1
|
Drommelschmidt K, Mayrhofer T, Hüning B, Stein A, Foldyna B, Schweiger B, Felderhoff-Müser U, Sirin S. Incidence of brain injuries in a large cohort of very preterm and extremely preterm infants at term-equivalent age: results of a single tertiary neonatal care center over 10 years. Eur Radiol 2024; 34:5239-5249. [PMID: 38279057 PMCID: PMC11255071 DOI: 10.1007/s00330-024-10592-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 11/30/2023] [Accepted: 12/22/2023] [Indexed: 01/28/2024]
Abstract
OBJECTIVES Cerebral magnetic resonance imaging (cMRI) at term-equivalent age (TEA) can detect brain injury (BI) associated with adverse neurological outcomes in preterm infants. This study aimed to assess BI incidences in a large, consecutive cohort of preterm infants born < 32 weeks of gestation, the comparison between very (VPT, ≥ 28 + 0 to < 32 + 0 weeks of gestation) and extremely preterm infants (EPT, < 28 + 0 weeks of gestation) and across weeks of gestation. METHODS We retrospectively analyzed cMRIs at TEA of VPT and EPT infants born at a large tertiary center (2009-2018). We recorded and compared the incidences of BI, severe BI, intraventricular hemorrhage (IVH), periventricular hemorrhagic infarction (PVHI), cerebellar hemorrhage (CBH), cystic periventricular leukomalacia (cPVL), and punctate white matter lesions (PWML) between VPTs, EPTs, and across weeks of gestation. RESULTS We included 507 preterm infants (VPT, 335/507 (66.1%); EPT, 172/507 (33.9%); mean gestational age (GA), 28 + 2 weeks (SD 2 + 2 weeks); male, 52.1%). BIs were found in 48.3% of the preterm infants (severe BI, 12.0%) and increased with decreasing GA. IVH, PVHI, CBH, cPVL, and PWML were seen in 16.8%, 0.8%, 10.5%, 3.4%, and 18.1%, respectively. EPT vs. VPT infants suffered more frequently from BI (59.3% vs. 42.7%, p < 0.001), severe BI (18.6% vs. 8.7%, p = 0.001), IVH (31.9% vs. 9.0%, p < 0.001), and CBH (18.0% vs. 6.6%, p < 0.001). CONCLUSION Brain injuries are common cMRI findings among preterm infants with a higher incidence of EPT compared to VPT infants. These results may serve as reference values for clinical management and research. CLINICAL RELEVANCE STATEMENT Our results with regard to gestational age might provide valuable clinical insights, serving as a key reference for parental advice, structured follow-up planning, and enhancing research and management within the Neonatal Intensive Care Unit. KEY POINTS • Brain injury is a common cMRI finding in preterm infants seen in 48.3% individuals. • Extremely preterm compared to very preterm infants have higher brain injury incidences driven by brain injuries such as intraventricular and cerebellar hemorrhage. • Reference incidence values are crucial for parental advice and structured follow-up planning.
Collapse
Affiliation(s)
- Karla Drommelschmidt
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care, and Pediatric Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (cTNBS), University Medicine Essen, Essen, Germany
| | - Thomas Mayrhofer
- School of Business Studies, Stralsund, University of Applied Sciences, Stralsund, Germany
- Cardiovascular Imaging Research Center, Department of Radiology, Massachusetts General Hospital - Harvard Medical School, Boston, MA, USA
| | - Britta Hüning
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care, and Pediatric Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (cTNBS), University Medicine Essen, Essen, Germany
| | - Anja Stein
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care, and Pediatric Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (cTNBS), University Medicine Essen, Essen, Germany
| | - Borek Foldyna
- Cardiovascular Imaging Research Center, Department of Radiology, Massachusetts General Hospital - Harvard Medical School, Boston, MA, USA
| | - Bernd Schweiger
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Ursula Felderhoff-Müser
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care, and Pediatric Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (cTNBS), University Medicine Essen, Essen, Germany
| | - Selma Sirin
- Department of Diagnostic Imaging, University Children's Hospital Zürich, University of Zürich, Zürich, Switzerland.
| |
Collapse
|
2
|
Frasch MG, Lear CA, Gunn AJ. When is a potential new screening algorithm ready for translation? Pediatr Res 2023:10.1038/s41390-023-02890-x. [PMID: 37952054 DOI: 10.1038/s41390-023-02890-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 10/26/2023] [Indexed: 11/14/2023]
Affiliation(s)
- Martin G Frasch
- Department of Obstetrics and Gynecology and Institute on Human Development and Disability, University of Washington School of Medicine, Seattle, WA, USA
| | - Christopher A Lear
- Department of Physiology, The University of Auckland, Auckland, New Zealand
| | - Alistair J Gunn
- Department of Physiology, The University of Auckland, Auckland, New Zealand.
| |
Collapse
|
3
|
Deng W, Anastasopoulos S, deRegnier RA, Pouppirt N, Barlow AK, Patrick C, O’Brien MK, Babula S, Sukal-Moulton T, Peyton C, Morgan C, Rogers JA, Lieber RL, Jayaraman A. Protocol for a randomized controlled trial to evaluate a year-long (NICU-to-home) evidence-based, high dose physical therapy intervention in infants at risk of neuromotor delay. PLoS One 2023; 18:e0291408. [PMID: 37725613 PMCID: PMC10508609 DOI: 10.1371/journal.pone.0291408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 08/29/2023] [Indexed: 09/21/2023] Open
Abstract
INTRODUCTION Developmental disabilities and neuromotor delay adversely affect long-term neuromuscular function and quality of life. Current evidence suggests that early therapeutic intervention reduces the severity of motor delay by harnessing neuroplastic potential during infancy. To date, most early therapeutic intervention trials are of limited duration and do not begin soon after birth and thus do not take full advantage of early neuroplasticity. The Corbett Ryan-Northwestern-Shirley Ryan AbilityLab-Lurie Children's Infant Early Detection, Intervention and Prevention Project (Project Corbett Ryan) is a multi-site longitudinal randomized controlled trial to evaluate the efficacy of an evidence-based physical therapy intervention initiated in the neonatal intensive care unit (NICU) and continuing to 12 months of age (corrected when applicable). The study integrates five key principles: active learning, environmental enrichment, caregiver engagement, a strengths-based approach, and high dosage (ClinicalTrials.gov identifier NCT05568264). METHODS We will recruit 192 infants at risk for neuromotor delay who were admitted to the NICU. Infants will be randomized to either a standard-of-care group or an intervention group; infants in both groups will have access to standard-of-care services. The intervention is initiated in the NICU and continues in the infant's home until 12 months of age. Participants will receive twice-weekly physical therapy sessions and caregiver-guided daily activities, assigned by the therapist, targeting collaboratively identified goals. We will use various standardized clinical assessments (General Movement Assessment; Bayley Scales of Infant and Toddler Development, 4th Edition (Bayley-4); Test of Infant Motor Performance; Pediatric Quality of Life Inventory Family Impact Module; Alberta Infant Motor Scale; Neurological, Sensory, Motor, Developmental Assessment; Hammersmith Infant Neurological Examination) as well as novel technology-based tools (wearable sensors, video-based pose estimation) to evaluate neuromotor status and development throughout the course of the study. The primary outcome is the Bayley-4 motor score at 12 months; we will compare scores in infants receiving the intervention vs. standard-of-care therapy.
Collapse
Affiliation(s)
- Weiyang Deng
- Shirley Ryan AbilityLab, Chicago, Illinois, United States of America
| | | | - Raye-Ann deRegnier
- Division of Neonatology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois, United States of America
- Department of Pediatrics (Neonatology), Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Nicole Pouppirt
- Division of Neonatology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois, United States of America
- Department of Pediatrics (Neonatology), Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Ann K. Barlow
- Shirley Ryan AbilityLab, Chicago, Illinois, United States of America
| | - Cheryl Patrick
- Division of Rehabilitative Services, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois, United States of America
| | - Megan K. O’Brien
- Shirley Ryan AbilityLab, Chicago, Illinois, United States of America
- Department of Physical Medicine & Rehabilitation, Feinberg School of Medicine, Northwestern Medicine, Chicago, IL, United States of America
| | - Sarah Babula
- Pathways.org, Shirley Ryan AbilityLab, Chicago, Illinois, United States of America
| | - Theresa Sukal-Moulton
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
| | - Colleen Peyton
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
| | - Catherine Morgan
- Cerebral Palsy Alliance Research Institute, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia
| | - John A. Rogers
- Department of Biomedical Engineering, Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, Illinois, United States of America
- Departments of Materials Science and Engineering, Chemistry, Mechanical Engineering, Electrical Engineering and Computer Science, Northwestern University, Evanston, Illinois, United States of America
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Richard L. Lieber
- Shirley Ryan AbilityLab, Chicago, Illinois, United States of America
- Department of Biomedical Engineering, Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, Illinois, United States of America
- Department of Neuroscience, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
- Jessie Brown Jr., Hines V.A. Medical Center, Hines, Illinois, United States of America
| | - Arun Jayaraman
- Shirley Ryan AbilityLab, Chicago, Illinois, United States of America
- Department of Physical Medicine & Rehabilitation, Feinberg School of Medicine, Northwestern Medicine, Chicago, IL, United States of America
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| |
Collapse
|
4
|
Øberg GK, Sørvoll M, Labori C, Girolami GL, Håkstad RB. A systematic synthesis of qualitative studies on parents' experiences of participating in early intervention programs with their infant born preterm. Front Psychol 2023; 14:1172578. [PMID: 37519356 PMCID: PMC10374197 DOI: 10.3389/fpsyg.2023.1172578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 06/26/2023] [Indexed: 08/01/2023] Open
Abstract
Early intervention programs involving both the parent and the infant born preterm have demonstrated positive effects on developmental outcomes for the children. However, studies have also shown that parental engagement and adherence when implementing intervention programs can be challenging. The aim of this review was to provide a comprehensive description and new insights into key messages gleaned from the parent reports on participating in early intervention with their infant born preterm; knowledge vital to facilitate implementation of early interventions into clinical practice when using a model of direct parent involvement. Early intervention is broadly defined as a multi-interdisciplinary field provided to children from birth to five years of age to foster child health, wellbeing, development, adapting parenting and family function. For this systematic synthesis we define early intervention as programs with specific activities completed with the infant during the first year after birth. We assembled qualitative interview studies on parents' experiences with participation in early intervention and applied Malterud's qualitative systematic meta-synthesis to synthesize and translate the original findings across studies. In the analysis we applied enactive concepts of embodiment, autonomy, participatory sensemaking, and agency. 10 qualitative studies were identified and included. The systematic synthesis reveals how parents' successful and meaningful participation in early intervention programs were facilitated by their "active embodied doing." The "embodied doing" appeared as the basis for the parents' sense-making processes, development of confidence, and the ability for parents to see new possibilities for actions within themselves, with and in the child. In that respect, a perception of mutuality in the interaction between parent, infant and interventionist was central. Consequently, an important consideration when implementing early intervention into clinical practice is to promote embodied parent-infant interactions as well as trust between the parent and the interventionist.
