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Kurbatfinski S, Komanchuk J, Dosani A, Letourneau N. Validity, Reliability, Accessibility, and Applicability of Young Children's Developmental Screening and Assessment Tools across Different Demographics: A Realist Review. CHILDREN (BASEL, SWITZERLAND) 2024; 11:745. [PMID: 38929324 PMCID: PMC11201752 DOI: 10.3390/children11060745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 06/09/2024] [Accepted: 06/16/2024] [Indexed: 06/28/2024]
Abstract
Valid and reliable developmental screening and assessment tools allow professionals to identify disabilities/delays in children, enabling timely intervention to limit adverse lifelong impacts on health. However, differences in child development related to culture, genetics, and perinatal outcomes may impact tool applicability. This study evaluated the validity, reliability, and accessibility of multidomain developmental screening tools for young children, analyzed the applicability of tools across different contexts, and created a compendium of tools. Employing adapted realist review methods, we searched APA PsycInfo, MEDLINE, CINAHL, ERIC, and Google to identify relevant articles and information. We assessed accessibility, validity, reliability, and contextual applicability (N = 4110 evidence sources) to create tool ratings and make recommendations. Of 33 identified tools, 22 were screening and 11 were assessment tools. Fewer screening tools than assessment tools were rated highly overall. Evidence for use in different cultures was often lacking for both types of tools. The ASQ (screening) and BDI (assessment) tools were rated most favorably and are recommended for use, though other tools may be more applicable in different contexts (e.g., NEPSY among children with Asperger's Syndrome). Future research should focus on assessing the validity and reliability of tools across different demographics to increase accessibility and ensure all children are properly supported.
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Affiliation(s)
- Stefan Kurbatfinski
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada;
| | - Jelena Komanchuk
- Faculty of Health and Social Development, School of Nursing, University of British Columbia Okanagan, Kelowna, BC V1V 1V7, Canada;
| | - Aliyah Dosani
- Faculty of Health, Community and Education, School of Nursing and Midwifery, Mount Royal University, Calgary, AB T3E 6K6, Canada;
| | - Nicole Letourneau
- Faculties of Nursing & Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
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Pokharel A, Webb P, Miller LC, Zaharia S, Shrestha R, Davis D, Trevino JA, Baral KP, Paudel K, Ghosh S. Relationship between Animal Sourced Food Consumption and Early Childhood Development Outcomes. Nutrients 2023; 15:nu15020315. [PMID: 36678186 PMCID: PMC9861056 DOI: 10.3390/nu15020315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 12/18/2022] [Accepted: 01/05/2023] [Indexed: 01/11/2023] Open
Abstract
Early-childhood development (ECD) is an important determinant of a child’s cognitive ability, learning, productivity, and lifetime earnings. Animal-sourced food (ASF), which is a rich source of high-quality protein and micronutrients, has been linked with ECD outcomes. This study investigates the relationship between the number, frequency, and cumulative consumption of ASF at 6, 9, 12, and 18 months of age and ECD outcomes at 24 months of age, controlling for physical growth. The study uses data collected from 701 mother−child pairs from an observational birth cohort study carried out in Banke, Nepal. ECD outcomes were assessed through a standardized ages and stages questionnaire (ASQ-3) tool. Separate multivariable ordinary least squares regression models were used to test for associations. Significant positive association was seen between total ASQ-3 score at 24 months of age and any ASF consumption at 18 months (β = 8.98, p-value < 0.01), controlling for growth outcomes. The study findings highlight the positive contribution and the accumulating benefit of consistent ASF consumption on ECD outcomes. This study recommends support and promotion of ASF intake among young children in Nepal through policy and programming actions relevant to female education; nutrition knowledge; quality ASF production; improved market access; cold storage; and poverty reduction.
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Affiliation(s)
- Ashish Pokharel
- Helen Keller International, Lalitpur 44600, Nepal
- Feed the Future Innovation Lab for Nutrition, Lalitpur 44600, Nepal
- Correspondence:
| | - Patrick Webb
- Feed the Future Innovation Lab for Nutrition, Lalitpur 44600, Nepal
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA 02111, USA
| | - Laurie C. Miller
- Feed the Future Innovation Lab for Nutrition, Lalitpur 44600, Nepal
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA 02111, USA
| | - Sonia Zaharia
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA 02111, USA
| | - Robin Shrestha
- Feed the Future Innovation Lab for Nutrition, Lalitpur 44600, Nepal
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA 02111, USA
| | - Dale Davis
- Helen Keller International, Lalitpur 44600, Nepal
- Feed the Future Innovation Lab for Nutrition, Lalitpur 44600, Nepal
| | - Johanna Andrews Trevino
- Feed the Future Innovation Lab for Nutrition, Lalitpur 44600, Nepal
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA 02111, USA
| | - Kedar Prasad Baral
- Feed the Future Innovation Lab for Nutrition, Lalitpur 44600, Nepal
- School of Public Health, Patan Academy of Health Sciences, Lalitpur 44600, Nepal
| | | | - Shibani Ghosh
- Feed the Future Innovation Lab for Nutrition, Lalitpur 44600, Nepal
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA 02111, USA
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Thapa P, Poudyal A, Poudel R, Upadhyaya DP, Timalsina A, Bhandari R, Baral J, Bhandari R, Joshi PC, Thapa P, Adhikari N. Prevalence of low birth weight and its associated factors: Hospital based cross sectional study in Nepal. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0001220. [PMID: 36962657 PMCID: PMC10021178 DOI: 10.1371/journal.pgph.0001220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 10/05/2022] [Indexed: 06/09/2023]
Abstract
Low birth weight is still an important public health problem worldwide. It is a major contributor to neonatal death in developing countries, including Nepal. The government of Nepal has developed and implemented different programs to improve maternal and neonatal health, including baby's birth weight. However, low birth weight is a major maternal and child health challenge. Maternal factors determining the birth weight of neonates have been poorly assessed in previous studies in Nepal. Thus, this study aims to assess the prevalence and risk factors associated with low birth weight in Nepal. An institution-based descriptive cross-sectional study was carried out in Paropakar Maternity Hospital and Tribhuvan University Teaching Hospital of Kathmandu district among 308 postnatal mothers. The data was collected through the face-to-face interview technique. The data was entered in EpiData 3.1 and exported to Statistical Package and Service Solutions version 21 for analysis. Multivariate logistic regression was used to obtain an adjusted odds ratio, while p-value < 0.05 with 95% Confidence Interval (CI) was considered significant. The findings showed that 15.3% of the children had low birth weight. The mean and standard deviation of childbirth weight was 2.96±0.59 kg. Mothers belonged to Dalit ethnic (AOR = 2.9, 95% CI = 1.2-7.1), Antenatal Care visited three or fewer (AOR = 2.6, 95%CI = 1.0-6.6) and did not comply with Iron and Folic Acid supplementation (AOR = 2.1, 95% CI = 1.0-4.4) were significantly associated with low birth weight. Nearly one in every six children had low birth weight. Maternal health services such as antenatal care and compliance with a recommended dose of maternal micronutrients significantly impact on birth weight. Maternal and neonatal health programs should consider these factors to reduce adverse birth outcomes in Nepal.
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Affiliation(s)
- Pratibha Thapa
- Central Department of Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Amod Poudyal
- Central Department of Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Rajan Poudel
- Central Department of Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Dipak Prasad Upadhyaya
- School of Medicine, Case Western Reserve University, Cleveland, OH, United States of America
| | - Ashish Timalsina
- Central Department of Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Rama Bhandari
- Central Department of Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Jijeebisha Baral
- Central Department of Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Rabindra Bhandari
- Central Department of Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | | | - Pratiksha Thapa
- Ace Institute of Management, Pokhara University, Kathmandu, Nepal
| | - Nabin Adhikari
- Research and Development Department, Dhulikhel Hospital, Dhulikhel, Kavre, Nepal
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Edwards T, Alsweiler JM, Gamble GD, Griffith R, Lin L, McKinlay CJD, Rogers JA, Thompson B, Wouldes TA, Harding JE. Neurocognitive Outcomes at Age 2 Years After Neonatal Hypoglycemia in a Cohort of Participants From the hPOD Randomized Trial. JAMA Netw Open 2022; 5:e2235989. [PMID: 36219444 PMCID: PMC9554702 DOI: 10.1001/jamanetworkopen.2022.35989] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Neonatal hypoglycemia is common, but its association with later neurodevelopment is uncertain. OBJECTIVE To examine associations between neonatal hypoglycemia and neurocognitive outcomes at corrected age 2 years. DESIGN, SETTING, AND PARTICIPANTS Exploratory cohort analysis of the Hypoglycaemia Prevention With Oral Dextrose (hPOD) randomized clinical trial was conducted. The trial recruited participants from January 9, 2015, to May 5, 2019, with follow-up between January 26, 2017, and July 31, 2021. Infants were recruited from 9 maternity hospitals in New Zealand and assessed at home or in a research clinic. Children born late preterm and at term at risk of neonatal hypoglycemia but without evidence of acute or imminent illness in the first hour after birth were screened and treated to maintain blood glucose concentrations greater than or equal to 47 mg/dL. EXPOSURES Hypoglycemia was defined as any blood glucose concentration less than 47 mg/dL, recurrent as 3 or more episodes, and severe as less than 36 mg/dL. MAIN OUTCOMES AND MEASURES Neurologic examination and tests of development (Bayley III) and executive function. The primary outcome was neurosensory impairment (any of the following: blindness, deafness, cerebral palsy, developmental delay, or executive function total score worse than 1.5 SD below the mean). RESULTS A total of 1197 of 1321 (91%) eligible children were assessed at a mean of corrected age 24 months; 616 (52%) were male. Compared with the normoglycemia group, children who experienced hypoglycemia were more likely to have neurosensory impairment (111 [23%] vs 125 [18%]; adjusted risk ratio [aRR], 1.28; 95% CI, 1.01-1.60), particularly if they experienced severe episodes (30 [28%] vs 125 [18%]; aRR, 1.68; 95% CI, 1.20-2.36), but not recurrent episodes (12 [19%] vs 125 [18%]; aRR, 1.06; 95% CI, 0.63-1.80). The risk of cognitive, language, or motor delay was similar between groups, but children who experienced hypoglycemia had lower Bayley-III composite cognitive (adjusted mean difference [aMD], -1.48; 95% CI, -2.79 to -0.18) and motor scores (aMD, -2.05; 95% CI, -3.30 to -0.79). CONCLUSIONS AND RELEVANCE In children born at risk of hypoglycemia but otherwise well, those who experienced neonatal hypoglycemia were more likely to have neurosensory impairment at corrected age 2 years, with higher risks after severe episodes. Further research is required to determine causality.
