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Bernabe-Zuñiga JE, Rodriguez-Lucenilla MI, Alias-Castillo AJ, Rueda-Ruzafa L, Roman P, Del Mar Sanchez-Joya M. Early interventions with parental participation and their implications on the neurodevelopment of premature children: a systematic review and meta-analysis. Eur Child Adolesc Psychiatry 2024:10.1007/s00787-024-02528-1. [PMID: 39028424 DOI: 10.1007/s00787-024-02528-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 07/09/2024] [Indexed: 07/20/2024]
Abstract
The occurrence of preterm birth is correlated with the potential emergence of disabilities in children. Early intervention programs are designed to promote better developmental outcomes. These interventions employ family-centered methodologies, wherein parents are instructed to facilitate neurodevelopment, thereby promoting heightened involvement of the child in their daily activities. The objective of this investigation was to evaluate the efficacy of early family-based interventions on motor, cognitive, and language development. A systematic review and meta-analysis was conducted utilizing the databases PubMed, Medline, PEDro, Scopus, CINAHL Complete, SciELO, and Open Grey. The search terms utilized included NDT (neuro-developmental treatment), Bobath, neurodevelopmental therapy, parents administered, family administered, physical therapy modalities, early intervention (educational), early intervention, premature infant, preterm, and premature. Randomized clinical trials and observational studies written in English or Spanish were taken into consideration. The initial search resulted in 420 articles. After removing duplicates and applying the selection criteria, 12 articles were selected for the systematic review and 5 articles were selected for the meta-analysis. The meta-analysis revealed a significant association between early intervention and enhanced cognitive function (p = 0.01) in this study. Additionally, the meta-analysis indicated improvements resulting from early family-based intervention (p = 0.02) in motor function. Early motor interventions that emphasize parent involvement and education in neurodevelopment show significant outcomes in motor and cognitive areas at 2 years of age in very premature or extremely premature infants. However, inconclusive effects have been found in the language area, which is the least studied domain. Due to the methodological heterogeneity observed, further research is needed to establish conclusive decisions regarding the administration of these interventions and the determination of key evaluation periods.
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Affiliation(s)
- Jose Enrique Bernabe-Zuñiga
- Faculty of Health Sciences, Department of Nursing Science, Physiotherapy and Medicine, University of Almería, Almería, Andalusia, 04120, Spain
| | | | - Antonio Javier Alias-Castillo
- Faculty of Health Sciences, Department of Nursing Science, Physiotherapy and Medicine, University of Almería, Almería, Andalusia, 04120, Spain
| | - Lola Rueda-Ruzafa
- Faculty of Health Sciences, Department of Nursing Science, Physiotherapy and Medicine, University of Almería, Almería, Andalusia, 04120, Spain.
- Research Group CTS-1114 Advances and Innovation in Health, University of Almería, Almería, 04120, Spain.
- Health Research Center CEINSA, University of Almería, Andalusía, 04120, Spain.
| | - Pablo Roman
- Faculty of Health Sciences, Department of Nursing Science, Physiotherapy and Medicine, University of Almería, Almería, Andalusia, 04120, Spain
- Research Group CTS-1114 Advances and Innovation in Health, University of Almería, Almería, 04120, Spain
- Health Research Center CEINSA, University of Almería, Andalusía, 04120, Spain
| | - Maria Del Mar Sanchez-Joya
- Faculty of Health Sciences, Department of Nursing Science, Physiotherapy and Medicine, University of Almería, Almería, Andalusia, 04120, Spain
- Health Research Center CEINSA, University of Almería, Andalusía, 04120, Spain
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Duncan AF, Gerner GJ, Neel ML, Burton VJ, Byrne R, Warschausky S. Interventions to improve executive functions in children aged 3 years and under: A systematic review. Child Care Health Dev 2024; 50:e13298. [PMID: 38958229 DOI: 10.1111/cch.13298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 12/27/2023] [Accepted: 06/11/2024] [Indexed: 07/04/2024]
Abstract