Collapse
Affiliation(s)
- Gunn Kristin Øberg
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway
- Department of Clinical Therapeutic Services, University Hospital North Norway, Tromsø, Norway
| | - Marit Sørvoll
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway
| | - Cathrine Labori
- Department of Clinical Therapeutic Services, University Hospital North Norway, Tromsø, Norway
| | - Gay L. Girolami
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, United States
| | - Ragnhild B. Håkstad
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway
| |
Collapse
|
5
|
Provera A, Neri E, Agostini F. Infant-Directed Speech to 3-Month-Old Severe Preterm Infants: The Influence of Birth Weight and Maternal Depressive Symptoms. Healthcare (Basel) 2023; 11:1807. [PMID: 37372924 DOI: 10.3390/healthcare11121807] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 06/16/2023] [Accepted: 06/19/2023] [Indexed: 06/29/2023] Open
Abstract
Severe premature birth (<32 weeks) is a risk factor for the development of maternal perinatal depression, while also affecting dyadic interactions and child outcomes. Although several studies have examined the impacts of prematurity and depression on early interactions, only a few studies have investigated the features of maternal verbal input. Furthermore, no study has investigated the relationship between the effect of severity of prematurity according to birth weight and maternal input. This study aimed to explore the effects of the severity of preterm birth and postnatal depression on maternal input during early interactions. The study included 64 mother-infant dyads, classified into three groups: 17 extremely low birth weight (ELBW) preterm infants, 17 very low birth weight (VLBW) preterm infants, and 30 full-term (FT) infants. At 3 months postpartum (corrected age for preterm infants), the dyads participated in a 5-min free interaction session. Maternal input was analyzed using the CHILDES system in terms of lexical and syntactic complexity (i.e., word types, word tokens, mean length of the utterance) and functional features. Maternal postnatal depression (MPD) was assessed using the Edinburgh Postnatal Depression Scale. The results showed that in high-risk conditions (i.e., ELBW preterm birth and maternal postnatal depression), maternal input was characterized by a lower frequency of affect-salient speech and a higher proportion of information-salient speech, specifically as directives and questions, suggesting that mothers in these conditions may experience more difficulty in conveying affective content to their infants. Moreover, the more frequent use of questions may reflect an interactive style characterized by a higher level of intrusiveness. These findings provide preliminary evidence of the impacts of prematurity severity and maternal depression on maternal verbal input, highlighting the importance of assessing both factors in clinical practice. Understanding the mechanisms underlying the impacts of prematurity and depression on early interactions may inform the development of tailored interventions aimed at promoting positive parent-infant interactions and child development.
Collapse
Affiliation(s)
- Alessandra Provera
- Department of Psychology "Renzo Canestrari", University of Bologna, 40137 Bologna, Italy
| | - Erica Neri
- Department of Psychology "Renzo Canestrari", University of Bologna, 40137 Bologna, Italy
| | - Francesca Agostini
- Department of Psychology "Renzo Canestrari", University of Bologna, 40137 Bologna, Italy
| |
Collapse
|
6
|
Montgomery C, Setänen S, Kaul YF, Farooqi A, Broström L, Aden U, Källén K, Serenius F. Predictive value of Bayley-III Motor Index for later motor difficulties in children born extremely preterm. Acta Paediatr 2023; 112:742-752. [PMID: 36723223 DOI: 10.1111/apa.16694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 12/21/2022] [Accepted: 01/30/2023] [Indexed: 02/02/2023]
Abstract
AIM To investigate the predictive ability of the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III) Motor Index, in children born extremely preterm (<27 gestational weeks) without cerebral palsy. METHODS Children from the EXPRESS study (all extremely preterm births in Sweden, 2004-2007) without neurosensory impairments assessed with Bayley-III at 2.5 years corrected age and Movement Assessment Battery for Children, Second Edition (MABC-2), at 6.5 years comprised the eligible study population (n = 282). Motor difficulty was defined as MABC-2 ≤5th percentile. RESULTS Motor difficulties were found in 57 of 282 children (20.2%) at 6.5 years. The Bayley-III explained 18.0% of the variance in the MABC-2 (p < 0.001). The area under the receiver operating curve was 0.71 (95% confidence interval 0.64-0.79, p < 0.001). At a Bayley-III cut-off value of 85, sensitivity, specificity and positive and negative predictive values for motor difficulties were 26.3% (15.5-39.7), 92.9% (88.1-95.9), 48.4% (33.0-64.0) and 83.3% (80.9-85.4). Likelihood ratios were inconclusive. CONCLUSION The Bayley-III at 2.5 years corrected age was a modest predictor of motor outcome in children born extremely preterm at 6.5 years, and underestimated the rate of motor difficulties. Children require follow-up beyond preschool age.
Collapse
Affiliation(s)
- Cecilia Montgomery
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Sirkku Setänen
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | | | - Aijaz Farooqi
- Department of Neonatology: Child and Adolescent Medicine, Umeå University Hospital, Umeå, Sweden
| | - Lina Broström
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Ulrika Aden
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Karin Källén
- Department of Clinical Sciences, Lund University, Lund, Sweden.,Department of Obstetrics and Gynecology, Lund University, Lund, Sweden
| | - Fredrik Serenius
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| |
Collapse
|
7
|
Abstract
Early childhood affords rapid brain development and advancement of the motor system. In High-Risk Infant Follow-Up programs, watchful waiting and monitoring of infants at high risk is shifting toward active surveillance and early diagnosis, followed by immediate targeted very early interventions. Infants with delayed motor skills benefit from developmental care, NIDCAP, and generic or specific motor training. Infants with cerebral palsy benefit from enrichment, targeted skills interventions, and task-specific motor training at high intensity. Infants with degenerative conditions benefit from enrichment but also require accommodations such as powered mobility.
Collapse
Affiliation(s)
- Lynda McNamara
- The Children's Hospital Westmead Clinical School, The University of Sydney, Locked Bag 4001, Westmead, Sydney, NSW 2145, Australia
| | - Catherine Morgan
- Cerebral Palsy Alliance Research Institute, Specialty of Child and Adolescent Health, Sydney Medical School, The University of Sydney, PO Box 171, Forestville, Sydney, NSW 2006, Australia
| | - Iona Novak
- Cerebral Palsy Alliance Research Institute, Specialty of Child and Adolescent Health, Sydney Medical School, The University of Sydney, PO Box 171, Forestville, Sydney, NSW 2006, Australia.
| |
Collapse
|
8
|
McCarty DB, Letzkus L, Attridge E, Dusing SC. Efficacy of Therapist Supported Interventions from the Neonatal Intensive Care Unit to Home: A Meta-Review of Systematic Reviews. Clin Perinatol 2023; 50:157-178. [PMID: 36868703 DOI: 10.1016/j.clp.2022.10.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
Infants born preterm or with complicated medical conditions requiring care in the neonatal intensive care unit (NICU) are at high risk for long-term developmental disabilities. The transition from NICU to early intervention/outpatient settings results in a disruptive gap in a therapeutic intervention during a period of maximal neuroplasticity and development. This meta-review evaluated evidence from existing systematic reviews regarding therapeutic interventions that start in the NICU and continue at home with the goal of improving developmental outcomes for infants at high risk for cerebral palsy. We also evaluated the impact of these interventions on parents' mental health outcomes.
Collapse
Affiliation(s)
- Dana B McCarty
- Division of Physical Therapy, Department of Health Sciences, The University of North Carolina at Chapel Hill, 3024 Bondurant Hall, CB#7135, Chapel Hill, NC 27599-7135, USA
| | - Lisa Letzkus
- Division of Neurodevelopmental and Behavioral Pediatrics, Department of Pediatrics, University of Virginia, 101 Hospital Drive, Charlottesville, VA, 22903 USA
| | - Elaine Attridge
- Claude Moore Health Sciences Library, University of Virginia, PO Box 800722, Charlottesville, VA 22908, USA
| | - Stacey C Dusing
- Division of Biokinesiology and Physical Therapy, University of Southern California, 1540 East Alcazar Street, CHP 155, Los Angeles CA 90033, USA.
| |
Collapse
|
9
|
Øberg GK, Handegård BH, Campbell SK, Ustad T, Fjørtoft T, Kaaresen PI, Girolami GL. Two-year motor outcomes associated with the dose of NICU based physical therapy: The Noppi RCT. Early Hum Dev 2022; 174:105680. [PMID: 36183567 DOI: 10.1016/j.earlhumdev.2022.105680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 09/21/2022] [Accepted: 09/22/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Interventions involving both the parent and the preterm infant have demonstrated lasting effects on cognitive outcomes, but motor effects are less salient. It remains unclear when to commence early intervention and if dosages have impact on motor outcomes. AIMS To examine the effect on motor performance at 24-months corrected age following a parent-administered intervention performed with infants born preterm in the NICU. Intervention dosing and longitudinal motor performance were also analyzed. STUDY DESIGN Single-blinded randomized multicenter clinical trial. SUBJECTS 153 infants born, gestational age ≤ 32 weeks at birth, were randomized into intervention or control group. OUTCOME MEASURES Infant Motor Performance Screening Test, Test of Infant Motor Performance, Peabody Developmental Motor Scales-2. RESULTS No significant difference was found between the intervention and the control group assessed with the PDMS-2 at 24-months CA. However, a significant positive association was found between dosing and the Gross Motor and Total Motor PDMS-2 scores. Analysis of longitudinal motor performance showed a decreasing motor performance between 6- and 24-months corrected age in both groups. CONCLUSIONS There was no difference in motor performance between groups at 24-months corrected age. However, increased intervention dosage was positively associated with improved motor outcome.
Collapse
Affiliation(s)
- Gunn Kristin Øberg
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway; Department of Clinical Therapeutic Services, University Hospital North Norway, Tromsø, Norway.
| | - Bjørn Helge Handegård
- Regional Center for Child and Youth Mental Health and Child Welfare, UiT the Arctic University of Norway, Tromsø, Norway.
| | - Suzann K Campbell
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA.
| | - Tordis Ustad
- Department of Clinical Services, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway; Department of Clinical and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Toril Fjørtoft
- Department of Clinical Services, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway; Department of Clinical and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Per Ivar Kaaresen
- Pediatric and Adolescent Department, University Hospital North Norway HF, Norway; Department of Clinical Medicine, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway.
| | - Gay L Girolami
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA.
| |
Collapse
|
10
|
Pedersen MRL, Hansen AF. Interventions by Caregivers to Promote Motor Development in Young Children, the Caregivers' Attitudes and Benefits Hereof: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11543. [PMID: 36141815 PMCID: PMC9517187 DOI: 10.3390/ijerph191811543] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/10/2022] [Accepted: 09/11/2022] [Indexed: 06/16/2023]
Abstract
In the first year of life, the child's caregivers, including parents and daycare staff, play an essential role, as they are responsible for implementing daily activities to promote the motor development of young children. However, what does the research show about interventions to promote the motor development of 0-36-month-olds carried out by the child's caregivers, and what are the caregivers' experiences and attitudes hereof? This scoping review aims to provide an overview of the published studies to derive an overall interpretation. A systematic search was conducted in five scientific databases, resulting in 10,219 articles, of which 9 met the inclusion criteria. The results indicate that providing early intervention to 0-36-month-old children, in which the caregivers carry out the activities, promotes the young child's motor development. Furthermore, the interventions increase the caregivers' interest and motivation to promote the young child's motor development, which is essential in maintaining the behaviour after the end of the interventions. Supervision and guidance provided for the child's caregivers concerning knowledge and skills about age-appropriate behaviours and facilitation of their child's motor development increases the caregivers' self-confidence, interest, and motivation.