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Affiliation(s)
- Taygen Edwards
- Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - Jane M. Alsweiler
- Department of Paediatrics: Child and Youth Health, The University of Auckland, Auckland, New Zealand
- Newborn Services, Auckland City Hospital, Auckland, New Zealand
| | - Greg D. Gamble
- Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - Rebecca Griffith
- Kidz First Neonatal Care, Counties Manukau Health, Auckland, New Zealand
| | - Luling Lin
- Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - Christopher J. D. McKinlay
- Department of Paediatrics: Child and Youth Health, The University of Auckland, Auckland, New Zealand
- Kidz First Neonatal Care, Counties Manukau Health, Auckland, New Zealand
| | - Jenny A. Rogers
- Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - Benjamin Thompson
- School of Optometry and Vision Science, Waterloo, Canada
- Center for Eye and Vision Research, Hong Kong
| | - Trecia A. Wouldes
- Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand
| | - Jane E. Harding
- Liggins Institute, The University of Auckland, Auckland, New Zealand
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5
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Acharya D, Gautam S, Poder TG, Lewin A, Gaussen A, Lee K, Singh JK. Maternal and dietary behavior-related factors associated with preterm birth in Southeastern Terai, Nepal: A cross sectional study. Front Public Health 2022; 10:946657. [PMID: 36187702 PMCID: PMC9521356 DOI: 10.3389/fpubh.2022.946657] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 08/19/2022] [Indexed: 01/21/2023] Open
Abstract
Background Preterm birth (PTB) is a global issue although its burden is higher in low- and middle-income countries. This study examined the risk factors of PTB in Southeastern Terai, Nepal. Methods In this community-based cross-sectional study, a total of 305 mothers having children under the age of 6 months were selected using systematic random sampling. Data were collected by structured interviewer-administered questionnaires and maternal antenatal cards from study participants for some clinical information. Predictors of PTB were identified using multi-level logistic regression analysis at a P-value < 0.05. Results Of the total 305 mother-live-born baby pairs, 13.77% (42/305) had preterm childbirth. Maternal socio-demographic factors such as mothers from Dalit caste/ethnicity [adjusted odds ratio (AOR) = 12.16, 95% CI = 2.2-64.61] and Aadibasi/Janajati caste/ethnicity (AOR = 3.83, 95% CI = 1.01-14.65), family income in the first tercile (AOR = 6.82, 95% CI = 1.65-28.08), than their counterparts, were significantly positively associated with PTB. Likewise, other maternal and dietary factors, such as birth order first-second (AOR = 9.56, 95% CI = 1.74-52.53), and birth spacing ≤ 2 years (AOR = 5.16, 95% CI = 1.62-16.42), mothers who did not consume additional meal (AOR = 9.53, 95% CI = 2.13-42.55), milk and milk products (AOR = 6.44, 95% CI = 1.56-26.51) during pregnancy, having <4 antenatal (ANC) visits (AOR = 4.29, 95% CI = 1.25-14.67), did not have intake of recommended amount of iron and folic acid tablets (IFA) (<180 tablets) (AOR = 3.46, 95% CI = 1.03-11.58), and not having adequate rest and sleep (AOR = 4.83, 95% CI = 1.01-23.30) during pregnancy had higher odds of having PTB than their counterparts. Conclusion Some socio-demographic, maternal, and dietary behavior-related factors were independently associated with PTB. These factors should be considered while designing targeted health interventions in Nepal. In addition, we recommend specific measures such as promoting pregnant women to use available antenatal care and counseling services offered to them, as well as having an adequate diet to a level that meets their daily requirements.
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Affiliation(s)
- Dilaram Acharya
- Department of Management, Evaluation and Health Policy, School of Public Health, Université de Montréal, Montréal, QC, Canada,Medical Affairs and Innovation, Héma-Québec, Montréal, QC, Canada
| | | | - Thomas G. Poder
- Department of Management, Evaluation and Health Policy, School of Public Health, Université de Montréal, Montréal, QC, Canada,Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal, CIUSSS de l'Est-de-l'île-de-Montréal, Montréal, QC, Canada
| | - Antoine Lewin
- Medical Affairs and Innovation, Héma-Québec, Montréal, QC, Canada,Faculty of Medicine and Health Science, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Amaury Gaussen
- Medical Affairs and Innovation, Héma-Québec, Montréal, QC, Canada
| | - Kwan Lee
- Department of Preventive Medicine, College of Medicine, Dongguk University, Gyeongju, South Korea,*Correspondence: Kwan Lee
| | - Jitendra Kumar Singh
- Department of Community Medicine, Janaki Medical College, Tribhuvan University, Janakpur, Nepal
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Anto EO, Ofori Boadu WI, Opoku S, Senu E, Tamakloe VCKT, Tawiah A, Ankobea F, Acheampong E, Anto AO, Appiah M, Wiafe YA, Annani-Akollor ME, Obirikorang C, Addai-Mensah O. Prevalence and Risk Factors of Preterm Birth Among Pregnant Women Admitted at the Labor Ward of the Komfo Anokye Teaching Hospital, Ghana. Front Glob Womens Health 2022; 3:801092. [PMID: 35734369 PMCID: PMC9207319 DOI: 10.3389/fgwh.2022.801092] [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: 10/24/2021] [Accepted: 05/09/2022] [Indexed: 11/16/2022] Open
Abstract
Preterm birth is a global epidemic and a leading cause of neonatal mortality in Sub-Saharan Africa. We evaluated the prevalence and risk factors of preterm birth among women attending the labor ward for delivery at a tertiary hospital in Ghana. This comparative cross-sectional study was conducted among a cohort of 209 pregnant women admitted to the labor ward of the Komfo Anokye Teaching Hospital (KATH). Pregnant women who delivered between 28 and 36 completed weeks of gestation were classified as preterm delivery whereas those who delivered after 37–42 completed weeks were described as term. Sociodemographic, clinical, and obstetric data were collected from patient's folder and hospital archives. Categorical variables were analyzed and expressed as frequencies and proportions. We determined the association between obstetric factors and preterm delivery with multiple logistic regressions. Significance level of the strength of association was determined at p-value < 0.05. of the 209 participants, the prevalence of preterm birth was 37.3% (78/209) whereas 62.7% (131/209) delivered at Term. Intrauterine growth restriction (IUGR) [aOR = 2.15, 95% CI = (1.819.55), p = 0.0390], HELLP (hemolysis, elevated liver enzymes and low platelet count) syndrome [aOR = 3.94, 95% CI = (1.64–9.48), p = 0.0020], early gestational obesity [aOR = 2.11, 95% CI = (1.31–11.92), p = 0.0480] and preeclampsia [aOR = 4.56, 95% CI = (1.63–12.76), p = 0.004] were identified as independent risk factors of preterm birth. Prevalence of preterm birth was high among women attending labor admission at the Komfo Anokye Teaching Hospital and this was independently influenced by IUGR, HELLP syndrome, early gestational obesity, and preeclampsia. Identifying early signs of adverse pregnancy outcomes would inform the need for management policy to prevent high prevalence of preterm births.
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Affiliation(s)
- Enoch Odame Anto
- Department of Medical Diagnostics, Faculty of Allied Health Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Centre for Precision Health, School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia
- *Correspondence: Enoch Odame Anto
| | - Wina Ivy Ofori Boadu
- Department of Medical Diagnostics, Faculty of Allied Health Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Stephen Opoku
- Department of Medical Diagnostics, Faculty of Allied Health Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Ebenezer Senu
- Department of Medical Diagnostics, Faculty of Allied Health Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Augustine Tawiah
- Department of Obstetrics and Gynaecology, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Frank Ankobea
- Department of Obstetrics and Gynaecology, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Emmanuel Acheampong
- Centre for Precision Health, School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia
- Department of Molecular Medicine, School of Medicine and Dentistry, College of Health Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Agartha Odame Anto
- Department of Obstetrics and Gynecology, Ho Teaching Hospital, Ho, Ghana
| | - Michael Appiah
- Department of Medical Laboratory Science, Accra Technical University, Accra, Ghana
| | - Yaw Amo Wiafe
- Department of Medical Diagnostics, Faculty of Allied Health Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Max Efui Annani-Akollor
- Department of Molecular Medicine, School of Medicine and Dentistry, College of Health Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Christian Obirikorang
- Department of Molecular Medicine, School of Medicine and Dentistry, College of Health Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Otchere Addai-Mensah
- Department of Medical Diagnostics, Faculty of Allied Health Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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7
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Hassan AM. Incidence of Preterm Infants, Indications of Admission, Risk Factors, and Discharge Outcome: A Retrospective Study. Open Nurs J 2022. [DOI: 10.2174/18744346-v16-e2203250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:
Prematurity is still a major cause of neonatal and infant mortality and morbidity.
Aim:
This study aimed to describe the incidence of preterm infants, indications of admission, risk factors, and discharge outcome.
Materials and Methods:
A retrospective, descriptive design was used. A sample of 692 preterm infants admitted to the Neonatal Intensive Care Unit (NICU) was included. A structured sheet was used to gather the necessary data. It involved two parts: characteristics of preterm infants and their mothers and risk factors concerning preterm birth.
Results:
The study found that 49.4% of admitted neonates were preterm; among them, 48.1% died on discharge. Moreover, there were significant relations between the type of gestation (p=0.000), mothers' age (p=0.001), anemia, pregnancy-induced hypertension, preeclampsia, antepartum hemorrhage, premature rupture of membranes, obstructed labor, family history of medical diseases, and mothers' history of medical diseases with preterm infants' gestational age (p=0.01, 0.001, 0.02, 0.01, 0.000, 0.000, 0.000, 0.000, respectively). Moreover, it was observed that higher admission of preterm infants who had respiratory problems, followed by gastrointestinal problems.
Conclusion:
There was a higher prevalence with a higher mortality rate of admitted preterm infants to NICU. Likewise, the type of gestation, mothers' age, presence of complications during pregnancy, bad obstetric history, and family and medical history of diseases were the most common risk factors of prematurity. Moreover, respiratory problems were the main etiology for admission of preterm infants to NICU. Therefore, early screening of diseases and obstetric complications during pregnancy is recommended.
Implications for Nursing Practice:
Providing educational programs for pediatric nurses will increase their level of awareness regarding incidence, indications, risk factors, and discharge outcome of prematurity, thus reducing the rate of mortality and morbidity among preterm infants.
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Blakstad MM, Perumal N, Bliznashka L, Lambiris MJ, Fink G, Danaei G, Sudfeld CR. Large gains in schooling and income are possible from minimizing adverse birth outcomes in 121 low- and middle-income countries: A modelling study. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000218. [PMID: 36962347 PMCID: PMC10021521 DOI: 10.1371/journal.pgph.0000218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 04/01/2022] [Indexed: 11/18/2022]
Abstract
While the global contributions of adverse birth outcomes to child morbidity and mortality is relatively well documented, the potential long-term schooling and economic consequences of adverse birth outcomes has not been estimated. We sought to quantify the potential schooling and lifetime income gains associated with reducing the excess prevalence of adverse birth outcomes in 121 low- and middle-income countries. We used a linear deterministic model to estimate the potential gains in schooling and lifetime income that may be achieved by attaining theoretical minimum prevalence of low birthweight, preterm birth and small-for-gestational age births at the national, regional, and global levels. We estimated that potential total gains across the 121 countries from reducing low birthweight to the theoretical minimum were 20.3 million school years (95% CI: 6.0,34.8) and US$ 68.8 billion (95% CI: 20.3,117.9) in lifetime income gains per birth cohort. As for preterm birth, we estimated gains of 9.8 million school years (95% CI: 1.5,18.4) and US$ 41.9 billion (95% CI: 6.1,80.9) in lifetime income. The potential gains from small-for-gestational age were 39.5 million (95% CI: 19.1,60.3) school years and US$113.6 billion (95% CI: 55.5,174.2) in lifetime income gained. In summary, reducing the excess prevalence of low birthweight, preterm birth or small-for-gestational age births in low- and middle-income countries may lead to substantial long-term human capital gains in addition to benefits on child mortality, growth, and development as well as on risk of non-communicable diseases in adults and other consequences across the life course.