BACKGROUND Early executive functioning (EF) skills are foundational capabilities that predict school readiness, academic development and psychiatric risk. Early interventions enhancing these capabilities could have critical import in improving outcomes. However, to develop interventions, it is necessary to identify specific EF skills that will vary with child age. Thus, we aimed to examine the characteristics and efficacy of interventions targeting EF in infancy and early childhood up to age 3. METHODS A comprehensive search of PubMed, Embase, CINAHL and APA PsycINFO databases was performed for studies published before December 2022. Randomized and non-randomized studies of interventions designed to improve at least one EF skill in children ≤3 years were included. EF skills included attentional control, inhibition/self-regulation, activity initiation, working memory, cognitive flexibility, planning ability, problem-solving and performance monitoring. We independently extracted data, used the revised Cochrane Risk-of-Bias tool to assess the quality of the evidence and conducted Synthesis Without Meta-analysis (SWiM). The overall quality of the evidence and the strength of recommendations was determined using elements of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. RESULTS Thirty-five studies met inclusion criteria (original n = 7467). Studies were highly variable in the EF skill targeted, target subject (i.e., child, parent and teacher), nature and dosage of the intervention, and timing of outcome assessment. Most interventions focused on improving impulse control and self-regulation. The overall quality of evidence was low to moderate with a high risk of bias, though six studies had low risk of bias but yielded mixed findings of efficacy. CONCLUSIONS The relatively small number of early EF intervention studies uses such variable methods that there is currently no converging evidence of efficacy to recommend a specific intervention. Thus, findings support the need for a more systematic, targeted approach to the design and implementation of early EF interventions for target populations.
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Affiliation(s)
- Andrea F Duncan
- Department of Pediatrics, Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Gwyn J Gerner
- Division of Neuropsychology, Kennedy Krieger Institute, Baltimore, Maryland, USA
- Department of Psychiatry, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Mary Lauren Neel
- Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Vera J Burton
- Division of Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, Maryland, USA
- Department of Neurology and Neurosurgery, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Rachel Byrne
- Cerebral Palsy Foundation, New York, New York, USA
| | - Seth Warschausky
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
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Orton J, Doyle LW, Tripathi T, Boyd R, Anderson PJ, Spittle A. Early developmental intervention programmes provided post hospital discharge to prevent motor and cognitive impairment in preterm infants. Cochrane Database Syst Rev 2024; 2:CD005495. [PMID: 38348930 PMCID: PMC10862558 DOI: 10.1002/14651858.cd005495.pub5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
BACKGROUND Infants born preterm are at increased risk of cognitive and motor impairments compared with infants born at term. Early developmental interventions for preterm infants are targeted at the infant or the parent-infant relationship, or both, and may focus on different aspects of early development. They aim to improve developmental outcomes for these infants, but the long-term benefits remain unclear. This is an update of a Cochrane review first published in 2007 and updated in 2012 and 2015. OBJECTIVES Primary objective To assess the effect of early developmental interventions compared with standard care in prevention of motor or cognitive impairment for preterm infants in infancy (zero to < three years), preschool age (three to < five years), and school age (five to < 18 years). Secondary objective To assess the effect of early developmental interventions compared with standard care on motor or cognitive impairment for subgroups of preterm infants, including groups based on gestational age, birthweight, brain injury, timing or focus of intervention and study quality. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO and trial registries in July 2023. We cross-referenced relevant literature, including identified trials and existing review articles. SELECTION CRITERIA Studies included randomised, quasi-randomised controlled trials (RCTs) or cluster-randomised trials of early developmental intervention programmes that began within the first 12 months of life for infants born before 37 weeks' gestational age (GA). Interventions could commence as an inpatient but had to include a post discharge component for inclusion in this review. Outcome measures were not prespecified, other than that they had to assess cognitive outcomes, motor outcomes or both. The control groups in the