Collapse
Affiliation(s)
- Marlene Rosager Lund Pedersen
- Department of Sports Science and Clinical Biomechanics, Faculty of Health Sciences, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark
| | - Anne Faber Hansen
- Department of Research and Analysis, University Library of Southern Denmark, 5230 Odense M, Denmark
| |
Collapse
|
11
|
Neurodevelopmental consequences of preterm punctate white matter lesions: a systematic review. Pediatr Res 2022; 93:1480-1490. [PMID: 36085366 DOI: 10.1038/s41390-022-02232-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 07/11/2022] [Accepted: 07/18/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To evaluate punctate white matter lesion (PWML) influence in preterm infants on the long-term neurodevelopmental outcome (NDO). METHODS PubMed and EMBASE were searched from January 1, 2000, to May 31, 2021. Studies were included in which PWML in preterm infants on MRI around term-equivalent age (TEA) and NDO at ≥12 months were reported. Study and patient characteristics and NDO on motor, cognitive, and behavioral domains were extracted. The quality of studies was assessed using the Cochrane-approved Quality in Prognosis Studies tool. RESULTS This analysis included nine studies with a total of 1655 patients. Mean incidence of isolated PWML was 22.1%. All studies showed a relationship between PWML and motor delay. Two studies found a significant correlation between cognitive and behavioral outcomes and PWML. Number and PWML location are related to severity and impairment types. LIMITATIONS PWML were not always separately described from generalized WMI, only studies with imaging around TEA were included, and studies were heterogenic in design and quality. CONCLUSIONS PWML is common in preterm infants and predictive of adverse NDO, in particular on motor outcomes and less on cognitive and behavioral outcomes. The type and severity of impairments are related to the number and location of PMWL. IMPACT PWML is common in preterm infants and seems predictive of adverse NDO. DWI and SWI MRI sequences are informative because the different patterns suggest a difference in the underlying pathology. The type and severity of impairments are related to the number and location of PMWL. Our review can inform clinicians and parents about the NDO of preterm infants with a diagnosis of PWML. Prospective neuroimaging case-control cohort studies are recommended.
Collapse
|
12
|
Intervención temprana en la unidad de cuidado intensivo neonatal con seguimiento en casa dirigidas a las habilidades motoras de niños prematuros. MOVIMIENTO CIENTÍFICO 2022. [DOI: 10.33881/2011-7191.mct.15206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Introducción: La prematurez es una importante causa de morbimortalidad perinatal asociado a un mayor riesgo neurológico esto debido a que entre las semanas 20 y 37 de gestación ocurre un rápido crecimiento cortical, particularmente de las áreas sensoriomotoras lo cual afecta potencialmente el neurodesarrollo. Desde diferentes campos se han propuesto estrategias que buscan prevenir que el cerebro sea lesionado por la estimulación intensa y dolorosa conocidas como “Cuidados centrados en el desarrollo”. Sin embargo, se reporta escasa literatura disponible a nivel nacional que proporcione evidencia de la efectividad de la intervención temprana que favorezca el desarrollo de las habilidades motoras de los bebés en la Unidad de Cuidado intensivo neonatal (UCIN). Por lo cual, el objetivo de este estudio es conocer las estrategias de intervención temprana utilizadas para mejorar las habilidades motoras en bebés prematuros según lo reportado en la literatura. Método: Se llevó a cabo una revisión de literatura en 3 bases de datos (Scopus, Clinicalkey y ScienceDirect) durante los años 2016 a 2020. Resultados: Se revisaron 7 artículos cuyo idioma prevalente es el inglés sobre estrategias de intervención que inician en la UCIN y continúan con seguimiento en el hogar. Conclusiones: En algunos estudios no se logra evidenciar claramente una dosificación de las intervenciones realizadas. A su vez, la participación activa de los padres es fundamental para la adquisición de habilidades motoras en esta población, donde el fisioterapeuta es primordial en el entrenamiento, guía y acompañamiento del proceso con la familia.
Collapse
|
13
|
Ochandorena-Acha M, Terradas-Monllor M, López Sala L, Cazorla Sánchez ME, Fornaguera Marti M, Muñoz Pérez I, Agut-Quijano T, Iriondo M, Casas-Baroy JC. Early Physiotherapy Intervention Program for Preterm Infants and Parents: A Randomized, Single-Blind Clinical Trial. CHILDREN 2022; 9:children9060895. [PMID: 35740832 PMCID: PMC9222162 DOI: 10.3390/children9060895] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/11/2022] [Accepted: 06/13/2022] [Indexed: 11/20/2022]
Abstract
Background: The early developmental interventions might be designed with a preventative approach to improving the development of at-risk preterm infants. The present study aimed to evaluate the effectiveness of an early physiotherapy intervention on preterm infants’ motor and global development, and on parents’ stress index. Methods: 48 infants were enrolled and randomized into two groups. Infants allocated to the intervention group received an early physiotherapy intervention, based on parental education sessions and tactile and kinesthetic stimulation during the NICU period, as well as a home-based activity program. The intervention commenced after 32 weeks post-menstrual age and ended at 2 months corrected age. Infants allocated to the control group received the usual care based on the NIDCAP-care. Results: No differences were found between groups on the Alberta Infant Motor Scale at 2- or 8-months corrected age. Infants in the intervention group showed more optimal fine motor, problem-solving, personal-social, and communication development at 1 month corrected age. Conclusions: The results showed no effect on the early physiotherapy intervention. Results might be related to the dose or intensity of the intervention, but also to the poor parental compliance. ClinicalTrials.gov NCT03313427.
Collapse
Affiliation(s)
- Mirari Ochandorena-Acha
- Research Group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVIC-UCC), C.Sagrada Família, 7, 08500 Vic, Barcelona, Spain; (M.O.-A.); (J.C.C.-B.)
- Sant Joan de Deu Barcelona Children’s Hospital, Passeig de Sant Joan de Déu, 2, 08950 Esplugues de Llobregat, Barcelona, Spain; (L.L.S.); (M.E.C.S.); (M.F.M.); (I.M.P.); (T.A.-Q.); (M.I.)
| | - Marc Terradas-Monllor
- Research Group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVIC-UCC), C.Sagrada Família, 7, 08500 Vic, Barcelona, Spain; (M.O.-A.); (J.C.C.-B.)
- Pain Medicine Section, Anaesthesiology Department, Hospital Clínic de Barcelona, 08036 Barcelona, Catalonia, Spain
- Correspondence:
| | - Laura López Sala
- Sant Joan de Deu Barcelona Children’s Hospital, Passeig de Sant Joan de Déu, 2, 08950 Esplugues de Llobregat, Barcelona, Spain; (L.L.S.); (M.E.C.S.); (M.F.M.); (I.M.P.); (T.A.-Q.); (M.I.)
| | - Maria Engracia Cazorla Sánchez
- Sant Joan de Deu Barcelona Children’s Hospital, Passeig de Sant Joan de Déu, 2, 08950 Esplugues de Llobregat, Barcelona, Spain; (L.L.S.); (M.E.C.S.); (M.F.M.); (I.M.P.); (T.A.-Q.); (M.I.)
| | - Montserrat Fornaguera Marti
- Sant Joan de Deu Barcelona Children’s Hospital, Passeig de Sant Joan de Déu, 2, 08950 Esplugues de Llobregat, Barcelona, Spain; (L.L.S.); (M.E.C.S.); (M.F.M.); (I.M.P.); (T.A.-Q.); (M.I.)
| | - Isabel Muñoz Pérez
- Sant Joan de Deu Barcelona Children’s Hospital, Passeig de Sant Joan de Déu, 2, 08950 Esplugues de Llobregat, Barcelona, Spain; (L.L.S.); (M.E.C.S.); (M.F.M.); (I.M.P.); (T.A.-Q.); (M.I.)
| | - Thais Agut-Quijano
- Sant Joan de Deu Barcelona Children’s Hospital, Passeig de Sant Joan de Déu, 2, 08950 Esplugues de Llobregat, Barcelona, Spain; (L.L.S.); (M.E.C.S.); (M.F.M.); (I.M.P.); (T.A.-Q.); (M.I.)
| | - Martín Iriondo
- Sant Joan de Deu Barcelona Children’s Hospital, Passeig de Sant Joan de Déu, 2, 08950 Esplugues de Llobregat, Barcelona, Spain; (L.L.S.); (M.E.C.S.); (M.F.M.); (I.M.P.); (T.A.-Q.); (M.I.)
| | - Joan Carles Casas-Baroy
- Research Group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVIC-UCC), C.Sagrada Família, 7, 08500 Vic, Barcelona, Spain; (M.O.-A.); (J.C.C.-B.)
| |
Collapse
|
14
|
Aranha VP, Chahal A, Bhardwaj AK. A randomized controlled trial protocol in modifying neuromotor behavior of hospitalized preterm neonates using multimodal stimulations: MMS trial. J Pediatr Rehabil Med 2022; 15:459-468. [PMID: 35848042 DOI: 10.3233/prm-200752] [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] [Indexed: 11/15/2022] Open
Abstract
PURPOSE Noxious sensory inputs from the neonatal Intensive Care Unit (NICU) and lack of placental support negatively impact neuronal organization which has implications later in life. Evidence regarding early interventions (EI) on preterm neonates (PN) at high risk for developmental motor disorders is limited and inconclusive. This study focuses on neuromotor changes following Multimodal stimulations (MMS) with sensory and motor interventions among stable hospitalized PNs. METHODS This single-center, non-blinded pre-test post-test control group study will recruit 60 PNs admitted to the Level II and III NICU of a recognized tertiary care teaching hospital by convenience sampling method into two groups by block randomization. Group A (n = 30) will receive MMS trial lasting for 30 minutes per session for five days per week, until discharge of the neonate from the NICU; Group B (n = 30) will receive regular lifesaving care from the NICU. Anthropometric evaluation, physiological status, and Infant Neurological International Battery (INFANIB) will be the outcome measures used to analyze the neuromotor behavioral modifications among the hospitalized PNs. All the outcome measures will be recorded at baseline, after every five days (to compare trajectories of scores between the groups), and at the end of the intervention at the time of discharge of neonate from the NICU. RESULTS Demographic and outcome measures will be assessed for their normality using the Shapiro-Wilk test. Within and between-group comparisons will be analyzed by the repeated measures analysis of variance/Friedman test and independent t-test/Mann-Whitney U test respectively. CONCLUSION MMS, which includes both sensory and motor interventions, will, to the best of the authors' knowledge, be the first trial for modifying the neuromotor behavior of hospitalized PNs. If successful, the clinical effects of this protocol could be revolutionary in mitigating developmental impairments of PNs.