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Affiliation(s)
- Mia M Blakstad
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, United States of America
| | - Nandita Perumal
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, United States of America
| | - Lilia Bliznashka
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, United States of America
| | - Mark J Lambiris
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Günther Fink
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Goodarz Danaei
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, United States of America
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| | - Christopher R Sudfeld
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, United States of America
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, United States of America
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9
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Younes S, Samara M, Salama N, Al-jurf R, Nasrallah G, Al-Obaidly S, Salama H, Olukade T, Hammuda S, Abdoh G, Abdulrouf PV, Farrell T, AlQubaisi M, Al Rifai H, Al-Dewik N. Incidence, risk factors, and feto-maternal outcomes of inappropriate birth weight for gestational age among singleton live births in Qatar: A population-based study. PLoS One 2021; 16:e0258967. [PMID: 34710154 PMCID: PMC8553085 DOI: 10.1371/journal.pone.0258967] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 10/09/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Abnormal fetal growth can be associated with factors during pregnancy and at postpartum. OBJECTIVE In this study, we aimed to assess the incidence, risk factors, and feto-maternal outcomes associated with small-for-gestational age (SGA) and large-for-gestational age (LGA) infants. METHODS We performed a population-based retrospective study on 14,641 singleton live births registered in the PEARL-Peristat Study between April 2017 and March 2018 in Qatar. We estimated the incidence and examined the risk factors and outcomes using univariate and multivariate analysis. RESULTS SGA and LGA incidence rates were 6.0% and 15.6%, respectively. In-hospital mortality among SGA and LGA infants was 2.5% and 0.3%, respectively, while for NICU admission or death in labor room and operation theatre was 28.9% and 14.9% respectively. Preterm babies were more likely to be born SGA (aRR, 2.31; 95% CI, 1.45-3.57) but male infants (aRR, 0.57; 95% CI, 0.4-0.81), those born to parous (aRR 0.66; 95% CI, 0.45-0.93), or overweight (aRR, 0.64; 95% CI, 0.42-0.97) mothers were less likely to be born SGA. On the other hand, males (aRR, 1.82; 95% CI, 1.49-2.19), infants born to parous mothers (aRR 2.16; 95% CI, 1.63-2.82), or to mothers with gestational diabetes mellitus (aRR 1.36; 95% CI, 1.11-1.66), or pre-gestational diabetes mellitus (aRR 2.58; 95% CI, 1.8-3.47) were significantly more likely to be LGA. SGA infants were at high risk of in-hospital mortality (aRR, 226.56; 95% CI, 3.47-318.22), neonatal intensive care unit admission or death in labor room or operation theatre (aRR, 2.14 (1.36-3.22). CONCLUSION Monitoring should be coordinated to alleviate the risks of inappropriate fetal growth and the associated adverse consequences.
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Affiliation(s)
- Salma Younes
- Department of Research, Women’s Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Muthanna Samara
- Department of Psychology, Kingston University London, Kingston upon Thames, United Kingdom
| | - Noor Salama
- Health Profession Awareness Program, Health Facilities Development, Hamad Medical Corporation (HMC), Doha, Qatar
- American University in Cairo (AUC), Cairo, Egypt
| | - Rana Al-jurf
- College of Health and Life Science (CHLS), Hamad Bin Khalifa University (HBKU), Doha, Qatar
| | - Gheyath Nasrallah
- Department of Biomedical Science, College of Health Sciences, Member of QU Health, Qatar University, Doha, Qatar
| | - Sawsan Al-Obaidly
- Obstetrics and Gynecology Department, Women’s Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Husam Salama
- Department of Pediatrics and Neonatology, Neonatal Intensive Care Unit, Newborn Screening Unit, Women’s Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Tawa Olukade
- Department of Pediatrics and Neonatology, Neonatal Intensive Care Unit, Newborn Screening Unit, Women’s Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Sara Hammuda
- Department of Psychology, Kingston University London, Kingston upon Thames, United Kingdom
| | - Ghassan Abdoh
- Department of Pediatrics and Neonatology, Neonatal Intensive Care Unit, Newborn Screening Unit, Women’s Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Palli Valapila Abdulrouf
- Department of Research, Women’s Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
- Department of Pharmacy, Women’s Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Thomas Farrell
- Department of Research, Women’s Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
- Obstetrics and Gynecology Department, Women’s Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Mai AlQubaisi
- Department of Pediatrics and Neonatology, Neonatal Intensive Care Unit, Newborn Screening Unit, Women’s Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Hilal Al Rifai
- Department of Pediatrics and Neonatology, Neonatal Intensive Care Unit, Newborn Screening Unit, Women’s Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Nader Al-Dewik
- College of Health and Life Science (CHLS), Hamad Bin Khalifa University (HBKU), Doha, Qatar
- Interim Translational Research Institute (iTRI), Hamad Medical Corporation (HMC), Doha, Qatar
- Faculty of Health and Social Care Sciences, Kingston University, St. George’s University of London, London, United Kingdom
- Department of Pediatrics, Clinical and Metabolic Genetics, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
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Perumal N, Manji KP, Darling AM, Kisenge RR, Kvestad I, Hysing M, Belinger DC, Urassa W, Strand TA, Duggan CP, Fawzi WW, Sudfeld CR. Gestational Age, Birth Weight, and Neurocognitive Development in Adolescents in Tanzania. J Pediatr 2021; 236:194-203.e6. [PMID: 33901518 PMCID: PMC8403162 DOI: 10.1016/j.jpeds.2021.04.036] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 03/08/2021] [Accepted: 04/19/2021] [Indexed: 12/26/2022]
Abstract
OBJECTIVES To investigate the association between gestational age, birthweight, and birthweight adjusted for gestational age, with domains of neurocognitive development and behavioral problems in adolescents in Tanzania. STUDY DESIGN Data from a long-term follow-up of adolescents aged 11-15 years born to women previously enrolled in a randomized controlled trial of prenatal multiple micronutrient supplementation in Dar es Salaam, Tanzania, were used. A battery of neurodevelopmental tests were administered to measure adolescent general intelligence, executive function, and behavioral problems. The INTERGROWTH-21st newborn anthropometric standards were used to derive birthweight for gestational age z-scores. We assessed the shape of relationships using restricted cubic splines and estimated the associations of gestational age, birthweight, and birthweight for gestational age z-score with adolescent development using multivariable linear regressions. RESULTS Among adolescents studied (n = 421), higher gestational age (per week), birthweight (per 100 grams), and birthweight for gestational age z-score (per SD) were linearly associated with higher intelligence score (adjusted standardized mean difference, 0.05 SD [95% CI, 0.01-0.09], 0.04 SD [95% CI, 0.02-0.06], and 0.09 SD [95% CI, 0.01-0.17], respectively). Birthweight and birthweight for gestational age z-score, but not gestational age, were also associated with improved executive function. Low birthweight (<2500 g) was associated with lower intelligence and executive function scores. Associations between birthweight and executive function were stronger among adolescents born to women with higher education. CONCLUSIONS The duration of gestation and birthweight were positively associated with adolescent neurodevelopment in Tanzania. These findings suggest that interventions to improve birth outcomes may also benefit adolescent cognitive function.
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Affiliation(s)
- Nandita Perumal
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA.
| | - Karim P Manji
- Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Anne Marie Darling
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Rodrick R Kisenge
- Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Ingrid Kvestad
- Regional Center for Child and Youth Mental Health and Child Welfare, NORCE Norwegian Research Center, Bergen, Norway
| | - Mari Hysing
- Department of Psychological Science, Faculty of Psychology, University of Bergen, Bergen, Norway
| | | | - Willy Urassa
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Tor A Strand
- Department of Research, Innlandet Hospital Trust, Lillehammer, Norway; Faculty of Medicine, Centre for International Health, University of Bergen, Bergen, Norway
| | - Christopher P Duggan
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA; Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital and Harvard Medical School, Boston, MA; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Wafaie W Fawzi
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Christopher R Sudfeld
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
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Ahmed MS. Mapping the prevalence and socioeconomic predictors of low birth weight among Bangladeshi newborns: evidence from the 2019 Multiple Indicator Cluster Survey. Int Health 2021; 14:485-491. [PMID: 34347870 PMCID: PMC9450642 DOI: 10.1093/inthealth/ihab048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 05/27/2021] [Accepted: 07/22/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Low birth weight (LBW) remains a global concern for childhood morbidity and mortality. This study examined the socioeconomic factors associated with LBW among Bangladeshi newborns and drew a district-level prevalence map. METHODS Data were extracted from the 2019 Multiple Indicator Cluster Survey for Bangladesh. Multivariate logistic regression was used to identify the predictors of LBW. RESULTS The prevalence of LBW among Bangladeshi newborns was found to be 14.5%. Overall, the Eastern and South-Eastern regions had a higher burden of LBW. Mothers' educational status, mode of delivery, wealth index quintile of the household and area were identified as independent predictors of newborns' LBW. Mothers who completed primary and secondary education grades had a 1.6- and 1.3-fold higher possibility of having an LBW baby compared with those who completed higher secondary or higher educational grades (adjusted OR=1.62 and 1.32, 95% CI 1.21 to 2.18 and 1.06 to 1.65, respectively). Children belonging to the poorest households and residing in urban areas had a 1.4-fold higher likelihood of being LBW (p<0.05). CONCLUSIONS This study indicates that LBW is still highly prevalent in Bangladesh. Immediate public health action is required in the highly prevalent regions identified in this study.
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Affiliation(s)
- Md Sabbir Ahmed
- Department of Community Health and Hygiene, Faculty of Nutrition and Food Science, Patuakhali Science and Technology University, Dumki, Patuakhali-8602, Bangladesh
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Sirajee R, Conroy AL, Namasopo S, Opoka RO, Lavoie S, Forgie S, Salami BO, Hawkes MT. Growth Faltering and Developmental Delay in HIV-Exposed Uninfected Ugandan Infants: A Prospective Cohort Study. J Acquir Immune Defic Syndr 2021; 87:730-740. [PMID: 33819206 DOI: 10.1097/qai.0000000000002626] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 12/30/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND HIV-exposed but uninfected (HEU) infants are at increased risk of impaired early linear growth and cognitive development. We examined associations between prenatal and postnatal growth and subsequent neurodevelopment in Ugandan HEU infants, hypothesizing that early insults may explain alterations in both somatic growth and brain development. METHODS We prospectively followed a cohort of HEU infants from birth to 18 months of age, and measured length/height, weight, head, and arm circumference longitudinally. The Malawi Development Assessment Tool (MDAT, 12 and 18 months) and the Color Object Association Test (18 months) were used for developmental assessments. RESULTS Among 170 HEU infants, the prevalence of low-birth weight and failure to thrive was 7.6% and 37%, respectively. HEU infants had MDAT scores that were similar to the reference population. The mean (SD) score on the Color Object Association Test was 5.5 (3.1) compared with 6.9 (5.3) in developmentally normal children. Developmental ability at age 18 months showed strong cross-sectional correlation with weight-for-age (ρ = 0.36, P < 0.0001), length/height-for-age (ρ = 0.41, P < 0.0001), head circumference-for-age (ρ = 0.26, P = 0.0011), and mid-upper arm circumference-for-age (ρ = 0.34, P = 0.0014). There was a statistically significant correlation between birth weight and MDAT z-score at 18 months (ρ = 0.20, P = 0.010). Failure to thrive was associated with lower MDAT z-score [median -0.13 (IQR -0.75 to +0.14) versus +0.14 (IQR -0.44 to +0.63), P = 0.042]. CONCLUSION Growth faltering in HEU infants was associated with lower attainment of developmental milestones at age 18 months. Our findings point to a simple screening method for identifying HEU infants at risk for developmental intervention.
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Affiliation(s)
- Reshma Sirajee
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Andrea L Conroy
- Ryan White Center for Pediatric Infectious Diseases and Global Health, Indiana University School of Medicine, Indianapolis, IN
| | - Sophie Namasopo
- Department of Paediatrics, Jinja Regional Referral Hospital, Jinja, Uganda
| | - Robert O Opoka
- Department of Paediatrics and Child Health, Mulago Hospital and Makerere University, Kampala, Uganda
| | - Stephanie Lavoie
- National Laboratory for HIV Reference Services (NLHRS), National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB, Canada
| | - Sarah Forgie
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Bukola O Salami
- Women and Children's Health Research Institute; and
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Michael T Hawkes
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
- Women and Children's Health Research Institute; and
- Department of Medical Microbiology and Immunology, University of Alberta, Edmonton, AB, Canada
- Department of Global Health, School of Public Health, University of Alberta, Edmonton, AB, Canada
- Distinguished Researcher, Stollery Science Lab
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13
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Sezavar AH, Pourhassan B, Kakavandi NR, Hooshangi Shayeste MR, Abyadeh M. Association of maternal blood lead concentration with the risk of small for gestational age: A dose-response meta-analysis. ARCHIVES OF ENVIRONMENTAL & OCCUPATIONAL HEALTH 2021; 77:293-300. [PMID: 33492189 DOI: 10.1080/19338244.2021.1874857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
In spite of growing evidence for the negative effect of lead, knowledge about the dose-response relationship of maternal blood lead level (BLL) and the risk of small for gestational age (SGA) is limited. We performed this meta-analysis to evaluate the dose-response relation between maternal BLL and the risk of SGA. A systematic search through Embase and PubMed was performed. Odds ratios (ORs) and 95% confidence intervals (95% CI) were calculated. The nonlinear and linear relationships between maternal BLL and the risk of SGA were also investigated. Results from 51,065 patients showed a significant association between maternal BLL and risk of SGA in highest versus lowest analysis (OR: 1.54; 95% CI: 1.12-2.10, p = 0.007). While there was no association in linear dose-response (OR: 1.02; 95% CI: 1.00-1.04, p = 0.021) meta-analysis, a direct relationship was observed in the nonlinear model (nonlinearity p < 0.001). Results of this dose-response meta-analysis showed that maternal BLL higher than ∼ 0.3 µg/dL is directly associated with the risk of SGA.