studies could receive standard care that would normally be provided. DATA COLLECTION AND ANALYSIS Data were extracted from the included studies regarding study and participant characteristics, timing and focus of interventions and cognitive and motor outcomes. Meta-analysis using RevMan was carried out to determine the effects of early developmental interventions at each age range: infancy (zero to < three years), preschool age (three to < five years) and school age (five to < 18 years) on cognitive and motor outcomes. Subgroup analyses focused on GA, birthweight, brain injury, time of commencement of the intervention, focus of the intervention and study quality. We used standard methodological procedures expected by Cochrane to collect data and evaluate bias. We used the GRADE approach to assess the certainty of evidence. MAIN RESULTS Forty-four studies met the inclusion criteria (5051 randomly assigned participants). There were 19 new studies identified in this update (600 participants) and a further 17 studies awaiting outcomes. Three previously included studies had new data. There was variability in the focus and intensity of the interventions, participant characteristics, and length of follow-up. All included studies were either single or multicentre trials and the number of participants varied from fewer than 20 to up to 915 in one study. The trials included in this review were mainly undertaken in middle- or high-income countries. The majority of studies commenced in the hospital, with fewer commencing once the infant was home. The focus of the intervention programmes for new included studies was increasingly targeted at both the infant and the parent-infant relationship. The intensity and dosages of interventions varied between studies, which is important when considering the applicability of any programme in a clinical setting. Meta-analysis demonstrated that early developmental intervention may improve cognitive outcomes in infancy (developmental quotient (DQ): standardised mean difference (SMD) 0.27 standard deviations (SDs), 95% confidence interval (CI) 0.15 to 0.40; P < 0.001; 25 studies; 3132 participants, low-certainty evidence), and improves cognitive outcomes at preschool age (intelligence quotient (IQ); SMD 0.39 SD, 95% CI 0.29 to 0.50; P < 0.001; 9 studies; 1524 participants, high-certainty evidence). However, early developmental intervention may not improve cognitive outcomes at school age (IQ: SMD 0.16 SD, 95% CI -0.06 to 0.38; P = 0.15; 6 studies; 1453 participants, low-certainty evidence). Heterogeneity between studies for cognitive outcomes in infancy and preschool age was moderate and at school age was substantial. Regarding motor function, meta-analysis of 23 studies showed that early developmental interventions may improve motor outcomes in infancy (motor scale DQ: SMD 0.12 SD, 95% CI 0.04 to 0.19; P = 0.003; 23 studies; 2737 participants, low-certainty evidence). At preschool age, the intervention probably did not improve motor outcomes (motor scale: SMD 0.08 SD, 95% CI -0.16 to 0.32; P = 0.53; 3 studies; 264 participants, moderate-certainty evidence). The evidence at school age for both continuous (motor scale: SMD -0.06 SD, 95% CI -0.31 to 0.18; P = 0.61; three studies; 265 participants, low-certainty evidence) and dichotomous outcome measures (low score on Movement Assessment Battery for Children (ABC) : RR 1.04, 95% CI 0.82 to 1.32; P = 0.74; 3 studies; 413 participants, low-certainty evidence) suggests that intervention may not improve motor outcome. The main source of bias was performance bias, where there was a lack of blinding of participants and personnel, which was unavoidable in this type of intervention study. Other biases in some studies included attrition bias where the outcome data were incomplete, and inadequate allocation concealment or selection bias. The GRADE assessment identified a lower certainty of evidence in the cognitive and motor outcomes at school age. Cognitive outcomes at preschool age demonstrated a high certainty due to more consistency and a larger treatment effect. AUTHORS' CONCLUSIONS Early developmental intervention programmes for preterm infants probably improve cognitive and motor outcomes during infancy (low-certainty evidence) while, at preschool age, intervention is shown to improve cognitive outcomes (high-certainty evidence). Considerable heterogeneity exists between studies due to variations in aspects of the intervention programmes, the population and outcome measures utilised. Further research is needed to determine which types of early developmental interventions are most effective in improving cognitive and motor outcomes, and in particular to discern whether there is a longer-term benefit from these programmes.
