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Lock NE, DeBoer MD, Scharf RJ, Miller SE. Academic performance in moderately and late preterm children in the United States: are they catching up? J Perinatol 2024; 44:819-826. [PMID: 38499752 PMCID: PMC11161401 DOI: 10.1038/s41372-024-01938-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 03/05/2024] [Accepted: 03/11/2024] [Indexed: 03/20/2024]
Abstract
OBJECTIVE To determine whether preterm birth of 32-36 6/7 weeks gestation affected school performance from kindergarten through fifth grade. STUDY DESIGN We assessed 14350 term infants and 1195 32-36 6/7 weeks gestation infants followed in the Early Childhood Longitudinal Study Kindergarten 2011 cohort for classroom performance in kindergarten-fifth grade. Multivariable regression was performed for comparisons, and data were weighted to be representative of the US population. RESULTS Children born 35-36 6/7 weeks gestation had no significant difference in their academic scores or performance, while 32-34 6/7 weeks' children had lower academic scores and teacher performance scores when compared to term children. Children born between 32 and 36 6/7 weeks gestation had higher odds of individualized education plan needs and had learning disability diagnoses compared to term children. CONCLUSIONS Children born between 32 and 34 6/7 weeks gestation have poor school performance compared to term children. Children born between 32 and 36 6/7 weeks gestation are at risk for learning disabilities and likely benefit from continued support and services to improve achievement throughout school.
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Affiliation(s)
- Nicole E Lock
- Department of Pediatrics, Division of Neonatology, University of Virginia, Charlottesville, VA, USA.
| | - Mark D DeBoer
- Department of Pediatrics, Division of Endocrinology, University of Virginia, Charlottesville, VA, USA
| | - Rebecca J Scharf
- Department of Pediatrics, Division of Developmental Pediatrics, University of Virginia, Charlottesville, VA, USA
| | - Sarah E Miller
- Department of Pediatrics, Division of Neonatology, University of Virginia, Charlottesville, VA, USA
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Wei X, Franke N, Alsweiler JM, Brown GTL, Gamble GD, McNeill A, Rogers J, Thompson B, Turuwhenua J, Wouldes TA, Harding JE, McKinlay CJD. Neonatal Hypoglycemia and Neurocognitive Function at School Age: A Prospective Cohort Study. J Pediatr 2024; 272:114119. [PMID: 38815750 DOI: 10.1016/j.jpeds.2024.114119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 04/22/2024] [Accepted: 05/22/2024] [Indexed: 06/01/2024]
Abstract
OBJECTIVE To determine the relationship between transient neonatal hypoglycemia in at-risk infants and neurocognitive function at 6-7 years of corrected age. STUDY DESIGN The pre-hPOD Study involved children born with at least 1 risk factor for neonatal hypoglycemia. Hypoglycemia was defined as ≥1 consecutive blood glucose concentrations <47 mg/dl (2.6 mmol/L), severe as <36 mg/dl (2.0 mmol/L), mild as 36 to <47 mg/dL (2.0 to <2.6 mmol/L), brief as 1-2 episodes, and recurrent as ≥3 episodes. At 6-7 years children were assessed for cognitive and motor function (NIH-Toolbox), learning, visual perception and behavior. The primary outcome was neurocognitive impairment, defined as >1 SD below the normative mean in ≥1 Toolbox tests. The 8 secondary outcomes covered children's cognitive, motor, language, emotional-behavioral, and visual perceptual development. Primary and secondary outcomes were compared between children who did and did not experience neonatal hypoglycemia, adjusting for potential confounding by gestation, birthweight, sex and receipt of prophylactic dextrose gel (pre-hPOD intervention). Secondary analysis included assessment by severity and frequency of hypoglycemia. RESULTS Of 392 eligible children, 315 (80%) were assessed at school age (primary outcome, n = 308); 47% experienced hypoglycemia. Neurocognitive impairment was similar between exposure groups (hypoglycemia 51% vs 50% no hypoglycemia; aRD -4%, 95% CI -15%, 7%). Children with severe or recurrent hypoglycemia had worse visual motion perception and increased risk of emotional-behavioral difficulty. CONCLUSION Exposure to neonatal hypoglycemia was not associated with risk of neurocognitive impairment at school-age in at-risk infants, but severe and recurrent episodes may have adverse impacts. TRIAL REGISTRATION Hypoglycemia Prevention in Newborns with Oral Dextrose: the Dosage Trial (pre-hPOD Study): ACTRN12613000322730.
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Affiliation(s)
- Xingyu Wei
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Nike Franke
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Jane M Alsweiler
- Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - Gavin T L Brown
- Education and Social Work, University of Auckland, Auckland, New Zealand
| | - Gregory D Gamble
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Alicia McNeill
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Jenny Rogers
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Benjamin Thompson
- School of Optometry and Vision Science, University of Waterloo, Waterloo, ON, Canada; School of Optometry and Vision Science, University of Auckland, Auckland, New Zealand; Centre for Eye and Vision Research, Hong Kong, China
| | - Jason Turuwhenua
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Trecia A Wouldes
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Jane E Harding
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Christopher J D McKinlay
- Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand.
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Sejer EPF, Ladelund AK, Bruun FJ, Slavensky JA, Mortensen EL, Kesmodel US. Preterm birth and subsequent intelligence and academic performance in youth: A cohort study. Acta Obstet Gynecol Scand 2024; 103:850-861. [PMID: 38348635 PMCID: PMC11019527 DOI: 10.1111/aogs.14796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 01/17/2024] [Accepted: 01/21/2024] [Indexed: 04/17/2024]
Abstract
INTRODUCTION Worldwide, more children than before survive preterm birth. Preterm birth can affect long-term cognitive outcomes. The aim of our study was to investigate the association between preterm birth and academic performance and intelligence in youth. MATERIAL AND METHODS This cohort study included all liveborn children in Denmark from 1978 to 2000. We used uni- and multivariable logistic and linear regressions to analyze associations between gestational age and school graduation, grade point average (GPA), attending conscription, and male intelligence scores at conscription. We adjusted for a priori defined potential confounders. RESULTS The study included 1 450 681 children and found an association between preterm birth and lower academic performance, with children born extremely preterm having the lowest odds of graduating from lower- and upper secondary education (LSE and USE) and appearing before the conscription board (odds ratios of 0.45 [0.38-0.54], 0.52 [0.46-0.59], and 0.47 [0.39-0.56] for LSE, USE, and conscription, respectively, compared to the term group). Statistically significant differences were observed in LSE for total GPA and core subject GPA with higher GPAs in the term group, which were considered clinically relevant for mathematics with a 0.71 higher grade point for the term compared to the extremely preterm. Conversely, USE differences were less evident, and in linear regression models we found that preterm birth was associated with higher GPAs in the adjusted analyses; however, this was not statistically significant. We demonstrated statistically significant differences in intelligence scores at conscription with lower scores in the three preterm groups (-5.13, -2.73, and - 0.76, respectively) compared to the term group. CONCLUSIONS Low gestational age at birth was associated with not graduating from LSE and USE, achieving lower GPAs in LSE, not attending conscription, and lower intelligence scores in young adulthood. The findings remained significant after adjusting for potential confounders.
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Affiliation(s)
| | | | - Frederik Jager Bruun
- Department of Obstetrics and GynecologyHerlev and Gentofte HospitalHerlevDenmark
| | - Julie Anna Slavensky
- Department of Obstetrics and GynecologyHerlev and Gentofte HospitalHerlevDenmark
| | | | - Ulrik Schiøler Kesmodel
- Department of Obstetrics and GynecologyHerlev and Gentofte HospitalHerlevDenmark
- Department of Obstetrics and GynecologyAalborg University HospitalAalborgDenmark
- Department of Clinical MedicineAalborg UniversityAalborgDenmark
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Mitha A, Chen R, Razaz N, Johansson S, Stephansson O, Altman M, Bolk J. Neurological development in children born moderately or late preterm: national cohort study. BMJ 2024; 384:e075630. [PMID: 38267070 DOI: 10.1136/bmj-2023-075630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
OBJECTIVE To assess long term neurodevelopmental outcomes of children born at different gestational ages, particularly 32-33 weeks (moderately preterm) and 34-36 weeks (late preterm), compared with 39-40 weeks (full term). DESIGN Nationwide cohort study. SETTING Sweden. PARTICIPANTS 1 281 690 liveborn singleton children without congenital malformations born at 32+0 to 41+6 weeks between 1998 and 2012. MAIN OUTCOME MEASURES The primary outcomes of interest were motor, cognitive, epileptic, hearing, and visual impairments and a composite of any neurodevelopmental impairment, diagnosed up to age 16 years. Hazard ratios and 95% confidence intervals were estimated using Cox regression adjusted for parental and infant characteristics in the study population and in the subset of full siblings. Risk differences were also estimated to assess the absolute risk of neurodevelopmental impairment. RESULTS During a median follow-up of 13.1 years (interquartile range 9.5-15.9 years), 75 311 (47.8 per 10 000 person years) liveborn singleton infants without congenital malformations had at least one diagnosis of any neurodevelopmental impairment: 5899 (3.6 per 10 000 person years) had motor impairment, 27 371 (17.0 per 10 000 person years) cognitive impairment, 11 870 (7.3 per 10 000 person years) epileptic impairment, 19 700 (12.2 per 10 000 person years) visual impairment, and 20 393 (12.6 per 10 000 person years) hearing impairment. Children born moderately or late preterm, compared with those born full term, showed higher risks for any impairment (hazard ratio 1.73 (95% confidence interval 1.60 to 1.87) and 1.30 (1.26 to 1.35); risk difference 4.75% (95% confidence interval 3.88% to 5.60%) and 2.03% (1.75% to 2.35%), respectively) as well as motor, cognitive, epileptic, visual, and hearing impairments. Risks for neurodevelopmental impairments appeared highest from 32 weeks (the earliest gestational age), gradually declined until 41 weeks, and were also higher at 37-38 weeks (early term) compared with 39-40 weeks. In the sibling comparison analysis (n=349 108), most associations remained stable except for gestational age and epileptic and hearing impairments, where no association was observed; for children born early term the risk was only higher for cognitive impairment compared with those born full term. CONCLUSIONS The findings of this study suggest that children born moderately or late preterm have higher risks of adverse neurodevelopmental outcomes. The risks should not be underestimated as these children comprise the largest proportion of children born preterm. The findings may help professionals and families achieve a better risk assessment and follow-up.
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Affiliation(s)
- Ayoub Mitha
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- CHU Lille, Pediatric and Neonatal Intensive Care Transport Unit, Department of Emergency Medicine, Lille, France
- Université Paris Cité, CRESS, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé) INSERM, INRAE, Paris, France
| | - Ruoqing Chen
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, 518107, China
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Neda Razaz
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Stefan Johansson
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
- Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
| | - Olof Stephansson
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Maria Altman
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Pediatric Rheumatology, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Jenny Bolk
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
- Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
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Kappelt J, Meigen C, Schild CE, Kiess W, Poulain T. Early child development and its determinants: Findings from a large cohort of healthy children growing up in a low-risk environment. Child Care Health Dev 2024; 50:e13177. [PMID: 37737540 DOI: 10.1111/cch.13177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 07/20/2023] [Accepted: 09/07/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND Despite numerous studies on early child development, there is still much to be discovered about the significance of possible risk factors. This study examines cognitive, motor, and language development of healthy children growing up in a low-risk environment and how various individual and environmental factors are associated with it. The study also considers whether the importance of particular parameters changes depending on child age. METHODS Within the framework of the LIFE Child study in Leipzig, Germany, 481 children participated in a total of 832 visits between 1 and 36 months of age. Developmental status was assessed using the Third Edition of the Bayley Scales of Infant and Toddler Development. Linear regression analyses were applied to examine the associations between child development and sex, gestational age, birth weight, birth mode, overweight, height, and parental education. RESULTS Mean Bayley composite scores for cognitive, language, and motor development were close to the standard value of 100. Poorer developmental outcomes were significantly associated with lower gestational age, vacuum cup/forceps birth, being overweight, small height, and lower parental education, although some of the associations became insignificant after applying multivariate models. While the association between gestational age and language development became weaker with advancing age, our interaction models found disparities related to parental education to become more apparent in older children across all three domains of early child development. CONCLUSIONS Several factors were identified to be associated with early child development. As children grow older, obstetric parameters, for example, gestational age, might become less relevant compared with sociodemographic factors, for example, parental education.
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Affiliation(s)
- Jonas Kappelt
- LIFE Leipzig Research Center for Civilization Diseases, Leipzig University, Leipzig, Germany
| | - Christof Meigen
- LIFE Leipzig Research Center for Civilization Diseases, Leipzig University, Leipzig, Germany
| | - Clara Elise Schild
- LIFE Leipzig Research Center for Civilization Diseases, Leipzig University, Leipzig, Germany
| | - Wieland Kiess
- LIFE Leipzig Research Center for Civilization Diseases, Leipzig University, Leipzig, Germany
- Department of Women and Children's Health, Hospital for Children and Adolescents and Center for Pediatric Research (CPL), Leipzig University, Leipzig, Germany
| | - Tanja Poulain
- LIFE Leipzig Research Center for Civilization Diseases, Leipzig University, Leipzig, Germany
- Department of Women and Children's Health, Hospital for Children and Adolescents and Center for Pediatric Research (CPL), Leipzig University, Leipzig, Germany
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Manerkar K, Crowther CA, Harding JE, Meyer MP, Conlon CA, Rush EC, Alsweiler JM, McCowan LME, Rowan JA, Edlin R, Amitrano F, McKinlay CJD. Impact of Gestational Diabetes Detection Thresholds on Infant Growth and Body Composition: A Prospective Cohort Study Within a Randomized Trial. Diabetes Care 2024; 47:56-65. [PMID: 37643291 DOI: 10.2337/dc23-0464] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 08/01/2023] [Indexed: 08/31/2023]
Abstract
OBJECTIVE Gestational diabetes mellitus (GDM) is associated with offspring metabolic disease, including childhood obesity, but causal mediators remain to be established. We assessed the impact of lower versus higher thresholds for detection and treatment of GDM on infant risk factors for obesity, including body composition, growth, nutrition, and appetite. RESEARCH DESIGN AND METHODS In this prospective cohort study within the Gestational Diabetes Mellitus Trial of Diagnostic Detection Thresholds (GEMS), pregnant women were randomly allocated to detection of GDM using the lower criteria of the International Association of Diabetes and Pregnancy Study Groups or higher New Zealand criteria (ACTRN12615000290594). Randomly selected control infants of women without GDM were compared with infants exposed to A) GDM by lower but not higher criteria, with usual treatment for diabetes in pregnancy; B) GDM by lower but not higher criteria, untreated; or C) GDM by higher criteria, treated. The primary outcome was whole-body fat mass at 5-6 months. RESULTS There were 760 infants enrolled, and 432 were assessed for the primary outcome. Fat mass was not significantly different between control infants (2.05 kg) and exposure groups: A) GDM by lower but not higher criteria, treated (1.96 kg), adjusted mean difference (aMD) -0.09 (95% CI -0.29, 0.10); B) GDM by lower but not higher criteria, untreated (1.94 kg), aMD -0.15 (95% CI -0.35, 0.06); and C) GDM detected and treated using higher thresholds (1.87 kg), aMD -0.17 (95% CI -0.37, 0.03). CONCLUSIONS GDM detected using lower but not higher criteria, was not associated with increased infant fat mass at 5-6 months, regardless of maternal treatment. GDM detected and treated using higher thresholds was also not associated with increased fat mass at 5-6 months.