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Affiliation(s)
- Ahmad Habibian Sezavar
- Department of Toxicology and Pharmacology, Faculty of Pharmacy, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Bahman Pourhassan
- Department of Occupational Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Nader Rahimi Kakavandi
- Department of Toxicology and Pharmacology, Faculty of Pharmacy, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | | | - Morteza Abyadeh
- Department of Molecular Systems Biology, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
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Gurung A, Wrammert J, Sunny AK, Gurung R, Rana N, Basaula YN, Paudel P, Pokhrel A, Kc A. Incidence, risk factors and consequences of preterm birth - findings from a multi-centric observational study for 14 months in Nepal. ACTA ACUST UNITED AC 2020; 78:64. [PMID: 32695337 PMCID: PMC7368758 DOI: 10.1186/s13690-020-00446-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 07/03/2020] [Indexed: 01/02/2023]
Abstract
Background Preterm birth is a worldwide epidemic and a leading cause of neonatal mortality. In this study, we aimed to evaluate the incidence, risk factors and consequences of preterm birth in Nepal. Methods This was an observational study conducted in 12 public hospitals of Nepal. All the babies born during the study period were included in the study. Babies born < 37 weeks of gestation were classified as preterm births. For the association and outcomes for preterm birth, univariate followed by multiple regression analysis was conducted. Results The incidence of preterm was found to be 93 per 1000 live births. Mothers aged less than 20 years (aOR 1.26;1.15–1.39) had a high risk for preterm birth. Similarly, education of the mother was a significant predictor for preterm birth: illiterate mothers (aOR 1.41; 1.22–1.64), literate mothers (aOR 1.21; 1.08–1.35) and mothers having basic level of education (aOR 1.17; 1.07–1.27). Socio-demographic factors such as smoking (aOR 1.13; 1.01–1.26), use of polluted fuel (aOR 1.26; 1.17–1.35) and sex of baby (aOR 1.18; 1.11–1.26); obstetric factors such as nulliparity (aOR 1.33; 1.20–1.48), multiple delivery (aOR 6.63; 5.16–8.52), severe anemia during pregnancy (aOR 3.27; 2.21–4.84), antenatal visit during second trimester (aOR 1.13; 1.05–1.22) and third trimester (aOR 1.24; 1.12–1.38), < 4 antenatal visits during pregnancy (aOR 1.49; 1.38–1.61) were found to be significant risk factors of preterm birth. Preterm has a risk for pre-discharge mortality (10.60; 9.28–12.10). Conclusion In this study, we found high incidence of preterm birth. Various socio-demographic, obstetric and neonatal risk factors were associated with preterm birth. Risk factor modifications and timely interventions will help in the reduction of preterm births and associated mortalities. Trial registration ISRCTN30829654.
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Affiliation(s)
| | - Johan Wrammert
- Department of Women's and Children's Health, Uppsala University, 75237 Uppsala, Sweden
| | | | | | - Netra Rana
- Lumbini Provincial Hospital, Government of Nepal, Butwal, Nepal
| | | | - Prajwal Paudel
- Ministry of Health and Population, Government of Nepal, Kathmandu, Nepal
| | - Amrit Pokhrel
- Syangya District Hospital, Government of Nepal, Syangya, Nepal
| | - Ashish Kc
- Department of Women's and Children's Health, Uppsala University, 75237 Uppsala, Sweden
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16
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Head circumference at birth and school performance: a nationwide cohort study of 536,921 children. Pediatr Res 2020; 87:1112-1118. [PMID: 31779026 DOI: 10.1038/s41390-019-0683-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 10/25/2019] [Accepted: 10/31/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND Early measures of cognitive function are of great public health interest. We aimed to estimate the association between head circumference at birth, a measure of cerebral size, and school performance. METHODS We conducted a nationwide cohort study of all liveborn singletons in Denmark, 1997-2005. The association between birth head circumference z score and test scores in reading and mathematics from a nationwide mandatory computer-based school test program (7-16 years) was estimated by multivariable linear regression adjusted for potential confounders. RESULTS The cohort included 536,921 children. Compared to normocephalic children, children with microcephaly [<-2 standard deviations (SD)] had lower mean reading scores: second grade: -0.08 SD (95% CI -0.10 to -0.06), eighth grade: -0.07 SD (95% CI -0.10 to -0.04). Macrocephaly (>+2 SD) was associated with higher scores. In normocephalic children, each SD increase in head circumference was associated with a 0.03 SD (95% CI 0.03 to 0.04) increase in mean reading scores. The results were similar across grades within both reading and mathematics. CONCLUSION Prenatal brain growth may be causally related to childhood school performance. The demonstrated differences are unlikely to be clinically relevant at the individual level but may be important at a public health level.
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Guo P, Chen Y, Wu H, Zeng J, Zeng Z, Li W, Zhang Q, Huo X, Feng W, Lin J, Miao H, Zhu Y. Ambient air pollution and markers of fetal growth: A retrospective population-based cohort study of 2.57 million term singleton births in China. ENVIRONMENT INTERNATIONAL 2020; 135:105410. [PMID: 31884132 DOI: 10.1016/j.envint.2019.105410] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Revised: 12/07/2019] [Accepted: 12/10/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUNDS Evidence is scarce on the relation between maternal exposure to ambient air pollution during pregnancy and fetal growth in developing countries. Moreover, the current evidence is inconsistent. We aimed to investigate the association of trimester-specific exposure to air pollution with risk of being born small for gestational age (SGA) and birth weight-markers of fetal growth-among Chinese term births. METHODS This retrospective population-based cohort study consisted of 2,567,457 singleton term live-births from January 1, 2014 to December 31, 2017 across 123 Chinese districts and counties. Personal exposure to ambient air pollutants including carbon monoxide (CO), sulfur dioxide (SO2), nitrogen dioxide (NO2), ozone (O3), particulate matter with aerodynamic diameter < 2.5 μm (PM2.5), and PM10 was assigned using the inverse distance weighting spatial interpolation algorithm. Generalized estimating equations (GEE) logistic regression models were performed to estimate the associations between trimester-specific exposure to air pollution and risk of SGA or low birth weight (LBW), and GEE linear regression to examine the associations between the exposure and term birth weight, adjusting for maternal demographics, maternal cigarette smoking status during pregnancy, mode of delivery, gravidity, gestational age, year and month of conception, neonate's sex, and meteorological factors. Stratified and sensitivity analyses were also performed. RESULTS When mother exposed to ambient air pollutants over the entire pregnancy, per IQR increment (0.122 mg/m3) in ambient CO concentrations was associated with higher risk of SGA (odds ratio (OR) = 1.04, 95% confidence interval (CI): 1.02, 1.05) and reduced birth weight among term births (-5.95 g, 95% CI: -8.01, -3.89). This association was also pronounced in the second and third trimesters. Term birth weight was negatively associated with per IQR increase of O3 (-3.52 g, 95% CI: -6.23, -0.81), PM2.5 (-5.93 g, 95% CI: -8.36, -3.49) and PM10 (-7.78 g, 95% CI: -10.41, -5.16) during the entire pregnancy, respectively. No significant association was detected between maternal exposure to air pollutants and term LBW. Effect estimates of heterogeneity suggested that maternal age and infant sex modified the impact of air pollution on birth weight. CONCLUSIONS The findings suggest that maternal exposure to air pollution during pregnancy is adversely affecting fetal growth. Further studies are warranted to integrate these findings and take clinical or public health interventions in pregnancy.
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Affiliation(s)
- Pi Guo
- Department of Preventive Medicine, Shantou University Medical College, Shantou 515041, China
| | - Yuliang Chen
- Department of Preventive Medicine, Shantou University Medical College, Shantou 515041, China
| | - Haisheng Wu
- Department of Preventive Medicine, Shantou University Medical College, Shantou 515041, China
| | - Jing Zeng
- Guangdong Women and Children Hospital, Guangzhou 511442, China
| | - Zhisheng Zeng
- Guangdong Women and Children Hospital, Guangzhou 511442, China
| | - Weiping Li
- Clinical Cohort Research Center, First Affiliated Hospital of Shantou University Medical College, Shantou 515041, China
| | - Qingying Zhang
- Department of Preventive Medicine, Shantou University Medical College, Shantou 515041, China
| | - Xia Huo
- Laboratory of Environmental Medicine and Developmental Toxicology, Guangzhou and Guangdong Key Laboratory of Environmental Pollution and Health, School of Environment, Jinan University, Guangzhou 510632, China
| | - Wenru Feng
- Guangzhou Center for Disease Control and Prevention, Guangzhou 510440, China
| | - Jiumin Lin
- Department of Hepatology and Infectious Diseases, the Second Affiliated Hospital, Shantou University Medical College, Shantou 515041, China
| | - Huazhang Miao
- Guangdong Women and Children Hospital, Guangzhou 511442, China.
| | - Yingxian Zhu
- Guangdong Women and Children Hospital, Guangzhou 511442, China.
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Effectiveness of a home fortification programme with multiple micronutrients on infant and young child development: a cluster-randomised trial in rural Bihar, India. Br J Nutr 2019; 120:176-187. [PMID: 29947323 PMCID: PMC6088539 DOI: 10.1017/s000711451800140x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Research demonstrates the importance of nutrition for early brain development. Few studies have examined the effectiveness of multiple micronutrient powders (MNP) on child development. This study examined the impacts of home fortification with MNP on motor and mental development, executive function and memory of children living in Bihar. This two-arm cluster-randomised effectiveness trial selected seventy health sub-centres to receive either MNP and nutrition counselling (intervention) or nutrition counselling alone (control) for 12 months. Front-line health workers delivered the intervention to all households in study communities with a child aged 6-18 months. Data were collected using cross-sectional surveys at baseline and endline by selecting households from intervention (baseline, n 2184; endline, n 2170) and control (baseline, n 2176; endline, n 2122) communities using a two-stage cluster-randomised sampling strategy. Children in the intervention group had a significantly larger improvement from baseline to endline compared with those in the control group on scores for motor and mental development (Cohen's d, motor=0·12; 95 % CI 0·03, 0·22; mental=0·15; 95 % CI 0·06, 0·25). Greater impacts of MNP on motor and mental development were observed in children from households with higher stimulation scores at baseline compared with those with lower stimulation (Cohen's d, motor=0·20 v. 0·09; mental=0·22 v. 0·14; P interaction<0·05). No significant treatment differences were seen for executive function or memory. Home fortification with MNP through the existing health infrastructure in Bihar was effective in improving motor and mental development and should be considered in combination with other child development interventions such as stimulation.