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Affiliation(s)
- Jane Orton
- Royal Women's Hospital, Parkville, Australia
- Department of Physiotherapy, University of Melbourne, Parkville, Australia
| | - Lex W Doyle
- Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Australia
| | - Tanya Tripathi
- Department of Physiotherapy, University of Melbourne, Parkville, Australia
| | - Roslyn Boyd
- The University of Queensland, Brisbane, Australia
| | - Peter J Anderson
- Department of Clinical Sciences, Murdoch Children's Research Institute, The Royal Children's Hospital, Melbourne, Australia
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia
| | - Alicia Spittle
- Department of Physiotherapy, University of Melbourne, Parkville, Australia
- Murdoch Childrens Research Institute and the University of Melbourne, Parkville, Australia
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Nava E, Giraud M, Bolognini N. The emergence of the multisensory brain: From the womb to the first steps. iScience 2024; 27:108758. [PMID: 38230260 PMCID: PMC10790096 DOI: 10.1016/j.isci.2023.108758] [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] [Indexed: 01/18/2024] Open
Abstract
The becoming of the human being is a multisensory process that starts in the womb. By integrating spontaneous neuronal activity with inputs from the external world, the developing brain learns to make sense of itself through multiple sensory experiences. Over the past ten years, advances in neuroimaging and electrophysiological techniques have allowed the exploration of the neural correlates of multisensory processing in the newborn and infant brain, thus adding an important piece of information to behavioral evidence of early sensitivity to multisensory events. Here, we review recent behavioral and neuroimaging findings to document the origins and early development of multisensory processing, particularly showing that the human brain appears naturally tuned to multisensory events at birth, which requires multisensory experience to fully mature. We conclude the review by highlighting the potential uses and benefits of multisensory interventions in promoting healthy development by discussing emerging studies in preterm infants.
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Affiliation(s)
- Elena Nava
- Department of Psychology & Milan Centre for Neuroscience (NeuroMI), University of Milan-Bicocca, Milan, Italy
| | - Michelle Giraud
- Department of Psychology & Milan Centre for Neuroscience (NeuroMI), University of Milan-Bicocca, Milan, Italy
| | - Nadia Bolognini
- Department of Psychology & Milan Centre for Neuroscience (NeuroMI), University of Milan-Bicocca, Milan, Italy
- Laboratory of Neuropsychology, IRCCS Istituto Auxologico Italiano, Milan, Italy
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Wohlers L, Maier RF, Cuttini M, Wilson E, Benhammou V, Lebeer J, Laroche S, Sarrechia I, Petrou S, Thiele N, Zeitlin J, Aubert AM. Maternal Wellbeing Five Years after a Very Preterm Delivery: Prevalence and Influencing Factors in a European Cohort. CHILDREN (BASEL, SWITZERLAND) 2023; 11:61. [PMID: 38255374 PMCID: PMC10814990 DOI: 10.3390/children11010061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 12/22/2023] [Accepted: 12/27/2023] [Indexed: 01/24/2024]
Abstract
(1) Background: Mothers of very preterm (VPT) infants may experience psychological symptoms compromising long-term emotional wellbeing. This study describes the emotional wellbeing of mothers of five-year-old children born VPT. We assess the association between sociodemographic, perinatal and neonatal characteristics, and the child's health and development at five years old and maternal emotional wellbeing. (2) Methods: Data are from the prospective European "Effective Perinatal Intensive Care in Europe" (EPICE) and subsequent "Screening for Health In very Preterm infantS in Europe" (SHIPS) projects including births <32 weeks' gestational age in 11 countries in 2011/12. Data were abstracted from obstetric and neonatal records. At five years old, 2605 mothers answered a parental questionnaire including the Mental Health Inventory-5 (MHI-5). Associations between sociodemographic and health characteristics and the mother's MHI-5 score were investigated using multilevel multivariate linear regression analysis with the country modelled as a random effect and inverse probability weighting to correct for attrition bias. (3) Results: The mean MHI-5 score was 71.3 (SD 16.7) out of 100 (highest emotional wellbeing) with a variation among countries from 63.5 (SD 16.8; Poland) to 82.3 (SD 15.8; the Netherlands). MHI-5 scores were significantly lower for mothers whose child had a severe health problem, developmental, or speech delay, for multiparous and single mothers, and when at least one of the parents was unemployed. (4) Conclusions: The emotional wellbeing of mothers of VPT infants differs between European countries. Identifying sociodemographic characteristics and child's health and developmental conditions that affect maternal emotional wellbeing may help to identify groups of mothers who need special assistance to cope with consequences of the delivery of a VPT child.
