Telephone interviews and online questionnaires can be used to improve neurodevelopmental follow-up rates

Parenting stress and health-related quality of life among parents of extremely preterm born early adolescents in England: a cross-sectional study

OBJECTIVE

To determine whether extremely preterm (EP) birth exerts persisting effects on parents in early adolescence.

DESIGN

Cross-sectional survey conducted between March 2017 and October 2018.

SETTING

Evaluation of a longitudinal population-based birth cohort in England at 11 years of age (EPICure2@11 Study).

PARTICIPANTS

Parents of EP (<27 weeks of gestation) adolescents and control parents of term born (≥37 weeks of gestation) classmates of similar age and sex.

MAIN OUTCOME MEASURES

The Parenting Stress Index Short Form (PSI-4-SF) and the Short Form Health Survey (SF-12v1).

RESULTS

The 163 EP and 125 comparison respondents were most commonly mothers in their mid-40s. EP parents reported higher total parenting stress scores compared with controls, overall (adjusted difference in means: 14 (95% CI 9 to 20)) and after exclusion of moderate and severe child disability and multiples (9 (95% CI 3 to 15). Average physical and mental health-related quality of life scores were similar in the two groups (adjusted difference in means physical health: -2 (95% CI -4 to 1) and mental health: -1 (95% CI -4 to 1)). Among EP parents, 12% (20/164) reported the combination of high parenting stress and low mental health scores. With increasing child age, parenting stress scores for preterm parents were lower in contrast to controls who reported increasing parenting stress.

CONCLUSIONS

In early adolescence, compared with parents of term-born children, EP parents experience increased levels of parenting stress that are particularly high among a proportion of parents and associated with lower mental health-related quality of life. Practitioner awareness of this continuing risk throughout childhood is important to support parental abilities and well-being.

Cerebral Palsy in Very Preterm Infants: A Nine-Year Prospective Study in a French Population-Based Tertiary Center

OBJECTIVES

To describe the prevalence of cerebral palsy (CP) at age 2 years in infants born before 33 weeks of gestation and to analyze the fetal neuroprotective effect of the antenatal administration of magnesium sulfate (MgSO₄) treatment on CP.

STUDY DESIGN

Preterm infants born before 33 weeks of gestation and discharged from the Rouen University Hospital's Neonatal Intensive Care Unit between 2007 and 2015 were included. At age 2 years, pediatricians of the perinatal network of Eure and Seine-Maritime counties administered standardized questionnaires analyzing motor, cognitive, and behavioral items, derived from the Denver and Amiel-Tison scales. A routine protocol based on MgSO₄ infusion was introduced in 2010. The primary outcome measure was the occurrence of CP according to the Surveillance of Cerebral Palsy in Europe network definition.

RESULTS

A total of 1759 very preterm infants were included, among whom 138 (7.8%) died and 148 (9.1%) were lost to follow-up. Assuming that those lost to follow-up had no CP, at 2 years, 55 of 1621 infants (3.4%; 95% CI, 2.6%-4.4%) had CP. After statistical adjustment for birth term and antenatal corticosteroid use, a significant decrease in CP was observed after implementation of a protocol of MgSO₄ administration in mothers before imminent preterm birth at <33 weeks of gestation (aOR, 0.53; 95% CI, 0.29-0.98; P = .04).

CONCLUSIONS

The prevalence of CP at 2 years after very preterm birth was low. The implementation of a neuroprotective protocol with MgSO₄ was associated with reduced CP occurrence; however, several relevant limitations must be considered for interpretation.

Weight-related behaviors and weight loss maintenance: a cross-sectional study in Cyprus

Background

This study examined the differences between maintainers and regainers regarding obesity related eating behaviors. A secondary objective was to develop an eating behavior index predicting the likelihood of successful weight loss maintenance.

Methods

The current cross-sectional evaluation conducted in Cyprus was part of the MedWeight (Greek) study. Eligible for participation were Cypriot (maintainers = 145; regainers = 87) adult men and women who reported being at least overweight (BMI ≥25 kg/m²) and experienced an intentional weight loss of ≥10% of their maximum lifetime weight, at least 1 year before participation. Among other assessments, weight-related behaviors were evaluated through Weight-Related Behaviors Index (WRBI).

Results

Statistically significant differences between the two groups were observed regarding meals per day (P = 0.008), frequency of eating home cooked meals (P = 0.004) and WRBI total score (P = 0.022). Results from logistic regression models indicated that the odds of maintaining weight loss increase at 30% (Model 1: P < 0.05, Odds ratio 1.306, 1.095–1.556 95% C.I., Model 2: P < 0.05, OR 1.308, 1.097–1.560 95% C.I.) and at 38% after adjusting for physical activity (Model 3: P < 0.05, OR 1.377, 1.114–1.701 95% C.I..) for each point scored in WRBI total score.