Collapse
Affiliation(s)
- Vencita P Aranha
- Department of Pediatric and Neonatal Physiotherapy, Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation, Maharishi Markandeshwar (Deemed to be University), Mullana, Haryana, India
| | - Aksh Chahal
- Department of Sports Physiotherapy, Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation, Maharishi Markandeshwar (Deemed to be University), Mullana, Haryana, India
| | - Anand K Bhardwaj
- Department of Pediatrics, Maharishi Markandeshwar Institute of Medical Sciences and Research, Maharishi Markandeshwar (Deemed to be University), Mullana, Haryana, India
| |
Collapse
|
15
|
Pedersen MRL, Stougaard MS, Ibsen B. Transferring Knowledge on Motor Development to Socially Vulnerable Parents of Infants: The Practice of Health Visitors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312425. [PMID: 34886151 PMCID: PMC8657119 DOI: 10.3390/ijerph182312425] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 11/18/2021] [Accepted: 11/22/2021] [Indexed: 11/16/2022]
Abstract
Parents are a determinant factor in a child’s development of motor skills. Studies show that programmes in which health visitors supervise parents may improve infants’ motor skills. This study examines which factors health visitors have found to enhance and hamper the implementation of a motor development programme among socially vulnerable parents of infants. The data consist of three group interviews with 4 health visitors in each (12 health visitors in total) and a subsequent member check with 27 health visitors. All were audio-recorded and transcribed verbatim, and a thematic analysis was conducted. The results show that according to the health visitors, the programme increases the ability and willingness of parents to engage in co-producing its implementation. In particular, the materials that they hand out to the parents enhance the implementation. On the other hand, they perceive the limited time provided for the implementation, together with the many pressing needs of the families, as hampering the implementation. Consequently, the study can inform future policies and programmes for frontline workers and socially vulnerable parents of infants.
Collapse
Affiliation(s)
- Marlene Rosager Lund Pedersen
- Centre for Sports, Health and Civil Society, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230 Odense, Denmark;
- Correspondence:
| | - Marianne Staal Stougaard
- Department of Health, Social Work, and Welfare Research, UCL University College, Niels Bohrs Allé 1, 5230 Odense, Denmark;
| | - Bjarne Ibsen
- Centre for Sports, Health and Civil Society, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230 Odense, Denmark;
| |
Collapse
|
16
|
Maria A, Upadhyay S, Vallomkonda N. Nurturing Beyond the Womb — Early Intervention Practices in Newborn Care Unit. Indian Pediatr 2021. [DOI: 10.1007/s13312-021-2357-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
17
|
Developmentally Supportive Positioning Policy for Preterm Low Birth Weight Infants in a Tertiary Care Neonatal Unit: A Quality Improvement Initiative. Indian Pediatr 2021. [PMID: 33408277 PMCID: PMC8384090 DOI: 10.1007/s13312-021-2281-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/30/2022]
Abstract
Objective Methods Results Conclusions
Collapse
|
18
|
Risk Factors of Growth Retardation and Developmental Deficits in Very Preterm Infants in a German Tertiary Neonatal Unit. CHILDREN-BASEL 2021; 8:children8050394. [PMID: 34068894 PMCID: PMC8156291 DOI: 10.3390/children8050394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 05/11/2021] [Accepted: 05/13/2021] [Indexed: 11/16/2022]
Abstract
Over the last two decades, improvements in perinatology have led to increased survival rates of preterm infants. A large number of studies and meta-analyses have investigated of preterm infants and/or the influence of developmental care. However, the combined influence of the most frequent risk factors and developmental care on the long-term somatic, motor, and cognitive outcome of preterm infants remains unclear. This retrospective, single-center cohort study includes 256 children treated in a tertiary neonatal intensive care unit in Rostock, Germany, between 2008 and 2013. Follow-up examinations (somatic, psychomotor, and mental development) were performed at (corrected) 24 months using Bayley Scales of Infant Development II (BSID-II). Developmental care was carried out according to the legal framework and national guidelines (physiotherapy and/or early education). Bronchopulmonary dysplasia (BPD) and an exclusive formula feeding showed a 2.8–4.6-fold higher risk (95% Confidence Interval: Mental Developmental Index 1.73–7.58; Psychomotor Developmental Index 1.44–14.54; body length 1.20–6.41) for developmental deficits (mental and psychomotor developmental index; body length). Developmental care after discharge according to national guidelines did not prevent this. Since this is a retrospective pilot study, no recommendations can be made based on this analysis. Therefore, future research should evaluate whether standard developmental care should be extended by tailored measures depending on individual risk factors.
Collapse
|
19
|
Fourdain S, Simard MN, Dagenais L, Materassi M, Doussau A, Goulet J, Gagnon K, Prud'Homme J, Vinay MC, Dehaes M, Birca A, Poirier NC, Carmant L, Gallagher A. Gross Motor Development of Children with Congenital Heart Disease Receiving Early Systematic Surveillance and Individualized Intervention: Brief Report. Dev Neurorehabil 2021; 24:56-62. [PMID: 31928274 DOI: 10.1080/17518423.2020.1711541] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Purpose: This retrospective study aims to describe the gross motor development of children aged 4 to 24 months with congenital heart disease (CHD) enrolled in a systematic developmental follow-up program and to describe the frequency of physical therapy sessions they received between 4 and 8 months of age. Methods: Twenty-nine infants with CHD underwent motor evaluations using the AIMS at 4 months, and the Bayley-III at 12 and 24 months. Results: Based on AIMS, 79% of 4-month-old infants had a gross motor delay and required physical therapy. Among these, 56.5% received one to two physical therapy sessions, and 43.5% received three to six sessions. Infants who benefited from regular interventions tended to show a better improvement in motor scores from 12 to 24 months. Conclusion: This study highlights the importance of early motor screening in infants with CHD and suggests a potential benefit of early physical therapy in at-risk children. Abbreviations: CHD: Congenital heart disease; AIMS: Alberta Infant Motor Scales; Bayley-III: Bayley Scales of Infant and Toddler Development, Third edition; Bayley-III/GM: Gross Motor section of the Bayley Scales of Infant and Toddler Development, Third edition.
Collapse
Affiliation(s)
- Solène Fourdain
- Sainte-Justine University Hospital Research Center , Montreal, Quebec, Canada.,University of Montreal , Montreal, Quebec, Canada
| | - Marie-Noëlle Simard
- Sainte-Justine University Hospital Research Center , Montreal, Quebec, Canada.,University of Montreal , Montreal, Quebec, Canada.,Clinique d'investigation neurocardiaque (CINC), Sainte-Justine University Hospital Center , Montreal, Quebec, Canada
| | - Lynn Dagenais
- Clinique d'investigation neurocardiaque (CINC), Sainte-Justine University Hospital Center , Montreal, Quebec, Canada
| | - Manuela Materassi
- Clinique d'investigation neurocardiaque (CINC), Sainte-Justine University Hospital Center , Montreal, Quebec, Canada
| | - Amélie Doussau
- Clinique d'investigation neurocardiaque (CINC), Sainte-Justine University Hospital Center , Montreal, Quebec, Canada
| | | | - Karine Gagnon
- Clinique d'investigation neurocardiaque (CINC), Sainte-Justine University Hospital Center , Montreal, Quebec, Canada
| | - Joëlle Prud'Homme
- Clinique d'investigation neurocardiaque (CINC), Sainte-Justine University Hospital Center , Montreal, Quebec, Canada
| | - Marie-Claude Vinay
- Clinique d'investigation neurocardiaque (CINC), Sainte-Justine University Hospital Center , Montreal, Quebec, Canada
| | - Mathieu Dehaes
- Sainte-Justine University Hospital Research Center , Montreal, Quebec, Canada.,University of Montreal , Montreal, Quebec, Canada.,Clinique d'investigation neurocardiaque (CINC), Sainte-Justine University Hospital Center , Montreal, Quebec, Canada
| | - Ala Birca
- Sainte-Justine University Hospital Research Center , Montreal, Quebec, Canada.,University of Montreal , Montreal, Quebec, Canada.,Clinique d'investigation neurocardiaque (CINC), Sainte-Justine University Hospital Center , Montreal, Quebec, Canada
| | - Nancy C Poirier
- Sainte-Justine University Hospital Research Center , Montreal, Quebec, Canada.,University of Montreal , Montreal, Quebec, Canada.,Clinique d'investigation neurocardiaque (CINC), Sainte-Justine University Hospital Center , Montreal, Quebec, Canada
| | - Lionel Carmant
- Sainte-Justine University Hospital Research Center , Montreal, Quebec, Canada.,University of Montreal , Montreal, Quebec, Canada.,Clinique d'investigation neurocardiaque (CINC), Sainte-Justine University Hospital Center , Montreal, Quebec, Canada
| | - Anne Gallagher
- Sainte-Justine University Hospital Research Center , Montreal, Quebec, Canada.,University of Montreal , Montreal, Quebec, Canada.,Clinique d'investigation neurocardiaque (CINC), Sainte-Justine University Hospital Center , Montreal, Quebec, Canada
| |
Collapse
|
20
|
Baumann N, Tresilian J, Wolke D. Effects of infant motor problems and treatment with physiotherapy on child outcomes at school-age. Early Hum Dev 2020; 149:105140. [PMID: 32738517 DOI: 10.1016/j.earlhumdev.2020.105140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 07/17/2020] [Accepted: 07/20/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Early motor coordination problems have previously been associated with various developmental outcomes at school-age. AIMS Investigate whether and how treatment with physiotherapy may alter associations between early motor problems and subsequent developmental outcomes. STUDY DESIGN A prospective whole-population study. SUBJECTS 1374 children were followed from birth to 8 years. OUTCOME MEASURES Early motor functioning was determined with standard neurological examinations at birth and at 5 months. Information on receipt of physiotherapy was collected through parent interviews at 5, 20 and 56 months. Developmental outcomes at 6 and 8 years included motor skills, mental health, cognitive function, and attention regulation and were determined through standard tests, parent reports and observed behavior ratings. RESULTS Early motor problems were associated with lower motor skills, cognitive function, and attention regulation at school-age, but not with mental health. In addition to early motor problems, receipt of physiotherapy was independently and negatively related to outcomes at school-age. Accounting for imbalances in covariates, including initial motor scores, via propensity score matching attenuated the adverse effects of receipt of physiotherapy on school-aged outcomes. CONCLUSIONS Infant motor problems are associated with motor and cognitive outcomes at school-age. Early motor problems may represent a starting point of a trajectory of difficulties that may lead to a higher risk of problems in multiple developmental domains. No evidence for a beneficial effect of treatment with physiotherapy was found.
Collapse
Affiliation(s)
- Nicole Baumann
- Department of Psychology, University of Warwick, Coventry, United Kingdom.
| | - James Tresilian
- Department of Psychology, University of Warwick, Coventry, United Kingdom
| | - Dieter Wolke
- Department of Psychology, University of Warwick, Coventry, United Kingdom; Warwick Medical School, University of Warwick, Coventry, United Kingdom
| |
Collapse
|
21
|
Pek JH, Yap BJ, Gan MY, Seethor STT, Greenberg R, Hornik CPV, Tan B, Lee JH, Chong SL. Neurocognitive impairment after neonatal sepsis: protocol for a systematic review and meta-analysis. BMJ Open 2020; 10:e038816. [PMID: 32532785 PMCID: PMC7295426 DOI: 10.1136/bmjopen-2020-038816] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 05/11/2020] [Accepted: 05/18/2020] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION The effect of neonatal sepsis on the developing brain is not well documented. We aim to perform evidence synthesis to determine the outcome of neurodevelopmental impairment and intellectual disability among survivors of neonatal sepsis. The data gathered will inform on the long-term neurocognitive outcomes of neonates with sepsis and the measures used to document their developmental disability. METHODS AND ANALYSIS We will perform a search based on the following parameters: neonates and infants less than 90 days old diagnosed with sepsis who had neurocognitive outcomes or measures of developmental disability reported. We will search PubMed, Cochrane Central, Embase and Web of Science for articles in English language published between January 2010 and December 2019. Clinical trials and observational studies will be included. Two independent reviewers will screen studies for eligibility. Data extraction will then be performed using a standardised form. The quality of evidence and risk of bias will be assessed using Cochrane Collaboration's tool and Risk of Bias in Non-randomised Studies of Intervention (ROBINS-I). The results will be synthesised qualitatively and pooled for meta-analysis. ETHICS AND DISSEMINATION No formal ethical approval is required as there is no collection of primary data. This systematic review and meta-analysis will be disseminated through conference meetings and peer-reviewed publications. PROSPERO REGISTRATION NUMBER Registration submitted CRD42020164334.