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Affiliation(s)
- Lena Wohlers
- Physiotherapy School, University Hospital of the Universities of Giessen and Marburg (UKGM), 35392 Giessen, Germany;
| | - Rolf F. Maier
- Children’s Hospital, University Hospital, Philipps University Marburg, 35033 Marburg, Germany;
| | - Marina Cuttini
- 0-3 Center for the at-Risk Infant, Scientific Institute IRCCS “Eugenio Medea”, 23842 Lecco, Italy;
| | - Emilija Wilson
- Unit of Reproductive Health, Women’s and Children’s Health, Karolinska Institutet, 17177 Stockholm, Sweden;
| | - Valérie Benhammou
- Inserm, INRAE, Centre for Research in Epidemiology and Statistics (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, Université Paris Cité, F-75004 Paris, France; (V.B.); (J.Z.)
| | - Jo Lebeer
- Department of Medicine & Population Health, Faculty of Medicine & Health Sciences, University of Antwerp, 2610 Antwerp, Belgium; (J.L.); (I.S.)
| | - Sabine Laroche
- Neonatal Intensive Care Unit, University Hospital Antwerp, 2610 Antwerp, Belgium;
- Center for Developmental Disabilities, University Hospital Antwerp, 2610 Antwerp, Belgium
| | - Iemke Sarrechia
- Department of Medicine & Population Health, Faculty of Medicine & Health Sciences, University of Antwerp, 2610 Antwerp, Belgium; (J.L.); (I.S.)
| | - Stavros Petrou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX1 2JD, UK;
| | - Nicole Thiele
- European Foundation for the Care of Newborn Infants (EFCNI), 81379 Munich, Germany;
| | - Jennifer Zeitlin
- Inserm, INRAE, Centre for Research in Epidemiology and Statistics (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, Université Paris Cité, F-75004 Paris, France; (V.B.); (J.Z.)
| | - Adrien M. Aubert
- Inserm, INRAE, Centre for Research in Epidemiology and Statistics (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, Université Paris Cité, F-75004 Paris, France; (V.B.); (J.Z.)
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Gould JF, Bednarz JM, Sullivan TR, McPhee AJ, Gibson RA, Makrides M. Subgroup analyses of a randomized trial of DHA supplementation for infants born preterm with assessments of cognitive development up to 7-years of age: What happens in infants born <29 weeks' gestation? Prostaglandins Leukot Essent Fatty Acids 2023; 198-199:102593. [PMID: 37979339 DOI: 10.1016/j.plefa.2023.102593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 10/27/2023] [Accepted: 10/27/2023] [Indexed: 11/20/2023]
Abstract
A recent trial showed that high-dose docosahexaenoic acid (high-DHA) supplementation of infants born <29 weeks' gestation improves intelligence quotient (IQ) at five years' corrected age. However, this finding has not been detected by other trials of DHA, which either did not measure IQ or included more mature infants. We analyzed the subgroup of 204 infants born <29 weeks' from our earlier randomized trial of high-DHA (∼1 % total fatty acids) or standard-DHA (∼ 0.3 % total fatty acids). Participants were assessed for cognition at 18 months, and IQ and behavior at seven years' corrected age. No group differences were detected for mean cognitive, IQ or behavior scores. At 18 months, 18.8 % of children in the high-DHA group had a cognitive score <85, compared with 31.1 % of children in the standard-DHA group, but at seven years there was no difference. Although an underpowered post-hoc subgroup analysis, this study provides limited support to recommendations that infants born <29 weeks' gestation require supplemental DHA.
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Affiliation(s)
- J F Gould
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, 72 King William Road, North Adelaide 5006, Australia.