Conclusions

Eating more frequently home cooked meals and less eating away from home meals may be beneficially associated with weight loss maintenance. WRBI seems to be a useful tool when dealing with patients who have previously lost significant weight.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11153-5.

Intermediate-term results of a prospective, multicenter study on remote programming sacral neuromodulation for refractory overactive bladder

Background

To evaluate the efficacy and safety of a novel remote programming sacral neuromodulation (SNM) system (BetterStim system) in the treatment of patients with refractory overactive bladder (OAB) for 3 years.

Methods

A total of 8 centers in China enrolled 84 patients with OAB. Following test stimulation 70 patients underwent implantation using BetterStim. All patients returned for follow-up at 3 and 6 months postoperatively. After that, the visits were conducted by telephone. Outcomes of voiding diaries, the overactive bladder symptom score (OABSS), questionnaires regarding OAB-related quality of life (OAB-qol), and adverse events (AEs) were evaluated at each visit. The clinical therapeutic success was defined as ≥50% improvement from baseline in any of the voiding diary variables or average voids/day return to normal voiding (<8 voids/day). The analysis is a modified Completers analysis.

Results

At the 36-month follow-up, the success rate was 79% for overall OAB symptoms, 69% for urge urinary incontinence (UUI) and 42% for urgency frequency (UF). The average number of voids/day decreased from 29.2±14.9 at baseline to 17.6±11.2 at 3 years, the average volume/void increased from 94.7±54.2 to 151.4±80.8 mL, the urgency reduced from 3.0±1.4 to 1.8±1.7 (all P<0.001). For patients with urge incontinence, mean leaking episodes/day decreased from 8.1±7.6 at baseline to 2.1±3.5 at three years (P<0.05). The devices were explanted in 8 (11.4%) patients. There were no remote programming-related AEs or device-related serious AEs that occurred.

Conclusions

The Intermediate-term results demonstrated that BetterStim SNM system with remote programming is safe and effective for patients with refractory OAB.

Performance of the German version of the PARCA-R questionnaire as a developmental screening tool in two-year-old very preterm infants

Objective

To validate and test a German version of the revised Parent Report of Children's Abilities questionnaire (PARCA-R).

Methods

Multicentre cross-sectional study. Parents of infants born <32 gestational weeks, completed the PARCA-R within three weeks before the follow-up assessment of their child at age two years. Infants were assessed using the Mental Development Index (MDI) of the Bayley Scales of Infant Development 2nd edition (BSID-II). Pearson correlation between the Parent Report Composite (PRC) of the PARCA-R and MDI was tested. The optimal PRC cut-off for predicting moderate-to-severe mental delay, defined as MDI<70, was identified through the receiver operating characteristic (ROC) curve.

Results

PARCA-R and BSID-II data were collected from 154 consecutive infants [51% girls, mean (SD) gestational age 29.0 (2.0) weeks, birth weight 1174 (345) grams] at 23.2 (1.6) months of corrected age. The PRC score [70.5 (31.1)] correlated with the MDI [92.2 (17.3); R = 0.54; p < 0.0001]. The optimal PRC cut-off for identifying mental delay was 44 with 0.81 (0.54–0.96) sensitivity (95%-CI), 0.81 (0.74–0.87) specificity, area under the ROC curve of 0.840 (0.729–0.952).

Conclusion

The German version of the PARCA-R had good validity with the BSID-II and PCR scores < 44 proved optimal discriminatory power for the identification of mental delay at two years of corrected age.

EPICE cohort: two-year neurodevelopmental outcomes after very preterm birth

OBJECTIVE

To determine whether the variation in neurodevelopmental disability rates between populations persists after adjustment for demographic, maternal and infant characteristics for an international very preterm (VPT) birth cohort using a standardised approach to neurodevelopmental assessment at 2 years of age.

DESIGN

Prospective standardised cohort study.

SETTING

15 regions in 10 European countries.

PATIENTS

VPT births: 22⁺⁰-31⁺⁶ weeks of gestation.

DATA COLLECTION

Standardised data collection tools relating to pregnancy, birth and neonatal care and developmental outcomes at 2 years corrected age using a validated parent completed questionnaire.

MAIN OUTCOME MEASURES

Crude and standardised prevalence ratios calculated to compare rates of moderate to severe neurodevelopmental impairment between regions grouped by country using fixed effects models.

