1
|
Topal Y, Yardımcı-Lokmanoğlu BN, Topuz S, Mutlu A. Early spontaneous movements and spatiotemporal gait characteristics in preterm children. Eur J Pediatr 2023:10.1007/s00431-023-04949-7. [PMID: 37060442 DOI: 10.1007/s00431-023-04949-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 03/16/2023] [Accepted: 03/23/2023] [Indexed: 04/16/2023]
Abstract
This study aimed to analyze spatiotemporal gait characteristics of preterm children from 3 to 4 years of age according to different gestational age groups and to examine the relationship between the detailed general movements assessment and spatiotemporal gait characteristics. A total of 74 preterm children, 32 extremely preterm and very preterm (EP-VP, < 32 weeks gestational age) and 42 moderate to late preterm (MLP, 32 to < 37 weeks gestational age), were included in this prospective study, along with 38 term children. Early spontaneous movements of preterm children were assessed from videos at 9-20 weeks post-term according to the general movements assessment, which determines the Motor Optimality Score-Revised (MOS-R). The spatiotemporal gait characteristics of all children were evaluated using the GAITRite®electronic walkway at self-selected walking speeds. EP-VP children walked with shorter step lengths (p = 0.039), and MLP children walked with greater step length variability (p = 0.003) than their term peers. The MOS-R results were related to step length (r = 0.36, p = 0.042), step length variability (r = -0.56, p = 0.001), and base of support (r = -0.37, p = 0.038) in EP-VP children. The MOS-R subcategories, age-adequate movement repertoire, and postural patterns were related to some of the spatiotemporal gait characteristics, including step length, step length variability, and base of support (p < 0.05). Conclusion: EP-VP and MLP children might catch up to their term peers at 3 to 4 years of age in terms of most gait parameters. In addition to the MOS-R, age-adequate movement repertoire and postural patterns of preterm children without cerebral palsy in early life may be a marker of later neurodevelopmental dysfunction. What is Known: • Preterm children walk with a wider step width, a greater step length asymmetry and step time, and a shorter stride length at 18 to 22 months of age compared with term children at a self-selected speed, while these differences disappear in children 4.5-5 years old and older. What is New: • Early spontaneous movements were related to some spatiotemporal gait characteristics. • Preterm children might catch up to term children at 3-4 years of age in spatiotemporal gait characteristics while walking at a self-selected speed.
Collapse
Affiliation(s)
- Yusuf Topal
- Developmental and Early Physiotherapy Unit, Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Türkiye.
| | - Bilge Nur Yardımcı-Lokmanoğlu
- Developmental and Early Physiotherapy Unit, Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Türkiye
| | - Semra Topuz
- Gait Analysis Laboratory, Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Türkiye
| | - Akmer Mutlu
- Developmental and Early Physiotherapy Unit, Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Türkiye
| |
Collapse
|
2
|
Bisi MC, Fabbri M, Cordelli DM, Stagni R. Gait performance in toddlers born preterm: A sensor based quantitative characterization. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 220:106808. [PMID: 35447429 DOI: 10.1016/j.cmpb.2022.106808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 03/11/2022] [Accepted: 04/09/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND AND OBJECTIVES Preterm children have an increased risk of motor difficulties. Gait analysis and wearable technologies allow the assessment of motor performance in toddlers, identifying early deviations from typical development. Using a sensor-based approach, gait performance of full-term and preterm toddlers at different risk of motor delay was analysed. The aim was to measure quantitative differences among groups. METHODS Twenty-nine two-year old children born preterm (≤36 gestational weeks) and 17 full-term controls, matched for age and walking experience, participated in the study. Preterm children were further divided based on risk of motor delay: preterm at high risk (n = 8, born at ≤28 gestational weeks or with ≤1000 g of body weight), and at moderate risk (n = 21). Children were asked to walk along a corridor while wearing 3 inertial sensors on the lower back and on the ankles. Gait temporal parameters, their variability, and nonlinear metrics of trunk kinematics (i.e. recurrence quantification analysis, multiscale entropy) were extracted from the collected data and compared among groups. RESULTS Children born preterm showed significantly longer stance and double support phases, higher variability of temporal parameters, and lower multiscale entropy values than peers born full-term. No difference was found for the other parameters when comparing preterm and full-term children. When comparing children grouped according to risk of delay, with increasing risk, children showed longer stride-, stance- and double-support-time, higher variability of temporal parameters, higher recurrence- and lower multiscale entropy values. CONCLUSIONS Sensor-based gait analysis allowed differentiating the gait performance of preterm from full-term toddlers, and of preterm toddlers at different risk of motor delay. When analysing the present results with respect to the expected trajectory of locomotor development, children born preterm, in particular those at higher risk of motor delay, exhibited a less mature motor control performance during gait: lower stability (i.e. longer support phases), and higher variability, although not structured towards the exploration of more complex movements (i.e. higher recurrence- and lower multiscale entropy values). These indexes can serve as biomarkers for monitoring locomotor development and early detecting risk to develop persistent motor impairments.