Collapse
Affiliation(s)
- Jen Heng Pek
- Department of Emergency Medicine, Sengkang General Hospital, Singapore
| | - Bei Jun Yap
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ming Ying Gan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Rachel Greenberg
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Christoph Paul Vincent Hornik
- Division of Quantitative Sciences, Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Bobby Tan
- Department of Emergency Medicine, KK Women's and Children's Hospital, Singapore
| | - Jan Hau Lee
- Children's Intensive Care Unit, KK Women's and Children's Hospital, Duke-NUS Medical School, Singapore
| | - Shu-Ling Chong
- Department of Emergency Medicine, KK Women's and Children's Hospital, Singapore
| |
Collapse
|
22
|
Engan M, Engeseth MS, Fevang S, Vollsæter M, Eide GE, Røksund OD, Halvorsen T, Clemm H. Predicting physical activity in a national cohort of children born extremely preterm. Early Hum Dev 2020; 145:105037. [PMID: 32438296 DOI: 10.1016/j.earlhumdev.2020.105037] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 03/29/2020] [Indexed: 10/24/2022]
Abstract
UNLABELLED Predicting physical activity in a national cohort of children born extremely preterm. OBJECTIVES To compare physical activity among school-aged children born extremely preterm or with extremely low birthweight (EP/ELBW) to term-born children, and to identify early predictors for physical inactivity in the EP/ELBW-children. METHODS A national cohort born during 1999-2000 at gestational age < 28 weeks or birthweight <1000 g and term-born controls were assessed. EP/ELBW-children without neurodevelopmental disabilities were labeled "healthy". At five years, we examined the EP/ELBW-children's motor, mental and intellectual functioning using the Movement Assessment Battery for Children (MABC), The Strength and Difficulties Questionnaire (SDQ) and The Wechsler Preschool and Primary Scale of Intelligence-revised. At 11 years, the parents reported their children's physical activity (PA) in questionnaires. RESULTS Information was obtained from 231/372 EP/ELBW and 57/61 term-born children. At 11 years, EP/ELBW-children had fewer exercise events per week, were less engaged in team sports, had lower endurance, lower sports proficiency, and were less vigorous during PA than term-born children (p < 0.05). Low sports proficiency in the healthy EP/ELBW-children at 11 years was predicted (odds ratio; 95% confidence interval) by abnormal MABC-score (3.0; 1.0 to 8.7), and abnormal SDQ-score (4.0; 1.6 to 10.0) at 5 years. Lower endurance at PA was predicted by abnormal MABC-score (2.6; 1.0 to 6.6), abnormal SDQ-score (3.0; 1.4 to 6.5), and borderline intellectual functioning (4.2; 1.8 to 10.1). CONCLUSIONS Eleven-year-old EP/ELBW-children were less physically active than term-born. In healthy EP/ELBW-children, impaired motor coordination, borderline intellectual functioning and behavioral problems at 5 years of age predicted unfavorable PA habits at 11 years.
Collapse
Affiliation(s)
- Mette Engan
- Department of Clinical Science, University of Bergen, Norway; Department of Paediatric and Adolescent Medicine, Haukeland University Hospital, Bergen, Norway.
| | - Merete Salveson Engeseth
- Department of Clinical Science, University of Bergen, Norway; Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Norway
| | - Silje Fevang
- Department of Paediatric and Adolescent Medicine, Haukeland University Hospital, Bergen, Norway
| | - Maria Vollsæter
- Department of Clinical Science, University of Bergen, Norway; Department of Paediatric and Adolescent Medicine, Haukeland University Hospital, Bergen, Norway
| | - Geir Egil Eide
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway; Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway
| | - Ola Drange Røksund
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Norway
| | - Thomas Halvorsen
- Department of Clinical Science, University of Bergen, Norway; Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Hege Clemm
- Department of Clinical Science, University of Bergen, Norway; Department of Paediatric and Adolescent Medicine, Haukeland University Hospital, Bergen, Norway
| |
Collapse
|
23
|
Evensen KAI, Ustad T, Tikanmäki M, Haaramo P, Kajantie E. Long-term motor outcomes of very preterm and/or very low birth weight individuals without cerebral palsy: A review of the current evidence. Semin Fetal Neonatal Med 2020; 25:101116. [PMID: 32461044 DOI: 10.1016/j.siny.2020.101116] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
We reviewed literature on long-term motor outcomes of individuals aged five years or older born very preterm (VP: ≤32 weeks of gestation) or with very low birth weight (VLBW: ≤1500g), without cerebral palsy (CP). PubMed produced 2827 articles, whereof 38 were eligible. Assessed by standardised and norm-based motor tests, the Movement Assessment Battery for Children being the most widely used, VP/VLBW individuals showed poorer motor skills compared with term-born controls with differences of approximately 1 SD in magnitude. Some studies assessed subdomains and differences were present in fine motor/manual dexterity, ball skills and gross motor/balance. Prevalence of motor problems varied largely from 8-37% in studies with cut-off at the 5th percentile or -1.5 SD to 12-71% in studies with cut-off at the 15th percentile or -1 SD. This review shows that the degree of motor impairments continues to be substantial among VP/VLBW individuals who do not develop CP.
Collapse
Affiliation(s)
- Kari Anne I Evensen
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway; Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway; Unit for Physiotherapy Services, Trondheim Municipality, Trondheim, Norway; Department of Physiotherapy, Oslo Metropolitan University, Oslo, Norway.
| | - Tordis Ustad
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway; Department of Clinical Services, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Marjaana Tikanmäki
- PEDEGO Research Unit, MRC Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland; Finnish Institute for Health and Welfare, Public Health Promotion Unit, Helsinki, Oulu, Finland
| | - Peija Haaramo
- Finnish Institute for Health and Welfare, Public Health Promotion Unit, Helsinki, Oulu, Finland
| | - Eero Kajantie
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway; PEDEGO Research Unit, MRC Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland; Finnish Institute for Health and Welfare, Public Health Promotion Unit, Helsinki, Oulu, Finland; Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| |
Collapse
|
24
|
Øberg GK, Girolami GL, Campbell SK, Ustad T, Heuch I, Jacobsen BK, Kaaresen PI, Aulie VS, Jørgensen L. Effects of a Parent-Administered Exercise Program in the Neonatal Intensive Care Unit: Dose Does Matter-A Randomized Controlled Trial. Phys Ther 2020; 100:860-869. [PMID: 31944250 DOI: 10.1093/ptj/pzaa014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 05/07/2019] [Accepted: 11/20/2019] [Indexed: 11/13/2022]
Abstract
BACKGROUND Despite the risk of delayed motor development in infants born preterm, knowledge about interventions in the neonatal intensive care unitt (NICU) and the effects of dosing is sparse. OBJECTIVE The objectives of this study were to examine the effectiveness of a parent-administered exercise program in the NICU on motor outcome at 3 months corrected age (CA) and the effect of dosing on motor performance. DESIGN This was a randomized clinical trial. SETTING The study was conducted at 3 university hospitals in Tromsø, Trondheim, and Oslo, Norway. PARTICIPANTS A total of 153 infants with gestational age <32 weeks at birth were randomly assigned to intervention or control groups. INTERVENTION A 3-week parent-administered intervention designed to facilitate movements in preterm infants was performed in the NICU. Parents were asked to administer the intervention 10 minutes twice a day. MEASUREMENTS Test of Infant Motor Performance (TIMP) was used to assess short-term outcome at 3 months CA. RESULTS No significant difference in the TIMP z-score was found between intervention and control groups at follow-up 3 months CA, but a significant positive relationship was found between total intervention dose and TIMP z-scores. The adjusted odds of having a clinical z-score < 0 at 3 months CA was about 6 times higher for infants with less than median intervention time than for infants with a longer intervention time. LIMITATIONS The number of infants born before 28 weeks was small. A spillover effect in favor of the control group was possible. We do not know if the infants received physical therapy after discharge from the hospital. CONCLUSIONS There was no difference in motor performance between the intervention group and the control group at 3 months CA. However, an increased intervention dose was positively associated with improved motor outcome.
Collapse
Affiliation(s)
- Gunn Kristin Øberg
- Department of Health and Care Sciences, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, PB 6050 Langnes, Tromsø, 9037 Norway; and Department of Clinical Therapeutic Services, University Hospital North Norway, Tromsø, Norway
| | - Gay L Girolami
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, Illinois
| | | | - Tordis Ustad
- Department of Clinical Services, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Ivar Heuch
- Department of Mathematics, University of Bergen, Bergen, Norway
| | - Bjarne K Jacobsen
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway; and Centre for Sami Health Research, Department of Community Medicine, University of Tromsø, The Arctic University of Norway
| | - Per Ivar Kaaresen
- Pediatric and Adolescent Department, University Hospital North Norway; and Department of Clinical Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway
| | - Vibeke Smith Aulie
- Section of Physiotherapy, Oslo University Hospital, Ullevål, Oslo, Norway
| | - Lone Jørgensen
- Department of Health and Care Sciences, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway; and Department of Clinical Therapeutic Services, University Hospital North Norway
| |
Collapse
|
25
|
Saha S, Pagnozzi A, Bourgeat P, George JM, Bradford D, Colditz PB, Boyd RN, Rose SE, Fripp J, Pannek K. Predicting motor outcome in preterm infants from very early brain diffusion MRI using a deep learning convolutional neural network (CNN) model. Neuroimage 2020; 215:116807. [PMID: 32278897 DOI: 10.1016/j.neuroimage.2020.116807] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 03/06/2020] [Accepted: 03/27/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND AIMS Preterm birth imposes a high risk for developing neuromotor delay. Earlier prediction of adverse outcome in preterm infants is crucial for referral to earlier intervention. This study aimed to predict abnormal motor outcome at 2 years from early brain diffusion magnetic resonance imaging (MRI) acquired between 29 and 35 weeks postmenstrual age (PMA) using a deep learning convolutional neural network (CNN) model. METHODS Seventy-seven very preterm infants (born <31 weeks gestational age (GA)) in a prospective longitudinal cohort underwent diffusion MR imaging (3T Siemens Trio; 64 directions, b = 2000 s/mm2). Motor outcome at 2 years corrected age (CA) was measured by Neuro-Sensory Motor Developmental Assessment (NSMDA). Scores were dichotomised into normal (functional score: 0, normal; n = 48) and abnormal scores (functional score: 1-5, mild-profound; n = 29). MRIs were pre-processed to reduce artefacts, upsampled to 1.25 mm isotropic resolution and maps of fractional anisotropy (FA) were estimated. Patches extracted from each image were used as inputs to train a CNN, wherein each image patch predicted either normal or abnormal outcome. In a postprocessing step, an image was classified as predicting abnormal outcome if at least 27% (determined by a grid search to maximise the model performance) of its patches predicted abnormal outcome. Otherwise, it was considered as normal. Ten-fold cross-validation was used to estimate performance. Finally, heatmaps of model predictions for patches in abnormal scans were generated to explore the locations associated with abnormal outcome. RESULTS For the identification of infants with abnormal motor outcome based on the FA data from early MRI, we achieved mean sensitivity 70% (standard deviation SD 19%), mean specificity 74% (SD 39%), mean AUC (area under the receiver operating characteristic curve) 72% (SD 14%), mean F1 score of 68% (SD 13%) and mean accuracy 73% (SD 19%) on an unseen test data set. Patch-based prediction heatmaps showed that the patches around the motor cortex and somatosensory regions were most frequently identified by the model with high precision (74%) as a location associated with abnormal outcome. Part of the cerebellum, and occipital and frontal lobes were also highly associated with abnormal NSMDA/motor outcome. DISCUSSION/CONCLUSION This study established the potential of an early brain MRI-based deep learning CNN model to identify preterm infants at risk of a later motor impairment and to identify brain regions predictive of adverse outcome. Results suggest that predictions can be made from FA maps of diffusion MRIs well before term equivalent age (TEA) without any prior knowledge of which MRI features to extract and associated feature extraction steps. This method, therefore, is suitable for any case of brain condition/abnormality. Future studies should be conducted on a larger cohort to re-validate the robustness and effectiveness of these models.