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Affiliation(s)
- Komal Manerkar
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | | | - Jane E Harding
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Michael P Meyer
- Te Whatu Ora, Counties Manukau, Auckland, New Zealand
- Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - Cathryn A Conlon
- School of Sport, Exercise and Nutrition, Massey University, Auckland, New Zealand
| | - Elaine C Rush
- School of Sport and Recreation, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Jane M Alsweiler
- Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
- Te Whatu Ora, Te Toka Tumai Auckland, Auckland, New Zealand
| | - Lesley M E McCowan
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - Janet A Rowan
- Te Whatu Ora, Te Toka Tumai Auckland, Auckland, New Zealand
| | - Richard Edlin
- Health Systems, University of Auckland, Auckland, New Zealand
| | | | - Christopher J D McKinlay
- Te Whatu Ora, Counties Manukau, Auckland, New Zealand
- Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
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Stephenson NL, Tough S, Williamson T, McDonald S, McMorrris C, Metcalfe A. Early childhood trajectories of domain-specific developmental delay and gestational age at birth: An analysis of the All Our Families cohort. PLoS One 2023; 18:e0294522. [PMID: 38150466 PMCID: PMC10752539 DOI: 10.1371/journal.pone.0294522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 11/03/2023] [Indexed: 12/29/2023] Open
Abstract
OBJECTIVE To describe developmental domain-specific trajectories from ages 1 through 5 years and to estimate the association of trajectory group membership with gestational age for children born between ≥34 and <41 weeks gestation. METHODS Using data from the All Our Families cohort, trajectories of the domain-specific Ages & Stages Questionnaire scores were identified and described using group-based trajectory modeling for children born ≥34 and <41 weeks of gestation (n = 2664). The trajectory groups association with gestational age was estimated using multinomial logistic regression. RESULTS Across the five domains, 4-5 trajectory groups were identified, and most children experienced changing levels of risk for delay over time. Decreasing gestational age increases the Relative risk of delays in fine motor (emerging high risk: 1.46, 95% CI: 1.19-1.80; resolving moderate risk: 1.11, 95% CI: 1.03-1.21) and gross motor (resolving high risk: 1.21, 95% CI: 1.04-1.42; and consistent high risk: 1.64, 95% CI: 1.20-2.24) and problem solving (consistent high risk: 1.58 (1.09-2.28) trajectory groups compared to the consistent low risk trajectory groups. CONCLUSION This study highlights the importance of longitudinal analysis in understanding developmental processes; most children experienced changing levels of risk of domain-specific delay over time instead of having a consistent low risk pattern. Gestational age had differential effects on the individual developmental domains after adjustment for social, demographic and health factors, indicating a potential role of these factors on trajectory group membership.
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Affiliation(s)
- Nikki L. Stephenson
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department Obstetrics and Gynecology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Suzanne Tough
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Paediatrics Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Tyler Williamson
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sheila McDonald
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Paediatrics Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Carly McMorrris
- School and Applied Child Psychology, Werklund School of Education, University of Calgary, Calgary, Alberta, Canada
| | - Amy Metcalfe
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department Obstetrics and Gynecology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Angeli L, Fieni S, Dall'Asta A, Ghi T, De Carolis S, Sorrenti S, Rizzo F, Della Gatta AN, Simonazzi G, Pilu G, Benvenuti M, Luchi C, Simoncini T, Gaibazzi N, Niccoli G, Ardissino D, Frusca T. Mode of delivery and peripartum outcome in women with heart disease according to the ESC guidelines: an Italian multicenter study. J Matern Fetal Neonatal Med 2023; 36:2184221. [PMID: 36935360 DOI: 10.1080/14767058.2023.2184221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
INTRODUCTION The European Society of Cardiology (ESC) guidelines (GL) provide indications on the mode of delivery in women with heart disease. However available data suggests that the rate of Cesarean Delivery (CD) is high and widely variable among such patients. In this study, we aimed to investigate the degree of adherence to the ESC recommendations among women delivering in four tertiary maternity services in Italy and how this affects the maternal and neonatal outcomes. MATERIAL AND METHODS Retrospective multicenter cohort study including pregnant women with heart disease who gave birth between January 2014 and July 2020. Composite adverse maternal outcome (CAM) was defined by the occurrence of one or more of the following: major postpartum hemorrhage, thrombo-embolic or ischemic event, de novo arrhythmia, heart failure, endocarditis, aortic dissection, need for re-surgery, sepsis, maternal death. Composite Adverse Neonatal outcome (CAN) was defined as cord arterial pH <7.00, APGAR <7 at 5 min, admission to the intensive care unit, and neonatal death. We compared the incidence of CAM and CAN between the cases with planned delivery in accordance (group "ESC consistent") or in disagreement (group "ESC not consistent") with the ESC GL. RESULTS Overall, 175 women and 181 liveborn were included. A higher frequency of CAN was found when delivery was not planned accordingly to the ESC guidelines [("ESC consistent" 9/124 (7.2%) vs "ESC not consistent" 13/57 (22.8%) p = 0.002 OR 3.74 (CI 95% 1.49-9.74) , while the occurrence of CAM was comparable between the two groups. At logistic regression analysis, the gestational age at delivery was the only parameter independently associated with the occurrence of CAN (p = 0.006). CONCLUSION Among pregnant women with heart disease, deviating from the ESC guidelines scheduling cesarean delivery does not seem to improve maternal outcomes and it is associated with worse perinatal outcomes, mainly due to lower gestational age at birth.
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Affiliation(s)
- L Angeli
- Department of Maternal Neonatal Medicine, University of Parma, Parma, Italy
| | - S Fieni
- Department of Maternal Neonatal Medicine, University of Parma, Parma, Italy
| | - A Dall'Asta
- Department of Maternal Neonatal Medicine, University of Parma, Parma, Italy
| | - T Ghi
- Department of Maternal Neonatal Medicine, University of Parma, Parma, Italy
| | - S De Carolis
- UOC of Obstetric Pathology, Departement of "Scienze della Salute della Donna, del Bambino e di Sanità Pubblica" Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - S Sorrenti
- UOC of Obstetric Pathology, Departement of "Scienze della Salute della Donna, del Bambino e di Sanità Pubblica" Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - F Rizzo
- UOC of Obstetric Pathology, Departement of "Scienze della Salute della Donna, del Bambino e di Sanità Pubblica" Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - A N Della Gatta
- Obstetric Unit, Department of Medical and Surgical Sciences (DIMEC) IRCSS Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - G Simonazzi
- Obstetric Unit, Department of Medical and Surgical Sciences (DIMEC) IRCSS Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - G Pilu
- Obstetric Unit, Department of Medical and Surgical Sciences (DIMEC) IRCSS Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - M Benvenuti
- Unità di Medicina Materno-Fetale, UOC Ginecologia ed Ostetricia University of Pisa, Pisa, Italy
| | - C Luchi
- Unità di Medicina Materno-Fetale, UOC Ginecologia ed Ostetricia University of Pisa, Pisa, Italy
| | - T Simoncini
- Unità di Medicina Materno-Fetale, UOC Ginecologia ed Ostetricia University of Pisa, Pisa, Italy
| | - N Gaibazzi
- Cardiology Department, University of Parma, Parma, Italy
| | - G Niccoli
- Cardiology Department, University of Parma, Parma, Italy
| | - D Ardissino
- Cardiology Department, University of Parma, Parma, Italy
| | - T Frusca
- Department of Maternal Neonatal Medicine, University of Parma, Parma, Italy
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Jamaluddine Z, Sharara E, Helou V, El Rashidi N, Safadi G, El-Helou N, Ghattas H, Sato M, Blencowe H, Campbell OMR. Effects of size at birth on health, growth and developmental outcomes in children up to age 18: an umbrella review. Arch Dis Child 2023; 108:956-969. [PMID: 37339859 DOI: 10.1136/archdischild-2022-324884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 05/04/2023] [Indexed: 06/22/2023]
Abstract
BACKGROUND Size at birth, an indicator of intrauterine growth, has been studied extensively in relation to subsequent health, growth and developmental outcomes. Our umbrella review synthesises evidence from systematic reviews and meta-analyses on the effects of size at birth on subsequent health, growth and development in children and adolescents up to age 18, and identifies gaps. METHODS We searched five databases from inception to mid-July 2021 to identify eligible systematic reviews and meta-analyses. For each meta-analysis, we extracted data on the exposures and outcomes measured and the strength of the association. FINDINGS We screened 16 641 articles and identified 302 systematic reviews. The literature operationalised size at birth (birth weight and/or gestation) in 12 ways. There were 1041 meta-analyses of associations between size at birth and 67 outcomes. Thirteen outcomes had no meta-analysis.Small size at birth was examined for 50 outcomes and was associated with over half of these (32 of 50); continuous/post-term/large size at birth was examined for 35 outcomes and was consistently associated with 11 of the 35 outcomes. Seventy-three meta-analyses (in 11 reviews) compared risks by size for gestational age (GA), stratified by preterm and term. Prematurity mechanisms were the key aetiologies linked to mortality and cognitive development, while intrauterine growth restriction (IUGR), manifesting as small for GA, was primarily linked to underweight and stunting. INTERPRETATION Future reviews should use methodologically sound comparators to further understand aetiological mechanisms linking IUGR and prematurity to subsequent outcomes. Future research should focus on understudied exposures (large size at birth and size at birth stratified by gestation), gaps in outcomes (specifically those without reviews or meta-analysis and stratified by age group of children) and neglected populations. PROSPERO REGISTRATION NUMBER CRD42021268843.
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Affiliation(s)
- Zeina Jamaluddine
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Eman Sharara
- Center for Research On Population and Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Vanessa Helou
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Nadine El Rashidi
- Center for Research On Population and Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Gloria Safadi
- Center for Research On Population and Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Nehmat El-Helou
- Center for Research On Population and Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Hala Ghattas
- Center for Research On Population and Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
- Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Miho Sato
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Hannah Blencowe
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Oona M R Campbell
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
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10
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Pettinger KJ, Copper C, Boyle E, Blower S, Hewitt C, Fraser L. Risk of Developmental Disorders in Children Born at 32 to 38 Weeks' Gestation: A Meta-Analysis. Pediatrics 2023; 152:e2023061878. [PMID: 37946609 PMCID: PMC10657778 DOI: 10.1542/peds.2023-061878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/23/2023] [Indexed: 11/12/2023] Open
Abstract
CONTEXT Very preterm birth (<32 weeks) is associated with increased risk of developmental disorders. Emerging evidence suggests children born 32 to 38 weeks might also be at risk. OBJECTIVES To determine the relative risk and prevalence of being diagnosed with, or screening positive for, developmental disorders in children born moderately preterm, late preterm, and early term compared with term (≥37 weeks) or full term (39-40/41 weeks). DATA SOURCES Medline, Embase, Psychinfo, Cumulative Index of Nursing, and Allied Health Literature. STUDY SELECTION Reported ≥1 developmental disorder, provided estimates for children born 32 to 38 weeks. DATA EXTRACTION A single reviewer extracted data; a 20% sample was second checked. Data were pooled using random-effects meta-analyses. RESULTS Seventy six studies were included. Compared with term born children, there was increased risk of most developmental disorders, particularly in the moderately preterm group, but also in late preterm and early term groups: the relative risk of cerebral palsy was, for 32 to 33 weeks: 14.1 (95% confidence intervals [CI]: 12.3-16.0), 34 to 36 weeks: 3.52 (95% CI: 3.16-3.92) and 37 to 38 weeks: 1.44 (95% CI: 1.32-1.58). LIMITATIONS Studies assessed children at different ages using varied criteria. The majority were from economically developed countries. All were published in English. Data were variably sparse; subgroup comparisons were sometimes based on single studies. CONCLUSIONS Children born moderately preterm are at increased risk of being diagnosed with or screening positive for developmental disorders compared with term born children. This association is also demonstrated in late preterm and early term groups but effect sizes are smaller.
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Affiliation(s)
| | | | - Elaine Boyle
- University of Leicester, Leicester, United Kingdom
| | | | | | - Lorna Fraser
- University of York, York, United Kingdom
- King’s College London, London, United Kingdom
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11
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Ryan MA, Murray DM, Dempsey EM, Mathieson SR, Livingstone V, Boylan GB. Neurodevelopmental outcome of low-risk moderate to late preterm infants at 18 months. Front Pediatr 2023; 11:1256872. [PMID: 38098644 PMCID: PMC10720582 DOI: 10.3389/fped.2023.1256872] [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: 07/11/2023] [Accepted: 10/30/2023] [Indexed: 12/17/2023] Open
Abstract
Background Of the 15 million preterm births that occur worldwide each year, approximately 80% occur between 32 and 36 + 6 weeks gestational age (GA) and are defined as moderate to late preterm (MLP) infants. This percentage substantiates a need for a better understanding of the neurodevelopmental outcome of this group. Aim To describe neurodevelopmental outcome at 18 months in a cohort of healthy low-risk MLP infants admitted to the neonatal unit at birth and to compare the neurodevelopmental outcome to that of a healthy term-born infant group. Study design and method This single-centre observational study compared the neurodevelopmental outcome of healthy MLP infants to a group of healthy term control (TC) infants recruited during the same period using the Griffith's III assessment at 18 months. Results Seventy-five MLP infants and 92 TC infants were included. MLP infants scored significantly lower in the subscales: Eye-hand coordination (C), Personal, Social and Emotional Development (D), Gross Motor Development (E) and General Developmental (GD) (p < 0.001 for each) and Foundations of Learning (A), (p = 0.004) in comparison to the TC infant group with Cohen's d effect sizes ranging from 0.460 to 0.665. There was no statistically significant difference in mean scores achieved in subscale B: Language and Communication between groups (p = 0.107). Conclusion MLP infants are at risk of suboptimal neurodevelopmental outcomes. Greater surveillance of the neurodevelopmental trajectory of this group of at-risk preterm infants is required.
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Affiliation(s)
- Mary Anne Ryan
- INFANT Centre, University College Cork, Cork, Ireland
- Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - Deirdre M. Murray
- INFANT Centre, University College Cork, Cork, Ireland
- Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - Eugene M. Dempsey
- INFANT Centre, University College Cork, Cork, Ireland
- Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
- Department of Neonatology, Cork University Maternity Hospital, Cork, Ireland
| | - Sean R. Mathieson
- INFANT Centre, University College Cork, Cork, Ireland
- Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - Vicki Livingstone
- INFANT Centre, University College Cork, Cork, Ireland
- Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - Geraldine B. Boylan
- INFANT Centre, University College Cork, Cork, Ireland
- Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
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12
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Fernández de Gamarra-Oca L, Zubiaurre-Elorza L, Gómez-Gastiasoro A, Molins-Sauri M, Loureiro B, Peña J, García-Guerrero MA, Ibarretxe-Bilbao N, Bruna O, Junqué C, Macaya A, Poca MA, Ojeda N. Preterm birth and early life environmental factors: neuropsychological profiles at adolescence and young adulthood. J Perinatol 2023; 43:1429-1436. [PMID: 37454175 DOI: 10.1038/s41372-023-01727-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 06/26/2023] [Accepted: 07/10/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVES To establish neuropsychological profiles after high- and low-risk preterm birth (i.e., with and without neonatal brain injury) during adolescence and young adulthood and to assess the potential role of early life environmental factors in cognition. STUDY DESIGN Participants (N = 177; Mage = 20.11 years) of both sexes were evaluated when adolescent or in young adulthood. They were grouped according to their birth status: 30 high-risk preterm, 83 low-risk preterm and 64 born at full term. RESULTS Significant differences were found in several cognitive domains between groups. Furthermore, familial socioeconomic status (SES) moderated the relation between the degree of maturity/immaturity at birth and cognition (F(5,171) = 11.94, p < 0.001, R2 = 0.26). DISCUSSION The findings showed different neuropsychological profiles during adolescence and young adulthood, with the high-risk preterm sample evidencing lower cognitive values. In addition, higher scores in the familial SES score in this study seem to have a protective effect on cognition.