RESULTS

Parent reported rates of moderate or severe neurodevelopmental impairment for the cohort were: 17.3% (ranging 10.2%-26.1% between regions grouped by country) with crude standardised prevalence ratios ranging from 0.60 to 1.53. Adjustment for population, maternal and infant factors resulted in a small reduction in the overall variation (ranging from 0.65 to 1.30).

CONCLUSION

There is wide variation in the rates of moderate to severe neurodevelopmental impairment for VPT cohorts across Europe, much of which persists following adjustment for known population, maternal and infant factors. Further work is needed to investigate whether other factors including quality of care and evidence-based practice have an effect on neurodevelopmental outcomes for these children.

Examining Childhood Obesity From Infancy: The Relationship Between Tummy Time, Infant BMI-z, Weight Gain, and Motor Development-An Exploratory Study

INTRODUCTION

This exploratory study investigated the infant time spent in tummy time (TT) in relation to body mass index z score (BMI-z), weight gain, and motor development in infants from birth to 4 months.

METHOD

Mothers and their infants were telephone surveyed at 2 and 4 months. Mother demographics; TT; feeding practices; and infant length, and height, and development were collected each time.

RESULTS

Results from Cochran-Mantel-Haenszel and single logistic regression showed a significant association between development, level of BMI-z, and time spent in TT at 2 months of age (p < .0001). The threshold model showed there was a decline in BMI-z at 4 months as daily time in TT increases past the threshold value of approximately 12 minutes per day. Mother education and TT at 2 months were significant predictors of BMI-z at 4 months.

DISCUSSION

Study outcomes suggest that infant positioning and time in TT promote infant motor development and may moderate rapid infant weight gain.

Differentiating the Preterm Phenotype: Distinct Profiles of Cognitive and Behavioral Development Following Late and Moderately Preterm Birth

OBJECTIVES

To explore patterns of comorbidity in cognitive and behavioral outcomes at 2 years' corrected age among children born late or moderately preterm (LMPT) and to identify predictors of different patterns of comorbidity.

STUDY DESIGN

Geographical, prospective population-based cohort study of 1139 infants born LMPT (32^0/7 to 36^6/7 weeks' gestation) and 1255 infants born at term (37^0/7 to 42^6/7 weeks' gestation). Parent questionnaires were obtained to identify impaired cognitive and language development, behavioral problems, delayed social-emotional competence, autistic features, and clinically significant eating difficulties at 24 months corrected age for 638 (57%) children born LMPT and 765 (62%) children born at term.

RESULTS

Latent class analysis revealed 2 profiles of development among the term group: optimal (84%) and a profile of social, emotional, and behavioral impairments termed "nonoptimal" (16%). These 2 profiles were also identified among the LMPT group (optimal: 67%; nonoptimal: 26%). In the LMPT group, a third profile was identified (7%) that was similar to the phenotype previously identified in infants born very preterm. Nonwhite ethnicity, socioeconomic risk, and not receiving breast milk at hospital discharge were risk factors for nonoptimal outcomes in both groups. Male sex, greater gestational age, and pre-eclampsia were only associated with the preterm phenotype.

CONCLUSIONS

Among children born LMPT with parent-reported cognitive or behavioral impairments, most had problems similar to the profile of difficulties observed in children born at term. A smaller proportion of children born LMPT had impairments consistent with the "very preterm phenotype" which are likely to have arisen through a preterm pathway. These results suggest that prematurity may affect development through several etiologic pathways in the late and moderately preterm population.

Evaluation of the use of a parent questionnaire to provide later health status data: the PANDA study

BACKGROUND

Routine comparable outcome data collection relating to the later health status of babies born very preterm has long been considered important, but has not been achieved in the UK.

AIM

To test the potential for a parental questionnaire to provide these data for all eligible babies from a geographical population.

METHODS

Consent for follow-up by questionnaire (using the Parent Report of Children's Abilities-Revised combined with questions derived from the Oxford minimum dataset) was sought for all babies ≤30 weeks of gestation, discharged from a hospital in the East Midlands and Yorkshire regions of the UK, having been born between 1 January 2007 and 31 December 2011.

RESULTS

The rate of consent to participate in follow-up showed a steady increase over time to 83.1% in 2011. However, the response rate in terms of completion and return of the questionnaire at 2 years, as a proportion of those eligible, showed little change over time, varying between 42% and 46%. Among those children where a questionnaire was returned, the rate of disability was broadly consistent over time: lowest in 2009, 21.0% (95% CI 16.8% to 25.6%) and highest in 2011, 25.5% (95% CI 21.5% to 31.2%). The instruments used appeared effective with the capability of discriminating between children with physical and/or cognitive disability.

