMCID: PMC4811321 DOI: 10.1542/peds.2015-4343] [Citation(s) in RCA: 99] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/15/2016] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Despite reductions in mortality and morbidity among children born extremely preterm, they remain at high risk of neurocognitive deficits, with up to 40% having significant cognitive deficits at school age. We assessed the rate of neurocognitive impairment in a contemporary US cohort of 873 children aged 10 years who were born <28 weeks' gestation. METHODS The families of 889 of 966 (92%) children enrolled from 2002 to 2004 at 14 sites in 5 states returned at age 10 years for a comprehensive assessment of IQ, language, attention, executive function, processing speed, visual perception, visual-motor function, and academic achievement. RESULTS A total of 873 children were assessed with well-validated tests of cognitive and academic function. Distributions of test scores were consistently and markedly shifted below normative expectation, with one-third to two-thirds of children performing >1 SD below age expectation. The most extreme downward shifts were on measures of executive control and processing speed. Multivariate analyses, adjusted for socioeconomic status, growth restriction, and other potential confounders, revealed that the risk of poor outcome was highest at the lowest gestational age across all 18 measures. CONCLUSIONS More than half of our extremely preterm cohort exhibited moderate or severe neurocognitive deficits at age 10 years, with the most extensive impairments found among those born at the lowest gestational age. Children born extremely preterm continue to be at significant risk of persistent impairments in neurocognitive function and academic achievement, underscoring the need for monitoring and remediating such outcomes beginning in early childhood.
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Affiliation(s)
| | - Thomas M. O’Shea
- Department of Pediatrics, University of North Carolina, Chapel Hill, North Carolina
| | - Elizabeth N. Allred
- Department of Neurology, Harvard Medical School, Boston, Massachusetts;,Neuroepidemiology Unit, Department of Neurology, Boston Children’s Hospital, Boston, Massachusetts
| | - Tim Heeren
- Department of Biostatistics, School of Public Health, Boston University, Boston, Massachusetts
| | - Deborah Hirtz
- National Institute of Neurologic Disorders and Stroke, Bethesda, Maryland; and
| | | | - Alan Leviton
- Department of Neurology, Harvard Medical School, Boston, Massachusetts;,Neuroepidemiology Unit, Department of Neurology, Boston Children’s Hospital, Boston, Massachusetts
| | - Karl C.K. Kuban
- Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
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Young JM, Morgan BR, Powell TL, Moore AM, Whyte HEA, Smith ML, Taylor MJ. Associations of Perinatal Clinical and Magnetic Resonance Imaging Measures with Developmental Outcomes in Children Born Very Preterm. J Pediatr 2016; 170:90-6. [PMID: 26707586 DOI: 10.1016/j.jpeds.2015.11.044] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 09/25/2015] [Accepted: 11/16/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To identify perinatal risk factors associated with long-term neurocognitive and behavioral impairments in children born very preterm using a multivariate, partial least squares approach. STUDY DESIGN Twenty-seven perinatal clinical and magnetic resonance imaging measures were collected at birth and during the neonatal intensive care stay for 105 neonates born very preterm (≤ 32 weeks gestational age). One-half of the children returned for neuropsychological assessments at 2 and 4 years of age. Parent-reported behavioral measures were also obtained at 4 years of age. Three partial least squares analyses were performed to determine associations between clinical and radiologic measures with cognitive outcomes at 2 and 4 years of age, as well as with behavioral measures at 4 years of age. RESULTS Within the first components of each analysis, only intrauterine growth restriction, male sex, and absence of antenatal corticosteroid use were associated with poorer cognitive and language ability at 2 and 4 years of age, accounting for 79.6% and 71.4% of the total variance, respectively. In addition, white matter injury at term-equivalent age contributed to more problematic internalizing behaviors, behavioral symptoms, and impaired executive function at 4 years of age, accounting for 67.9% of the total variance. CONCLUSIONS Using this data-driven multivariate approach, specific measures in prenatal and early postnatal life are shown to be selectively and significantly associated with cognitive and behavioral outcomes in children born very preterm. Early detection of risk factors can help inform prognoses of children at greatest risk of long-term impairments.