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Hillman LS, Day LS, Hoffman HJ, Stockbauer JW. Poorer outcomes of all low birth weight groups at age 10: Missouri statewide case-control study. Early Hum Dev 2019; 136:60-69. [PMID: 31377564 DOI: 10.1016/j.earlhumdev.2019.05.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Revised: 04/26/2019] [Accepted: 05/09/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND In 1989-1991, a population-based cohort of every Missouri birth weighing < 1500 g was identified over a 16-month period. Infants born moderately low birth weight (MLBW, 1500-2499 g) and normal birth weight (NBW, ≥ 2500 g), were matched to < 1500 g infants by delivery date, race, maternal age, and residence. AIMS To compare outcomes of extremely low birth weight (ELBW, < 1000 g), very low birth weight (VLBW, 1000-1499 g), and MLBW, to NBW infants at age 10. STUDY DESIGN A population-based cohort and matched case-control study OUTCOME MEASURES: A Child Health and Development Questionnaire developed for this study collected social, medical, educational and special services history. The Conners' Parent Rating Scale-Revised was also completed by parents/caregivers. RESULTS As birth weight declined, the prevalence of adverse outcomes increased. Children in all LBW groups were more likely than NBW children to have problems in speech and language, vision, fine and gross motor tasks, illnesses, attention, school performance, and increased requirements for therapy and accommodation. Repetition of a grade was three times higher for MLBW children and over three times higher for the other LBW groups. CONCLUSION In this statewide population-based study, controlling for child's sex, mother's age, race, residence, education, marital status, Medicaid assistance, and smoking or alcohol use during pregnancy, failed to eliminate the strong effect of decreasing birth weight. Problems were most frequent in ELBW, however, VLBW and MLBW also had many significantly greater problems than NBW children. All LBW groups of children experienced greater adverse health and developmental outcomes resulting in significant habilitation and educational challenges.
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Affiliation(s)
- Laura S Hillman
- Department of Child Health, University of Missouri Medical School, Columbia, MO, USA
| | - Linda S Day
- Department of Communication Science and Disorders, University of Missouri, Columbia, MO, USA
| | - Howard J Hoffman
- Epidemiology and Statistics Program, National Institute on Deafness and Other Communication Disorders (NIDCD), National Institutes of Health (NIH), Bethesda, MD, USA.
| | - Joseph W Stockbauer
- Bureau of Health Data Analysis (retired), Missouri Department of Health and Senior Services, Jefferson City, MO, USA
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20
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Abstract
Objective: The objective of this study was to find out the maternal risk factors and perinatal complications in small for gestational age (SGA) newborns. Methods: A total of 181 SGA cases and 1299 cases of appropriate for gestational age (AGA) with the same gestational age between January 2015 and December 2016 were enrolled in Linyi People’s Hospital, China. The risk factors were analyzed and the frequencies of perinatal complications were compared between the two groups. Results: The frequencies of maternal risk factors such as pregnancy-induced hypertension, abnormal placenta and twins in the SGA group were significantly higher than that in the AGA group (P<0.05). The incidence of hyperbilirubinemia and hypoglycemia in the perinatal period was also higher in the SGA newborns group (P<0.05), while there were no significant differences in the incidence of pneumonia, apnea, septicemia, intracranial hemorrhage, neonatal asphyxia, congenital malformations, hypoxic-ischemic encephalopathy, respiratory distress syndrome and necrotizing enterocolitis between the two groups. Conclusions: SGA can cause perinatal complications including neonatal hypoglycemia and hyperbilirubinemia. It is necessary to strengthen the perinatal monitoring and antenatal care to reduce SGA and the perinatal complications of SGA.
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Affiliation(s)
- Qiang Liu
- Dr. Qiang Liu, Department of Newborn, Linyi People's Hospital, Linyi, Shandong, 276003, China
| | - Hui Yang
- Dr. Hui Yang, Department of Anesthesiology, Linyi People's Hospital, Linyi, Shandong, 276003, China
| | - Xuemei Sun
- Dr. Xuemei Sun, Department of Newborn, Linyi People's Hospital, Linyi, Shandong, 276003, China
| | - Guimei Li
- Dr. Guimei Li, Department of Pediatrics, Shandong Provincial Hospital Affiliated to Shandong University, Shandong University, Jinan, Shandong, 250021, China
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21
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Surkan PJ, Dong L, Ji Y, Hong X, Ji H, Kimmel M, Tang WY, Wang X. Paternal involvement and support and risk of preterm birth: findings from the Boston birth cohort. J Psychosom Obstet Gynaecol 2019; 40:48-56. [PMID: 29144191 PMCID: PMC6143424 DOI: 10.1080/0167482x.2017.1398725] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE To investigate to what extent paternal involvement and support during pregnancy were associated with preterm (PTB) and small-for-gestational age (SGA) births. METHODS Using data from the Boston Birth Cohort (n = 7047), multiple logistic regression models were performed to estimate the log odds of either PTB or SGA birth, with paternal involvement, paternal social support, and family and friend social support variables as the primary independent variables. RESULTS About 10% of participating mothers reported their husbands not being involved or supportive during their pregnancies. Lack of paternal involvement was associated with 21% higher risk of PTB (OR = 1.21, 95% CI: 1.01-1.45). Similarly, lack of paternal support was borderline associated with PTB (OR = 1.13, 95% CI: 0.94-1.35). Also marginally significant, lack of paternal involvement (OR = 1.18, 95% CI: 0.95-1.47) and father's support (OR = 1.19, 95% CI: 0.96-1.48) were associated with higher odds of SGA birth. No associations were found between familial and friend support during pregnancy and PTB or SGA. CONCLUSIONS Among predominantly low-income African Americans, lack of paternal involvement and lack of paternal support during pregnancy were associated with an increased risk of PTB, and suggestive of SGA birth. These findings, if confirmed in future research, underscore the important role a father can play in reducing PTB and/or SGA.
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Affiliation(s)
- Pamela J. Surkan
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, USA, 21205, 410-502-7396,
| | - Liming Dong
- University of Michigan School of Public Health, Ann Arbor, MI, USA, 48109, 734-763-3645,
| | - Yuelong Ji
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, USA, 21205, 213-509-7601,
| | - Xiumei Hong
- Department of Population, Family and Reproductive Health, Center on the Early Life Origins of Disease, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA 21205, , 410-502-8919
| | - Hongkai Ji
- Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Room E3638, Baltimore, MD 21205, USA, 410-955-3517,
| | - Mary Kimmel
- University of North Carolina-Chapel Hill Department of Psychiatry, Campus Box #7160, Chapel Hill, NC USA 27599-7160, 919-445-0216,
| | - Wan-yee Tang
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Room E4132, Baltimore, MD, USA, 21205, 410-614-3910,
| | - Xiaobin Wang
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Room E4132, Baltimore, MD, USA, 21205, 410-955-5824,
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Guan Q, Sproule BA, Vigod SN, Cadarette SM, Greaves S, Martins D, Gomes T. Impact of timing of methadone initiation on perinatal outcomes following delivery among pregnant women on methadone maintenance therapy in Ontario. Addiction 2019; 114:268-277. [PMID: 30276907 DOI: 10.1111/add.14453] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 04/20/2018] [Accepted: 09/26/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND AND AIMS Methadone maintenance therapy (MMT) is associated with improved outcomes for children exposed to maternal opioid dependence in utero. We examined Ontario's population of pregnant women on MMT and determined the impact of timing of MMT initiation on perinatal outcomes. DESIGN Cohort study. SETTING Ontario, Canada. PARTICIPANTS Women eligible for public drug benefits and on MMT during pregnancy between 2005 and 2015. MEASUREMENTS We stratified women based on their timing of MMT initiation: (1) stabilized prior to conception, (2) newly initiated prior to conception, (3) initiation in trimester 1, (4) initiation in trimester 2 or (5) initiation in trimester 3. The primary outcomes in the multivariable logistic regression analysis were key perinatal health indicators: small for gestational age, preterm birth, congenital anomalies, severe maternal morbidity, caesarean section and induced labor. Secondary outcomes were specific to maternal opioid dependence: neonatal abstinence syndrome (NAS), admission to a neonatal intensive care unit (NICU), NAS treatment, removal from mother's custody at hospital discharge and neonatal death. FINDINGS Among 1842 women on MMT during pregnancy, 87.6% (n = 1614) initiated MMT before conception. Almost a quarter of their infants (22.2%; n = 408) were born small for gestational age, 17.5% (n = 323) were preterm and 5.9% (n = 109) were born with a congenital anomaly. The odds of primary outcomes occurring did not differ based on timing of methadone initiation; however, infants of mothers who initiated methadone during pregnancy had up to a fourfold increase in the odds of social services removal at the hospital [adjusted odds ratio (aOR) range = 3.70-4.19] compared with those whose mothers were stabilized on MMT prior to conception. CONCLUSIONS Later initiation of methadone maintenance therapy among pregnant women in Ontario, Canada has not been found to be clearly related to most key perinatal adverse health outcomes.
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Affiliation(s)
- Qi Guan
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
| | - Beth A Sproule
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada.,Centre for Addiction and Mental Health, Toronto, Canada
| | - Simone N Vigod
- The Institute for Clinical Evaluative Sciences, Toronto, Canada.,The Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada.,Women's College Hospital and Research Institute, Toronto, Canada
| | - Suzanne M Cadarette
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada.,The Institute for Clinical Evaluative Sciences, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Simon Greaves
- The Institute for Clinical Evaluative Sciences, Toronto, Canada
| | - Diana Martins
- The Institute for Clinical Evaluative Sciences, Toronto, Canada
| | - Tara Gomes
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada.,Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Canada.,The Institute for Clinical Evaluative Sciences, Toronto, Canada.,The Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
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23
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Upadhyay RP, Naik G, Choudhary TS, Chowdhury R, Taneja S, Bhandari N, Martines JC, Bahl R, Bhan MK. Cognitive and motor outcomes in children born low birth weight: a systematic review and meta-analysis of studies from South Asia. BMC Pediatr 2019; 19:35. [PMID: 30696415 PMCID: PMC6350290 DOI: 10.1186/s12887-019-1408-8] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 01/17/2019] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND South Asia contributes substantially to global low birth weight population (i.e. those with birth weight < 2500 g). Synthesized evidence is lacking on magnitude of cognitive and motor deficits in low birth weight (LBW) children compared to those with normal birth weight (NBW) (i.e. birth weight ≥ 2500 g). The meta-analysis aimed to generate this essential evidence. METHODS Literature search was performed using PubMed and Google Scholar. Original research articles from south Asia that compared cognitive and/or motor scores among LBW and NBW individuals were included. Weighted mean differences (WMD) and pooled relative risks (RR) were calculated. All analyses were done using STATA 14 software. RESULTS Nineteen articles (n = 5999) were included in the analysis. Children < 10 years of age born LBW had lower cognitive (WMD -4.56; 95% CI: -6.38, - 2.74) and motor scores (WMD -4.16; 95% CI: -5.42, - 2.89) compared to children with NBW. Within LBW children, those with birth weight < 2000 g had much lower cognitive (WMD -7.23, 95% CI; - 9.20, - 5.26) and motor scores (WMD -6.45, 95% CI; - 9.64, - 3.27). CONCLUSIONS In south Asia, children born LBW, especially with < 2000 g birth weight, have substantial cognitive and motor impairment compared to children with NBW. Early child development interventions should lay emphasis to children born LBW.