| | - J M Bednarz
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, 72 King William Road, North Adelaide 5006, Australia; School of Psychology & Discipline of Paediatrics, Faculty of Health and Medical Sciences, The University of Adelaide, North Terrace Adelaide, Australia
| | - T R Sullivan
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, 72 King William Road, North Adelaide 5006, Australia; School of Public Health, Faculty of Health and Medical Sciences, The University of Adelaide, North Terrace Adelaide, Australia
| | - A J McPhee
- Neonatal Medicine, Women's and Children's Hospital, 72 King William Road, North Adelaide, Australia
| | - R A Gibson
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, 72 King William Road, North Adelaide 5006, Australia; School of Agriculture, Food and Wine, The University of Adelaide, Waite Campus, Glen Osmond, Australia
| | - M Makrides
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, 72 King William Road, North Adelaide 5006, Australia; Discipline of Paediatrics, Faculty of Health and Medical Sciences, The University of Adelaide, North Terrace Adelaide 5000, Australia
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Duncan AF. Interventions for Executive Function in High-Risk Infants and Toddlers. Clin Perinatol 2023; 50:103-119. [PMID: 36868701 DOI: 10.1016/j.clp.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
This review summarizes the current state of evidence regarding interventions for executive function in high-risk infants and toddlers. Currently, there is a paucity of data in this area, with the interventions that have been studied highly variable in their content, dosage, target, and results. Self-regulation is the executive function construct targeted the most, with mixed results. The few studies that report later child outcomes in prekindergarten/school-aged children are encouraging, overall indicating improved cognition and behavior in the children of parents who received a parenting style intervention.
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Affiliation(s)
- Andrea F Duncan
- Division of Neonatology, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, 2nd Floor Main, Philadelphia, PA 19104, USA; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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Abstract
OBJECTIVES Children born very preterm (VP) are susceptible to a range of cognitive impairments, yet the effects of VP birth on long-term, episodic, and prospective memory remains unclear. This study examined episodic and prospective memory functioning in children born VP compared with their term-born counterparts at 13 years. METHOD VP (n = 81: born <30 weeks' gestation) and term (n = 26) groups were aged between 12 and 14 years. Children completed: (i) standardized verbal and visuospatial episodic memory tests; and (ii) an experimental time- and event-based prospective memory test that included short-term (within assessment session) and long-term (up to 1-week post-session) tasks. Parents completed a questionnaire assessing memory functions in everyday life. RESULTS The VP group performed worse on all measures of verbal and visuospatial episodic memory than the term group. While there were no group differences in event-based or long-term prospective memory, the VP group performed worse on time-based and short-term prospective memory tasks than term-born counterparts. Parents of children born VP reported more everyday memory difficulties than parents of children born at term, with parent-ratings indicating significantly elevated rates of everyday memory challenges in children born VP. CONCLUSIONS Children born VP warrant long-term surveillance, as challenges associated with VP birth include memory difficulties at 13 years. This study highlights the need for greater research and clinical attention into childhood functional memory outcomes.
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Kvaratskhelia N, Rurua N, Vadachkoria SG. Biomedical and Psychosocial Determinants of Early Neurodevelopment After Preterm Birth. Glob Pediatr Health 2023; 10:2333794X231160366. [PMID: 36968456 PMCID: PMC10037732 DOI: 10.1177/2333794x231160366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 02/09/2023] [Indexed: 03/29/2023] Open
Abstract
Prematurity and them related conditions are subject of scientific discussion. From the point of view optimization of postpartum processes, timely assessment of individual biomedical and psychosocial conditions and management of preventive intervention is very important, because of its linkage to issues of preterm infants and their families in long-term perspectives. The goal of the literature review is to bring together existing body of knowledge on biomedical, psychological, and social issues of premature infants related to early neurodevelopment in order to achieve better systemic vision. For this goal scientific articles related to neurological development delay of premature children and the possibilities of their timely identification were processed using electronic scientific search systems. Diagnostic tools to identify at-risk children and early intervention programs discussed in the article, significantly improve the chances of premature child development. In the article Introduced materials are to support: Clinicians to make correct decisions regarding important components of premature infants; Healthcare policy makers to plan targeted programs and activities; Public to better understand prematurity issues, especially in case of prematurely-born family members.
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Affiliation(s)
- Natia Kvaratskhelia
- University of Georgia, Tbilisi,
Georgia
- Natia Kvaratskhelia, School of Health
Sciences and Public Health, University of Georgia, Merab Kostava Street, 77a,
Tbilisi GE 0171, Georgia.