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Affiliation(s)
| | - Leire Zubiaurre-Elorza
- Department of Psychology, Faculty of Health Sciences, University of Deusto, Bilbao, Vizcaya, Spain.
| | - Ainara Gómez-Gastiasoro
- Department of Basic Psychological Processes and Development, Faculty of Psychology, University of the Basque Country, Donostia, Gipuzkoa, Spain
| | - Marta Molins-Sauri
- School of Psychology, Education and Sport Science Blanquerna, Ramon Llull University, Barcelona, Catalonia, Spain
| | - Begoña Loureiro
- Neonatal Intensive Care Unit, Cruces University Hospital, Biocruces Health Research Institute, Barakaldo, Vizcaya, Spain
| | - Javier Peña
- Department of Psychology, Faculty of Health Sciences, University of Deusto, Bilbao, Vizcaya, Spain
| | - M Acebo García-Guerrero
- Department of Psychology, Faculty of Health Sciences, University of Deusto, Bilbao, Vizcaya, Spain
| | - Naroa Ibarretxe-Bilbao
- Department of Psychology, Faculty of Health Sciences, University of Deusto, Bilbao, Vizcaya, Spain
| | - Olga Bruna
- School of Psychology, Education and Sport Science Blanquerna, Ramon Llull University, Barcelona, Catalonia, Spain
| | - Carme Junqué
- Medical Psychology Unit, Department of Medicine, Institute of Neuroscience, University of Barcelona, Barcelona, Catalonia, Spain
- Institute of Biomedical Research August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Alfons Macaya
- Pediatric Neurology Research Group, Vall d'Hebron Research Institute, Vall d'Hebron University Hospital, Barcelona, Catalonia, Spain
| | - Maria A Poca
- Department of Neurosurgery and Neurotraumatology and Neurosurgery Research Unit, Vall d'Hebron Research Institute, Autonomous University of Barcelona, Barcelona, Catalonia, Spain
| | - Natalia Ojeda
- Department of Psychology, Faculty of Health Sciences, University of Deusto, Bilbao, Vizcaya, Spain
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13
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Stephenson N, Metcalfe A, McDonald S, Williamson T, McMorris C, Tough S. The association of gestational age at birth with trajectories of early childhood developmental delay among late preterm and early term born children: A longitudinal analysis of All Our Families pregnancy cohort. Paediatr Perinat Epidemiol 2023; 37:505-515. [PMID: 36959728 DOI: 10.1111/ppe.12965] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 02/10/2023] [Accepted: 02/15/2023] [Indexed: 03/25/2023]
Abstract
BACKGROUND Like infants born very preterm (<32 weeks), late preterm (≥34 and <37 weeks) and early term (≥37 and <39 weeks) births have been associated with increased risk of developmental delay (DD); yet, the evidence remains heterogeneous across the continuum of gestational ages, hindering early identification and intervention. OBJECTIVE To estimate the association of gestational age at birth with early childhood trajectories of DD in early childhood for infants born ≥34 and <41 weeks, and determine how various maternal, pregnancy and infant characteristics relate to these trajectory groups. METHODS Analysis of mother-child dyad data with infants born ≥34 and <41 weeks gestational age within an observational pregnancy cohort in Alberta, Canada, from 2008 to 2011 (n = 2644). The association between gestational age and trajectories of the total number of Ages and Stages Questionnaire domains indicating risk of DD from 1 through 5 years of age were estimated using group-based trajectory modelling along with other perinatal risk factors. RESULTS Three distinct trajectory groups were identified: low-risk, moderate-risk (transiently at risk of DD in one domain over time) and high-risk (consistently at risk of delay in ≥2 domains over time). Per week of decreasing gestational age, the risk ratio of membership in the high-risk group increases by 1.77 (95% confidence interval [CI] 1.43, 2.20) or 1.84 (95% CI 1.49, 2.27) relative to the moderate-risk and low-risk respectively. Increasing maternal age, identifying as Black, indigenous or a person of colour, elevated maternal depressive symptoms in pregnancy, and male infant sex were associated with high- and moderate-risk trajectories compared to the low-risk trajectory. CONCLUSIONS In combination with decreasing gestational age, poor maternal mental health and social determinants of health increase the probability of membership in trajectories with increased risk of DD, suggesting that additional monitoring of children born late preterm and early term is warranted.
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Affiliation(s)
- Nikki Stephenson
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Amy Metcalfe
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Obstetrics and Gynaecology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sheila McDonald
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Tyler Williamson
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Carly McMorris
- School and Applied Child Psychology, Werklund School of Education, University of Calgary, Calgary, Alberta, Canada
| | - Suzanne Tough
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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14
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Mielewczyk FJ, Boyle EM. Uncharted territory: a narrative review of parental involvement in decision-making about late preterm and early term delivery. BMC Pregnancy Childbirth 2023; 23:526. [PMID: 37464284 DOI: 10.1186/s12884-023-05845-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 07/11/2023] [Indexed: 07/20/2023] Open
Abstract
Almost 30% of live births in England and Wales occur late preterm or early term (LPET) and are associated with increased risks of adverse health outcomes throughout the lifespan. However, very little is known about the decision-making processes concerning planned LPET births or the involvement of parents in these. This aim of this paper is to review the evidence on parental involvement in obstetric decision-making in general, to consider what can be extrapolated to decisions about LPET delivery, and to suggest directions for further research.A comprehensive, narrative review of relevant literature was conducted using Medline, MIDIRS, PsycInfo and CINAHL databases. Appropriate search terms were combined with Boolean operators to ensure the following broad areas were included: obstetric decision-making, parental involvement, late preterm and early term birth, and mode of delivery.This review suggests that parents' preferences with respect to their inclusion in decision-making vary. Most mothers prefer sharing decision-making with their clinicians and up to half are dissatisfied with the extent of their involvement. Clinicians' opinions on the limits of parental involvement, especially where the safety of mother or baby is potentially compromised, are highly influential in the obstetric decision-making process. Other important factors include contextual factors (such as the nature of the issue under discussion and the presence or absence of relevant medical indications for a requested intervention), demographic and other individual characteristics (such as ethnicity and parity), the quality of communication; and the information provided to parents.This review highlights the overarching need to explore how decisions about potential LPET delivery may be reached in order to maximise the satisfaction of mothers and fathers with their involvement in the decision-making process whilst simultaneously enabling clinicians both to minimise the number of LPET births and to optimise the wellbeing of women and babies.
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Affiliation(s)
- Frances J Mielewczyk
- Leicester City Football Club (LCFC) Research Programme, Department of Population Health Sciences, College of Life Sciences, George Davies Centre, University of Leicester, University Road, Leicester, LE1 7RH, UK.
| | - Elaine M Boyle
- Department of Population Health Sciences, College of Life Sciences, George Davies Centre, University of Leicester, University Road, Leicester, LE1 7RH, UK
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15
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Ashorn P, Ashorn U, Muthiani Y, Aboubaker S, Askari S, Bahl R, Black RE, Dalmiya N, Duggan CP, Hofmeyr GJ, Kennedy SH, Klein N, Lawn JE, Shiffman J, Simon J, Temmerman M. Small vulnerable newborns-big potential for impact. Lancet 2023; 401:1692-1706. [PMID: 37167991 DOI: 10.1016/s0140-6736(23)00354-9] [Citation(s) in RCA: 45] [Impact Index Per Article: 45.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 01/27/2023] [Accepted: 02/14/2023] [Indexed: 05/13/2023]
Abstract
Despite major achievements in child survival, the burden of neonatal mortality has remained high and even increased in some countries since 1990. Currently, most neonatal deaths are attributable to being born preterm, small for gestational age (SGA), or with low birthweight (LBW). Besides neonatal mortality, these conditions are associated with stillbirth and multiple morbidities, with short-term and long-term adverse consequences for the newborn, their families, and society, resulting in a major loss of human capital. Prevention of preterm birth, SGA, and LBW is thus critical for global child health and broader societal development. Progress has, however, been slow, largely because of the global community's failure to agree on the definition and magnitude of newborn vulnerability and best ways to address it, to frame the problem attractively, and to build a broad coalition of actors and a suitable governance structure to implement a change. We propose a new definition and a conceptual framework, bringing preterm birth, SGA, and LBW together under a broader umbrella term of the small vulnerable newborn (SVN). Adoption of the framework and the unified definition can facilitate improved problem definition and improved programming for SVN prevention. Interventions aiming at SVN prevention would result in a healthier start for live-born infants, while also reducing the number of stillbirths, improving maternal health, and contributing to a positive economic and social development in the society.
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Affiliation(s)
- Per Ashorn
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Department of Paediatrics, Tampere University Hospital, Tampere, Finland.
| | - Ulla Ashorn
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Yvonne Muthiani
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | | | | | - Rajiv Bahl
- Indian Council for Medical Research, New Delhi, India
| | - Robert E Black
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Nita Dalmiya
- United Nations Children's Fund, New York, NY, USA
| | - Christopher P Duggan
- Center for Nutrition, Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA, USA
| | - G Justus Hofmeyr
- Department of Obstetrics and Gynaecology, University of Botswana, Gaborone, Botswana; Effective Care Research Unit, University of the Witwatersrand, Johannesburg, South Africa; Department of Obstetrics and Gynaecology, Walter Sisulu University, East London, South Africa
| | - Stephen H Kennedy
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
| | - Nigel Klein
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Joy E Lawn
- Maternal, Adolescent, Reproductive & Child Health Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Jeremy Shiffman
- Paul H Nitze School of Advanced International Studies, Johns Hopkins University, Baltimore, MD, USA
| | | | - Marleen Temmerman
- Centre of Excellence in Women and Child Health, Aga Khan University, Nairobi, Kenya
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16
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Hadders-Algra M, van Iersel PAM, Heineman KR, la Bastide-van Gemert S. Longer duration of gestation in term singletons is associated with better infant neurodevelopment. Early Hum Dev 2023; 181:105779. [PMID: 37120903 DOI: 10.1016/j.earlhumdev.2023.105779] [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: 02/20/2023] [Revised: 04/20/2023] [Accepted: 04/20/2023] [Indexed: 05/02/2023]
Abstract
BACKGROUND Longer gestation at term and post-term age is associated with increased perinatal mortality. Nonetheless, recent neuroimaging studies indicated that longer gestation is also associated with better functioning of the child's brain. AIMS to assess whether longer gestation in term and post-term (in short: term) singletons is associated with better infant neurodevelopment. STUDY DESIGN cross-sectional observational study. SUBJECTS Participants were all singleton term infants (n = 1563) aged 2-18 months of the IMP-SINDA project that collected normative data for the Infant Motor Profile (IMP) and Standardized Infant NeuroDevelopmental Assessment (SINDA). The group was representative of the Dutch population. OUTCOME MEASURES Total IMP score was the primary outcome. Secondary outcomes were atypical total IMP scores (scores <15th percentile) and SINDA's neurological and developmental scores. RESULTS Duration of gestation had a quadratic relationship with IMP and SINDA developmental scores. IMP scores were lowest at a gestation of 38·5 weeks, SINDA developmental scores at 38·7 weeks. Next, both scores increased with increasing duration of gestation. Infants born at 41-42 weeks had significantly less often atypical IMP scores (adjusted OR [95 % CI]: 0·571 [0·341-0·957] and atypical SINDA developmental scores (adjusted OR: 0·366 [0·195-0·688]) than infants born at 39-40 weeks. Duration of gestation was not associated with SINDA's neurological score. CONCLUSIONS In term singleton infants representative of the Dutch population longer gestation is associated with better infant neurodevelopment scores suggesting better neural network efficiency. Longer gestation in term infants is not associated with atypical neurological scores.
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Affiliation(s)
- Mijna Hadders-Algra
- University of Groningen, University Medical Center Groningen, Dept. Pediatrics - section Developmental Neurology, Groningen, the Netherlands.
| | - Patricia A M van Iersel
- University of Groningen, University Medical Center Groningen, Dept. Pediatrics - section Developmental Neurology, Groningen, the Netherlands
| | - Kirsten R Heineman
- University of Groningen, University Medical Center Groningen, Dept. Pediatrics - section Developmental Neurology, Groningen, the Netherlands; Stichting Epilepsie Instellingen Nederland (SEIN), Zwolle, the Netherlands
| | - Sacha la Bastide-van Gemert
- University of Groningen, University Medical Center Groningen, Dept. Epidemiology, Groningen, the Netherlands
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17
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Vittner D, D'Agata A, Choi BY, McGrath J. Release of Oxytocin and Cortisol Is Associated With Neurobehavioral Patterns in Premature Infants. J Obstet Gynecol Neonatal Nurs 2023; 52:248-256. [PMID: 36965512 DOI: 10.1016/j.jogn.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 03/05/2023] [Accepted: 03/06/2023] [Indexed: 03/27/2023] Open
Abstract
OBJECTIVE To examine relationships among salivary oxytocin and cortisol levels in parents and preterm infants and neurobehavioral functioning in preterm infants after skin-to-skin contact. DESIGN A secondary analysis of a randomized crossover study. SETTING NICU. PARTICIPANTS Twenty-eight stable premature infants and their mothers and fathers. METHODS Participating infants contributed 108 saliva samples that we collected 45 minutes after skin-to-skin contact and tested for oxytocin and cortisol. We randomized data collection by whether the infant was held first by the mother or by the father. We conducted linear regression to test if summary scores on the NICU Network Neurobehavioral Scale were associated with salivary oxytocin and cortisol levels. RESULTS We found a significant negative relationship between infant oxytocin levels and the Stress scores (b = -0.07, p < .01) and the Excitability scores (b = -1.12, p = .04) among infants held skin-to-skin with their mothers. We found a significant positive relationship between infant oxytocin levels and the Self-Regulatory scores (b = 0.38, p = .05) among infants held skin-to-skin with their mothers. We found a significant positive relationship between infant cortisol level and the Stress scores (b = 0.05, p = .04), Excitability scores (b = 1.06, p = 0.05), and Asymmetrical Reflexes scores (b = 1.21, p = .03) among infants held skin-to-skin with their mothers. We only found a negative significant relationship between infant cortisol levels and the Stress scores (b = -0.03, p = .04) among infants held skin-to-skin with their fathers. CONCLUSION We found that oxytocin is an important biomarker that may improve infant neurobehavioral functioning. The data showed a difference in oxytocin responses after skin-to-skin contact with mothers compared to fathers.
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18
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Liu MX, Li HF, Wu MQ, Geng SS, Ke L, Lou BW, Du W, Hua J. Associations of preterm and early-term birth with suspected developmental coordination disorder: a national retrospective cohort study in children aged 3-10 years. World J Pediatr 2023; 19:261-272. [PMID: 36469242 PMCID: PMC9974676 DOI: 10.1007/s12519-022-00648-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 10/26/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND This study analyzed the motor development and suspected developmental coordination disorder of very and moderately preterm (< 34+0 gestational age), late preterm (34+0-36+6 gestational week), and early-term (37+0-38+6 gestational week) children compared to their full-term peers with a national population-based sample in China. METHODS A total of 1673 children (799 girls, 874 boys) aged 3-10 years old were individually assessed with the Movement Assessment Battery for Children-second edition (MABC-2). The association between gestational age and motor performance of children was analyzed using a multilevel regression model. RESULTS The global motor performance [β = - 5.111, 95% confidence interval (CI) = - 9.200 to - 1.022; P = 0.015] and balance (β = - 5.182, 95% CI = - 5.055 to - 1.158; P = 0.003) for very and moderately preterm children aged 3-6 years old were significantly lower than their full-term peers when adjusting for confounders. Late preterm and early-term children showed no difference. Moreover, very and moderately preterm children aged 3-6 years had a higher risk of suspected developmental coordination disorder (DCD) (≤ 5 percentile of MABC-2 score) when adjusting for potential confounders [odds ratio (OR) = 2.931, 95% CI = 1.067-8.054; P = 0.038]. Late preterm and early-term children showed no difference in motor performance from their full-term peers (each P > 0.05). CONCLUSIONS Our findings have important implications for understanding motor impairment in children born at different gestational ages. Very and moderately preterm preschoolers have an increased risk of DCD, and long-term follow-up should be provided for early detection and intervention.
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Affiliation(s)
- Ming-Xia Liu
- The Women's and Children's Department, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
- Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Hai-Feng Li
- Department of Rehabilitation, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Mei-Qin Wu
- The Women's and Children's Department, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
- Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Shan-Shan Geng
- The Women's and Children's Department, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
- Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Li Ke
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
| | - Bi-Wen Lou
- Leitontech Research Institution, Suzhou, China
| | - Wenchong Du
- Department of Psychology, NTU Psychology, Nottingham Trent University, Nottingham, UK.
| | - Jing Hua
- The Women's and Children's Department, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China.
- Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China.
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Best KP, Yelland LN, Collins CT, McPhee AJ, Rogers GB, Choo J, Gibson RA, Murguia-Peniche T, Varghese J, Cooper TR, Makrides M. Growth of late preterm infants fed nutrient-enriched formula to 120 days corrected age-A randomized controlled trial. Front Pediatr 2023; 11:1146089. [PMID: 37205223 PMCID: PMC10185835 DOI: 10.3389/fped.2023.1146089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 03/29/2023] [Indexed: 05/21/2023] Open
Abstract
Objectives We aimed to compare the effects of nutrient-enriched formula with standard term formula on rate of body weight gain of late preterm infants appropriately grown for gestational age. Study design A multi-center, randomized, controlled trial. Late preterm infants (34-37 weeks' gestation), with weight appropriate for gestational age (AGA), were randomized to nutrient enriched formula (NEF) with increased calories (22 kcal/30 ml) from protein, added bovine milk fat globule membrane, vitamin D and butyrate or standard term formula 20 kcal/30 ml (STF). Breastfed term infants were enrolled as an observational reference group (BFR). Primary outcome was rate of body weight gain from enrollment to 120 days corrected age (d/CA). Planned sample size was 100 infants per group. Secondary outcomes included body composition, weight, head circumference and length gain, and medically confirmed adverse events to 365 d/CA. Results The trial was terminated early due to recruitment challenges and sample size was substantially reduced. 40 infants were randomized to NEF (n = 22) and STF (n = 18). 39 infants were enrolled in the BFR group. At 120 d/CA there was no evidence of a difference in weight gain between randomized groups (mean difference 1.77 g/day, 95% CI, -1.63 to 5.18, P = 0.31). Secondary outcomes showed a significant reduction in risk of infectious illness in the NEF group at 120 d/CA [relative risk 0.37 (95% CI, 0.16-0.85), P = 0.02]. Conclusion We saw no difference in rate of body weight gain between AGA late preterm infants fed NEF compared to STF. Results should be interpreted with caution due to small sample size. Clinical Trial Registration The Australia New Zealand Clinical Trials Registry (ACTRN 12618000092291). "mailto:maria.makrides@sahmri.com" maria.makrides@sahmri.com.