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Affiliation(s)
- Ravi Prakash Upadhyay
- Knowledge Integration and Translational Platform (KnIT) at Centre for Health Research and Development, Society for Applied Studies, New Delhi, India.
| | - Gitismita Naik
- Knowledge Integration and Translational Platform (KnIT) at Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Tarun Shankar Choudhary
- Knowledge Integration and Translational Platform (KnIT) at Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Ranadip Chowdhury
- Knowledge Integration and Translational Platform (KnIT) at Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Sunita Taneja
- Knowledge Integration and Translational Platform (KnIT) at Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Nita Bhandari
- Knowledge Integration and Translational Platform (KnIT) at Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Jose Carlos Martines
- Centre for Intervention Science in Maternal and Child Health, Centre for International Health, University of Bergen, Bergen, Norway
| | - Rajiv Bahl
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
| | - Maharaj Kishan Bhan
- Indian Institute of Technology (IIT), New Delhi, India.,Knowledge Integration and Translational Platform (KnIT), Biotechnology Industry Research Assistance Council (BIRAC), New Delhi, India
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24
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Maternal Factors and Utilization of the Antenatal Care Services during Pregnancy Associated with Low Birth Weight in Rural Nepal: Analyses of the Antenatal Care and Birth Weight Records of the MATRI-SUMAN Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15112450. [PMID: 30400313 PMCID: PMC6267196 DOI: 10.3390/ijerph15112450] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 10/29/2018] [Accepted: 10/31/2018] [Indexed: 12/12/2022]
Abstract
Low birth weight (LBW) remains a major public health problem in developing countries, including Nepal. This study was undertaken to examine the association between LBW and maternal factors and antenatal care service utilization, in rural Nepal, using data obtained for a capacity-building and text-messaging intervention, designed to enhance maternal and child health service utilization among pregnant women, in rural Nepal ("MATRI-SUMAN"). The study used a clustered randomized controlled design and was conducted during 2015⁻2016. We investigated maternal and antenatal care service utilization determinants of LBW, using a logistic regression model. Of the four hundred and two singleton babies, included in the present study, seventy-eight (19.4%) had an LBW (mean (SD), 2210.64 (212.47)) grams. It was found that Dalit caste/ethnicity, illiteracy, manual labor, a female baby, and having more than four family members were significantly positively associated with LBW. In addition, mothers who did not visit an antenatal care (ANC) unit, visited an ANC < 4 times, did not take iron and folic acid (IFA), de-worming tablets, and mothers that did not consume additional food, during pregnancy, were more likely to have an LBW baby, than their counterparts. The MATRI-SUMAN intervention and availability of a kitchen garden at home, were found to reduce the risk of LBW. Nepalese child survival policies and programs should pay attention to these maternal and antenatal care service utilization factors, while designating preventive strategies to improve child health outcomes.
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25
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Georgieff MK, Ramel SE, Cusick SE. Nutritional influences on brain development. Acta Paediatr 2018; 107:1310-1321. [PMID: 29468731 PMCID: PMC6045434 DOI: 10.1111/apa.14287] [Citation(s) in RCA: 121] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 02/12/2018] [Accepted: 02/16/2018] [Indexed: 12/19/2022]
Abstract
There is increasing evidence from preclinical and human studies that nutrition in the late foetal and early neonatal period has a significant impact on neurodevelopment across the lifespan. Certain nutrients have particularly large effects in this time period, and their deficits cause greater long-term risk. The mechanisms by which nutrients influence early brain growth and the sensitive periods for when certain nutrients should be provided are being elucidated. Assessments of nutritional status that index brain growth and predict long-term development are important to assess the efficacy of early life nutritional therapies. CONCLUSION Optimizing nutrition during foetal and early postnatal life is a golden opportunity to impact neurodevelopment and brain function across the lifespan.
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Affiliation(s)
- Michael K. Georgieff
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN
| | - Sara E. Ramel
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN
| | - Sarah E. Cusick
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN
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26
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Lee SE, West KP, Cole RN, Schulze KJ, Wu LSF, Yager JD, Groopman J, Christian P. Novel Plasma Proteins in Nepalese School-aged Children are Associated with a Small Head Size at Birth. Sci Rep 2018; 8:6390. [PMID: 29686285 PMCID: PMC5913316 DOI: 10.1038/s41598-018-24640-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 04/06/2018] [Indexed: 12/21/2022] Open
Abstract
Fetal growth restriction increases the risk of poor childhood growth and development and chronic disease in adulthood. Yet, little is known about biological pathways that mediate the long-lasting effects of suboptimal intrauterine growth. We explored the plasma proteome in a cohort of 500 Nepalese children 6–8 years of age to identify plasma proteins associated with multiple anthropometric size indicators at birth. Among 982 proteins analyzed, no proteins differed by birth weight, length, or weight-for-length indicators. However, 25 proteins were differentially abundant in children with a small vs normal head circumference at birth (<−2 vs. ≥−2 z-scores of the WHO growth standards). Angiopoietin-like 6 was 19.4% more abundant and the other 24 proteins were 7–21% less abundant in children with a small vs normal head circumference at birth, adjusted for potential confounders. The less abundant proteins included actins, actin filament organizing proteins (α-actinin, talin, filamin, cofilin, profilin, and vinculin), proteins involved in muscle contraction, and glycolytic enzymes, which were all positively correlated with each other. A novel cluster of childhood plasma proteins involved in angiogenesis and cytoskeleton dynamics was associated with a small head size at birth. The prognostic value of an altered proteomic phenotype remains to be investigated.
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Affiliation(s)
- Sun Eun Lee
- Center for Human Nutrition, Dept. of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA.
| | - Keith P West
- Center for Human Nutrition, Dept. of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Robert N Cole
- Mass Spectrometry and Proteomics Facility, Department of Biological Chemistry, Johns Hopkins School of Medicine, Baltimore, MD, 21205, USA
| | - Kerry J Schulze
- Center for Human Nutrition, Dept. of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Lee S-F Wu
- Center for Human Nutrition, Dept. of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - James D Yager
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - John Groopman
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Parul Christian
- Center for Human Nutrition, Dept. of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
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27
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HOLAKOUIE-NAIENI K, NEMATOLLAHI S, MANSOURNIA MA, SHEKARI M, AGHA-MOLAYI T, ALAVI A, MADANI AH, HOLAKOUIE-NAIENI N, SHABKHIZ H, TORABI E, AHMADI-GHARAEE H. A Population-based Prospective Study to Identify Contributors to Mother and Child Health in Suburban Communities: The Cohort Profile. IRANIAN JOURNAL OF PUBLIC HEALTH 2018; 47:441-448. [PMID: 29845034 PMCID: PMC5971183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Following community health assessment Project (CHAP) in suburbs of Bandar Abbas city, health problems in women and children such as pregnancy complications and infant/child impaired growth are highly prevalent. Therefore, the present population-based prospective cohort study investigated the effects of a wide range of modifiable exposures during pregnancy and postpartum on mother and child health. METHODS The sample comprised of 1000 pregnant women in their first gestational trimester, who live in the three most socially and economically vulnerable neighborhoods of Bandar Abbas, are under recruitment during Feb 2016-18. Four structured questionnaires are being carried out from pregnancy to 30 d, 6 months, and 12 months postpartum. Biologic and ultrasound results are also gathered through hospital and health center records. The study is currently close to the end of the recruitment phase. CONCLUSION The results of the interim and final analyses are being translated into applicable preventive action plans aiming to reduce and control modifiable risk factors for ill-health in mothers and children in suburb communities in South of Iran.
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Affiliation(s)
- Kourosh HOLAKOUIE-NAIENI
- Dept. of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran, Bandar Abbas Health Research Station, WHO Regional Malaria Training Center, Tehran University of Medical Sciences, Bandar Abbas, Iran
| | - Shahrzad NEMATOLLAHI
- Dept. of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran,Corresponding Author:
| | - Mohammad Ali MANSOURNIA
- Dept. of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad SHEKARI
- Dept. of Medical Genetics, School of Medicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Teimour AGHA-MOLAYI
- Dept. of Public Health, School of Public Health, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Azin ALAVI
- Dept. of Obstetrics and Gynecology, School of Medicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Abdul-Hussain MADANI
- Dept. of Public Health, School of Public Health, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Nadereh HOLAKOUIE-NAIENI
- Bandar Abbas Health Research Station, WHO Regional Malaria Training Center, Tehran University of Medical Sciences, Bandar Abbas, Iran
| | - Hossein SHABKHIZ
- Bandar Abbas Health Research Station, WHO Regional Malaria Training Center, Tehran University of Medical Sciences, Bandar Abbas, Iran
| | - Elham TORABI
- Bandar Abbas Health Research Station, WHO Regional Malaria Training Center, Tehran University of Medical Sciences, Bandar Abbas, Iran
| | - Hasan AHMADI-GHARAEE
- Dept. of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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28
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Chen Y, Zhu B, Wu X, Li S, Tao F. Association between maternal vitamin D deficiency and small for gestational age: evidence from a meta-analysis of prospective cohort studies. BMJ Open 2017; 7:e016404. [PMID: 28844987 PMCID: PMC5629738 DOI: 10.1136/bmjopen-2017-016404] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE To determine whether maternal vitamin D deficiency during pregnancy is associated with small for gestational age (SGA). METHODS A comprehensive literature search of PubMed, the Cochrane Library, Embase, and the Elsevier ScienceDirect library was conducted to identify relevant articles reporting prospective cohort studies in English, with the last report included published in February 2017. Pooled odds ratios (ORs) and corresponding 95% confidence intervals (CIs) were used to evaluate the correlation in a random effects model. RESULTS A total of 13 cohort studies were included in this meta-analysis with a sample of 28 285 individuals from seven countries. The pooled overall OR for babies born SGA was 1.588 (95% CI 1.138 to 2.216; p<0.01) for women with vitamin D deficiency. The prevalence of vitamin D deficiency during pregnancy varied from 13.2% to 77.3%. Subgroup analyses identified no significant differences in the association between vitamin D deficiency and SGA based on study quality, gestational week during which blood sampling was performed, cut-off vitamin D levels, sample size, adjustment for critical confounders and method for measuring vitamin D. CONCLUSION This meta-analysis suggests that vitamin D deficiency is associated with an increased risk of SGA.
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Affiliation(s)
- Yao Chen
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Beibei Zhu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, China
- Anhui Provincial Key Laboratory of Population Health and Aristogenics, Hefei, Anhui, China
| | - Xiaoyan Wu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, China
- Anhui Provincial Key Laboratory of Population Health and Aristogenics, Hefei, Anhui, China
| | - Si Li
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Fangbiao Tao
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, China
- Anhui Provincial Key Laboratory of Population Health and Aristogenics, Hefei, Anhui, China
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29
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Haworth EJN, Tumbahangphe KM, Costello A, Manandhar D, Adhikari D, Budhathoki B, Shrestha DK, Sagar K, Heys M. Prenatal and perinatal risk factors for disability in a rural Nepali birth cohort. BMJ Glob Health 2017; 2:e000312. [PMID: 29082010 PMCID: PMC5656139 DOI: 10.1136/bmjgh-2017-000312] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 06/02/2017] [Accepted: 06/17/2017] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Improving newborn health remains a global health priority. Little however is known about the neurodevelopmental consequences for survivors of complications in pregnancy, labour and the neonatal period in in low-income countries outside of small selective and typically urban facility studies. We ask which antenatal, birth and neonatal factors are associated with disability in childhood in a large community birth cohort from rural Nepal. METHODS 6436 infants were recruited during a cluster randomised control trial (RCT) of participatory women's groups (ISRCTN31137309), of whom 6075 survived beyond 28 days. At mean age of 11∙5 years (range 9.5-13.1), 4219 children (27% lost to follow-up) were available for disability screening which was conducted by face-to-face interview using the Module on Child Functioning and Disability produced by the Washington Group/UNICEF. Hypothesised risk factors for disability underwent multivariable regression modelling. FINDINGS Overall prevalence of disability was 7.4%. Maternal underweight (OR 1.44 (95% CI 1.01-2.08)), maternal cohabitation under 16 years of age (OR 1.50 (1.13-2.00)), standardised infant weight at 1 month (OR 0.82 (0.71-0.95)) and reported infant diarrhoea and vomiting in the first month (OR 2.48 (1.58-3.89)) were significantly associated with disability adjusted for trial allocation. The majority of hypothesised risk factors, including prematurity, were not significant. INTERPRETATION Proxies for early marriage and low birth weight and a measure of maternal undernutrition were associated with increased odds of disability. The lack of association of most other recognised risk factors for adverse outcome and disability may be due to survival bias.