| | - Nana Rurua
- Pediatric Clinic Babymed, Tbilisi,
Georgia
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Exploring Effect of Postdischarge Developmental Support Program on Preterm Infant Neurodevelopment and BDNF Gene DNA Methylation. Adv Neonatal Care 2022; 23:E50-E58. [PMID: 36409665 DOI: 10.1097/anc.0000000000001046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Although developmental supportive care is an effective approach to improve the long-term psychomotor and/or neurobehavioral function of preterm infants, very limited studies have focused on the impact of after-discharge developmental support. The underlying epigenetic changes are unclear. PURPOSE This study aimed to explore the preliminary effect of an evidence-based Postdischarge Developmental Support Program (PDSP) on preterm infant neurodevelopment and underlying epigenetic changes, including brain-derived neurotrophic factor (BDNF) gene-related DNA methylation and expression. METHODS In this randomized controlled pilot trial, the preterm infant-parent dyads were randomized into either the intervention group/PDSP group (n = 22) or the control group/usual care group (n = 22). The neurodevelopmental outcomes of preterm infants were measured by Ages & Stages Questionnaires. Urine BDNF concentration level was tested by the enzyme-linked immunosorbent assay. Infant saliva specimens were collected to analyze the methylation level of BDNF gene promoter I at pre- and postintervention test. RESULTS After PDSP intervention, the total neurodevelopmental and the 5 domain scores of the PDSP group were all significantly higher than those of the control group ( P < .05). The BDNF levels decreased significantly only within control group ( P = .01). The difference in BDNF concentration and methylation levels between groups was not statistically significant. IMPLICATIONS FOR PRACTICE AND RESEARCH Postdischarge Developmental Support Program may promote the neurodevelopment of preterm infants but has no effect on BDNF's expression and gene methylation level at 3 months of corrected age. The epigenetic mechanism of PDSP needs further study using a larger sample and longer follow-up.
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Gould JF, Makrides M, Gibson RA, Sullivan TR, McPhee AJ, Anderson PJ, Best KP, Sharp M, Cheong JLY, Opie GF, Travadi J, Bednarz JM, Davis PG, Simmer K, Doyle LW, Collins CT. Neonatal Docosahexaenoic Acid in Preterm Infants and Intelligence at 5 Years. N Engl J Med 2022; 387:1579-1588. [PMID: 36300974 DOI: 10.1056/nejmoa2206868] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Docosahexaenoic acid (DHA) is a component of neural tissue. Because its accretion into the brain is greatest during the final trimester of pregnancy, infants born before 29 weeks' gestation do not receive the normal supply of DHA. The effect of this deficiency on subsequent cognitive development is not well understood. METHODS We assessed general intelligence at 5 years in children who had been enrolled in a trial of neonatal DHA supplementation to prevent bronchopulmonary dysplasia. In the previous trial, infants born before 29 weeks' gestation had been randomly assigned in a 1:1 ratio to receive an enteral emulsion that provided 60 mg of DHA per kilogram of body weight per day or a control emulsion from the first 3 days of enteral feeds until 36 weeks of postmenstrual age or discharge home, whichever occurred first. Children from 5 of the 13 centers in the original trial were invited to undergo assessment with the Wechsler Preschool and Primary Scale of Intelligence (WPPSI) at 5 years of corrected age. The primary outcome was the full-scale intelligence quotient (FSIQ) score. Secondary outcomes included the components of WPPSI. RESULTS A total of 1273 infants underwent randomization in the original trial; of the 656 surviving children who had undergone randomization at the centers included in this follow-up study, 480 (73%) had an FSIQ score available - 241 in the DHA group and 239 in the control group. After imputation of missing data, the mean (±SD) FSIQ scores were 95.4±17.3 in the DHA group and 91.9±19.1 in the control group (adjusted difference, 3.45; 95% confidence interval, 0.38 to 6.53; P = 0.03). The results for secondary outcomes generally did not support that obtained for the primary outcome. Adverse events were similar in the two groups. CONCLUSIONS In infants born before 29 weeks' gestation who had been enrolled in a trial to assess the effect of DHA supplementation on bronchopulmonary dysplasia, the use of an enteral DHA emulsion until 36 weeks of postmenstrual age was associated with modestly higher FSIQ scores at 5 years of age than control feeding. (Funded by the Australian National Health and Medical Research Council and Nu-Mega Ingredients; N3RO Australian New Zealand Clinical Trials Registry number, ACTRN12612000503820.).