Collapse
Affiliation(s)
- Maria Cristina Bisi
- Department of Electrical, Electronic and Information Engineering, "Guglielmo Marconi" - DEI, University of Bologna, Italy; Interdepartmental Center for Industrial Research - Life Sciences and Health Technologies, University of Bologna, Italy.
| | - Manuela Fabbri
- IRCCS Institute of Neurological Sciences of Bologna, UOC Neuropsychiatry of the Pediatric Age, Bologna, Italy
| | - Duccio Maria Cordelli
- IRCCS Institute of Neurological Sciences of Bologna, UOC Neuropsychiatry of the Pediatric Age, Bologna, Italy; Department of Medical and Surgical Sciences - DIMEC, University of Bologna, Italy
| | - Rita Stagni
- Department of Electrical, Electronic and Information Engineering, "Guglielmo Marconi" - DEI, University of Bologna, Italy; Interdepartmental Center for Industrial Research - Life Sciences and Health Technologies, University of Bologna, Italy
| |
Collapse
|
3
|
Albesher RA, Spittle AJ, Dobson FL, Mentiplay BF, FitzGerald TL, Cameron KL, Zannino D, Josev EK, Doyle LW, Cheong JLY, McGinley JL. Spatiotemporal gait variables and step-to-step variability in preschool-aged children born < 30 weeks' gestation and at term in preferred speed, dual-task paradigm, and tandem walking. Gait Posture 2022; 92:236-242. [PMID: 34883423 DOI: 10.1016/j.gaitpost.2021.11.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 10/12/2021] [Accepted: 11/16/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Children born very preterm (< 32 weeks' gestation) are at greater risk of motor impairment and executive/attentional dysfunctions than term-born children; however, little is known about how functional tasks, including walking, may be affected by very preterm birth. RESEARCH QUESTION How does the gait pattern of preschool-age children born < 30 weeks compare with term-born controls under a variety of walking conditions? METHODS In this prospective cohort study, children born < 30 weeks and at term were assessed at 4.5-5 years' corrected age, blinded to birth group. Four walking conditions were assessed using the GAITRite® system: preferred speed, cognitive dual-task, motor dual-task, and tandem walking. Gait variables analysed included speed, cadence, step length, step time, base of support (BOS), and single and double support time. Spatiotemporal variables were compared between groups using linear regression, adjusting for lower-limb length, corrected age at assessment, and number of trials. RESULTS 224 children (112 < 30 weeks and 112 term-born) were assessed. Gait variables of children born < 30 weeks did not differ from their term-born peers when walking at their preferred speed, except for higher BOS variability (mean difference [MD] = 0.19 cm, 95% confidence interval [CI] 0.10, 0.27, p < 0.001). Under the motor dual-task condition, children born < 30 weeks walked faster (MD= 3.06 cm/s, 95% CI 0.14, 5.97, p = 0.040), with a longer step length (MD= 1.10 cm, 95%CI 0.19, 2.01, p = 0.018), and a wider BOS (MD= 0.37 cm, 95%CI 0.06, 0.67, p = 0.019). In cognitive dual-task and tandem conditions, children born < 30 weeks walked with a wider BOS compared with term-born peers (MD= 0.43 cm, 95%CI 0.05, 0.81, p = 0.028; and MD= 0.30 cm, 95%CI 0.09, 0.51, p = 0.005, respectively). SIGNIFICANCE This research highlights the need to consider the walking performance of preschool-age children born < 30 weeks under challenging conditions, such as dual-task or tandem walking, when assessing gait patterns and planning interventions.