CONCLUSIONS

The overall response rate in terms of returned questionnaires was disappointing and inadequate to recommend for implementation. It is possible that response rates would have been higher had clinical follow-up been linked to the data obtained from the questionnaires rather than running as a parallel process.

Eating difficulties in children born late and moderately preterm at 2 y of age: a prospective population-based cohort study

BACKGROUND

Very preterm (<32 wk of gestation) infants are at increased risk of eating difficulties compared with their term-born peers. Little is known about the impact of late and moderately preterm (LMPT; 32-36 wk of gestation) birth on eating difficulties in early childhood.

OBJECTIVES

The aims were to assess the prevalence of eating difficulties in infants born LMPT at 2 y corrected age and to explore the impact of neonatal and neurodevelopmental factors.

DESIGN

A geographic population-based cohort of 1130 LMPT and 1255 term-born controls was recruited at birth. The parents of 651 (59%) LMPT and 771 (62%) term-born infants completed questionnaires at 2 y corrected age to assess neurodevelopmental outcomes. Parents also completed a validated questionnaire to assess eating behaviors in 4 domains: refusal/picky eating, oral motor problems, oral hypersensitivity, and eating behavior problems. Infants with scores >90th percentile were classified with eating difficulties in each domain. Neonatal data were collected at discharge, and sociodemographic information was collected via maternal interview. Poisson regression was used to assess between-group differences in eating difficulties and to explore associations with neonatal factors and neurodevelopmental outcomes at 2 y of age.

RESULTS

In unadjusted analyses, LMPT infants were at increased risk of refusal/picky eating (RR: 1.53; 95% CI: 1.03, 2.25) and oral motor problems (RR: 1.62; 95% CI: 1.06, 2.47). Prolonged nasogastric feeding >2 wk (RR: 1.87; 95% CI: 1.07, 3.25), behavior problems (RR: 2.95; 95% CI: 1.93, 4.52), and delayed social competence (RR: 2.28; 95% CI: 1.49, 3.48) were independently associated with eating difficulties in multivariable analyses. After adjustment for these factors, there was no excess of eating difficulties in LMPT infants.

CONCLUSIONS

Infants born LMPT are at increased risk of oral motor and picky eating problems at 2 y corrected age. However, these are mediated by other neurobehavioral sequelae in this population. This trial was registered on the UK Clinical Research Network Portfolio at http://public.ukcrn.org.uk/search/ as UKCRN Study ID 7441.

Dietary patterns in weight loss maintenance: results from the MedWeight study

PURPOSE

The dietary habits contributing to weight loss maintenance are not sufficiently understood. We studied weight loss maintainers in comparison with regainers, to identify the differentiating behaviors.

METHODS

The MedWeight study is a Greek registry of weight loss maintainers and regainers. Participants had intentionally lost ≥10 % of their weight and either had maintained this loss for over a year, or had regained weight. Questionnaires on demographics and lifestyle habits were completed online. Dietary assessment was carried out by two telephone 24-h recalls.

RESULTS

Present analysis focused on 361 participants (32 years old, 39 % men): 264 maintainers and 97 regainers. Energy and macronutrient intake did not differ by maintenance status (1770 ± 651 kcal in maintainers vs. 1845 ± 678 kcal in regainers, p = 0.338), although protein intake per kg of body weight was higher in maintainers (1.02 ± 0.39 vs. 0.83 ± 0.28 g/kg in regainers, p < 0.001). Physical activity energy expenditure was greater for maintainers in men (by 1380 kcal per week, p = 0.016), but not women. Salty snacks, alcohol and regular soda were more frequently consumed by men regainers. Principal component analysis identified a healthy dietary pattern featuring mainly unprocessed cereal, fruit, vegetables, olive oil and low-fat dairy. Male maintainers were 4.6 times more likely to follow this healthy pattern compared to regainers (OR 4.6, 95 % CI 2.0-11.0). No similar finding was revealed in women. Other characteristics of maintainers but not of regainers were: involvement in meal preparation and eating at home for men, and a higher eating frequency and slower eating rate for women.

CONCLUSIONS

Men maintaining weight loss were much more likely to adhere to a healthy eating pattern. Eating at home, involvement in meal preparation, higher eating frequency and slower eating rate were also associated with maintenance. These lifestyle habits of successful maintainers provide target behaviors to improve obesity treatment.