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Affiliation(s)
- Karen P. Best
- Women and Kids Theme, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
| | - Lisa N. Yelland
- Women and Kids Theme, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
- School of Public Health, The University of Adelaide, Adelaide, SA, Australia
| | - Carmel T. Collins
- Women and Kids Theme, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
| | - Andrew J. McPhee
- Women and Kids Theme, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Geraint B. Rogers
- Lifelong Health Theme, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
- Infection and Immunity, Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Jocelyn Choo
- Lifelong Health Theme, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
- Infection and Immunity, Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Robert A. Gibson
- Women and Kids Theme, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
- School of Agriculture, Food and Wine, University of Adelaide, Adelaide, SA, Australia
| | - Teresa Murguia-Peniche
- School of Medicine, Indiana University, Evansville, IN, United States
- Medical Sciences, Mead Johnson Nutrition|Reckitt, Evansville, IN, United States
| | - Jojy Varghese
- Department of Neonatology, Lyell McEwin Hospital, Adelaide, SA, Australia
| | - Timothy R. Cooper
- Medical Sciences, Mead Johnson Nutrition|Reckitt, Evansville, IN, United States
| | - Maria Makrides
- Women and Kids Theme, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
- Correspondence: Maria Makrides
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20
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Balalian AA, Graeve R, Richter M, Fink A, Kielstein H, Martins SS, Philbin MM, Factor-Litvak P. Prenatal exposure to opioids and neurodevelopment in infancy and childhood: A systematic review. Front Pediatr 2023; 11:1071889. [PMID: 36896405 PMCID: PMC9989202 DOI: 10.3389/fped.2023.1071889] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 01/23/2023] [Indexed: 02/23/2023] Open
Abstract
Aim This systematic review aims to estimate the relationship between prenatal exposure to opioids and neurodevelopmental outcomes and examines potential sources of heterogeneity between the studies. Methods We searched four databases through May 21st, 2022: PubMed, Embase, PsycInfo and the Web of Science according to a specified search strings. Study inclusion criteria include: (1) cohort and case-control peer-reviewed studies published in English; (2) studies comparing neurodevelopmental outcomes among children with prenatal opioid-exposure (prescribed or used non-medically) vs. an unexposed group. Studies investigating fetal alcohol syndrome or a different primary prenatal exposure other than opioids were excluded. Two main performed data extraction using "Covidence" systematic review platform. This systematic review was conducted in accordance with PRISMA guidelines. The Newcastle-Ottawa-Scale was used for quality assessment of the studies. Studies were synthesized based on the type of neurodevelopmental outcome and the instrument used to assess neurodevelopment. Results Data were extracted from 79 studies. We found significant heterogeneity between studies due to their use of different instruments to explore cognitive skills, motor, and behavioral outcomes among children of different ages. The other sources of heterogeneity included: procedures to assess prenatal exposure to opioids; period of pregnancy in which exposure was assessed; type of opioids assessed (non-medical, medication used for opioid use dis-order, prescribed by health professional), types of co-exposure; source of selection of prenatally exposed study participants and comparison groups; and methods to address lack of comparability between exposed and unexposed groups. Cognitive and motor skills as well as behavior were generally negatively affected by prenatal opioid exposure, but the significant heterogeneity precluded a meta-analysis. Conclusion We explored sources of heterogeneity in the studies assessing the association between prenatal exposure to opioids and neurodevelopmental outcomes. Sources of heterogeneity included different approaches to participant recruitment as well as exposure and outcome ascertainment methods. Nonetheless, overall negative trends were observed between prenatal opioid exposure and neuro-developmental outcomes.
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Affiliation(s)
- Arin A Balalian
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Richard Graeve
- Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Matthias Richter
- Social Determinants of Health Group, Department of Sport and Health Sciences, Technical University of Munich (TUM), Germany
| | - Astrid Fink
- Department of Health and Consumer Protection, Kreis Groß-Gerau, Groß-Gerau, Germany
| | - Heike Kielstein
- Institut für Anatomie und Zellbiologie, Martin-Luther-Universität Halle, Halle (Saale), Germany
| | - Silvia S Martins
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Morgan M Philbin
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Pam Factor-Litvak
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States
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21
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Lingasubramanian G, Corman H, Noonan K, Reichman NE. Gestational Age at Term and Teacher-Reported Attention-Deficit Hyperactivity Disorder Symptom Patterns. J Pediatr 2022; 251:120-126.e4. [PMID: 35940292 PMCID: PMC10281338 DOI: 10.1016/j.jpeds.2022.07.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 07/23/2022] [Accepted: 07/28/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The objective of this study was to estimate associations between gestational age and teacher-reported attention-deficit hyperactivity disorder (ADHD)-related symptom patterns at age 9 years among children born at term (37-41 weeks). STUDY DESIGN A secondary data analysis of approximately 1400 children in the Fragile Families and Child Wellbeing study, a US birth cohort study that oversampled nonmarital births, was conducted. At age 9 years, students were evaluated by their teachers using the Conners Teacher Rating Scale-Revised Short Form that included subscales for symptoms of hyperactivity, ADHD, oppositional behavior, and cognitive problems/inattention. Unadjusted and adjusted negative binomial and logistic regression models of associations between gestational age and teacher-reported scores were estimated. RESULTS Each week of gestational age at term was associated with hyperactivity scores that were 6% lower (adjusted incidence rate ratio [IRR]: 0.94; 95% CI: 0.89-0.99) and ADHD and cognitive problems/inattention scores that were 5% lower (adjusted IRR: 0.95; 95% CI: 0.91-0.98 in both cases). Early-term birth (37-38 weeks) was associated with 23% higher hyperactivity scores (adjusted IRR: 1.23; 95% CI:1.07-1.41), 17% higher ADHD scores (adjusted IRR: 1.17; 95% CI: 1.05-1.30), and ∼50% higher odds of scoring 1.5+ SDs above the sample mean for hyperactivity (aOR: 1.51; 95% CI: 1.05-2.18) when compared with birth at 39-41 weeks. There were no significant associations between gestational age and oppositional behavior scores. CONCLUSION The findings add to growing evidence supporting current recommendations for delaying elective deliveries to at least 39 weeks and suggest that regular screenings for ADHD symptoms are important for children born at 37- to 38-weeks gestation.
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Affiliation(s)
- Geethanjali Lingasubramanian
- Division of Neonatology, Department of Pediatrics, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ
| | - Hope Corman
- Department of Economics, Rider University, Lawrenceville, NJ; National Bureau of Economic Research, New York, NY
| | - Kelly Noonan
- Department of Economics, Princeton University, Princeton, NJ
| | - Nancy E Reichman
- Department of Pediatrics, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ; Child Health Institute of New Jersey, Rutgers University, New Brunswick, NJ.
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22
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Hwang YS, Chen CC, Shih HN, Tsai WH. Higher risk for poor handwriting in Taiwanese children born late preterm. Pediatr Neonatol 2022; 64:306-312. [PMID: 36464586 DOI: 10.1016/j.pedneo.2022.06.017] [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: 02/11/2022] [Revised: 06/07/2022] [Accepted: 06/14/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Late-preterm and early-term births constitute a significant proportion of live births. However, handwriting skills of these two populations remain unclear. We aimed to investigate their risk for poor Chinese handwriting in grade two. METHODS In this observational study, 185 second graders born late preterm (34+0-36+6 weeks' gestation, n = 54), early term (37+0-38+6 weeks' gestation, n = 56), and full term (39+0-41+6 weeks' gestation, n = 75) without any intervention or diagnosis related to developmental delays were included. Their handwriting performance was rated by class teachers using the Chinese Handwriting Evaluation Form (CHEF), which is a standardized handwriting scale including five handwriting dimensions (construction, accuracy, directionality, speed, and pencil grasp). RESULTS After controlling for demographic risk factors, the late-preterm born group had a greater risk of having worse performance in the full form (adjusted odds ratio [aOR] = 3.93; p = .038) and construction dimension (aOR = 4.77; p = .009) of the CHEF than peers born at full term, whereas the risks were comparable for the early- and full-term born groups (aOR = 0.14-1.90; p = .073-0.453 in the handwriting dimensions). CONCLUSIONS Late-preterm but not early-term born children were found to be at higher risk for poor Chinese handwriting in grade two. They particularly have difficulty with spatial construction including size, spacing, and alignment of Chinese characters and components that may influence handwriting legibility.
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Affiliation(s)
- Yea-Shwu Hwang
- Department of Occupational Therapy, College of Medicine, National Cheng Kung University, 1 University Road, East District, Tainan City, 701401, Taiwan
| | - Chih-Cheng Chen
- Section of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital Kaohsiung Branch and Chang Gung University, College of Medicine, 123 Dapi Road, Kaohsiung City, Niaosong District, 833401, Taiwan
| | - Hui-Ning Shih
- Department of Occupational Therapy, College of Medicine, National Cheng Kung University, 1 University Road, East District, Tainan City, 701401, Taiwan
| | - Wen-Hui Tsai
- Graduate Institute of Medical Sciences, College of Health Sciences, Chang Jung Christian University, 1 Changda Road, Gueiren District, Tainan City, 711301, Taiwan; Division of Neonatology, Department of Pediatrics, Chi Mei Medical Center, 901 Zhonghua Rd., Yongkang District, Tainan City, 71004, Taiwan.
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23
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Huf IU, Baque E, Colditz PB, Chatfield MD, Ware RS, Boyd RN, George JM. Neurological examination at 32-weeks postmenstrual age predicts 12-month cognitive outcomes in very preterm-born infants. Pediatr Res 2022; 93:1721-1727. [PMID: 36151299 PMCID: PMC10172122 DOI: 10.1038/s41390-022-02310-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 09/02/2022] [Accepted: 09/03/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND To determine the diagnostic accuracy of Hammersmith Neonatal Neurological Examination (HNNE) at 30-32 weeks postmenstrual age (PMA, 'Early') and term equivalent age (TEA) in infants born <31 weeks PMA to predict cognitive outcomes at 12 months corrected age (CA). METHODS Prospective cohort study of 119 infants (73 males; median 28.4 weeks gestational age at birth) who underwent Early and TEA HNNE. At 12 months CA, 104 participants completed Bayley Scales of Infant and Toddler Development, 3rd Edition, (Bayley-III). Optimum cut-off points for each HNNE subscale were determined to establish diagnostic accuracy for predicting adverse cognitive outcomes on the Bayley-III Cognitive Composite Scale (≤85). RESULTS The best diagnostic accuracy for HNNE total score at 30-32 weeks PMA predicting cognitive impairment occurred at cut-off ≤16.7 (sensitivity (Se) = 71%, specificity (Sp) = 51%). The Abnormal Signs subscale demonstrated the best balance of sensitivity/specificity combination (Se = 71%, Sp = 71%; cut-off ≤1.5). For HNNE at TEA, the total score at cut-off ≤24.5 had Se = 71% and Sp = 47% for predicting cognitive impairment. The Tone Patterns subscale demonstrated the strongest diagnostic accuracy at TEA (Se = 71%, Sp = 63%; cut-off ≤3). CONCLUSIONS Early and TEA HNNE demonstrated moderate diagnostic accuracy for cognitive outcomes at 12-months CA in infants born <31 weeks gestational age. CLINICAL TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry; Trial Registration Number: ACTRN12613000280707; web address of trial: http://www.ANZCTR.org.au/ACTRN12613000280707.aspx . IMPACT Early Hammersmith Neonatal Neurological Examination (HNNE) assessment at 30-32 weeks postmenstrual age has moderate diagnostic accuracy for cognitive outcomes at 12 months corrected age in infants born <31 weeks gestation. Early HNNE at 30-32 weeks has stronger predictive validity than HNNE at term equivalent age. Early HNNE may provide an early marker for risk-stratification to optimise the planning of post-discharge support and follow-up services for infants born preterm.
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Affiliation(s)
- Isabel U Huf
- School of Health Sciences and Social Work, Griffith University, Brisbane, QLD, Australia
| | - Emmah Baque
- School of Health Sciences and Social Work, Griffith University, Brisbane, QLD, Australia.,Menzies Health Institute Queensland, Griffith University, Brisbane, QLD, Australia
| | - Paul B Colditz
- University of Queensland Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia.,Perinatal Research Centre, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Mark D Chatfield
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Centre for Children's Health Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Robert S Ware
- Menzies Health Institute Queensland, Griffith University, Brisbane, QLD, Australia
| | - Roslyn N Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Centre for Children's Health Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Joanne M George
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Centre for Children's Health Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia. .,Physiotherapy Department, Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, Brisbane, QLD, Australia.
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24
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Lindquist A, Hastie R, Kennedy A, Gurrin L, Middleton A, Quach J, Cheong J, Walker SP, Hiscock R, Tong S. Developmental Outcomes for Children After Elective Birth at 39 Weeks' Gestation. JAMA Pediatr 2022; 176:654-663. [PMID: 35532925 PMCID: PMC9086934 DOI: 10.1001/jamapediatrics.2022.1165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Elective births at 39 weeks' gestation are increasing. While this option may improve maternal and perinatal outcomes compared with expectant management, longer-term childhood developmental outcomes are uncertain. OBJECTIVE To investigate the association between elective birth at 39 weeks' gestation and the risk of childhood developmental vulnerability. DESIGN, SETTING, AND PARTICIPANTS For this cohort study, 2 causal inference analyses were conducted using Australian statewide, population-based data. Perinatal data from births between January 1, 2005, and December 31, 2013, were linked to childhood developmental outcomes at age 4 to 6 years (assessed using multiple imputation via inverse probability-weighted regression adjustment). Data analyses were conducted between September 7 and November 9, 2021. EXPOSURES Two exposure groups were considered: (1) elective birth between 39 weeks and 0 days' and 39 weeks and 6 days' gestation vs expectant management and (2) birth via induction of labor vs planned cesarean delivery among those born electively at 39 weeks' gestation. MAIN OUTCOMES AND MEASURES Childhood developmental vulnerability at school entry, defined as scoring below the 10th percentile in at least 2 of 5 developmental domains (physical health and well-being, social competence, emotional maturity, school-based language and cognitive skills, and communication skills and general knowledge). RESULTS Of 176 236 births with linked outcome data, 88 165 met the inclusion criteria. Among these, 15 927 (18.1%) were elective births at 39 weeks' gestation (induction of labor or planned cesarean delivery), and 72 238 (81.9%) were expectantly managed with subsequent birth between 40 and 43 weeks' gestation. Compared with expectant management, elective birth at 39 weeks' gestation was not associated with an altered risk of childhood global developmental vulnerability (adjusted relative risk [aRR], 1.03; 95% CI, 0.96-1.12) or with developmental vulnerability in any of the individual domains. In an analysis restricted to elective births at 39 weeks' gestation, induction of labor (n = 7928) compared with planned cesarean delivery (n = 7999) was not associated with childhood developmental vulnerability (aRR, 0.96; 95% CI, 0.82-1.12) or with vulnerability in any individual domains. CONCLUSIONS AND RELEVANCE In this cohort study, elective birth at 39 weeks' gestation was not associated with childhood developmental vulnerability. For those born electively at 39 weeks' gestation, birth after induction of labor or by elective cesarean delivery had similar developmental outcomes.