Collapse
Affiliation(s)
- Susmita Saha
- Australian e-Health Research Centre, CSIRO, Brisbane, Australia.
| | - Alex Pagnozzi
- Australian e-Health Research Centre, CSIRO, Brisbane, Australia
| | | | - Joanne M George
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Centre for Children's Health Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | | | - Paul B Colditz
- Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Roslyn N Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Centre for Children's Health Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Stephen E Rose
- Australian e-Health Research Centre, CSIRO, Brisbane, Australia
| | - Jurgen Fripp
- Australian e-Health Research Centre, CSIRO, Brisbane, Australia
| | - Kerstin Pannek
- Australian e-Health Research Centre, CSIRO, Brisbane, Australia
| |
Collapse
|
26
|
Baumann N, Tresilian J, Heinonen K, Räikkönen K, Wolke D. Predictors of early motor trajectories from birth to 5 years in neonatal at-risk and control children. Acta Paediatr 2020; 109:728-737. [PMID: 31442325 DOI: 10.1111/apa.14985] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 07/12/2019] [Accepted: 08/21/2019] [Indexed: 11/26/2022]
Abstract
AIM To describe motor development in preschool children, to identify perinatal, neonatal and social environmental risk factors of poor motor development, and to replicate results in a second cohort. METHODS Two prospective samples in Germany (Bavarian Longitudinal Study, BLS) and Finland (Arvo Ylppö Longitudinal Study, AYLS) assessed 4741 and 1423 children from birth to 56 months, respectively. Motor functioning was evaluated at birth, and 5, 20 and 56 months. Perinatal, neonatal and social environmental information was collected at birth and 5 months. RESULTS Two distinct motor trajectories were identified: low (BLS: n = 4486 (94.6%), AYLS: n = 1391 (97.8%)) and high (BLS: n = 255 (5.4%), AYLS: n = 32 (2.2%)) degree of motor difficulties. High degree of motor difficulties was predicted by neonatal complications, abnormal neonatal neurological status, duration of hospitalisation and poor parent-infant relationships. Although neonatal complications and poor parent-infant relationships did not significantly predict high degree of motor difficulties in the AYLS, the trends identified were similar to those obtained from the BLS. CONCLUSION Early identification of children at-risk of motor difficulties across infancy and toddlerhood may help referring those children to interventions earlier. Modifiable risk factors, such as parent-infant relationships, may be addressed by intervention strategies to prevent children from developing motor difficulties.
Collapse
Affiliation(s)
- Nicole Baumann
- Department of Psychology University of Warwick Coventry UK
| | | | - Kati Heinonen
- Department of Psychology and Logopedics University of Helsinki Helsinki Finland
| | - Katri Räikkönen
- Department of Psychology and Logopedics University of Helsinki Helsinki Finland
| | - Dieter Wolke
- Department of Psychology University of Warwick Coventry UK
- Warwick Medical School University of Warwick Coventry UK
| |
Collapse
|
27
|
Neri E, Genova F, Monti F, Trombini E, Biasini A, Stella M, Agostini F. Developmental Dimensions in Preterm Infants During the 1st Year of Life: The Influence of Severity of Prematurity and Maternal Generalized Anxiety. Front Psychol 2020; 11:455. [PMID: 32292365 PMCID: PMC7119226 DOI: 10.3389/fpsyg.2020.00455] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 02/26/2020] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND The literature has recognized premature birth as a risk factor for infant development and maternal anxiety. This study investigated the impact of the severity of birth weight, as well as of maternal anxiety at 3 months of infants' corrected age, on infants' outcomes during the 1st year postpartum. Moreover, it described the longitudinal trajectories of developmental outcomes, additionally exploring the impact of anxiety. METHODS The study compared 147 mothers and their 147 newborns, differentiated in 25 Extremely Low Birth Weight (ELBW), 41 Very Low Birth Weight (VLBW), and 81 Full-Term (FT) infants. At 3, 9, and 12 months (corrected age in the case of preterm infants) the level of infants' development was investigated according to the 5 quotients (Locomotor, Personal and Social, Hearing and Language, Eye-hand Co-ordination and Performance) of the Griffiths Mental Development Scales (GMDS-R). During the assessment of 3 months, mothers fulfilled Penn State Worry Questionnaire (PSWQ) to evaluate the presence of generalized anxiety. RESULTS Among the 5 GMDS-R quotients, significant effect of severity of birth weight emerged only for Performance quotient: preterm infants (ELBW at 3 months; VLBW at 12 months) showed lower scores than FT ones. Moreover, this quotient decreased from 3 to 9 and to 12 months for VLBW and FT infants, while it was stable for ELBW ones. A significant interaction between severity of birth weight and maternal anxiety emerged for Hearing and Language and Locomotor quotients. In the first case, scores for ELBW infants, independently from maternal anxiety, decreased from 9 to 12 months. The same results emerged for VLBW infants, in the case of non-anxious mothers. Regarding Locomotor quotient, mean scores decreased from 3 to 9 and to 12 months for all groups in the case of non-anxious mothers. Conversely, when mothers were anxious, this decrease emerged only for VLBW infants. Lastly, ELBW, VLBW and FT showed difference in the growth and slope of the trajectories of different quotients. CONCLUSION The severity of birth weight for preterm infants, also in interaction with maternal anxiety, had significant and specific impact on different dimensions of infants' development. Clinical implications of these results underline the need for individualized interventions.
Collapse
Affiliation(s)
- Erica Neri
- Department of Psychology, University of Bologna, Bologna, Italy
| | - Federica Genova
- Department of Psychology, University of Bologna, Bologna, Italy
| | - Fiorella Monti
- Department of Psychology, University of Bologna, Bologna, Italy
| | - Elena Trombini
- Department of Psychology, University of Bologna, Bologna, Italy
| | - Augusto Biasini
- Donor Human Milk Bank Italian Association (AIBLUD), Milan, Italy
| | - Marcello Stella
- Paediatric and Neonatal Intensive Care Unit, Maurizio Bufalini Hospital, Cesena, Italy
| | | |
Collapse
|
28
|
Howell HB, Zaccario M, Kazmi SH, Desai P, Sklamberg FE, Mally P. Neurodevelopmental outcomes of children with congenital heart disease: A review. Curr Probl Pediatr Adolesc Health Care 2019; 49:100685. [PMID: 31708366 DOI: 10.1016/j.cppeds.2019.100685] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Congenital heart defects are the most common birth anomaly affecting approximately 1% of births. With improved survival in this population, there is enhanced ability to assess long-term morbidities including neurodevelopment. There is a wide range of congenital heart defects, from those with minimal physiologic consequence that do not require medical or surgical intervention, to complex structural anomalies requiring highly specialized medical management and intricate surgical repair or palliation. The impact of congenital heart disease on neurodevelopment is multifactorial. Susceptibility for adverse neurodevelopment increases with advancing severity of the defect with initial risk factors originating during gestation. Complex structural heart anomalies may pre-dispose the fetus to abnormal circulatory patterns in utero that ultimately impact delivery of oxygen rich blood to the fetal brain. Thus, the brain of a neonate born with complex congenital heart disease may be particularly vulnerable from the outset. That vulnerability is compounded during the newborn period and through childhood, as this population endures a myriad of medical and surgical interventions. For each individual patient, these factors are likely cumulative and synergistic with progression from fetal life through childhood. This review discusses the spectrum of risk factors that may impact neurodevelopment in children with congenital heart disease, describes current recommendations and practices for neurodevelopmental follow-up of children with congenital heart disease and reviews important neurodevelopmental trends in this high risk population.
Collapse
Affiliation(s)
- Heather B Howell
- New York University School of Medicine, Department of Pediatrics, 317 East 34th Street, Suite 902, New York, NY 10016, USA.
| | - Michele Zaccario
- New York University School of Medicine, Department of Pediatrics, 317 East 34th Street, Suite 902, New York, NY 10016, USA; Pace University, Department of Psychology, 41 Park Row, New York, NY 10038 USA
| | - Sadaf H Kazmi
- New York University School of Medicine, Department of Pediatrics, 317 East 34th Street, Suite 902, New York, NY 10016, USA
| | - Purnahamsi Desai
- New York University School of Medicine, Department of Pediatrics, 317 East 34th Street, Suite 902, New York, NY 10016, USA
| | - Felice E Sklamberg
- New York University School of Medicine, Department of Pediatrics, 317 East 34th Street, Suite 902, New York, NY 10016, USA
| | - Pradeep Mally
- New York University School of Medicine, Department of Pediatrics, 317 East 34th Street, Suite 902, New York, NY 10016, USA
| |
Collapse
|
29
|
Pallás‐Alonso CR, Loureiro B, De la Cruz Bértolo J, García P, Ginovart G, Jiménez A, Martín Y, Soriano J, Torres MJ, Vento M. Spanish survey on follow-up programmes for children born very preterm. Acta Paediatr 2019; 108:1042-1048. [PMID: 30447072 PMCID: PMC7586806 DOI: 10.1111/apa.14647] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 11/02/2018] [Accepted: 11/14/2018] [Indexed: 11/30/2022]
Abstract
AIM To describe variations in practice between follow-up programmes for very preterm children born at less than 32 weeks' gestation or with very low birth weight of less than 1,500 g. METHODS A survey on follow-up practices was electronically distributed to level II and III units among hospitals of the Spanish National Health Service in 2016. The survey included 70 questions covering issues such as follow-up organisation and resources, routine assessments, relationships with other services and families, information management and training. RESULTS The response rate was 91.5% (141/154). Among respondents, 70.9% (100/141) reported that they do provide follow-up and 42% do so up to six years of age. Routine neurological and ophthalmological follow-up is not performed in 60% and 37% of hospitals, respectively, and a second hearing assessment is not given in 62%. Just 38% of units have psychologist. In 41% of hospitals, training in follow-up skills is not included in Paediatric Residency training programme. CONCLUSION Although Spain has a nationwide health system that provides universal health coverage, we found that follow-up care for children born very preterm/very low birth weight is not equitable. Nearly half of paediatric residents receive no training in follow-up for this high-risk population.