A randomised controlled trial comparing opt-in and opt-out home visits for tracing lost participants in a prospective birth cohort study

BACKGROUND

Attrition is an important problem in cohort studies. Tracing cohort members who have moved or otherwise lost contact with the study is vital. There is some debate about the acceptability and relative effectiveness of opt-in versus opt-out methods of contacting cohort members to re-engage them in this context. We conducted a randomised controlled trial to compare the two approaches in terms of effectiveness (tracing to confirm address and consenting to continue in the study), cost-effectiveness and acceptability.

METHODS

Participants in this trial were individuals (young people and mothers) recruited to the Avon Longitudinal Study of Parents and Children (ALSPAC), who had not engaged with the study in the previous 5 years and for whom mail had been returned from their last known address. The sampling frame was restricted to those for whom database searching led to a potential new address being found in the Bristol area. 300 participants were randomly selected and assigned using stratified randomisation to the opt-in or opt-out arm. A tailored letter was sent to the potential new address, either asking participants to opt in to a home visit, or giving them the option to opt out of a home visit. Fieldworkers from Ipsos MORI conducted home visits to confirm address details.

RESULTS

The proportion who were traced was higher in the opt-out arm (77/150 = 51 %) than the opt-in arm (6/150 = 4 %), as was the proportion who consented to continue in ALSPAC (46/150 = 31 % v 4/150 = 3 %). The mean cost per participant was £8.14 in the opt-in arm and £71.93 in the opt-out arm. There was no evidence of a difference in acceptability between the opt-in and opt-out approaches.

CONCLUSION

Since the opt-in approach yielded very low response rates, and there were no differences in terms of acceptability, we conclude that the opt-out approach is the most effective method of tracing disengaged study members. The gains made in contacting participants must be weighed against the increase in cost using this methodology.

Neurodevelopmental outcomes following late and moderate prematurity: a population-based cohort study

OBJECTIVE

There is a paucity of data relating to neurodevelopmental outcomes in infants born late and moderately preterm (LMPT; 32(+0)-36(+6) weeks). This paper present the results of a prospective, population-based study of 2-year outcomes following LMPT birth.

DESIGN

1130 LMPT and 1255 term-born children were recruited at birth. At 2 years corrected age, parents completed a questionnaire to assess neurosensory (vision, hearing, motor) impairments and the Parent Report of Children's Abilities-Revised to identify cognitive impairment. Relative risks for adverse outcomes were adjusted for sex, socio-economic status and small for gestational age, and weighted to account for over-sampling of term-born multiples. Risk factors for cognitive impairment were explored using multivariable analyses.

RESULTS

Parents of 638 (57%) LMPT infants and 765 (62%) controls completed questionnaires. Among LMPT infants, 1.6% had neurosensory impairment compared with 0.3% of controls (RR 4.89, 95% CI 1.07 to 22.25). Cognitive impairments were the most common adverse outcome: LMPT 6.3%; controls 2.4% (RR 2.09, 95% CI 1.19 to 3.64). LMPT infants were at twice the risk for neurodevelopmental disability (RR 2.19, 95% CI 1.27 to 3.75). Independent risk factors for cognitive impairment in LMPT infants were male sex, socio-economic disadvantage, non-white ethnicity, preeclampsia and not receiving breast milk at discharge.

CONCLUSIONS

Compared with term-born peers, LMPT infants are at double the risk for neurodevelopmental disability at 2 years of age, with the majority of impairments observed in the cognitive domain. Male sex, socio-economic disadvantage and preeclampsia are independent predictors of low cognitive scores following LMPT birth.

Parental preference and ability to participate in web-based developmental screening and surveillance: preliminary evidence for preterm infants after NICU discharge

OBJECTIVES

The objectives of this article were (a) to describe prevalence of Internet and email access among parents of preterm infants attending high-risk follow-up, (b) to describe parent preference for completing developmental questionnaires online versus on paper, and (c) to examine predictors of access and preference.

DESIGN/METHODS

We surveyed 270 parents of preterm infants attending a high-risk follow-up clinic about Internet and email access, preference for completing a developmental questionnaire online versus on paper.

RESULTS

Median (interquartile range) gestational age was 28 (26, 30) weeks, and birth weight was 970 (765, 1230) grams. Ninety-five percent of parents had Internet and email access, and 71% preferred completing a developmental questionnaire online versus on paper or were indifferent. Less maternal education, lower family income, and Hispanic ethnicity were associated with less Internet and email access.

CONCLUSIONS

Most families attending a high-risk preterm infant follow-up clinic had Internet and email access and preferred completing developmental questionnaires online to on paper or were indifferent.