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Affiliation(s)
- Anthea Lindquist
- Mercy Perinatal, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Roxanne Hastie
- Mercy Perinatal, Mercy Hospital for Women, Heidelberg, Victoria, Australia,Translational Obstetrics Group, Department of Obstetrics and Gynaecology, Mercy Hospital for Women, University of Melbourne, Heidelberg, Victoria, Australia
| | - Amber Kennedy
- Mercy Perinatal, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Lyle Gurrin
- Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia
| | - Anna Middleton
- Mercy Perinatal, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Jon Quach
- Policy, Equity and Translation, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
| | - Jeanie Cheong
- Newborn Research, Royal Women's Hospital, Parkville, Victoria, Australia,Victorian Infant Brain Studies, Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Susan P. Walker
- Mercy Perinatal, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Richard Hiscock
- Mercy Perinatal, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Stephen Tong
- Mercy Perinatal, Mercy Hospital for Women, Heidelberg, Victoria, Australia,Translational Obstetrics Group, Department of Obstetrics and Gynaecology, Mercy Hospital for Women, University of Melbourne, Heidelberg, Victoria, Australia
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25
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Balalian AA, McVeigh KH, Stingone JA. Air pollution, children's academic achievement and the potential mediating role of preterm birth. Int J Hyg Environ Health 2022; 243:113991. [PMID: 35688002 PMCID: PMC9541921 DOI: 10.1016/j.ijheh.2022.113991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 05/31/2022] [Accepted: 06/03/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Previous research has observed relationships between higher prenatal exposure to air pollutants and neurodevelopmental and academic outcomes later in childhood. Identifying intermediate outcomes mediating this relationship would inform prevention and intervention efforts. We aimed to investigate if previously observed associations between prenatal exposure to common urban air pollutants, diesel and perchloroethylene, and performance on third grade standardized tests were mediated through increased risk of preterm birth. METHODS Data from the 1994-1998 birth cohorts within the New York City Longitudinal Study of Early Development were included in this analysis. Exposure was determined by linking the mother's residence at the time of delivery to the U.S. EPA's 1996 National Air Toxic Assessment of estimated ambient concentrations of diesel and perchloroethylene. Children's third grade standardized math and language tests were used as the markers for academic achievement. Missing data on covariates were imputed, while participants with missing information on gestational age and test scores were excluded. Linear regression models and causal mediation analysis were used to examine potential mediation by preterm birth. RESULTS In total, 187,723 and 196,122 participants were included in language and math analyses, respectively. Children with exposure to the fourth quartile of diesel or perchloroethylene had approximately 0.03 (95%CI: 0.02, 0.04) lower math z-scores when compared to individuals with exposure in the first quartile, although there was no consistent decreasing trend in math z-scores over increasing quartiles of diesel or perchloroethylene. We did not find evidence of mediation by preterm birth or exposure-mediator interaction in our models. CONCLUSION We did not find evidence that observed relationships between exposure to common urban air pollutants and test z-scores in childhood were mediated through an increased risk of preterm birth. This suggests other pathways between early exposure to air pollution and neurodevelopment should be investigated with causal mediation approaches.
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Affiliation(s)
- Arin A Balalian
- Columbia University Department of Epidemiology, Mailman School of Public Health, 722 West 168th St. 16thfloor, New York, NY, 10032, USA.
| | - Katharine H McVeigh
- New York City Department of Health and Mental Hygiene, Division of Family and Child Health, 42-09 28thStreet, Queens, NY, 11101, USA.
| | - Jeanette A Stingone
- Columbia University Department of Epidemiology, Mailman School of Public Health, 722 West 168th St. 16thfloor, New York, NY, 10032, USA.
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26
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Reflecting the trends in the academic landscape of special education using probabilistic dynamic topic modeling. LIBRARY HI TECH 2022. [DOI: 10.1108/lht-12-2021-0441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeSpecial education is the education segment that deals with the students facing hurdles in the traditional education system. Research data have evolved in the domain of special education due to scientific advances. The present study aims to employ text mining to extract the latent patterns from the scientific data.Design/methodology/approachThis study examined the 12,781 Scopus-indexed titles, abstracts and keywords published from 1987 to 2021 through an integrated text-mining and topic modeling approach. It combines dynamic topic models with highly cited reviews of this domain. It facilitates the extraction of topic clusters and communities in the topic network.FindingsThis methodology discovered children’s communication and speech using gaming techniques, mental retardation, cost effect on infant birth, involvement of special education children and their families, assistive technology information for special education, syndrome epilepsy and the impact of group study on skill development peers or self as the hottest topic of research in this domain. In addition to finding research hotspots, it further explores annual topic proportion trends, topic correlations and intertopic research areas.Originality/valueThe results provide a comprehensive summary of the popularity of research topics in special education in the past 34 years, and the results can provide useful insights and implications, and it could be used as a guide for contributors in special education form a structured view of past research and plan future research directions.
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27
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Gale-Grant O, Fenn-Moltu S, França LGS, Dimitrova R, Christiaens D, Cordero-Grande L, Chew A, Falconer S, Harper N, Price AN, Hutter J, Hughes E, O'Muircheartaigh J, Rutherford M, Counsell SJ, Rueckert D, Nosarti C, Hajnal JV, McAlonan G, Arichi T, Edwards AD, Batalle D. Effects of gestational age at birth on perinatal structural brain development in healthy term-born babies. Hum Brain Mapp 2022; 43:1577-1589. [PMID: 34897872 PMCID: PMC8886657 DOI: 10.1002/hbm.25743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 11/19/2021] [Accepted: 11/30/2021] [Indexed: 11/12/2022] Open
Abstract
Infants born in early term (37-38 weeks gestation) experience slower neurodevelopment than those born at full term (40-41 weeks gestation). While this could be due to higher perinatal morbidity, gestational age at birth may also have a direct effect on the brain. Here we characterise brain volume and white matter correlates of gestational age at birth in healthy term-born neonates and their relationship to later neurodevelopmental outcome using T2 and diffusion weighted MRI acquired in the neonatal period from a cohort (n = 454) of healthy babies born at term age (>37 weeks gestation) and scanned between 1 and 41 days after birth. Images were analysed using tensor-based morphometry and tract-based spatial statistics. Neurodevelopment was assessed at age 18 months using the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III). Infants born earlier had higher relative ventricular volume and lower relative brain volume in the deep grey matter, cerebellum and brainstem. Earlier birth was also associated with lower fractional anisotropy, higher mean, axial, and radial diffusivity in major white matter tracts. Gestational age at birth was positively associated with all Bayley-III subscales at age 18 months. Regression models predicting outcome from gestational age at birth were significantly improved after adding neuroimaging features associated with gestational age at birth. This work adds to the body of evidence of the impact of early term birth and highlights the importance of considering the effect of gestational age at birth in future neuroimaging studies including term-born babies.
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Affiliation(s)
- Oliver Gale-Grant
- Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Centre for the Developing Brain, School of Imaging Sciences and Biomedical Engineering, King's College London, London, UK.,MRC Centre for Neurodevelopmental Disorders, King's College London, London, UK
| | - Sunniva Fenn-Moltu
- Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Centre for the Developing Brain, School of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
| | - Lucas G S França
- Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Centre for the Developing Brain, School of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
| | - Ralica Dimitrova
- Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Centre for the Developing Brain, School of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
| | - Daan Christiaens
- Centre for the Developing Brain, School of Imaging Sciences and Biomedical Engineering, King's College London, London, UK.,Department of Electrical Engineering, ESAT/PSI, KU Leuven, Leuven, Belgium
| | - Lucilio Cordero-Grande
- Centre for the Developing Brain, School of Imaging Sciences and Biomedical Engineering, King's College London, London, UK.,Biomedical Image Technologies, ETSI Telecomunicación, Universidad Politécnica de Madrid and CIBER-BBN, Madrid, Spain
| | - Andrew Chew
- Centre for the Developing Brain, School of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
| | - Shona Falconer
- Centre for the Developing Brain, School of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
| | - Nicholas Harper
- Centre for the Developing Brain, School of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
| | - Anthony N Price
- Centre for the Developing Brain, School of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
| | - Jana Hutter
- Centre for the Developing Brain, School of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
| | - Emer Hughes
- Centre for the Developing Brain, School of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
| | - Jonathan O'Muircheartaigh
- Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Centre for the Developing Brain, School of Imaging Sciences and Biomedical Engineering, King's College London, London, UK.,MRC Centre for Neurodevelopmental Disorders, King's College London, London, UK
| | - Mary Rutherford
- Centre for the Developing Brain, School of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
| | - Serena J Counsell
- Centre for the Developing Brain, School of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
| | - Daniel Rueckert
- Department of Computing, Imperial College London, London, UK.,Department of Medicine and Informatics, Technical University of Munich, Munich, Germany
| | - Chiara Nosarti
- Centre for the Developing Brain, School of Imaging Sciences and Biomedical Engineering, King's College London, London, UK.,Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Joseph V Hajnal
- Centre for the Developing Brain, School of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
| | - Grainne McAlonan
- Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,MRC Centre for Neurodevelopmental Disorders, King's College London, London, UK
| | - Tomoki Arichi
- Centre for the Developing Brain, School of Imaging Sciences and Biomedical Engineering, King's College London, London, UK.,Paediatric Neurosciences, Evelina London Children's Hospital Guy's and St Thomas' NHS Foundation Trust, London, UK.,Department of Bioengineering, Imperial College London, London, UK
| | - A David Edwards
- Centre for the Developing Brain, School of Imaging Sciences and Biomedical Engineering, King's College London, London, UK.,MRC Centre for Neurodevelopmental Disorders, King's College London, London, UK
| | - Dafnis Batalle
- Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Centre for the Developing Brain, School of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
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Shah R, Dai DWT, Alsweiler JM, Brown GTL, Chase JG, Gamble GD, Harris DL, Keegan P, Nivins S, Wouldes TA, Thompson B, Turuwhenua J, Harding JE, McKinlay CJD. Association of Neonatal Hypoglycemia With Academic Performance in Mid-Childhood. JAMA 2022; 327:1158-1170. [PMID: 35315886 PMCID: PMC8941348 DOI: 10.1001/jama.2022.0992] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Neonatal hypoglycemia is associated with increased risk of poor executive and visual-motor function, but implications for later learning are uncertain. OBJECTIVE To test the hypothesis that neonatal hypoglycemia is associated with educational performance at age 9 to 10 years. DESIGN, SETTING, AND PARTICIPANTS Prospective cohort study of moderate to late preterm and term infants born at risk of hypoglycemia. Blood and masked interstitial sensor glucose concentrations were measured for up to 7 days. Infants with hypoglycemic episodes (blood glucose concentration <47 mg/dL [2.6 mmol/L]) were treated to maintain a blood glucose concentration of at least 47 mg/dL. Six hundred fourteen infants were recruited at Waikato Hospital, Hamilton, New Zealand, in 2006-2010; 480 were assessed at age 9 to 10 years in 2016-2020. EXPOSURES Hypoglycemia was defined as at least 1 hypoglycemic event, representing the sum of nonconcurrent hypoglycemic and interstitial episodes (sensor glucose concentration <47 mg/dL for ≥10 minutes) more than 20 minutes apart. MAIN OUTCOMES AND MEASURES The primary outcome was low educational achievement, defined as performing below or well below the normative curriculum level in standardized tests of reading comprehension or mathematics. There were 47 secondary outcomes related to executive function, visual-motor function, psychosocial adaptation, and general health. RESULTS Of 587 eligible children (230 [48%] female), 480 (82%) were assessed at a mean age of 9.4 (SD, 0.3) years. Children who were and were not exposed to neonatal hypoglycemia did not significantly differ on rates of low educational achievement (138/304 [47%] vs 82/176 [48%], respectively; adjusted risk difference, -2% [95% CI, -11% to 8%]; adjusted relative risk, 0.95 [95% CI, 0.78-1.15]). Children who were exposed to neonatal hypoglycemia, compared with those not exposed, were significantly less likely to be rated by teachers as being below or well below the curriculum level for reading (68/281 [24%] vs 49/157 [31%], respectively; adjusted risk difference, -9% [95% CI, -17% to -1%]; adjusted relative risk, 0.72 [95% CI, 0.53-0.99; P = .04]). Groups were not significantly different for other secondary end points. CONCLUSIONS AND RELEVANCE Among participants at risk of neonatal hypoglycemia who were screened and treated if needed, exposure to neonatal hypoglycemia compared with no such exposure was not significantly associated with lower educational achievement in mid-childhood.
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Affiliation(s)
- Rajesh Shah
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Darren W. T. Dai
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Jane M. Alsweiler
- Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - Gavin T. L. Brown
- Faculty of Education and Social Work, University of Auckland, Auckland, New Zealand
| | - J. Geoffrey Chase
- Department of Mechanical Engineering, University of Canterbury, Christchurch, New Zealand
| | | | - Deborah L. Harris
- Liggins Institute, University of Auckland, Auckland, New Zealand
- School of Nursing, Midwifery, and Health Practice, Victoria University of Wellington, Wellington, New Zealand
| | - Peter Keegan
- Te Puna Wānanga, University of Auckland, Auckland, New Zealand
| | - Samson Nivins
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Trecia A. Wouldes
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Benjamin Thompson
- School of Optometry and Vision Science, University of Waterloo, Waterloo, Ontario, Canada
- School of Optometry and Vision Science, University of Auckland, Auckland, New Zealand
- Centre for Eye and Vision Research, Hong Kong
| | - Jason Turuwhenua
- School of Optometry and Vision Science, University of Auckland, Auckland, New Zealand
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Jane E. Harding
- Liggins Institute, University of Auckland, Auckland, New Zealand
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29
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Liu W, Sun Q, Huang L, Bhattacharya A, Wang GW, Tan X, Kuban KCK, Joseph RM, O'Shea TM, Fry RC, Li Y, Santos HP. Innovative computational approaches shed light on genetic mechanisms underlying cognitive impairment among children born extremely preterm. J Neurodev Disord 2022; 14:16. [PMID: 35240980 PMCID: PMC8903548 DOI: 10.1186/s11689-022-09429-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 02/22/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Although survival rates for infants born extremely preterm (gestation < 28 weeks) have improved significantly in recent decades, neurodevelopmental impairment remains a major concern. Children born extremely preterm remain at high risk for cognitive impairment from early childhood to adulthood. However, there is limited evidence on genetic factors associated with cognitive impairment in this population. METHODS First, we used a latent profile analysis (LPA) approach to characterize neurocognitive function at age 10 for children born extremely preterm. Children were classified into two groups: (1) no or low cognitive impairment, and (2) moderate-to-severe cognitive impairment. Second, we performed TOPMed-based genotype imputation on samples with genotype array data (n = 528). Third, we then conducted a genome-wide association study (GWAS) for LPA-inferred cognitive impairment. Finally, computational analysis was conducted to explore potential mechanisms underlying the variant x LPA association. RESULTS We identified two loci reaching genome-wide significance (p value < 5e-8): TEA domain transcription factor 4 (TEAD4 at rs11829294, p value = 2.40e-8) and syntaxin 18 (STX18 at rs79453226, p value = 1.91e-8). Integrative analysis with brain expression quantitative trait loci (eQTL), chromatin conformation, and epigenomic annotations suggests tetraspanin 9 (TSPAN9) and protein arginine methyltransferase 8 (PRMT8) as potential functional genes underlying the GWAS signal at the TEAD4 locus. CONCLUSIONS We conducted a novel computational analysis by utilizing an LPA-inferred phenotype with genetics data for the first time. This study suggests that rs11829294 and its LD buddies have potential regulatory roles on genes that could impact neurocognitive impairment for extreme preterm born children.
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Affiliation(s)
- Weifang Liu
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Quan Sun
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Le Huang
- Curriculum in Bioinformatics and Computational Biology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Arjun Bhattacharya
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Geoffery W Wang
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Xianming Tan
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Karl C K Kuban
- Department of Pediatrics, Boston University, Boston, MA, USA
| | - Robert M Joseph
- Department of Anatomy & Neurobiology, Boston University, Boston, MA, USA
| | - T Michael O'Shea
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Rebecca C Fry
- Department of Environmental Sciences and Engineering, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Yun Li
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
- Department of Computer Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Hudson P Santos
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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30
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Shinya Y, Kawai M, Niwa F, Kanakogi Y, Imafuku M, Myowa M. Cognitive flexibility in 12-month-old preterm and term infants is associated with neurobehavioural development in 18-month-olds. Sci Rep 2022; 12:3. [PMID: 35013426 PMCID: PMC8748813 DOI: 10.1038/s41598-021-04194-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 12/10/2021] [Indexed: 02/08/2023] Open
Abstract
There is growing evidence that preterm children are at an increased risk of poor executive functioning, which underlies behavioural and attention problems. Previous studies have suggested that early cognitive flexibility is a possible predictor of later executive function; however, how it develops in infancy and relates to the later neurobehavioural outcomes is still unclear in the preterm population. Here, we conducted a longitudinal study to investigate oculomotor response shifting in 27 preterm and 25 term infants at 12 months and its relationship with general cognitive development and effortful control, which is a temperamental aspect closely associated with executive function, at 18 months. We found that moderate to late preterm and term infants significantly inhibited previously rewarded look responses, while very preterm infants did not show significant inhibition of perseverative looking at 12 months. Moreover, lower inhibition of perseverative looking was significantly associated with lower general cognitive development and attentional shifting at 18 months. These findings suggest that the early atypical patterns of oculomotor response shifting may be a behavioural marker for predicting a higher risk of negative neurobehavioural outcomes, including attention-related problems in preterm children.