Collapse
Affiliation(s)
- Carmen Rosa Pallás‐Alonso
- Division of NeonatologyHealth Research Institute i + 12University Hospital 12 de OctubreUniversidad ComplutenseMadridSpain
| | - Begoña Loureiro
- Division of NeonatologyUniversity Hospital CrucesBarakaldoSpain
| | - Javier De la Cruz Bértolo
- Division of NeonatologyHealth Research Institute i + 12University Hospital 12 de OctubreUniversidad ComplutenseMadridSpain
| | - Pilar García
- Division of NeonatologyUniversity Hospital de SalamancaSalamancaSpain
| | - Gemma Ginovart
- Division of NeonatologyHospital de la Santa Creu I Sant PauBarcelonaSpain
| | - Ana Jiménez
- Division of NeonatologyHospital de AlgecirasCádizSpain
| | - Yolanda Martín
- Primary Care PaediatricianHealth Care Center GoyaMadridSpain
| | - Javier Soriano
- Primary Care PaediatricianHealth Care Center FuensantaValenciaSpain
| | | | - Máximo Vento
- Division of NeonatologyUniversity and Polytechnic Hospital La FeValenciaSpain
| |
Collapse
|
30
|
Early-life growth of preterm infants and its impact on neurodevelopment. Pediatr Res 2019; 85:283-292. [PMID: 30140070 DOI: 10.1038/s41390-018-0139-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 06/08/2018] [Accepted: 07/26/2018] [Indexed: 11/08/2022]
Abstract
BACKGROUND Increasing numbers of preterm-born children survive nowadays, and improving long-term health and neurodevelopment is becoming more important. Early-life growth has been linked to neurodevelopmental outcomes. We aimed to study whether this association has changed with time. METHODS We studied two cohorts of preterm-born children (gestational age ≤32 weeks and/or birth weight ≤1500 g) from 1983 (n = 708) and 2003-2006 (n = 138), respectively. We distinguished four early-life growth patterns at 3 months corrected age: appropriate for gestational age (AGA) with or without growth restriction (AGA GR+/AGA GR-), and small for gestational age (SGA) with or without catch-up growth (SGA CUG+/SGA CUG-). Intelligence quotient (IQ), neuromotor function, and behavior were assessed at ages 19 and 8 years, respectively, for the cohorts. RESULTS In the 2003-2006 cohort, less children had early-life GR. In both cohorts, SGA CUG- subjects had unfavorable growth trajectories and neurodevelopmental outcomes (IQ β -6.5, 95% confidence interval (CI) -9.8; -3.2, P < 0.001; neuromotor score β -1.9%, 95% CI -3.2; -0.6, P = 0.005), while SGA CUG+ subjects were comparable to adequately grown subjects. CONCLUSION Although the incidence of adverse growth patterns decreased between the cohorts, possibly indicating improvements in care over time, the impact of these growth patterns on neurodevelopmental outcomes was not significantly different. Achieving adequate early-life growth may be crucial for improving neurodevelopmental outcomes, especially for preterms born SGA.
Collapse
|
31
|
Charafeddine L, Masri S, Ibrahim P, Badin D, Cheayto S, Tamim H. Targeted educational program improves infant positioning practice in the NICU. Int J Qual Health Care 2019; 30:642-648. [PMID: 29889251 DOI: 10.1093/intqhc/mzy123] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 05/17/2018] [Indexed: 11/12/2022] Open
Abstract
Quality problem or issue Infant positioning may interfere with neuromotor development. Bedside education and Infant Positioning Assessment Tool (IPAT) improve nurses' and doctors' proficiency in applying proper infant positioning. Initial assessment Nursing compliance with proper positioning is suboptimal due to many factors. One factor was the inadequate knowledge and practice of infant positioning, since the baseline mean IPAT score was 3.4. Choice of solution Three experienced neonatal intensive care unit (NICU) nurses were chosen as position champions to help other NICU nurses apply proper positioning and monitor IPAT scores. Education and hands-on demonstration sessions were developed based on the observed baseline practice. Implementation Periodic education with hands-on demonstration was given to NICU nurses and residents. Infants' positions were objectively scored using IPAT. Two Plan, Do, Study and Act cycles were completed and adjustments were made based on each cycle's achieved results. Evaluation Mean IPAT scores increased from 3.4 at baseline and 6.3 in the second cycle to 7.3 in the third cycle of intervention. Lessons learned A systematic approach targeting infants' positioning succeeded in improving nurses' and residents' clinical performance. Not reaching significant change until after 18 months highlights the difficulty and complexity in changing behaviors.
Collapse
Affiliation(s)
- Lama Charafeddine
- Department of Pediatrics and Adolescent Medicine, Faculty of Medicine, American University of Beirut, Riad El-Solh, Beirut, Lebanon
| | - Saadieh Masri
- Department of Pediatrics and Adolescent Medicine, Faculty of Medicine, American University of Beirut, Riad El-Solh, Beirut, Lebanon
| | - Perla Ibrahim
- School of Medicine, Faculty of Medicine, American University of Beirut, Riad El-Solh, Beirut, Lebanon
| | - Daniel Badin
- Department of Biology, Faculty of Arts and Sciences, American University of Beirut, Riad El-Solh, Beirut, Lebanon
| | - Salam Cheayto
- Department of Nursing, American University of Beirut, Riad El-Solh, Beirut, Lebanon
| | - Hani Tamim
- Department of Internal Medicine Clinical Research Institute, Faculty of Medicine, American University of Beirut, Riad El-Solh, Beirut, Lebanon
| |
Collapse
|
32
|
Gill K, Osiovich A, Synnes A, A Agnew J, Grunau RE, Miller SP, Zwicker JG. Concurrent Validity of the Bayley-III and the Peabody Developmental Motor Scales-2 at 18 Months. Phys Occup Ther Pediatr 2019; 39:514-524. [PMID: 30541412 DOI: 10.1080/01942638.2018.1546255] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Aim: To determine concurrent validity between the Bayley Scales of Infant and Toddler Development, 3rd edition (Bayley-III) and the Peabody Developmental Motor Scales, 2nd edition (PDMS-2). Methods: Both assessments were administered to 184 preterm children at 18 months corrected age; standard scores for total score, gross motor, and fine motor were calculated for each child. Cross-tabulation and Pearson correlation coefficient (r) determined concurrent validity between the Bayley-III and the PDMS-2 motor domains. Results: High correlations were found between total motor (r = 0.88), gross motor (r = 0.88), and fine motor scores (r = 0.79). Both assessments had 93% agreement on classification for motor impairment; 23 children were identified by both assessments as having motor impairments, but 12 children were identified differently on each assessment (7 as impaired on PDMS-2 but average on Bayley-III; 5 as impaired on Bayley-III but average on PDMS-2). Most children with motor impairments were identified as 1SD below the mean on the PDMS-2 (27/30) and Bayley-III (18/28); however, the Bayley-III identified more children 2SD below the mean (10/28) compared to the PDMS-2 (3/30). Conclusions: Both the Bayley-III and PDMS-2 identify motor delays in children; however, clinicians should be aware of the concurrent validity as each assessment may lead to differing results.
Collapse
Affiliation(s)
- Kamaldeep Gill
- a Rehabilitation Sciences, University of British Columbia , Vancouver , BC , Canada.,b British Columbia Children's Hospital Research Institute , Vancouver , BC , Canada
| | - Alan Osiovich
- c Department of Occupational Science & Occupational Therapy, University of British Columbia , Vancouver , BC , Canada
| | - Anne Synnes
- b British Columbia Children's Hospital Research Institute , Vancouver , BC , Canada.,d British Columbia Women's Hospital , Vancouver , BC , Canada.,e Department of Pediatrics, University of British Columbia , Vancouver , BC , Canada
| | | | - Ruth E Grunau
- b British Columbia Children's Hospital Research Institute , Vancouver , BC , Canada.,d British Columbia Women's Hospital , Vancouver , BC , Canada.,e Department of Pediatrics, University of British Columbia , Vancouver , BC , Canada
| | - Steven P Miller
- b British Columbia Children's Hospital Research Institute , Vancouver , BC , Canada.,e Department of Pediatrics, University of British Columbia , Vancouver , BC , Canada.,f Department of Neurology, Hospital for Sick Children and University of Toronto , Toronto , ON , Canada
| | - Jill G Zwicker
- b British Columbia Children's Hospital Research Institute , Vancouver , BC , Canada.,c Department of Occupational Science & Occupational Therapy, University of British Columbia , Vancouver , BC , Canada.,e Department of Pediatrics, University of British Columbia , Vancouver , BC , Canada.,g Sunny Hill Health Centre for Children , Vancouver , BC , Canada
| |
Collapse
|
33
|
Guttmann K, Flibotte J, DeMauro SB. Parental Perspectives on Diagnosis and Prognosis of Neonatal Intensive Care Unit Graduates with Cerebral Palsy. J Pediatr 2018; 203:156-162. [PMID: 30244983 DOI: 10.1016/j.jpeds.2018.07.089] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 07/18/2018] [Accepted: 07/26/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To describe how parents of neonatal intensive care unit (NICU) graduates with cerebral palsy (CP) perceive both the accuracy of prognoses provided in the NICU and the timing of their child's diagnosis of CP, and to assess the influence of functional outcome on these perceptions. STUDY DESIGN We surveyed parents of NICU graduates with CP about timing and benefit of diagnosis, accuracy of prognosis, and functional abilities of their children. After piloting and validation, CP parent support groups circulated the survey on social media, websites, and email lists. Bivariate relationships between categorical responses to survey questions were assessed with the χ2 test, and multivariable logistic regression was performed to identify independent factors associated with perceptions about the timing of diagnosis. RESULTS Parents of 463 children were included. Two-thirds (67%) of the children were diagnosed with CP before age 2 years, yet 40% of the respondents felt that diagnosis was made late, and only 11% categorized diagnosis as early. More than one-half (59%) perceived a benefit to diagnosis. There was a significant association between earlier age at diagnosis and greater functional limitations; 24% of parents who recalled being given a prognosis reported that their child functioned as predicted, and 46% reported that their child exceeded expectations. Parents were more likely to believe that children with fewer functional limitations had exceeded expectations. CONCLUSION Parents remember prognostic discussions about children who develop CP as underestimating functional outcome. Diagnosis is rarely seen as early and is associated with benefits. These observations suggest that clinicians should aim to diagnose CP early and to maintain guarded optimism about future outcomes. Tools for improved communication are urgently needed.