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Affiliation(s)
- Julia M Young
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Psychology, University of Toronto, Toronto, Ontario, Canada.
| | - Benjamin R Morgan
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Tamara L Powell
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Aideen M Moore
- Department of Neonatology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Hilary E A Whyte
- Department of Neonatology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mary Lou Smith
- Department of Psychology, University of Toronto, Toronto, Ontario, Canada; Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Margot J Taylor
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Psychology, University of Toronto, Toronto, Ontario, Canada; Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
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Sancak S, Gursoy T, Imamoglu EY, Karatekin G, Ovali F. Effect of Prematurity on Cerebellar Growth. J Child Neurol 2016; 31:138-44. [PMID: 25971263 DOI: 10.1177/0883073815585350] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 04/06/2015] [Indexed: 12/15/2022]
Abstract
The aim of this study was to evaluate cerebellar growth of preterm infants. Vermis height and transverse cerebellar diameter were measured by cranial ultrasonography in 38 preterm infants (27-32 weeks) at birth and term equivalent age. Measurements were compared with 40 term appropriate-for-gestational-age infants. Preterms at term equivalent age had larger vermis height than term infants (2.39 ± 0.25 cm vs 2.25 ± 0.18 cm, P = .005), whereas no significant difference was found in the transverse cerebellar diameter (5.32 ± 0.38 cm vs 5.44 ± 0.23 cm, P = .13). Vermis height and transverse cerebellar diameter of appropriate-for-gestational-age preterm infants (n = 29) were found larger than small-for-gestational-age ones (n = 9). Vermis height and transverse cerebellar diameter at term equivalent age of appropriate-for-gestational-age preterm infants born before and after 29 weeks of age showed no significant difference. Cerebellar growth is preserved in extreme preterms. However, being small for gestational age may have deleterious effects on cerebellar development.
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Affiliation(s)
- Selim Sancak
- Zeynep Kamil Maternity and Children's Training and Research Hospital, Neonatal Intensive Care Unit, Istanbul, Turkey
| | - Tugba Gursoy
- Department of Pediatrics, Koç University School of Medicine, Neonatology Unit, Istanbul, Turkey
| | - Ebru Yalın Imamoglu
- Zeynep Kamil Maternity and Children's Training and Research Hospital, Neonatal Intensive Care Unit, Istanbul, Turkey
| | - Güner Karatekin
- Zeynep Kamil Maternity and Children's Training and Research Hospital, Neonatal Intensive Care Unit, Istanbul, Turkey
| | - Fahri Ovali
- Zeynep Kamil Maternity and Children's Training and Research Hospital, Neonatal Intensive Care Unit, Istanbul, Turkey
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Guellec I, Marret S, Baud O, Cambonie G, Lapillonne A, Roze JC, Fresson J, Flamant C, Charkaluk ML, Arnaud C, Ancel PY. Intrauterine Growth Restriction, Head Size at Birth, and Outcome in Very Preterm Infants. J Pediatr 2015; 167:975-81.e2. [PMID: 26384436 DOI: 10.1016/j.jpeds.2015.08.025] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 07/10/2015] [Accepted: 08/06/2015] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To determine whether small head circumference (HC) or birth weight (BW) or both are associated with neonatal and long-term neurologic outcome in very preterm infants. STUDY DESIGN All 2442 live births from the 1997 Epipage study between 26 and 32 weeks of gestational age in 9 regions of France were analyzed. A total of 1395 were tested at age 5 years for cognitive performance and 1315 with school performance reports at age 8 years. Symmetric growth restriction (SGR) was defined by HC and BW <20th percentile and in the same percentile range, and asymmetric growth restriction by at least 1 of HC and BW <20th percentile and the other in a higher decile range. There were 2 forms of asymmetric growth restriction: head growth restriction (HGR) and weight growth restriction (WGR). Appropriate for gestational age was defined by both BW and HC >20th percentile. RESULTS Compared with appropriate for gestational age, SGR was significantly associated with neonatal mortality (aOR 2.99, 95% CI 1.78-5.03), moderate and severe cognitive deficiency (aOR 1.65, 95% CI 1.01-2.71 and aOR 2.61, 95% CI 1.46-4.68, respectively), and poor school performance (aOR 1.79; 95% CI 1.13-2.83). HGR was significantly associated with severe cognitive deficiency (aOR 2.07, 95% CI 1.15-3.74). WGR was not significantly associated with cognitive or school performance despite higher rates of neonatal morbidity. CONCLUSIONS SGR in preterm infants was associated with neonatal mortality and impaired cognitive and school performance. The outcome of asymmetric growth restriction differed according to HC. HGR was associated with impaired cognitive function; WGR was not.