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Affiliation(s)
- Yuta Shinya
- Graduate School of Education, The University of Tokyo, Tokyo, Japan.
| | - Masahiko Kawai
- Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Fusako Niwa
- Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | | | | | - Masako Myowa
- Graduate School of Education, Kyoto University, Kyoto, Japan
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31
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Gleason JL, Gilman SE, Sundaram R, Yeung E, Putnick DL, Vafai Y, Saha A, Grantz KL. Gestational age at term delivery and children's neurocognitive development. Int J Epidemiol 2022; 50:1814-1823. [PMID: 34999875 PMCID: PMC8932293 DOI: 10.1093/ije/dyab134] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 06/16/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Preterm birth is associated with lower neurocognitive performance. However, whether children's neurodevelopment improves with longer gestations within the full-term range (37-41 weeks) is unclear. Given the high rate of obstetric intervention in the USA, it is critical to determine whether long-term outcomes differ for children delivered at each week of term. METHODS This secondary analysis included 39 199 live-born singleton children of women who were admitted to the hospital in spontaneous labour from the US Collaborative Perinatal Project (1959-76). At each week of term gestation, we evaluated development at 8 months using the Bayley Scales of Infant Development, 4 years using the Stanford-Binet IQ (SBIQ) domains and 7 years using the Wechsler Intelligence Scales for Children (WISC) and Wide-Range Achievement Tests (WRAT). RESULTS Children's neurocognitive performance improved with each week of gestation from 37 weeks, peaking at 40 or 41 weeks. Relative to those delivered at 40 weeks, children had lower neurocognitive scores at 37 and 38 weeks for all assessments except SBIQ and WISC Performance IQ. Children delivered at 39 weeks had lower Bayley Mental (β = -1.18; confidence interval -1.77, -0.58) and Psychomotor (β = -1.18; confidence interval -1.90, -0.46) scores. Results were similar for within-family analyses comparing siblings, with the addition of lower WRAT scores at 39 weeks. CONCLUSIONS The improvement in development scores across assessment periods indicates that each week up to 40 or 41 weeks of gestation is important for short- and long-term cognitive development, suggesting 40-41 weeks may be the ideal delivery window for optimal neurodevelopmental outcomes.
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Affiliation(s)
- Jessica L Gleason
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Stephen E Gilman
- Social and Behavioral Sciences Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Rajeshwari Sundaram
- Biostatistics Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Edwina Yeung
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Diane L Putnick
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Yassaman Vafai
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Abhisek Saha
- Biostatistics Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Katherine L Grantz
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
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32
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Sawada Y, Honda N, Narumiya M, Mizumoto H. Evaluation of the social skills of low birthweight infants using the Interaction Rating Scale. J Phys Ther Sci 2022; 34:697-703. [PMID: 36213188 PMCID: PMC9535250 DOI: 10.1589/jpts.34.697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 07/21/2022] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This study aimed to examine, using the Interaction Rating Scale, the effect of
social skills at 18 months of life on the subsequent development of low birthweight
infants. [Participants and Methods] The study participants were made up of a total of 23
infants who were admitted to the neonatal intensive care unit of Hospital A and whose
developmental indexes were followed up at the outpatient clinic for up to 3 years of age.
The survey was conducted twice in each infant, at a corrected age of 18 months and at 36
full months of age. Social skills and developmental indexes were assessed at the corrected
age of 18 months, meanwhile only developmental indexes were assessed at 36 full months, to
examine associations. The Interaction Rating Scale was used to assess social skills. This
scale measures various aspects of social development by observing caregiver-child
interactions in situations wherein children are engaged in tasks more difficult for their
age. [Results] The results demonstrated that social skills at 18 months were associated
with the developmental indexes at 18 and 36 months, whereas more items were associated
with the developmental index at 36 months. [Conclusion] The results indicate the need for
early prediction of developmental delay and timely intervention, by assessing social
skills in low birthweight infants.
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Affiliation(s)
- Yuko Sawada
- Department of Physical Therapy, Morinomiya University of Medical Sciences: 1-26-16 Nanko-kita, Suminoe-ku, Osaka 559-8611, Japan
| | - Noritsugu Honda
- Department of Physical Therapy, Morinomiya University of Medical Sciences: 1-26-16 Nanko-kita, Suminoe-ku, Osaka 559-8611, Japan
| | - Makiko Narumiya
- Department of Pediatrics, Kitano Hospital, Tazuke Kofukai Medical Research Institute, Japan
| | - Hiroshi Mizumoto
- Rehabilitation Center, Kitano Hospital, Tazuke Kofukai Medical Research Institute, Japan
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33
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Bilsteen JF, Alenius S, Bråthen M, Børch K, Ekstrøm CT, Kajantie E, Lashkariani M, Nurhonen M, Risnes K, Sandin S, van der Wel KA, Wolke D, Andersen AMN. Gestational Age, Parent Education, and Education in Adulthood. Pediatrics 2022; 149:183795. [PMID: 34877601 PMCID: PMC9645686 DOI: 10.1542/peds.2021-051959] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/15/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Adults born preterm (<37 weeks) have lower educational attainment than those born term. Whether this relationship is modified by family factors such as socioeconomic background is, however, less well known. We investigated whether the relationship between gestational age and educational attainment in adulthood differed according to parents' educational level in 4 Nordic countries. METHODS This register-based cohort study included singletons born alive from 1987 up to 1992 in Denmark, Finland, Norway, and Sweden. In each study population, we investigated effect modification by parents' educational level (low, intermediate, high) on the association between gestational age at birth (25-44 completed weeks) and low educational attainment at 25 years (not having completed upper secondary education) using general estimation equations logistic regressions. RESULTS A total of 4.3%, 4.0%, 4.8%, and 5.0% singletons were born preterm in the Danish (n = 331 448), Finnish (n = 220 095), Norwegian (n = 292 840), and Swedish (n = 513 975) populations, respectively. In all countries, both lower gestational age and lower parental educational level contributed additively to low educational attainment. For example, in Denmark, the relative risk of low educational attainment was 1.84 (95% confidence interval 1.44 to 2.26) in adults born at 28 to 31 weeks whose parents had high educational level and 5.25 (95% confidence interval 4.53 to 6.02) in adults born at 28 to 31 weeks whose parents had low educational level, compared with a reference group born at 39 to 41 weeks with high parental educational level. CONCLUSIONS Although higher parental education level was associated with higher educational attainment for all gestational ages, parental education did not mitigate the educational disadvantages of shorter gestational age.
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Affiliation(s)
- Josephine Funck Bilsteen
- Department of Paediatrics, Hvidovre University Hospital, Hvidovre, Denmark,Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark,Address correspondence to Josephine Funck Bilsteen, MSc, Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark, Øster Farimagsgade 5, 1014 København K. E-mail:
| | - Suvi Alenius
- Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland,Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Magne Bråthen
- Department of Social Work, Child Welfare and Social Policy, Oslo Metropolitan University, Norway
| | - Klaus Børch
- Department of Paediatrics, Hvidovre University Hospital, Hvidovre, Denmark
| | - Claus Thorn Ekstrøm
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Eero Kajantie
- Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland,Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland,Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway,PEDEGO Research Unit, MRC Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Mariam Lashkariani
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Markku Nurhonen
- Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Kari Risnes
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway,Department of Research, Innovation, and Education and Children’s Clinic, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Sven Sandin
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden,Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York,Seaver Autism Center for Research and Treatment at Mount Sinai, New York, New York
| | - Kjetil A. van der Wel
- Department of Social Work, Child Welfare and Social Policy, Oslo Metropolitan University, Norway
| | - Dieter Wolke
- Department of Psychology and Centre of Early Life, University of Warwick, Coventry, United Kingdom
| | - Anne-Marie Nybo Andersen
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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34
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Hua J, Barnett AL, Williams GJ, Dai X, Sun Y, Li H, Chen G, Wang L, Feng J, Liu Y, Zhang L, Zhu L, Weng T, Guan H, Gu Y, Zhou Y, Butcher A, Du W. Association of Gestational Age at Birth With Subsequent Suspected Developmental Coordination Disorder in Early Childhood in China. JAMA Netw Open 2021; 4:e2137581. [PMID: 34905005 PMCID: PMC8672235 DOI: 10.1001/jamanetworkopen.2021.37581] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE It remains unknown whether children born at different degrees of prematurity, early term, and post term might have a higher risk of developmental coordination disorder (DCD) compared with completely full-term children (39-40 gestational weeks). OBJECTIVE To differentiate between suspected DCD in children with different gestational ages based on a national representative sample in China. DESIGN, SETTING, AND PARTICIPANTS A retrospective cohort study was conducted in China from April 1, 2018, to December 31, 2019. A total of 152 433 children aged 3 to 5 years from 2403 public kindergartens in 551 cities of China were included in the final analysis. A multilevel regression model was developed to determine the strength of association for different gestational ages associated with suspected DCD when considering kindergartens as clusters. MAIN OUTCOMES AND MEASURES Children's motor performance was assessed using the Little Developmental Coordination Disorder Questionnaire, completed by their parents. Gestational age was determined according to the mother's medical records and divided into 7 categories: completely full term (39 to 40 weeks' gestation), very preterm (<32 weeks), moderately preterm (32-33 weeks), late preterm (34-36 weeks), early term (37-38 weeks), late term (41 weeks), and post term (>41 weeks). RESULTS A total of 152 433 children aged 3 to 5 years (mean [SD] age, 4.5 [0.8] years), including 80 370 boys (52.7%) and 72 063 girls (47.3%), were included in the study. There were 45 052 children (29.6%) aged 3 years, 59 796 (39.2%) aged 4 years, and 47 585 (31.2%) aged 5 years. Children who were born very preterm (odds ratio [OR], 1.35; 95% CI, 1.23-1.48), moderately preterm (OR, 1.18; 95% CI, 1.02-1.36), late preterm (OR, 1.24; 95% CI, 1.16-1.32), early term (OR, 1.11; 95% CI, 1.06-1.16), and post term (OR, 1.17; 95% CI, 1.07-1.27) were more likely to be classified in the suspected DCD category on the Little Developmental Coordination Disorder Questionnaire than completely full-term children after adjusting for the same characteristics. Additionally, there was no association with suspected DCD in younger (aged 3 years) early-term and postterm children by stratified analyses. CONCLUSIONS AND RELEVANCE In this cohort study, every degree of prematurity at birth, early-term birth, and postterm birth were associated with suspected DCD when compared with full-term birth. These findings have important implications for understanding motor development in children born at different gestational ages. Long-term follow-up and rehabilitation interventions should be considered for children born early and post term.
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Affiliation(s)
- Jing Hua
- Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Anna L. Barnett
- Centre for Psychological Research, Oxford Brookes University, Oxford, United Kingdom
| | - Gareth J. Williams
- School of Social Sciences, Nottingham Trent University, Nottingham, United Kingdom
| | - Xiaotian Dai
- Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yuanjie Sun
- Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Haifeng Li
- Department of Rehabilitation, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Zhejiang, China
| | - Guixia Chen
- Department of Children Healthcare, Women and Children’s Hospital, School of Medicine, Xiamen University, Fujian, China
| | - Lei Wang
- Department of Child Health Care, Maternal and Child Health Care Hospital of Yangzhou, Affiliated Hospital of Medical College Yangzhou University, Jiangsu, China
| | - Junyan Feng
- Department of Developmental Behaviour Pediatrics, The First Hospital of Jilin University, Jilin, China
| | - Yingchun Liu
- Maternity Service Center of Changchun Maternal & Child Health Care Hospital, Jilin, China
| | - Lan Zhang
- Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Sichuan, China
| | - Ling Zhu
- Maternal and Child Health Hospital of Shanxi, Shanxi, China
| | - Tingting Weng
- Maanshan Maternal and Child Health Hospital of Anhui Province, Anhui, China
| | | | - Yue Gu
- School of Statistics, East China Normal University, Shanghai, China
| | - Yingchun Zhou
- School of Statistics, East China Normal University, Shanghai, China
| | - Andrew Butcher
- Department of Psychology, Nottingham Trent University, Nottingham, United Kingdom
| | - Wenchong Du
- Department of Psychology, Nottingham Trent University, Nottingham, United Kingdom
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Bilsteen JF, Ekstrøm CT, Børch K, Nybo Andersen A. The role of parental education on the relationship between gestational age and school outcomes. Paediatr Perinat Epidemiol 2021; 35:726-735. [PMID: 34080707 PMCID: PMC8597013 DOI: 10.1111/ppe.12766] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 02/10/2021] [Accepted: 02/14/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Individuals born preterm may experience difficulties beyond the neonatal period, such as poorer school outcomes. However, whether these outcomes are modified by family factors is less well-known. OBJECTIVES To investigate whether parental educational level modify the relationship of gestational age with completion of final examinations and grade point average in compulsory education. METHODS This nationwide register-based cohort study included singletons born in Denmark during 1995-2001. We investigated the differences in the associations between gestational age (24-44 weeks) and two school outcomes at 16 years according to parental educational level (lower (≤10 years), intermediate (11-13 years), and higher (>13 years)). Mixed-effect logistic regression and mixed-effect linear regression were used to model completion of final examination and grade point average, respectively. RESULTS Of the 425 101 singletons, 4.7% were born before 37 weeks. The risk of not completing final examination increased with shorter gestational age and lower parental educational level. For instance, among adolescents whose parents had a lower educational level, the risk increased from 23.9% (95% CI, 23.1, 24.6) for those born in week 40 to 36.6% (95% CI, 31.5, 42.1) for those born in week 28. For adolescents whose parents had a higher educational level, the corresponding risk increase was 5.9% (95% CI, 5.7, 6.1) to 10.5% (95% CI, 8.6, 12.8), respectively. Grade point average decreased with shorter gestational age in adolescents born before 30 weeks and with lower parental educational level. The associations between gestational age and grade point average were similar across parental educational levels. For completions of final examination, the associations with gestational age were weaker with higher parental educational level. CONCLUSIONS Shorter gestational age and lower parental educational level were associated with poorer school outcomes. Our findings suggest that parental educational level mitigates the adverse effects of shorter gestational age on some school outcomes.
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Affiliation(s)
- Josephine Funck Bilsteen
- Department of PaediatricsHvidovre University HospitalHvidovreDenmark,Section of EpidemiologyDepartment of Public HealthUniversity of CopenhagenCopenhagenDenmark
| | - Claus Thorn Ekstrøm
- Section of BiostatisticsDepartment of Public HealthUniversity of CopenhagenCopenhagenDenmark
| | - Klaus Børch
- Department of PaediatricsHvidovre University HospitalHvidovreDenmark
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Abstract
The preterm birth rate in the United States is 10%, with 8% being born between 36 and 32 weeks of gestation, and the remaining 2% born less than 31 weeks of gestation. The global preterm birth rate varies from 5% to 18%, with varying survival rates. These percentages signify a population of people that will receive health care across the life course without ever being asked about a preterm birth history. With a steady rise in the survival rate of preterm infants being discharged home from the neonatal intensive care unit, with limited referrals for neonatal or developmental follow up, it is essential adult care providers ask the right questions and identify risk factors for this vulnerable population. This review describes the recently published, evidence-based recommendations for addressing preterm history across the life course. A robust review of the literature has demonstrated that the long-term sequelae of being born preterm can adversely affect health and quality of life. The following will offer preterm birth history recommendations based on assessment and diagnosis, prevention and management and referral and treatment. The goal of the recommendations is to create awareness among adult health providers in acknowledging a past medical history of preterm birth and providing appropriate preventive care, therefore shifting the paradigm of care from reactive intervention to proactive care.