Collapse
Affiliation(s)
- Katherine Guttmann
- Department of Pediatrics, Division of Neonatology, The Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - John Flibotte
- Department of Pediatrics, Division of Neonatology, The Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Sara B DeMauro
- Department of Pediatrics, Division of Neonatology, The Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
| |
Collapse
|
34
|
Øberg GK, Ustad T, Jørgensen L, Kaaresen PI, Labori C, Girolami GL. Parents’ perceptions of administering a motor intervention with their preterm infant in the NICU. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2018. [DOI: 10.1080/21679169.2018.1503718] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Gunn Kristin Øberg
- Faculty of Health Sciences, Department of Health and Care Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
| | - Tordis Ustad
- Department of Clinical Services, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Lone Jørgensen
- Faculty of Health Sciences, Department of Health and Care Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
- Section of Physiotherapy, University Hospital North Norway HF, Tromsø, Norway
| | - Per Ivar Kaaresen
- Pediatric and Adolecent Department, BUK, University Hospital of North Norway HF, Tromsø, Norway
- Department of Clinical Medicine, University of Tromsø The arctic university of Norway, Tromsø, Norway
| | - Cathrine Labori
- Section of Physiotherapy, University Hospital North Norway HF, Tromsø, Norway
| | - Gay L. Girolami
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
| |
Collapse
|
35
|
Andrew MJ, Parr JR, Montague-Johnson C, Laler K, Holmes J, Baker B, Sullivan PB. Neurodevelopmental outcome of nutritional intervention in newborn infants at risk of neurodevelopmental impairment: the Dolphin neonatal double-blind randomized controlled trial. Dev Med Child Neurol 2018; 60:897-905. [PMID: 29806081 DOI: 10.1111/dmcn.13914] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/27/2018] [Indexed: 11/30/2022]
Abstract
AIM To investigate whether neonates at risk for neurodevelopmental impairment have improved neurodevelopment after docosahexaenoic acid, choline, and uridine-5-monophosphate supplementation versus controls. METHOD Recruitment was from UK neonatal units. Eligible for inclusion were infants born at less than 31 weeks' gestation with a weight less than the ninth centile; infants born at less than 31 weeks' gestation with a grade II or higher intraventricular haemorrhage/preterm white matter injury; infants born between 31 weeks' and 40 weeks' gestation plus 28 days with a grade II or higher intraventricular haemorrhage/preterm white matter injury, moderate or severe hypoxic-ischaemic encephalopathy, or defined neuroimaging abnormalities. Treatment/control supplementation was for 2 years (double-blind, randomized, controlled design). Infants were stratified according to sex, gestation, and brain injury severity. Primary outcome was cognitive composite score (CCS) of the Bayley Scales of Infant Development, Third Edition (Bayley-III at 24mo). Secondary outcomes were language composite score (LCS) of the Bayley-III, motor composite score (MCS) of the Bayley-III, and Vineland Adaptive Behaviour Scales, Second Edition (VABS-II) score. RESULTS Sixty-two neonates were recruited, 59 were randomized (34 males, 25 females). Fifty-three started supplementation. Most families found supplementation acceptable. The treatment group CCS-Bayley-III scores were non-significantly higher than controls (mean score difference at 24mo: 9.0; 95% confidence interval -0.2 to 18.2). Language and VABS-II scores, but not motor score, were non-significantly higher in the treatment group. INTERPRETATION Most families found supplementation feasible. Improved neurodevelopmental outcomes in the treatment group were not statistically significant. A larger multicentre trial exploration is warranted. WHAT THIS PAPER ADDS Dietary supplementation of neonates at risk of neurodevelopmental impairment is feasible. No statistically significant neurodevelopmental advantages were identified for the treatment group compared to controls. Treatment group cognitive and language advantage are of a clinically meaningful magnitude.
Collapse
Affiliation(s)
- Morag J Andrew
- Department of Paediatrics, University of Oxford, Oxford, UK
| | - Jeremy R Parr
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | | | - Karen Laler
- Department of Paediatrics, University of Oxford, Oxford, UK
| | - Jane Holmes
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Centre for Statistics in Medicine, University of Oxford, Oxford, UK
| | - Bonny Baker
- Department of Paediatrics, University of Oxford, Oxford, UK
| | | |
Collapse
|
36
|
Gorgon EJR. Caregiver-Provided Physical Therapy Home Programs for Children with Motor Delay: A Scoping Review. Phys Ther 2018; 98:480-493. [PMID: 29351642 DOI: 10.1093/ptj/pzy009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 01/16/2018] [Indexed: 02/09/2023]
Abstract
BACKGROUND Caregiver-provided physical therapy home programs (PTHP) play an important role in enhancing motor outcomes in pediatric patient populations. PURPOSE This scoping review systematically mapped clinical trials of caregiver-provided PTHP that were aimed at enhancing motor outcomes in children who have or who are at risk for motor delay, with the purpose of (1) describing trial characteristics; (2) assessing methodologic quality; and (3) examining the reporting of caregiver-related components. DATA SOURCES Physiotherapy Evidence Database (PEDro), Cochrane CENTRAL, PubMed, Scopus, ScienceDirect, ProQuest Central, CINAHL, LILACS, and OTseeker were searched up to July 31, 2017. STUDY SELECTION Two reviewers independently assessed study eligibility. Randomized or quasi-randomized controlled trials on PTHP administered by parents, other family members, friends, or informal caregivers to children who had or who were at risk for motor delay were included. DATA EXTRACTION Two reviewers independently appraised trial quality on the PEDro scale and extracted data. DATA SYNTHESIS Twenty-four articles representing 17 individual trials were identified. Populations and interventions investigated were heterogeneous. Most of the trials had important research design limitations and methodological issues that could limit usefulness in ascertaining the effectiveness of caregiver-provided PTHP. Few (4 of 17) trials indicated involvement of caregivers in the PTHP planning, assessed how the caregivers learned from the training or instructions provided, or carried out both. LIMITATIONS Included studies were heterogeneous, and unpublished data were excluded. CONCLUSIONS Although caregiver-provided PTHP are important in addressing motor outcomes in this population, there is a lack of evidence at the level of clinical trials to guide practice. More research is urgently needed to determine the effectiveness of care-giver-provided PTHP. Future studies should address the many important issues identified in this scoping review to improve the usefulness of the trial results.
Collapse
Affiliation(s)
- Edward James R Gorgon
- Department of Physical Therapy, College of Allied Medical Professions, University of the Philippines Manila, Pedro Gil Street, Malate, Manila, 1004, Philippines
| |
Collapse
|
37
|
Spiegler J, Ortfeld S, Herting E, Göpel W, Thyen U. Frühförderung bei sehr kleinen Frühgeborenen in Deutschland. Monatsschr Kinderheilkd 2018. [DOI: 10.1007/s00112-018-0517-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
|
38
|
Pallás Alonso C, García González P, Jimenez Moya A, Loureiro González B, Martín Peinador Y, Soriano Faura J, Torres Valdivieso MJ, Ginovart Galiana G. Follow-up protocol for newborns of birthweight less than 1500 g or less than 32 weeks gestation. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2018. [DOI: 10.1016/j.anpede.2017.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
|
39
|
Pallás Alonso C, García González P, Jimenez Moya A, Loureiro González B, Martín Peinador Y, Soriano Faura J, Torres Valdivieso MJ, Ginovart Galiana G. [Follow-up protocol for newborns of birthweight less than 1500 g or less than 32 weeks gestation]. An Pediatr (Barc) 2018; 88:229.e1-229.e10. [PMID: 29486919 DOI: 10.1016/j.anpedi.2017.12.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 12/25/2017] [Indexed: 10/18/2022] Open
Abstract
The mortality of children with a birthweight of less than 1500g or with a gestational age of less than 32 weeks (<1500<32) has decreased significantly in the last 20 years or so. Given the higher risk of disability in these children, follow-up after hospital discharge is considered essential. In this document, the Follow-Up Group of the Spanish Society of Neonatology, in collaboration with the Spanish Society of Paediatric Primary Care, propose a follow-up protocol specific for the<1500<32, which has as its aim to standardise the activities and evaluations according to good practice criteria.
Collapse
Affiliation(s)
- Carmen Pallás Alonso
- Servicio de Neonatología, Instituto de Investigación del Hospital Universitario 12 de Octubre de Madrid, Red SAMID del Instituto Carlos III, Madrid, España.
| | | | | | | | | | | | - María José Torres Valdivieso
- Servicio de Neonatología, Instituto de Investigación del Hospital Universitario 12 de Octubre de Madrid, Red SAMID del Instituto Carlos III, Madrid, España
| | | | | |
Collapse
|
40
|
|
41
|
Fjørtoft T, Ustad T, Follestad T, Kaaresen PI, Øberg GK. Does a parent-administrated early motor intervention influence general movements and movement character at 3months of age in infants born preterm? Early Hum Dev 2017; 112:20-24. [PMID: 28672273 DOI: 10.1016/j.earlhumdev.2017.06.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 05/13/2017] [Accepted: 06/23/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Studies of preterm and term-born infants have shown absent fidgety movements and an abnormal movement character to be related to brain lesions and unfavourable neurological outcomes. AIMS The present study examines what effect a parent-administered early intervention program applied to preterm infants in a randomised control trial (RCT) between 34 and 36weeks gestational age has on their fidgety movements and overall movement character at three months of age. STUDY DESIGN The study was part of the RCT in an early intervention programme including preterm infants born between 2010 and 2014 at three Norwegian university hospitals. SUBJECTS 130 preterm infants participated in the study, with 59 of them in the control group and 71 in the intervention group. OUTCOME MEASURES Fidgety movements and overall movement character at three months corrected age. RESULTS No difference was found between the intervention group and the control group in terms of fidgety movements or movement character. Approximately half of the infants in both groups showed an abnormal movement character. CONCLUSION No evidence was found in this RCT to suggest that an intervention at 34 to 37weeks gestational age has a significant effect on the fidgety movements or overall movement character of preterm infants. This is in line with the assumption that absent fidgety movements and an abnormal movement character are due to permanent brain injury and are therefore good predictors for later neurological impairments.
Collapse
Affiliation(s)
- Toril Fjørtoft
- Clinics of Clinical services, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway; Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Tordis Ustad
- Clinics of Clinical services, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway; Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Turid Follestad
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Per Ivar Kaaresen
- Faculty of Clinical Medicine, University of Tromsø, The Arctic University of Norway, Norway; Pediatric and Adolescent Department, University Hospital North Norway, Tromsø, Norway
| | - Gunn Kristin Øberg
- Department of Health and Care Sciences, University of Tromsø, The Arctic University of Norway, Norway
| |
Collapse
|
42
|
Hadfield K, O'Brien F, Gerow A. Is level of prematurity a risk/plasticity factor at three years of age? Infant Behav Dev 2017; 47:27-39. [PMID: 28324848 DOI: 10.1016/j.infbeh.2017.03.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Revised: 03/06/2017] [Accepted: 03/07/2017] [Indexed: 11/29/2022]
Abstract
Children born preterm have poorer outcomes than children born full-term, but the caregiving environment can ameliorate some of these differences. Recent research has proposed that preterm birth may be a plasticity factor, leading to better outcomes for preterm than full-term infants in higher quality environments. This analysis uses data from two waves of an Irish study of children (at 9 months and 3 years of age, n=11,134 children) and their caregivers (n=11,132 mothers, n=9998 fathers) to investigate differences in how caregiving affects social, cognitive, and motor skills between full-term, late preterm, and very preterm children. Results indicate that parental emotional distress and quality of attachment are important for child outcomes. Both being born very preterm and late preterm continue to be risk factors for poorer outcomes at 3 years of age. Only fathers' emotional distress significantly moderated the effect of prematurity on infants' cognitive and social outcomes-no other interactions between prematurity and environment were significant. These interactions were somewhat in line with diathesis stress, but the effect sizes were too small to provide strong support for this model. There is no evidence that preterm birth is a plasticity factor.
Collapse
Affiliation(s)
- Kristin Hadfield
- Resilience Research Centre, Dalhousie University, Halifax, NS, Canada.
| | - Fearghal O'Brien
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, MD, United States
| | - Aaron Gerow
- Faculty of Computer Science, Dalhousie University, Halifax, NS, Canada
| |
Collapse
|