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Affiliation(s)
- Isabelle Guellec
- Institut National de la Santé et de la Recherche Médicale (INSERM), UMR 1153, Equipe de recherche en Epidémiologie Obstétricale, Périnatale et Pédiatrique, Paris, France; Assistance Publique - Hôpitaux de Paris, Department of Neonatology and Intensive Care, A. Trousseau Hospital, Paris, France.
| | - Stephane Marret
- Rouen University Hospital, Neonatal Medicine, Rouen, France; Institute of Biomedical Research, University, Inserm Avenir Research Group, IFR 23, Rouen, France
| | - Olivier Baud
- INSERM UMR 1141, Paris, France; Assistance Publique - Hôpitaux de Paris, Department of Neonatology, R. Debré Hospital, Paris, France
| | - Gilles Cambonie
- Montpellier University Hospital Center, Neonatal and Pediatric Intensive Care Unit, Montpellier, France
| | - Alexandre Lapillonne
- Assistance Publique - Hôpitaux de Paris, Department of Neonatology, Necker Hospital, Paris, France
| | - Jean-Christophe Roze
- Nantes University, Department of Neonatology, Maternite Regionale, Clinical Epidemiology and Biostatistics Department France, Nantes University, INSERM CIC004, Nantes, France
| | - Jeanne Fresson
- Institut National de la Santé et de la Recherche Médicale (INSERM), UMR 1153, Equipe de recherche en Epidémiologie Obstétricale, Périnatale et Pédiatrique, Paris, France; Clinical Epidemiology and Biostatistics Department, CHRU Nancy, France
| | - Cyril Flamant
- Nantes University, Department of Neonatology, Maternite Regionale, Clinical Epidemiology and Biostatistics Department France, Nantes University, INSERM CIC004, Nantes, France
| | - Marie-Laure Charkaluk
- Institut National de la Santé et de la Recherche Médicale (INSERM), UMR 1153, Equipe de recherche en Epidémiologie Obstétricale, Périnatale et Pédiatrique, Paris, France
| | - Catherine Arnaud
- Clinical Epidemiology and Biostatistics Department, CHRU Nancy, France
| | - Pierre-Yves Ancel
- Institut National de la Santé et de la Recherche Médicale (INSERM), UMR 1153, Equipe de recherche en Epidémiologie Obstétricale, Périnatale et Pédiatrique, Paris, France; Centre de Recherche Epidémiologie et Statistique Sorbonne Paris Cité DHU Risques et grossesse Université Paris Descartes, Paris, France
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Sucksdorff M, Lehtonen L, Chudal R, Suominen A, Joelsson P, Gissler M, Sourander A. Preterm Birth and Poor Fetal Growth as Risk Factors of Attention-Deficit/ Hyperactivity Disorder. Pediatrics 2015; 136:e599-608. [PMID: 26304830 DOI: 10.1542/peds.2015-1043] [Citation(s) in RCA: 145] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Previous studies have shown an association between prematurity and attention- abstract deficit/hyperactivity disorder (ADHD). Results concerning late preterm infants are controversial, and studies examining fetal growth represented by weight for gestational age are scarce. Our objective was to examine the association between gestational age by each week of fetal maturity, weight for gestational age, and ADHD. METHODS In this population-based study, 10 321 patients with ADHD, diagnosed according to the International Classification of Diseases and 38 355 controls individually matched for gender, date and place of birth, were identified from Finnish nationwide registers. Perinatal data were obtained from the Finnish Medical Birth Register. Conditional logistic regression was used to examine the association between gestational age, weight for gestational age, and ADHD after controlling for confounding factors. RESULTS The risk of ADHD increased by each declining week of gestation. The