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Affiliation(s)
- Michelle M Kelly
- Villanova University, Fitzpatrick College of Nursing, United States of America; University of Rhode Island, College of Nursing, Research Fellow, United States of America.
| | - Jane Tobias
- Thomas Jefferson University, Jefferson College of Nursing, United States of America
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Zen M, Schneuer F, Alahakoon TI, Nassar N, Lee VW. Perinatal and Child Factors Mediate the Association between Preeclampsia and Offspring School Performance. J Pediatr 2021; 238:153-160.e4. [PMID: 34216627 DOI: 10.1016/j.jpeds.2021.06.069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 06/14/2021] [Accepted: 06/25/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To determine whether maternal preeclampsia is an independent risk factor for poorer academic school performance in offspring, taking into account important perinatal and child factors. STUDY DESIGN A population-based cohort study using record-linkage of state-wide data was undertaken. We evaluated children born at 28+ weeks of gestation in New South Wales, Australia who had grade 3 record-linked education outcomes via the National Assessment Program-Literacy and Numeracy (NAPLAN) between 2009 and 2014. Children with in utero preeclampsia exposure were compared with those without exposure. Robust multivariable Poisson models were used to determine adjusted relative risks. RESULTS Crude models demonstrated an increased risk of scoring below the national minimal standard in all 5 domains (reading, writing, spelling, grammar and punctuation, and numeracy) for children exposed to preeclampsia, ranging from a relative risk (RR) of 1.13 (95% CI, 1.04-1.24) for reading to 1.19 (95% CI, 1.09-1.30) for numeracy. These differences were attenuated once adjusted for perinatal and child factors (RR, 1.07 [95% CI, 0.97-1.18] to 1.11 (95% CI, 0.99-1.22]), with combined perinatal and childhood factors mediating between 35.7% (writing) to 55.1% (spelling) of the association. Gestational age at birth was the most important perinatal factor, explaining 10.5% (grammar and punctuation) to 20.6% (writing) of the association between preeclampsia and poor school performance, followed by small for gestational age. CONCLUSION The poorer educational performance experienced by children born to women with preeclampsia appears largely attributable to perinatal and childhood factors, suggesting an opportunity to improve school performance in children exposed to preeclampsia by optimizing these perinatal factors, particularly gestational age at birth.
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Affiliation(s)
- Monica Zen
- Westmead Institute for Maternal & Fetal Medicine, Westmead Hospital, Westmead, New South Wales, Australia; Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Westmead, New South Wales, Australia.
| | - Francisco Schneuer
- Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Westmead, New South Wales, Australia
| | - Thushari I Alahakoon
- Westmead Institute for Maternal & Fetal Medicine, Westmead Hospital, Westmead, New South Wales, Australia; Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Westmead, New South Wales, Australia
| | - Natasha Nassar
- Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Westmead, New South Wales, Australia
| | - Vincent W Lee
- Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Westmead, New South Wales, Australia; Westmead Applied Research Centre, The University of Sydney, Westmead, New South Wales, Australia
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Suder AM, Gniadek AJ, Micek AM, Pawlik DW. Functional development of preterm children born from singleton and multiple pregnancies: Preliminary study. JOURNAL OF MOTHER AND CHILD 2021; 25:3-8. [PMID: 34643351 PMCID: PMC8603849 DOI: 10.34763/jmotherandchild.20212501.d-20-00002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 04/16/2021] [Indexed: 12/02/2022]
Abstract
BACKGROUND In recent years an increasing number of multiple pregnancies have been observed, which is a result of advancements made in reproductive technologies for infertility treatments as well as a tendency for women to delay childbearing until later in life. The risk of preterm birth in the case of a twin pregnancy is five to seven times higher than that of a singleton pregnancy, and in the case of triplet pregnancy, the risk is even 10 times higher. The objective of the study was to assess and compare the functional development of children aged between 2 and 2.5 who were prematurely born from singleton, twin and triplet pregnancies. MATERIAL AND METHODS The study was carried out in a group of 43 children aged between 2 and 2.5 who were born prematurely (between the 32nd and 36th week of pregnancy) in 2017 and 2018. Group I was made up of 10 children born from singleton pregnancies, group II included 12 children born from six twin pregnancies and group III consisted of 21 children born from seven triplet pregnancies. The evaluation of functional development was conducted using the Munich Functional Developmental Diagnostics. RESULTS There were no statistically significant differences in functional development between the studied singletons, twins and triplets. In the examined groups of singletons, twins and triplets, the calculated quotient medians for the 50th percentile approximated 1, which means that development was typical and did not differ from the development of the general population. In turn, for the 95th percentile, the median scores usually approximated 0.8, which also indicated that there was no significant delay in development. Had scores been higher than 1, this might have indicated a delay. CONCLUSIONS On the basis of the study group, no relationship was found between the multiplicity of pregnancies and the functional development of premature babies born between the 32nd and 36th weeks of gestation.
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Affiliation(s)
- Aneta M Suder
- Clinical Department of Neonatology, University Hospital in Cracow, postgraduate student at the Faculty of Health Sciences, Jagiellonian University Medical CollegeCracowPoland, E-mail:
| | - Agnieszka J Gniadek
- Institute of Nursing and Midwifery, Faculty of Health Sciences, Jagiellonian University Medical CollegeCracowPoland
| | - Agnieszka M Micek
- Institute of Nursing and Midwifery, Faculty of Health Sciences, Jagiellonian University Medical CollegeCracowPoland
| | - Dorota W Pawlik
- Clinical Department of Neonatology, University Hospital in CracowCracowPoland
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Fernández de Gamarra-Oca L, Ojeda N, Gómez-Gastiasoro A, Peña J, Ibarretxe-Bilbao N, García-Guerrero MA, Loureiro B, Zubiaurre-Elorza L. Long-Term Neurodevelopmental Outcomes after Moderate and Late Preterm Birth: A Systematic Review. J Pediatr 2021; 237:168-176.e11. [PMID: 34171360 DOI: 10.1016/j.jpeds.2021.06.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 06/04/2021] [Accepted: 06/08/2021] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To systematically review and perform meta-analyses on the long-term neurodevelopmental outcomes of adults born moderate and late preterm (MLPT) in relation to cognitive functioning and psychiatric disorders. STUDY DESIGN A search was conducted to identify any studies that involved prematurity in adulthood. From these studies, reports that included a group of MLPT adults and included description of cognitive and/or mental health domains (including specific long-term outcomes) were selected. RESULTS In total, 155 publications were identified, but only 16 papers met the inclusion criteria. A small effect size (g = 0.38) was found in MLPT to demonstrate poorer intellectual performance compared with those born at term. Moreover, MLPT adults exhibited greater odds for any psychiatric (OR 1.14), substance use (OR 1.16), mood (OR 1.06), and psychotic disorders (OR 1.40). CONCLUSIONS Despite inconsistency due to the methodologic differences between the selected studies, MLPT showed minor long-term effects into adulthood. However, more studies are needed, because prematurity seems to confer some vulnerability to biological and environmental factors that enhance susceptibility to adverse neurodevelopment outcomes.
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Affiliation(s)
- Lexuri Fernández de Gamarra-Oca
- Department of Methods and Experimental Psychology, Faculty of Psychology and Education, University of Deusto, Bilbao, Bizkaia, Spain
| | - Natalia Ojeda
- Department of Methods and Experimental Psychology, Faculty of Psychology and Education, University of Deusto, Bilbao, Bizkaia, Spain.
| | - Ainara Gómez-Gastiasoro
- Department of Methods and Experimental Psychology, Faculty of Psychology and Education, University of Deusto, Bilbao, Bizkaia, Spain
| | - Javier Peña
- Department of Methods and Experimental Psychology, Faculty of Psychology and Education, University of Deusto, Bilbao, Bizkaia, Spain
| | - Naroa Ibarretxe-Bilbao
- Department of Methods and Experimental Psychology, Faculty of Psychology and Education, University of Deusto, Bilbao, Bizkaia, Spain
| | - M Acebo García-Guerrero
- Department of Methods and Experimental Psychology, Faculty of Psychology and Education, University of Deusto, Bilbao, Bizkaia, Spain
| | - Begoña Loureiro
- Neonatal Unit, Cruces University Hospital, Biocruces Bizkaia Health Research Institute, Barakaldo, Bizkaia, Spain
| | - Leire Zubiaurre-Elorza
- Department of Methods and Experimental Psychology, Faculty of Psychology and Education, University of Deusto, Bilbao, Bizkaia, Spain
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40
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Hedges A, Corman H, Noonan K, Reichman NE. Gestational Age at Term and Educational Outcomes at Age Nine. Pediatrics 2021; 148:peds.2020-021287. [PMID: 34244451 PMCID: PMC8344335 DOI: 10.1542/peds.2020-021287] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/24/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To estimate associations between gestational age (GA) and teacher-reported academic outcomes at age 9 years among children born at term (37-41 weeks). METHODS A secondary data analysis of 1405 children participating in a national US birth cohort study was conducted. At age 9 years, students were evaluated by their teachers in the areas of mathematics, science and social studies, and language and literacy. Unadjusted and adjusted logistic regression models of associations between GA and teacher-reported academic outcomes were estimated and neonatal morbidities were explored as potential pathways. RESULTS A continuous measure of GA in weeks was significantly associated with above-average rankings in all areas. The associations were similar across outcomes (eg, mathematics [odds ratio (OR): 1.13; confidence interval (CI): 1.02-1.25], science and social studies [OR: 1.13; CI: 1.01-1.26], and language and literacy [OR: 1.16; CI: 1.05-1.28]) in a model that adjusted for child sex, maternal characteristics, and obstetric risk factors and delivery complications. Other specifications indicate a positive association between late term (41 weeks) and mathematics and a negative association between early term (37-38 weeks) and language and literacy, compared with term (39-40). The associations did not appear to operate through neonatal morbidity. CONCLUSIONS The findings highlight the importance of GA, even at term. Whereas current guidelines suggest waiting until at least 39 weeks to deliver when possible, our findings add to a small group of studies suggesting that GA through 41 weeks is associated with improvements in some educational outcomes.
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Affiliation(s)
| | - Hope Corman
- Department of Economics, Rider University and National Bureau of Economic Research, Lawrenceville, New Jersey
| | - Kelly Noonan
- Department of Economics, Princeton University, Princeton, New Jersey
| | - Nancy E. Reichman
- Department of Pediatrics, Robert Wood Johnson Medical School, and,Child Health Institute of New Jersey, Rutgers University, New Brunswick, New Jersey
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Xia Y, Xiao J, Yu Y, Tseng WL, Lebowitz E, DeWan AT, Pedersen LH, Olsen J, Li J, Liew Z. Rates of Neuropsychiatric Disorders and Gestational Age at Birth in a Danish Population. JAMA Netw Open 2021; 4:e2114913. [PMID: 34185070 PMCID: PMC8243234 DOI: 10.1001/jamanetworkopen.2021.14913] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
IMPORTANCE Nonoptimal gestational durations could be associated with neurodevelopmental disabilities, yet evidence regarding finer classification of gestational age and rates of multiple major neuropsychiatric disorders beyond childhood is limited. OBJECTIVE To comprehensively evaluate associations between 6 gestational age groups and rates of 9 major types and 8 subtypes of childhood and adult-onset neuropsychiatric disorders. DESIGN, SETTING, AND PARTICIPANTS This cohort study evaluated data from a nationwide register of singleton births in Denmark from January 1, 1978, to December 31, 2016. Data analyses were conducted from October 1, 2019, through November 15, 2020. EXPOSURES Gestational age subgroups were classified according to data from the Danish Medical Birth Register: very preterm (20-31 completed weeks), moderately preterm (32-33 completed weeks), late preterm (34-36 completed weeks), early term (37-38 completed weeks), term (39-40 completed weeks, reference), and late or postterm (41-45 completed weeks). MAIN OUTCOMES AND MEASURES Neuropsychiatric diagnostic records (International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes F00-F99) were ascertained from the Danish Psychiatric Central Register up to August 10, 2017. Poisson regression was used to estimate the incidence rate ratio (IRR) and 95% CI for neuropsychiatric disorders, adjusting for selected sociodemographic factors. RESULTS Of all 2 327 639 singleton births studied (1 194 925 male newborns [51.3%]), 22 647 (1.0%) were born very preterm, 19 801 (0.9%) were born moderately preterm, 99 488 (4.3%) were born late preterm, 388 416 (16.7%) were born early term, 1 198 605 (51.5%) were born at term, and 598 682 (25.7%) were born late or postterm. A gradient of decreasing IRRs was found from very preterm to late preterm for having any or each of the 9 neuropsychiatric disorders (eg, very preterm: IRR, 1.49 [95% CI, 1.43-1.55]; moderately preterm: IRR, 1.23 [95% CI, 1.18-1.28]; late preterm: IRR, 1.17 [95% CI, 1.14-1.19] for any disorders) compared with term births. Individuals born early term had 7% higher rates (IRR, 1.07 [95% CI, 1.06-1.08]) for any neuropsychiatric diagnosis and a 31% higher rate for intellectual disability (IRR, 1.31 [95% CI, 1.25-1.37]) compared with those born at term. The late or postterm group had lower IRRs for most disorders, except pervasive developmental disorders, for which the rate was higher for postterm births compared with term births (IRR, 1.06 [95% CI, 1.03-1.09]). CONCLUSIONS AND RELEVANCE Higher incidences of all major neuropsychiatric disorders were observed across the spectrum of preterm births. Early term and late or postterm births might not share a homogeneous low risk with individuals born at term. These findings suggest that interventions that address perinatal factors associated with nonoptimal gestation might reduce long-term neuropsychiatric risks in the population.
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Affiliation(s)
- Yuntian Xia
- Yale Center for Perinatal, Pediatric, and Environmental Epidemiology, Yale School of Public Health, New Haven, Connecticut
| | - Jingyuan Xiao
- Yale Center for Perinatal, Pediatric, and Environmental Epidemiology, Yale School of Public Health, New Haven, Connecticut
- Department of Environmental Health Sciences, Yale School of Public Health, New Haven, Connecticut
| | - Yongfu Yu
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Biostatistics, School of Public Health, The Key Laboratory of Public Health Safety of the Ministry of Education, Fudan University, Shanghai, China
| | - Wan-Ling Tseng
- Yale Child Study Center, Yale School of Medicine, New Haven, Connecticut
| | - Eli Lebowitz
- Yale Child Study Center, Yale School of Medicine, New Haven, Connecticut
| | - Andrew Thomas DeWan
- Yale Center for Perinatal, Pediatric, and Environmental Epidemiology, Yale School of Public Health, New Haven, Connecticut
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
| | - Lars Henning Pedersen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
- Department of Obstetrics & Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Jørn Olsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Jiong Li
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Zeyan Liew
- Yale Center for Perinatal, Pediatric, and Environmental Epidemiology, Yale School of Public Health, New Haven, Connecticut
- Department of Environmental Health Sciences, Yale School of Public Health, New Haven, Connecticut
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Psychomotor development in late premature newborns at five years. Comparison with term newborns using the ASQ3®. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2021. [DOI: 10.1016/j.anpede.2020.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Pierrat V, Marchand-Martin L, Marret S, Arnaud C, Benhammou V, Cambonie G, Debillon T, Dufourg MN, Gire C, Goffinet F, Kaminski M, Lapillonne A, Morgan AS, Rozé JC, Twilhaar S, Charles MA, Ancel PY. Neurodevelopmental outcomes at age 5 among children born preterm: EPIPAGE-2 cohort study. BMJ 2021; 373:n741. [PMID: 33910920 PMCID: PMC8080137 DOI: 10.1136/bmj.n741] [Citation(s) in RCA: 101] [Impact Index Per Article: 33.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To describe neurodevelopment at age 5 among children born preterm. DESIGN Population based cohort study, EPIPAGE-2. SETTING France, 2011. PARTICIPANTS 4441 children aged 5½ born at 24-26, 27-31, and 32-34 weeks MAIN OUTCOME MEASURES: Severe/moderate neurodevelopmental disabilities, defined as severe/moderate cerebral palsy (Gross Motor Function Classification System (GMFCS) ≥2), or unilateral or bilateral blindness or deafness, or full scale intelligence quotient less than minus two standard deviations (Wechsler Preschool and Primary Scale of Intelligence, 4th edition). Mild neurodevelopmental disabilities, defined as mild cerebral palsy (GMFCS-1), or visual disability ≥3.2/10 and <5/10, or hearing loss <40 dB, or full scale intelligence quotient (minus two to minus one standard deviation) or developmental coordination disorders (Movement Assessment Battery for Children, 2nd edition, total score less than or equal to the fifth centile), or behavioural difficulties (strengths and difficulties questionnaire, total score greater than or equal to the 90th centile), school assistance (mainstream class with support or special school), complex developmental interventions, and parents' concerns about development. The distributions of the scores in contemporary term born children were used as reference. Results are given after multiple imputation as percentages of outcome measures with exact binomial 95% confidence intervals. RESULTS Among 4441 participants, 3083 (69.4%) children were assessed. Rates of severe/moderate neurodevelopmental disabilities were 28% (95% confidence interval 23.4% to 32.2%), 19% (16.8% to 20.7%), and 12% (9.2% to 14.0%) and of mild disabilities were 38.5% (33.7% to 43.4%), 36% (33.4% to 38.1%), and 34% (30.2% to 37.4%) at 24-26, 27-31, and 32-34 weeks, respectively. Assistance at school was used by 27% (22.9% to 31.7%), 14% (12.1% to 15.9%), and 7% (4.4% to 9.0%) of children at 24-26, 27-31, and 32-34 weeks, respectively. About half of the children born at 24-26 weeks (52% (46.4% to 57.3%)) received at least one developmental intervention which decreased to 26% (21.8% to 29.4%) for those born at 32-34 weeks. Behaviour was the concern most commonly reported by parents. Rates of neurodevelopment disabilities increased as gestational age decreased and were higher in families with low socioeconomic status. CONCLUSIONS In this large cohort of children born preterm, rates of severe/moderate neurodevelopmental disabilities remained high in each gestational age group. Proportions of children receiving school assistance or complex developmental interventions might have a significant impact on educational and health organisations. Parental concerns about behaviour warrant attention.