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Affiliation(s)
- Edward J N Haworth
- Great Ormond Street UCL Institute for Child Health, University College London, London, UK
| | | | - Anthony Costello
- Department of Maternal, Newborn, Child and Adolescent Health (MCA), World Health Organization, Geneva, Switzerland
- UCL Institute for Global Health, University College London, London, UK
| | | | | | | | | | - Khadka Sagar
- Mother and Infant Research Activities, Kathmandu, Nepal
| | - Michelle Heys
- Great Ormond Street UCL Institute for Child Health, University College London, London, UK
- UCL Institute for Global Health, University College London, London, UK
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Vaivada T, Gaffey MF, Bhutta ZA. Promoting Early Child Development With Interventions in Health and Nutrition: A Systematic Review. Pediatrics 2017; 140:peds.2016-4308. [PMID: 28771408 DOI: 10.1542/peds.2016-4308] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/04/2017] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Although effective health and nutrition interventions for reducing child mortality and morbidity exist, direct evidence of effects on cognitive, motor, and psychosocial development is lacking. OBJECTIVE To review existing evidence for health and nutrition interventions affecting direct measures of (and pathways to) early child development. DATA SOURCES Reviews and recent overviews of interventions across the continuum of care and component studies. STUDY SELECTION We selected systematic reviews detailing the effectiveness of health or nutrition interventions that have plausible links to child development and/or contain direct measures of cognitive, motor, and psychosocial development. DATA EXTRACTION A team of reviewers independently extracted data and assessed their quality. RESULTS Sixty systematic reviews contained the outcomes of interest. Various interventions reduced morbidity and improved child growth, but few had direct measures of child development. Of particular benefit were food and micronutrient supplementation for mothers to reduce the risk of small for gestational age and iodine deficiency, strategies to reduce iron deficiency anemia in infancy, and early neonatal care (appropriate resuscitation, delayed cord clamping, and Kangaroo Mother Care). Neuroprotective interventions for imminent preterm birth showed the largest effect sizes (antenatal corticosteroids for developmental delay: risk ratio 0.49, 95% confidence interval 0.24 to 1.00; magnesium sulfate for gross motor dysfunction: risk ratio 0.61, 95% confidence interval 0.44 to 0.85). LIMITATIONS Given the focus on high-quality studies captured in leading systematic reviews, only effects reported within studies included in systematic reviews were captured. CONCLUSIONS These findings should guide the prioritization and scale-up of interventions within critical periods of early infancy and childhood, and encourage research into their implementation at scale.
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Affiliation(s)
- Tyler Vaivada
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada; and
| | - Michelle F Gaffey
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada; and
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada; and .,Center of Excellence in Women and Child Health, The Aga Khan University, Karachi, Pakistan
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Johnson W, Elmrayed SA, Sosseh F, Prentice AM, Moore SE. Preconceptional and gestational weight trajectories and risk of delivering a small-for-gestational-age baby in rural Gambia. Am J Clin Nutr 2017; 105:1474-1482. [PMID: 28490512 PMCID: PMC5445671 DOI: 10.3945/ajcn.116.144196] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 03/29/2017] [Indexed: 12/18/2022] Open
Abstract
Background: Maternal nutritional status is a key determinant of small for gestational age (SGA), but some knowledge gaps remain, particularly regarding the role of the energy balance entering pregnancy.Objective: We investigated how preconceptional and gestational weight trajectories (summarized by individual-level traits) are associated with SGA risk in rural Gambia.Design: The sample comprised 670 women in a trial with serial weight data (7310 observations) that were available before and during pregnancy. Individual trajectories from 6 mo before conception to 30 wk of gestation were produced with the use of multilevel modeling. Summary traits were expressed as weight z scores [weight z score at 3 mo preconception (zwt-3 mo), weight z score at conception, weight z score at 3 mo postconception, weight z score at 7 mo postconception (zwt+7 mo), and conditional measures that represented the change from the preceding time] and were related to SGA risk with the use of Poisson regression with confounder adjustment; linear splines were used to account for nonlinearity.Results: Maternal weight at each time point had a consistent nonlinear relation with SGA risk. For example, the zwt-3 mo estimate was stronger in women with values ≤0.5 (RR: 0.736; 95% CI: 0.594, 0.910) than in women with values >0.5 (RR: 0.920; 95% CI: 0.682, 1.241). The former group had the highest observed SGA prevalence. Focusing on weight change, only conditional zwt+7 mo was associated with SGA and only in women with values >-0.5 (RR: 0.579; 95% CI: 0.463, 0.724).Conclusions: Protection against delivering an SGA neonate offered by greater preconceptional or gestational weight may be most pronounced in more undernourished and vulnerable women. Independent of this possibility, greater second- and third-trimester weight gain beyond a threshold may be protective. This trial was registered at http://www.isrctn.com/ as ISRCTN49285450.
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Affiliation(s)
- William Johnson
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom;
| | - Seham Aa Elmrayed
- Medical Research Council (MRC) Elsie Widdowson Laboratory, Cambridge, United Kingdom
| | - Fatou Sosseh
- Nutrition Theme, MRC Unit The Gambia, Banjul, Gambia
| | - Andrew M Prentice
- Nutrition Theme, MRC Unit The Gambia, Banjul, Gambia
- MRC International Nutrition Group, London School of Hygiene & Tropical Medicine, London, United Kingdom; and
| | - Sophie E Moore
- Nutrition Theme, MRC Unit The Gambia, Banjul, Gambia
- Division of Women's Health, King's College London, London, United Kingdom
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Black MM, Walker SP, Fernald LCH, Andersen CT, DiGirolamo AM, Lu C, McCoy DC, Fink G, Shawar YR, Shiffman J, Devercelli AE, Wodon QT, Vargas-Barón E, Grantham-McGregor S. Early childhood development coming of age: science through the life course. Lancet 2017; 389:77-90. [PMID: 27717614 PMCID: PMC5884058 DOI: 10.1016/s0140-6736(16)31389-7] [Citation(s) in RCA: 1142] [Impact Index Per Article: 163.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 07/07/2016] [Accepted: 08/05/2016] [Indexed: 12/19/2022]
Abstract
Early childhood development programmes vary in coordination and quality, with inadequate and inequitable access, especially for children younger than 3 years. New estimates, based on proxy measures of stunting and poverty, indicate that 250 million children (43%) younger than 5 years in low-income and middle-income countries are at risk of not reaching their developmental potential. There is therefore an urgent need to increase multisectoral coverage of quality programming that incorporates health, nutrition, security and safety, responsive caregiving, and early learning. Equitable early childhood policies and programmes are crucial for meeting Sustainable Development Goals, and for children to develop the intellectual skills, creativity, and wellbeing required to become healthy and productive adults. In this paper, the first in a three part Series on early childhood development, we examine recent scientific progress and global commitments to early childhood development. Research, programmes, and policies have advanced substantially since 2000, with new neuroscientific evidence linking early adversity and nurturing care with brain development and function throughout the life course.
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Affiliation(s)
- Maureen M Black
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA; RTI International, Research Park, NC, USA.
| | - Susan P Walker
- Caribbean Institute for Health Research, University of the West Indies, Kingston, Jamaica
| | - Lia C H Fernald
- Division of Community Health Sciences, School of Public Health, University of California at Berkeley, Berkeley, CA, USA
| | | | | | - Chunling Lu
- Division of Global Health Equity, Brigham and Women's Hospital, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Dana C McCoy
- Harvard Graduate School of Education, Boston, MA, USA
| | - Günther Fink
- Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Yusra R Shawar
- School of Social Policy and Practice, University of Pennsylvania, Philadelphia, PA, USA
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General intelligence is associated with subclinical inflammation in Nepalese children: A population-based plasma proteomics study. Brain Behav Immun 2016; 56:253-63. [PMID: 27039242 PMCID: PMC4929134 DOI: 10.1016/j.bbi.2016.03.023] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 03/11/2016] [Accepted: 03/28/2016] [Indexed: 01/25/2023] Open
Abstract
Improving child cognition in impoverished countries is a public health priority. Yet, biological pathways and associated biomarkers of impaired cognition remain poorly understood and largely unknown, respectively. This study aimed to explore and quantify associations between functional plasma protein biomarkers and childhood intellectual test performance. We applied proteomics to quantify proteins in plasma samples of 249 rural Nepalese children, 6-8years of age who, 1year later at 7-9years of age, were administered the Universal Nonverbal Intelligence Test (UNIT). Among 751 plasma proteins quantified, 22 were associated with UNIT scores, passing a false discovery rate threshold of 5.0% (q<0.05). UNIT scores were higher by 2.3-9.2 points for every 50% increase in relative abundance of two insulin-like growth factor binding proteins (IGFBPs), six subclasses of apolipoprotein (Apo) and transthyretin, and lower by 4.0-15.3 points for each 50% increase in relative abundance of 13 proteins predominantly involved in inflammation. Among them, IGFBP-acid labile subunit, orosomucoid 1 (ORM1), Apo C-I, and pyruvate kinase isoenzymes M1/M2 jointly explained 37% of the variance in UNIT scores. After additional adjustment for height-for-age Z-score and household socio-economic status as indicators of long-term nutritional and social stress, associations with 6 proteins involved in inflammation, including ORM1, α-1-antichymotrypsin, reticulocalbin 1, and 3 components of the complement cascade, remained significant (q<0.05). Using untargeted proteomics, stable, constitutive facets of subclinical inflammation were associated with lower developmental test performance in this rural South Asian child population. Plasma proteomics may offer opportunities to identify functional, antecedent biomarkers of child cognitive development.
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Blake RA, Park S, Baltazar P, Ayaso EB, Monterde DBS, Acosta LP, Olveda RM, Tallo V, Friedman JF. LBW and SGA Impact Longitudinal Growth and Nutritional Status of Filipino Infants. PLoS One 2016; 11:e0159461. [PMID: 27441564 PMCID: PMC4956033 DOI: 10.1371/journal.pone.0159461] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 07/01/2016] [Indexed: 11/26/2022] Open
Abstract
We performed this study to longitudinally compare rates of stunting, wasting and underweight among low birthweight (LBW), non-LBW, and/or small-for-gestational age (SGA) and non-SGA infants in Leyte, The Philippines and factors that predicted catch up. Birthweights of 357 infants born in Leyte, The Philippines were obtained within 48 hours of delivery and infants were evaluated at one, six and 12 months. Newborns were classified as LBW, SGA, or both. We derived length-for-age, weight-for-length and weight-for-age Z-scores using WHOAnthro. Generalized estimating equations models were used to compare the differences in prevalence and mean Z-scores for these growth and nutritional outcomes, with separate models made with LBW and SGA as distinct primary predictors. We compared the longitudinal risk of stunting, wasting and underweight during infancy among LBW versus non-LBW and SGA versus non-SGA infants, while also evaluating key potential confounding, explanatory and modifying covariates. Overall, 9.0% of infants were born prematurely, 14.0% of infants were LBW and 22.9% were SGA. LBW infants had significantly increased odds of stunting, wasting and underweight persisting to 12 months of age, and SGA infants had significantly increased odds of stunting and underweight. LBW and SGA infants had higher rates of weight-for-length gain in the first month of life. Maternal educational attainment and exclusive breastfeeding decreased the risk of stunting and undernutrition. In this setting, LBW and SGA infants have higher rates of growth stunting and undernutrition during the first year of life and do not exhibit catch-up growth by 12 months of age.