associations were robust after adjusting for confounders. An elevated risk also was seen among late preterm and early term infants. As for fetal growth, the odds ratio showed a U-shaped curve with an increased risk seen when the weight for gestational age was 1 SD below and 2 SD above the mean. CONCLUSIONS Our findings suggest that each gestational week has significance for child's subsequent neurodevelopment and risk for ADHD. We also showed that poor fetal growth increased the risk of ADHD. This highlights the importance of taking into account both prematurity and poor fetal growth when planning the timing of birth as well as later follow-up and support policies.
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Affiliation(s)
- Minna Sucksdorff
- Departments of Child Psychiatry, and
- Departments of Pediatrics, and
| | - Liisa Lehtonen
- Departments of Pediatrics, and
- Pediatrics, University of Turku, Turku, Finland
| | | | | | | | - Mika Gissler
- National Institute for Health and Welfare, Helsinki, Finland; and
- Nordic School of Public Health, Gothenburg, Sweden
| | - Andre Sourander
- Departments of Child Psychiatry, and
- Child Psychiatry, Turku University Hospital, Turku, Finland
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Griesmaier E, Burger C, Ralser E, Neubauer V, Kiechl-Kohlendorfer U. Amplitude-integrated electroencephalography shows mild delays in electrocortical activity in preterm infants born small for gestational age. Acta Paediatr 2015; 104:e283-8. [PMID: 25656306 DOI: 10.1111/apa.12967] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Revised: 12/22/2014] [Accepted: 02/02/2015] [Indexed: 11/26/2022]
Abstract
AIM Being born small for gestational age (SGA) seems to be a relevant risk factor for long-term neurologic deficits. We compared the differences between amplitude-integrated electroencephalography (aEEG) signals in very preterm infants born small for gestational age (SGA) and those in age-matched infants born appropriate size for gestational age (AGA). METHODS We performed serial aEEG recording on 305 infants: 255 (83.6%) were AGA, and 50 (16.3%) were SGA. RESULTS The number of bursts per hour decreased over time in both groups, but was higher in the SGA group at every time point. On day one, it was significantly higher in the SGA group (17.4) than in the AGA group (10.1) (p = 0.016). The total Burdjalov score increased with post-natal age and tended to be lower in SGA infants, but did not reach statistical significance at any time point. The percentage of continuous background patterns increased with post-natal age in both groups, with no significant difference between the groups. CONCLUSION Very preterm infants born SGA showed normal maturation of aEEG signals during post-natal life, but they also showed mild delays in electrocortical activity compared to age-matched AGA infants. The predictive value of these findings on neurodevelopmental outcome needs to be further evaluated.
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Affiliation(s)
- E Griesmaier
- Department of Pediatrics II; Neonatology; Innsbruck Medical University; Innsbruck Austria
| | - C Burger
- Department of Pediatrics II; Neonatology; Innsbruck Medical University; Innsbruck Austria
| | - E Ralser
- Department of Pediatrics II; Neonatology; Innsbruck Medical University; Innsbruck Austria
| | - V Neubauer
- Department of Pediatrics II; Neonatology; Innsbruck Medical University; Innsbruck Austria
| | - U Kiechl-Kohlendorfer
- Department of Pediatrics II; Neonatology; Innsbruck Medical University; Innsbruck Austria
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