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Affiliation(s)
- Véronique Pierrat
- University of Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRAE, F-75004 Paris, France
- CHU Lille, Department of Neonatal Medicine, Jeanne de Flandre Hospital, Lille, France
| | - Laetitia Marchand-Martin
- University of Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRAE, F-75004 Paris, France
| | - Stéphane Marret
- Department of Neonatal Medicine, Intensive Care, and Neuropediatrics, Rouen University Hospital, Rouen, France
- INSERM U1254, Neovascular Team, Perinatal Handicap, Institute of Biomedical Research and Innovation, Normandy University, Rouen, France
| | - Catherine Arnaud
- INSERM U1027, SPHERE Team, France
- Toulouse 3 University Paul-Sabatier, Toulouse, France
- Clinical Epidemiology Unit, University Hospital Toulouse, Toulouse, France
| | - Valérie Benhammou
- University of Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRAE, F-75004 Paris, France
| | - Gilles Cambonie
- Department of Neonatal Medicine, Montpellier University Hospital, Montpellier, France
| | - Thierry Debillon
- Neonatal Intensive Care Unit, Grenoble Alps University Hospital, Grenoble, France
- UMR 5525 Techniques pour l'Evaluation et la Modélisation des Actions de la Santé, Centre National de la Recherche Scientifique, Techniques de l'Ingénierie Médicale et de la Complexité-Informatique, Mathématiques et Applications, Grenoble Alps University, Grenoble, France
| | - Marie-Noëlle Dufourg
- French Institute for Demographic Studies, French Institute for Medical Research and Health, French Blood Agency, ELFE Joint Unit, Paris, France
| | - Catherine Gire
- Department of Neonatology, North Hospital, Assistance Publique des Hôpitaux de Marseille, Marseille, France
| | - François Goffinet
- University of Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRAE, F-75004 Paris, France
- Port-Royal Maternity, Assistance Publique-Hôpitaux de Paris, Centre-University of Paris, Federation Hospitalo-Universitairefor prematurity, Paris, France
| | - Monique Kaminski
- University of Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRAE, F-75004 Paris, France
| | - Alexandre Lapillonne
- Assistance Publique-Hôpitaux de Paris, University Hospital Necker-Enfants Malades, University of Paris, Paris, France
| | - Andrei Scott Morgan
- University of Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRAE, F-75004 Paris, France
- UCL Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| | - Jean-Christophe Rozé
- Department of Neonatal Medicine, Nantes University Hospital, Nantes, France
- Clinical Epidemiology, Clinical Investigation Centre CIC004, Nantes University Hospital, Nantes, France
| | - Sabrina Twilhaar
- University of Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRAE, F-75004 Paris, France
| | - Marie-Aline Charles
- Neonatal Intensive Care Unit, Grenoble Alps University Hospital, Grenoble, France
- University of Paris, CRESS, Team Early Life Research on Later Health, UMR 1153, INSERM, INRAE, Villejuif, France
| | - Pierre-Yves Ancel
- University of Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRAE, F-75004 Paris, France
- Clinical Investigation Centre P1419, Assistance Publique-Hôpitaux de Paris, Paris, France
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Nielsen TM, Glavind J, Milidou I, Henriksen TB. Early-term elective Caesarean sections did not increase the risk of behavioural problems at six to eight years of age. Acta Paediatr 2021; 110:857-868. [PMID: 32649011 DOI: 10.1111/apa.15468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 07/04/2020] [Accepted: 07/06/2020] [Indexed: 11/28/2022]
Abstract
AIM Our aim was to explore the under-researched associations between an elective Caesarean section (C-section) at early-term or full-term gestation and behaviour at 6-8 years of age. METHODS We identified 1220 eligible children born by elective C-sections at Danish hospital from 2009 to 2011. Their mothers were randomised to elective C-sections at either 38+3 (early-term) or 39+3 (full-term) weeks of gestation. From December 2017 to August 2018, the parents completed the Strengths and Difficulties Questionnaire. The results were adjusted for maternal education, parity and the child's sex. RESULTS Of the 574 (45%) children followed up, 288 were delivered early-term and 286 were delivered full-term. The groups had similar baseline characteristics. There were no differences in the total difficulties score, subscale scores or the risk of being classified as having a possible or probable psychiatric disorder. Early-term boys had a lower risk of being classified as having a possible or probable psychiatric disorder and early-term girls had higher risk, but the results were not statistically significant. CONCLUSION We found no difference in behaviour at 6-8 years of age between children born by elective C-section at early- versus full-term gestation.
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Affiliation(s)
| | - Julie Glavind
- Perinatal Epidemiology Research Unit Aarhus University Aarhus Denmark
- Department of Obstetrics and Gynaecology Aarhus University Hospital Aarhus Denmark
| | - Ioanna Milidou
- Perinatal Epidemiology Research Unit Aarhus University Aarhus Denmark
- Department of Paediatrics and Adolescent Medicine Herning Regional Hospital Herning Denmark
| | - Tine Brink Henriksen
- Perinatal Epidemiology Research Unit Aarhus University Aarhus Denmark
- Department of Paediatrics and Adolescent Medicine Aarhus University Hospital Aarhus Denmark
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45
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Martínez-Nadal S, Schonhaut L, Armijo I, Demestre X. Predictive value of the Ages and Stages Questionnaire® for school performance and school intervention in late preterm- and term-born children. Child Care Health Dev 2021; 47:103-111. [PMID: 32978787 DOI: 10.1111/cch.12814] [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: 04/10/2020] [Revised: 09/10/2020] [Accepted: 09/19/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND The new health supervision guidelines emphasize the importance of surveillance or a formal developmental screening test at 4 years, one of the most used tests is Ages & Stages Questionnaire. Nevertheless, there is still not enough evidence whether these tools will be useful to predict future school performance (SP). OBJECTIVES The objectives of this study were to evaluate the Ages & Stages Questionnaire 3rd edition 48-month interval (ASQ3-48) translated to Spanish for predicting the need for school intervention (SI) and poor SP at 8-9 years of age, in late preterm infants (LPIs) and term-born infants (Terms) and to compare the prevalence of SI and poor SP in the two groups. METHODS Data were collected from a cohort of 75 LPIs and 58 Terms assessed with ASQ3-48 and with a further assessment of academic results at 8-9 years, through a standardized school test of the Education Department of Catalonia. SI data were obtained through a parent report. Area under the curve (AUC), sensitivity, specificity and predictive values were calculated, and logistic regression analysis was used. RESULTS The prevalence of poor SP was 12.8%, without statistically significant differences between LPIs and Terms. LPIs had higher SI than Terms (29.3% vs. 10.3%, P = 0.001). AUC for poor SP was 0.73 and for receiving SI was 0.56 without differences between the two groups. The sensitivity of the ASQ3-48 for poor SP was 41%, for specificity 92%, and for receiving SI 14% and 89%, respectively. Poor SP was related to having positive screening in the ASQ3-48 (OR 6.5 [95% CI, 1.9-22.2]) while having received SI was related to late prematurity (OR 3.6 [95% CI, 1.3-9.6]). CONCLUSIONS The ASQ3-48 shows acceptable predictive properties for poor SP but not for receiving SI. No differences were found in SP between LPI and Term cohorts, but LPIs are likelier to require SI.
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Affiliation(s)
| | - Luisa Schonhaut
- Clínica Alemana, Facultad de Medicina, Universidad del Desarrollo, Santiago, Chile
| | - Iván Armijo
- Faculty of Psychology, Universidad del Desarrollo, Santiago, Chile
| | - Xavier Demestre
- Department of Pediatrics, Hospital de Barcelona, SCIAS, Barcelona, Spain
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46
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Cognitive and Learning Outcomes in Late Preterm Infants at School Age: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 18:ijerph18010074. [PMID: 33374182 PMCID: PMC7795904 DOI: 10.3390/ijerph18010074] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 12/17/2020] [Accepted: 12/20/2020] [Indexed: 12/22/2022]
Abstract
Late preterm children born between 340/7 and 366/7 weeks’ gestation account for ≈70% of prematurely born infants. There is growing concern about this population at risk of mild neurodevelopmental problems, learning disabilities and lower academic performance. Following the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement, this paper analyzes recent published evidence from 16selected studies involving late preterm children and control group assessments at preschool and/or school age, mainly focusing on cognitive functioning, language learning and academic achievement. The review identifies the assessment tools used in these studies (standardized tests, parental questionnaires and laboratory tasks) and the areas being evaluated from preschool (age 3 years) to primary school levels. Results reveal the presence of mild difficulties, pointing to suboptimal outcomes in areas such as executive function, short term verbal memory, literacy skills, attention and processing speed. Some difficulties are transient, but others persist, possibly compromising academic achievement, as suggested by the few studies reporting on higher risk for poor school performance. Given the increasing number of late preterm children in our society the review highlights the need to implement screening strategies to facilitate early risk detection and minimize the negative effects of this morbidity in childhood.
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47
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Johannesson L, Testa G, Flyckt R, Farrell R, Quintini C, Wall A, O'Neill K, Tzakis A, Richards EG, Gordon SM, Porrett PM. Guidelines for standardized nomenclature and reporting in uterus transplantation: An opinion from the United States Uterus Transplant Consortium. Am J Transplant 2020; 20:3319-3325. [PMID: 32379930 DOI: 10.1111/ajt.15973] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 04/08/2020] [Accepted: 04/25/2020] [Indexed: 01/25/2023]
Abstract
Uterus transplantation is a nascent but growing field. To support this growth, the United States Uterus Transplant Consortium proposes guidelines for nomenclature related to operative technique, vascular anatomy, and donor, recipient, and offspring outcomes. In terms of anatomy, the group recommends reporting donor arterial inflow and recipient anastomotic site delivering inflow to the graft and offers standardization of the names for the 4 veins originating from the uterus because of current inconsistency in this particular nomenclature. Seven progressive stages with milestones of success are defined for reporting on uterus transplantation outcomes: (1) technical, (2) menstruation, (3) embryo implantation, (4) pregnancy, (5) delivery, (6) graft removal, and (7) long-term follow-up. The 3 primary metrics for success are recipient survival (as reported for other organ transplant recipients), graft survival, and uterus transplant live birth rate (defined as live birth per transplanted recipient). A number of secondary outcomes should also be reported, most of which capture stage-specific milestones, as well as data on graft failure. Outcome metrics for living donors include patient survival, survival free of operative intervention, and data on complications and hospitalizations. Finally, we make specific recommendations on follow-up for offspring born from uterine grafts, which includes specialty surveillance as well as collection and reporting of routine pediatric outcomes. The goal of standardization in reporting is to create consistency and improve the quality of evidence available on the efficacy and value of the procedure.
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Affiliation(s)
- Liza Johannesson
- Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, Texas, USA
| | - Giuliano Testa
- Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, Texas, USA
| | - Rebecca Flyckt
- Fertility Preservation Program, Obstetrics, Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ruth Farrell
- Fertility Preservation Program, Obstetrics, Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Anji Wall
- Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, Texas, USA
| | - Kathleen O'Neill
- Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Andreas Tzakis
- Department of Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Elliott G Richards
- Fertility Preservation Program, Obstetrics, Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Scott M Gordon
- Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Pediatrics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Paige M Porrett
- Division of Transplantation, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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48
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Nam YS, Heo JS, Byeon JH, Lee EH. Neurodevelopmental Outcomes of Moderate-to-Late Preterm Infants. NEONATAL MEDICINE 2020. [DOI: 10.5385/nm.2020.27.4.159] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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49
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Foss S, Flanders TM, Heuer GG, Schreiber JE. Neurobehavioral outcomes in patients with myelomeningocele. Neurosurg Focus 2020; 47:E6. [PMID: 31574480 DOI: 10.3171/2019.7.focus19445] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 07/25/2019] [Indexed: 01/26/2023]
Abstract
This paper describes some of the more common patterns in neurobehavioral deficits and their underlying neuroanatomical basis in myelomeningocele (MMC). Patients with MMC can face a lifetime of specific organ system dysfunction, chief among them spinal cord malformations, orthopedic issues, hydrocephalus, and urological disabilities. In addition, patients can experience specific patterns of neurobehavioral difficulties due to the changes in neuroanatomy associated with the open spinal defect. Although there is variability in these patterns, some trends have been described among MMC patients. It is thought that early recognition of these potential neurobehavioral deficits by treating neurosurgeons and other members of the treatment team could lead to earlier intervention and positively impact the overall outcome for patients. Neurodevelopmental and neurobehavioral follow-up assessments are recommended to help guide planning for relevant treatments or accommodations.
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Affiliation(s)
- Sophie Foss
- 1Department of Child and Adolescent Psychiatry and Behavioral Sciences, and Divisions of
| | | | - Gregory G Heuer
- 2Neurosurgery and.,3Pediatric General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia, Pennsylvania
| | - Jane E Schreiber
- 1Department of Child and Adolescent Psychiatry and Behavioral Sciences, and Divisions of.,3Pediatric General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia, Pennsylvania
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50
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刘 明, 戴 霄, 花 静. [Neurobehavioral development of 25 254 children with different gestational ages at birth in three cities of China]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2020; 22:931-935. [PMID: 32933621 PMCID: PMC7499444 DOI: 10.7499/j.issn.1008-8830.2003338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 08/05/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To study the effect of gestational age at birth on the neurobehavioral development of preschool children. METHODS A total of 25 254 preschool children from Ma'anshan of Anhui Province, Taizhou of Zhejiang Province, and Yangzhou of Jiangsu Province were enrolled. The preschool children were divided into three groups based on their gestational ages at birth: preterm group (2 760 cases; 28-36+6 weeks), early term group (6 005 cases; 37-38+6 weeks), and full term group (16 489 cases; ≥39 weeks). The Ages and Stages Questionnaires-Third Edition (ASQ-3) was employed to evaluate the children's neurobehavioral development. RESULTS The preterm group had significantly lower scores of the five domains of ASQ-3, communication, gross motor, fine motor, problem solving, and personal-social, than the full term group (P<0.05), and significantly lower scores of communication, gross motor, fine motor, and problem solving than the early term group (P<0.05). There were no significant differences in the scores of the five domains of ASQ-3 between the early term and full term groups (P>0.05). The multiple linear regression analysis indicated a significant positive correlation between gestational age and the five domains of ASQ-3 after adjustment for confounding factors including sex, age, body mass index, and parental education level (P<0.01). CONCLUSIONS Children born preterm have poorer neurobehavioral development than those born full term and early term, whereas children born full term and early term have similar neurobehavioral development. Gestational age at birth is an independent influencing factor for neurobehavioral development in preschool children.
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Affiliation(s)
- 明霞 刘
- />同济大学附属第一妇婴保健院妇幼保健部, 上海 201204Department of Maternal and Child Health Care, Shanghai First Maternity and Infant Hospital, Tongji University, Shanghai 201204, China
| | - 霄天 戴
- />同济大学附属第一妇婴保健院妇幼保健部, 上海 201204Department of Maternal and Child Health Care, Shanghai First Maternity and Infant Hospital, Tongji University, Shanghai 201204, China
| | - 静 花
- />同济大学附属第一妇婴保健院妇幼保健部, 上海 201204Department of Maternal and Child Health Care, Shanghai First Maternity and Infant Hospital, Tongji University, Shanghai 201204, China
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