Collapse
Affiliation(s)
- Reem A Albesher
- Victorian Infant Brain Studies, Clinical Sciences, Murdoch Children's Research Institute, The Royal Children's Hospital, Flemington Rd, Parkville, Melbourne 3052, Australia; Department of Physiotherapy, University of Melbourne, Parkville, Melbourne 3053, Australia; Neonatal Research, The Royal Women's Hospital, Parkville, Melbourne 3052, Australia; Department of Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, Riyadh 11564, Saudi Arabia.
| | - Alicia J Spittle
- Victorian Infant Brain Studies, Clinical Sciences, Murdoch Children's Research Institute, The Royal Children's Hospital, Flemington Rd, Parkville, Melbourne 3052, Australia; Department of Physiotherapy, University of Melbourne, Parkville, Melbourne 3053, Australia; Neonatal Research, The Royal Women's Hospital, Parkville, Melbourne 3052, Australia
| | - Fiona L Dobson
- Department of Physiotherapy, University of Melbourne, Parkville, Melbourne 3053, Australia
| | - Benjamin F Mentiplay
- Victorian Infant Brain Studies, Clinical Sciences, Murdoch Children's Research Institute, The Royal Children's Hospital, Flemington Rd, Parkville, Melbourne 3052, Australia; La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne 3086, Australia
| | - Tara L FitzGerald
- Victorian Infant Brain Studies, Clinical Sciences, Murdoch Children's Research Institute, The Royal Children's Hospital, Flemington Rd, Parkville, Melbourne 3052, Australia; Department of Physiotherapy, University of Melbourne, Parkville, Melbourne 3053, Australia; Neonatal Research, The Royal Women's Hospital, Parkville, Melbourne 3052, Australia
| | - Kate L Cameron
- Victorian Infant Brain Studies, Clinical Sciences, Murdoch Children's Research Institute, The Royal Children's Hospital, Flemington Rd, Parkville, Melbourne 3052, Australia; Department of Physiotherapy, University of Melbourne, Parkville, Melbourne 3053, Australia; Neonatal Research, The Royal Women's Hospital, Parkville, Melbourne 3052, Australia
| | - Diana Zannino
- Victorian Infant Brain Studies, Clinical Sciences, Murdoch Children's Research Institute, The Royal Children's Hospital, Flemington Rd, Parkville, Melbourne 3052, Australia; Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Melbourne 3052, Australia
| | - Elisha K Josev
- Department of Paediatrics, University of Melbourne, The Royal Children's Hospital, Melbourne 3052, Australia; Neurodisability and Rehabilitation, Murdoch Children's Research Institute, Melbourne 3052, Australia
| | - Lex W Doyle
- Victorian Infant Brain Studies, Clinical Sciences, Murdoch Children's Research Institute, The Royal Children's Hospital, Flemington Rd, Parkville, Melbourne 3052, Australia; Neonatal Research, The Royal Women's Hospital, Parkville, Melbourne 3052, Australia; Department of Paediatrics, University of Melbourne, The Royal Children's Hospital, Melbourne 3052, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, The Royal Women's Hospital, Melbourne, Victoria 3052, Australia
| | - Jeanie L Y Cheong
- Victorian Infant Brain Studies, Clinical Sciences, Murdoch Children's Research Institute, The Royal Children's Hospital, Flemington Rd, Parkville, Melbourne 3052, Australia; Neonatal Research, The Royal Women's Hospital, Parkville, Melbourne 3052, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, The Royal Women's Hospital, Melbourne, Victoria 3052, Australia
| | - Jennifer L McGinley
- Department of Physiotherapy, University of Melbourne, Parkville, Melbourne 3053, Australia
| |
Collapse
|
4
|
Ito Y, Ito T, Sugiura H, Kidokoro H, Sugiyama Y, Mizusawa J, Natsume J, Noritake K, Kato Y, Ochi N. Physical functions and gait performance in school-aged children born late preterm. Early Hum Dev 2021; 163:105478. [PMID: 34601425 DOI: 10.1016/j.earlhumdev.2021.105478] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 08/29/2021] [Accepted: 09/20/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Children born late preterm (LP) have an increased risk of poor developmental motor outcomes. AIMS This study aimed to assess physical functions and gait performance in school-aged children born LP. STUDY DESIGN Cross-sectional study. SUBJECTS Physical functions and gait performance were evaluated in 277 children aged 6-10 years born LP (n = 22) and full-term (FT) (n = 255). OUTCOME MEASURES Physical function tests consisted of five times sit-to-stand test (FTSST), one-leg standing time, and grip strength. FTSST was used to assess the functional muscle strength of the lower limbs and dynamic balance function. Gait performance tests included gait quality, spatiotemporal gait parameters, and gait variability. Clinical data, physical functions, and gait performance were compared between two groups. Furthermore, logistic regression analysis was performed to assess the association between all variables and LP birth. RESULTS In physical function tests, children born LP showed poorer FTSST than those born FT (p = 0.039). No significant difference in gait performance tests were identified between the two groups. Logistic regression analysis of FTSST for LP (adjusted for age at assessment) revealed that FTSST was significantly associated with LP birth (p = 0.004, odds ratio = 1.579, 95% confidence interval = 1.160-2.149). CONCLUSIONS We demonstrated the physical functions and gait performance in school-aged children born LP. Our findings indicate that it is important to focus on the decreased functional muscle strength of the lower limbs and reduced dynamic balance function related to LP birth to improve functional mobility in children born LP.