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Affiliation(s)
- Rachel A. Blake
- The Warren Alpert Medical School of Brown University, Providence, RI, United States of America
| | - Sangshin Park
- The Warren Alpert Medical School of Brown University, Providence, RI, United States of America
- Center for International Health Research, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI, United States of America
- * E-mail:
| | - Palmera Baltazar
- Research Institute for Tropical Medicine, Manila, Philippines
- Remedios Trinidad Romualdez Hospital, Tacloban City, Leyte, The Philippines
| | - Edna B. Ayaso
- Remedios Trinidad Romualdez Hospital, Tacloban City, Leyte, The Philippines
| | | | - Luz P. Acosta
- Research Institute for Tropical Medicine, Manila, Philippines
| | | | - Veronica Tallo
- Research Institute for Tropical Medicine, Manila, Philippines
| | - Jennifer F. Friedman
- The Warren Alpert Medical School of Brown University, Providence, RI, United States of America
- Center for International Health Research, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI, United States of America
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SADEGHZADEH M, KHOSHNEVISASL P, PARVANEH M, MOUSAVINASAB N. Early and Late Outcome of Premature Newborns with History of Neonatal Intensive Care Units Admission at 6 Years Old in Zanjan, Northwestern Iran. IRANIAN JOURNAL OF CHILD NEUROLOGY 2016; 10:67-73. [PMID: 27247586 PMCID: PMC4885157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
OBJECTIVE Premature birth is an important factor for mortality and morbidity of neonates. This study was designed to evaluate the outcome of preterm neonates who needed neonatal intensive care (NICU) hospitalization after 6 yr at their entrance to the school. MATERIALS & METHODS This cross sectional study was conducted on premature neonates consecutively hospitalized in NICU of Valie Asr Hospital (the Academic Pediatric Hospital, Zanjan, Northwestern Iran) from September 2001 to September 2003. All children with a history of prematurity and NICU treatment were evaluated at their entrance to the school. Demographic findings, clinical examinations, IQ test, hearing and visual acuity exams were recorded. RESULTS From 179 neonates, 78 (43.6%) survived and were discharged from hospital. Fifty-four of them were available and entered first grade in primary school. Only one case had severe mental retardation. One case had severe retinopathy of prematurity (ROP). Hearing abnormality was not detected in any case. There was no significant relation between IQ score, visual as well as hearing findings and gestational age. CONCLUSION We did not find significant disability in the outcome of surviving infants. This could be explained by the high mortality rate of neonates during hospitalization.
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Affiliation(s)
- Mansour SADEGHZADEH
- Zanjan Metabolic Disease Research Center, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Parisa KHOSHNEVISASL
- Social Determinants of Health Research Center, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Mehdi PARVANEH
- Pediatrician, Zanjan University of Medical Sciences, Zanjan, Iran
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Thorne C, Aebi-Popp K. Beyond prevention of mother-to-child HIV transmission. Lancet HIV 2015; 3:e5-6. [PMID: 26762994 DOI: 10.1016/s2352-3018(15)00243-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2015] [Revised: 11/09/2015] [Accepted: 11/09/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Claire Thorne
- UCL Institute of Child Health, University College London, London WC1N 1EH, UK.
| | - Karoline Aebi-Popp
- Department of Infectious Diseases, University Hospital Bern, Bern, Switzerland
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Wallace JM, Milne JS, Aitken RP, Redmer DA, Reynolds LP, Luther JS, Horgan GW, Adam CL. Undernutrition and stage of gestation influence fetal adipose tissue gene expression. J Mol Endocrinol 2015; 54:263-75. [PMID: 25917833 PMCID: PMC4449808 DOI: 10.1530/jme-15-0048] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/24/2015] [Indexed: 12/14/2022]
Abstract
Low birthweight is a risk factor for neonatal mortality and adverse metabolic health, both of which are associated with inadequate prenatal adipose tissue development. In the present study, we investigated the impact of maternal undernutrition on the expression of genes that regulate fetal perirenal adipose tissue (PAT) development and function at gestation days 89 and 130 (term=145 days). Singleton fetuses were taken from adolescent ewes that were either fed control (C) intake to maintain adiposity throughout pregnancy or were undernourished (UN) to maintain conception weight but deplete maternal reserves (n=7/group). Fetal weight was independent of maternal intake at day 89, but by day 130, fetuses from UN dams were 17% lighter and had lower PAT mass that contained fewer unilocular adipocytes. Relative PAT expression of IGF1, IGF2, IGF2R and peroxisome proliferator-activated receptor gamma (PPARG) mRNA was lower in UN than in controls, predominantly at day 89. Independent of maternal nutrition, PAT gene expression of PPARG, glycerol-3-phosphate dehydrogenase, hormone sensitive lipase, leptin, uncoupling protein 1 and prolactin receptor increased, whereas IGF1, IGF2, IGF1R and IGF2R decreased between days 89 and 130. Fatty acid synthase and lipoprotein lipase (LPL) mRNAs were not influenced by nutrition or stage of pregnancy. Females had greater LPL and leptin mRNA than males, and LPL, leptin and PPARG mRNAs were decreased in UN at day 89 in females only. PAT gene expression correlations with PAT mass were stronger at day 89 than they were at day 130. These data suggest that the key genes that regulate adipose tissue development and function are active beginning in mid-gestation, at which point they are sensitive to maternal undernutrition: this leads to reduced fetal adiposity by late pregnancy.
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Affiliation(s)
- Jacqueline M Wallace
- Rowett Institute of Nutrition and Health University of Aberdeen, Bucksburn, Aberdeen AB21 9SB, UK Department of Animal Sciences North Dakota State University, Fargo, North Dakota 58108-6050, USA Biomathematics and Statistics Scotland Aberdeen AB21 9SB, UK
| | - John S Milne
- Rowett Institute of Nutrition and Health University of Aberdeen, Bucksburn, Aberdeen AB21 9SB, UK Department of Animal Sciences North Dakota State University, Fargo, North Dakota 58108-6050, USA Biomathematics and Statistics Scotland Aberdeen AB21 9SB, UK
| | - Raymond P Aitken
- Rowett Institute of Nutrition and Health University of Aberdeen, Bucksburn, Aberdeen AB21 9SB, UK Department of Animal Sciences North Dakota State University, Fargo, North Dakota 58108-6050, USA Biomathematics and Statistics Scotland Aberdeen AB21 9SB, UK
| | - Dale A Redmer
- Rowett Institute of Nutrition and Health University of Aberdeen, Bucksburn, Aberdeen AB21 9SB, UK Department of Animal Sciences North Dakota State University, Fargo, North Dakota 58108-6050, USA Biomathematics and Statistics Scotland Aberdeen AB21 9SB, UK
| | - Lawrence P Reynolds
- Rowett Institute of Nutrition and Health University of Aberdeen, Bucksburn, Aberdeen AB21 9SB, UK Department of Animal Sciences North Dakota State University, Fargo, North Dakota 58108-6050, USA Biomathematics and Statistics Scotland Aberdeen AB21 9SB, UK
| | - Justin S Luther
- Rowett Institute of Nutrition and Health University of Aberdeen, Bucksburn, Aberdeen AB21 9SB, UK Department of Animal Sciences North Dakota State University, Fargo, North Dakota 58108-6050, USA Biomathematics and Statistics Scotland Aberdeen AB21 9SB, UK Rowett Institute of Nutrition and Health University of Aberdeen, Bucksburn, Aberdeen AB21 9SB, UK Department of Animal Sciences North Dakota State University, Fargo, North Dakota 58108-6050, USA Biomathematics and Statistics Scotland Aberdeen AB21 9SB, UK
| | - Graham W Horgan
- Rowett Institute of Nutrition and Health University of Aberdeen, Bucksburn, Aberdeen AB21 9SB, UK Department of Animal Sciences North Dakota State University, Fargo, North Dakota 58108-6050, USA Biomathematics and Statistics Scotland Aberdeen AB21 9SB, UK
| | - Clare L Adam
- Rowett Institute of Nutrition and Health University of Aberdeen, Bucksburn, Aberdeen AB21 9SB, UK Department of Animal Sciences North Dakota State University, Fargo, North Dakota 58108-6050, USA Biomathematics and Statistics Scotland Aberdeen AB21 9SB, UK
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Sharma SR, Giri S, Timalsina U, Bhandari SS, Basyal B, Wagle K, Shrestha L. Low birth weight at term and its determinants in a tertiary hospital of Nepal: a case-control study. PLoS One 2015; 10:e0123962. [PMID: 25853813 PMCID: PMC4390309 DOI: 10.1371/journal.pone.0123962] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2014] [Accepted: 03/09/2015] [Indexed: 11/21/2022] Open
Abstract
Birth weight of a child is an important indicator of its vulnerability for childhood illness and chances of survival. A large number of infant deaths can be averted by appropriate management of low birth weight babies and prevention of factors associated with low birth weight. The prevalence of low birth weight babies in Nepal is estimated to be about 12-32%.Our study aimed at identifying major determinants of low birth weight among term babies in Nepal. A hospital-based retrospective case control study was conducted in maternity ward of Tribhuvan University Teaching Hospital from February to July 2011. A total of 155 LBW babies and 310 controls were included in the study. Mothers admitted to maternity ward during the study period were interviewed, medical records were assessed and anthropometric measurements were done. Risk factors, broadly classified into proximal and distal factors, were assessed for any association with birth of low-birth weight babies. Regression analysis revealed that a history of premature delivery (adjusted odds ratio; aOR5.24, CI 1.05-26.28), hard physical work during pregnancy (aOR1.48, CI 0.97-2.26), younger age of mother (aOR1.98, CI 1.15-3.41), mothers with haemoglobin level less than 11gm/dl (aOR0.51, CI0.24-1.07) and lack of consumption of nutritious food during pregnancy (aOR1.99, CI 1.28-3.10) were significantly associated with the birth of LBW babies. These factors should be addressed with appropriate measures so as to decrease the prevalence of low birth weight among term babies in Nepal.
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Affiliation(s)
| | - Smith Giri
- The University of Tennessee Health Science Center, Memphis, United States of America
| | - Utsav Timalsina
- Maharajgunj Medical Campus, Institute of Medicine, Kathmandu, Nepal
| | | | - Bikash Basyal
- Maharajgunj Medical Campus, Institute of Medicine, Kathmandu, Nepal
| | | | - Laxman Shrestha
- Maharajgunj Medical Campus, Institute of Medicine, Kathmandu, Nepal
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Gladstone M, Oliver C, Van den Broek N. Survival, morbidity, growth and developmental delay for babies born preterm in low and middle income countries - a systematic review of outcomes measured. PLoS One 2015; 10:e0120566. [PMID: 25793703 PMCID: PMC4368095 DOI: 10.1371/journal.pone.0120566] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Accepted: 01/29/2015] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Premature birth is the leading cause of neonatal death and second leading in children under 5. Information on outcomes of preterm babies surviving the early neonatal period is sparse although it is considered a major determinant of immediate and long-term morbidity. METHODS Systematic review of studies reporting outcomes for preterm babies in low and middle income settings was conducted using electronic databases, citation tracking, expert recommendations and "grey literature". Reviewers screened titles, abstracts and articles. Data was extracted using inclusion and exclusion criteria, study site and facilities, assessment methods and outcomes of mortality, morbidity, growth and development. The Child Health Epidemiology Reference Group criteria (CHERG) were used to assess quality. FINDINGS Of 197 eligible publications, few (10.7%) were high quality (CHERG). The majority (83.3%) report on the outcome of a sample of preterm babies at time of birth or admission. Only 16.0% studies report population-based data using standardised mortality definitions. In 50.5% of studies, gestational age assessment method was unclear. Only 15.8% followed-up infants for 2 years or more. Growth was reported using standardised definitions but recommended morbidity definitions were rarely used. The criteria for assessment of neurodevelopmental outcomes was variable with few standardised tools - Bayley II was used in approximately 33% of studies, few studies undertook sensory assessments. CONCLUSIONS To determine the relative contribution of preterm birth to the burden of disease in children and to inform the planning of healthcare interventions to address this burden, a renewed understanding of the assessment and documentation of outcomes for babies born preterm is needed. More studies assessing outcomes for preterm babies who survive the immediate newborn period are needed. More consistent use of data is vital with clear and aligned definitions of health outcomes in newborn (preterm or term) and intervention packages aimed to save lives and improve health.
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Affiliation(s)
- Melissa Gladstone
- Department of Women and Children’s Health, Institute of Translational Medicine, University of Liverpool, Alder Hey NHS Foundation Trust, Liverpool, United Kingdom
| | - Clare Oliver
- Department of Women and Children’s Health, Institute of Translational Medicine, University of Liverpool, Alder Hey NHS Foundation Trust, Liverpool, United Kingdom
| | - Nynke Van den Broek
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
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Cimadevilla JM, Roldán L, París M, Arnedo M, Roldán S. Spatial learning in a virtual reality-based task is altered in very preterm children. J Clin Exp Neuropsychol 2014; 36:1002-8. [DOI: 10.1080/13803395.2014.963520] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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