Collapse
Affiliation(s)
- Yuji Ito
- Department of Pediatrics, Aichi Prefecture Mikawa Aoitori Medical and Rehabilitation Center for Developmental Disabilities, 9-3 Koyaba, Koryuji-cho, Okazaki, Aichi 444-0002, Japan.
| | - Tadashi Ito
- Three-dimensional motion analysis room, Aichi Prefecture Mikawa Aoitori Medical and Rehabilitation Center for Developmental Disabilities, 9-3 Koyaba, Koryuji-cho, Okazaki, Aichi 444-0002, Japan.
| | - Hideshi Sugiura
- Department of Physical Therapy, Nagoya University Graduate School of Medicine, 1-1-20 Daiko-Minami, Higashi-ku, Nagoya, Aichi 461-8673, Japan.
| | - Hiroyuki Kidokoro
- Department of Pediatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi 466-8550, Japan.
| | - Yuichiro Sugiyama
- Department of Neonatology, Anjo Kosei Hospital, 28 Higashihirokute, Anjo-cho, Anjo, Aichi 446-8602, Japan.
| | - Jun Mizusawa
- Department of Rehabilitation, Aichi Prefecture Mikawa Aoitori Medical and Rehabilitation Center for Developmental Disabilities, 9-3 Koyaba, Koryuji-cho, Okazaki, Aichi 444-0002, Japan.
| | - Jun Natsume
- Department of Pediatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi 466-8550, Japan; Department of Developmental Disability Medicine, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi 466-8550, Japan.
| | - Koji Noritake
- Department of Orthopedic Surgery, Aichi Prefecture Mikawa Aoitori Medical and Rehabilitation Center for Developmental Disabilities, 9-3 Koyaba, Koryuji-cho, Okazaki, Aichi 444-0002, Japan.
| | - Yuichi Kato
- Department of Neonatology, Anjo Kosei Hospital, 28 Higashihirokute, Anjo-cho, Anjo, Aichi 446-8602, Japan.
| | - Nobuhiko Ochi
- Department of Pediatrics, Aichi Prefecture Mikawa Aoitori Medical and Rehabilitation Center for Developmental Disabilities, 9-3 Koyaba, Koryuji-cho, Okazaki, Aichi 444-0002, Japan.
| |
Collapse
|
5
|
Ma Y, Zhang K, Li S, Wang L, Wang T. Biomechanical analysis of gait patterns in children with intellectual disabilities. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2021; 65:912-921. [PMID: 34414625 DOI: 10.1111/jir.12872] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 06/09/2021] [Accepted: 07/13/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Children with intellectual disabilities (ID) typically master walking skills much later than typically developing (TD) children and have poor postural control ability. This study aimed to explore the gait ability and characteristics of children with ID and whether there is any difference in walking ability between them and TD children. METHOD In this study, integrating kinematic-biomechanic-dynamic measurement methods and corresponding analysis methods (video analysis, three-dimensional force analysis and electromyography test analysis) were used to characterise and compare the gait patterns between ID children and TD children. RESULTS ID children's step length/leg length ratio was lower than TD children. The left-leg single-leg support time and step length of ID children were shorter than TD children. While walking, ID children touched the ground with the whole foot pad and could not powerfully thrust against the ground with their toes. Their left legs had obvious disadvantages compared with their right legs. ID children's lower limb muscle strength was lower than TD children, and their thigh muscles had an obvious compensation function. CONCLUSIONS Correcting ID children's gait should be an important teaching goal for physical education institutors and teachers. Muscle-strength and flexibility training can help ID children reinforce core strength and better coordinate lower limbs.
Collapse
Affiliation(s)
- Y Ma
- School of Education, Shaanxi Normal University, Xi'an, China
- Faculty of Education, Beijing Normal University, Beijing, China
| | - K Zhang
- School of Education, Shaanxi Normal University, Xi'an, China
| | - S Li
- School of Teacher Education, West Yunnan University, Lincang, Yunnan, China
| | - L Wang
- School of Psychology, Shaanxi Normal University, Xi'an, China
| | - T Wang
- School of Education, Shaanxi Normal University, Xi'an, China
| |
Collapse
|
6
|
Early developmental screening and intervention for high-risk neonates - From research to clinical benefits. Semin Fetal Neonatal Med 2021; 26:101203. [PMID: 33547000 DOI: 10.1016/j.siny.2021.101203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
With advances in neonatal care there has been an increase in survival rates for infants born very preterm and/or with complex needs, such as those who require major surgery, who may not have survived decades ago. Despite advances in survival, these infants remain at high-risk for a range of neurodevelopmental delays and/or impairments including motor, cognitive and emotional/behavioural challenges. Research has improved our ability to identify which infants are at high-risk of developmental delay and/or impairments, and there is mounting evidence that early interventions can improve outcomes of these infants. However, clinical practice varies throughout the world regarding recommendations for developmental screening. Moreover, intervention, when available, is often not commenced early enough in development. Given limited resources, those infants most at risk of developmental impairments and their families should be targeted, with further research needed on the cost-effectiveness of surveillance and early interventions.
Collapse
|
7
|
Vanden Hole C, Ayuso M, Aerts P, Van Cruchten S, Thymann T, Sangild PT, Van Ginneken C. Preterm Birth Affects Early Motor Development in Pigs. Front Pediatr 2021; 9:731877. [PMID: 34692609 PMCID: PMC8529956 DOI: 10.3389/fped.2021.731877] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 08/26/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Preterm infants frequently show neuromotor dysfunctions, but it is not clear how reduced gestational age at birth may induce developmental coordination disorders. Advancing postnatal age, not only post-conceptional age, may determine neuromuscular development, and early interventions in preterm newborns may improve their later motor skills. An animal model of preterm birth that allows early postnatal detection of movement patterns may help to investigate this hypothesis. Methods: Using pigs as a model for moderately preterm infants, preterm (106-day gestation, equivalent to 90% of normal gestation time; n = 38) and term (115-day gestation, equivalent to 99% of normal gestation time; n = 20) individuals were delivered by cesarean section and artificially reared until postnatal day 19 (preweaning period). The neuromotor skills of piglets were documented using spatiotemporal gait analyses on video recordings of locomotion at self-selected speed at postnatal age 3, 4, 5, 8, and 18 days. Results were controlled for effects of body weight and sex. Results: Both preterm and term piglets reached mature neuromotor skills and performance between postnatal days 3-5. However, preterm pigs took shorter steps at a higher frequency, than term piglets, irrespective of their body size. Within preterm pigs, males and low birth weight individuals took the shortest steps, and with the highest frequency. Conclusion: Postnatal development of motor skills and gait characteristics in pigs delivered in late gestation may show similarity to the compromised development of gait pattern in preterm infants. Relative to term pigs, the postnatal delay in gait development in preterm pigs was only few days, that is, much shorter than the 10-day reduction in gestation length. This indicates rapid postnatal adaptation of gait pattern after reduced gestational age at birth. Early-life physical training and medical interventions may support both short- and long-term gait development after preterm birth in both pigs and infants.
Collapse
Affiliation(s)
- Charlotte Vanden Hole
- Laboratory of Comparative Perinatal Development, Department of Veterinary Sciences, Faculty of Biomedical, Pharmaceutical and Veterinary Sciences, University of Antwerp, Antwerp, Belgium
| | - Miriam Ayuso
- Laboratory of Comparative Perinatal Development, Department of Veterinary Sciences, Faculty of Biomedical, Pharmaceutical and Veterinary Sciences, University of Antwerp, Antwerp, Belgium
| | - Peter Aerts
- Laboratory of Functional Morphology, Department of Biology, Faculty of Sciences, University of Antwerp, Antwerp, Belgium
| | - Steven Van Cruchten
- Laboratory of Comparative Perinatal Development, Department of Veterinary Sciences, Faculty of Biomedical, Pharmaceutical and Veterinary Sciences, University of Antwerp, Antwerp, Belgium
| | - Thomas Thymann
- Comparative Pediatrics and Nutrition, University of Copenhagen, Copenhagen, Denmark
| | - Per Torp Sangild
- Comparative Pediatrics and Nutrition, University of Copenhagen, Copenhagen, Denmark
| | - Chris Van Ginneken
- Laboratory of Comparative Perinatal Development, Department of Veterinary Sciences, Faculty of Biomedical, Pharmaceutical and Veterinary Sciences, University of Antwerp, Antwerp, Belgium
| |
Collapse
|