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Affiliation(s)
- Jacqueline F Gould
- From SAHMRI Women and Kids, South Australian Health and Medical Research Institute (J.F.G., M.M., R.A.G., T.R.S., A.J.M., K.P.B., J.M.B., C.T.C.), the Schools of Medicine (J.F.G., M.M., A.J.M., K.P.B., C.T.C.), Psychology (J.F.G.), Agriculture, Food, and Wine (R.A.G.), and Public Health (T.R.S.), University of Adelaide, and the Department of Neonatal Medicine, Women's and Children's Hospital (A.J.M.), Adelaide, SA, Newborn Research, Royal Women's Hospital (J.L.Y.C., P.G.D., L.W.D.), the Murdoch Children's Research Institute (P.J.A., J.L.Y.C., P.G.D., L.W.D.), and the Departments of Obstetrics and Gynaecology (J.L.Y.C., P.G.D., L.W.D.) and Paediatrics (L.W.D.), University of Melbourne, the School of Psychological Sciences, Monash University (P.J.A.), and the Department of Paediatrics, Mercy Hospital for Women (G.F.O.), Melbourne, VIC, King Edward Memorial Hospital, Subiaco, WA (M.S.), Newborn Medicine, Centre for Neonatal Research and Education, University of Western Australia, Perth, WA (M.S., K.S.), and the Neonatal Intensive Care Unit, John Hunter Children's Hospital, New Lambton Heights, NSW (J.T.) - all in Australia
| | - Maria Makrides
- From SAHMRI Women and Kids, South Australian Health and Medical Research Institute (J.F.G., M.M., R.A.G., T.R.S., A.J.M., K.P.B., J.M.B., C.T.C.), the Schools of Medicine (J.F.G., M.M., A.J.M., K.P.B., C.T.C.), Psychology (J.F.G.), Agriculture, Food, and Wine (R.A.G.), and Public Health (T.R.S.), University of Adelaide, and the Department of Neonatal Medicine, Women's and Children's Hospital (A.J.M.), Adelaide, SA, Newborn Research, Royal Women's Hospital (J.L.Y.C., P.G.D., L.W.D.), the Murdoch Children's Research Institute (P.J.A., J.L.Y.C., P.G.D., L.W.D.), and the Departments of Obstetrics and Gynaecology (J.L.Y.C., P.G.D., L.W.D.) and Paediatrics (L.W.D.), University of Melbourne, the School of Psychological Sciences, Monash University (P.J.A.), and the Department of Paediatrics, Mercy Hospital for Women (G.F.O.), Melbourne, VIC, King Edward Memorial Hospital, Subiaco, WA (M.S.), Newborn Medicine, Centre for Neonatal Research and Education, University of Western Australia, Perth, WA (M.S., K.S.), and the Neonatal Intensive Care Unit, John Hunter Children's Hospital, New Lambton Heights, NSW (J.T.) - all in Australia
| | - Robert A Gibson
- From SAHMRI Women and Kids, South Australian Health and Medical Research Institute (J.F.G., M.M., R.A.G., T.R.S., A.J.M., K.P.B., J.M.B., C.T.C.), the Schools of Medicine (J.F.G., M.M., A.J.M., K.P.B., C.T.C.), Psychology (J.F.G.), Agriculture, Food, and Wine (R.A.G.), and Public Health (T.R.S.), University of Adelaide, and the Department of Neonatal Medicine, Women's and Children's Hospital (A.J.M.), Adelaide, SA, Newborn Research, Royal Women's Hospital (J.L.Y.C., P.G.D., L.W.D.), the Murdoch Children's Research Institute (P.J.A., J.L.Y.C., P.G.D., L.W.D.), and the Departments of Obstetrics and Gynaecology (J.L.Y.C., P.G.D., L.W.D.) and Paediatrics (L.W.D.), University of Melbourne, the School of Psychological Sciences, Monash University (P.J.A.), and the Department of Paediatrics, Mercy Hospital for Women (G.F.O.), Melbourne, VIC, King Edward Memorial Hospital, Subiaco, WA (M.S.), Newborn Medicine, Centre for Neonatal Research and Education, University of Western Australia, Perth, WA (M.S., K.S.), and the Neonatal Intensive Care Unit, John Hunter Children's Hospital, New Lambton Heights, NSW (J.T.) - all in Australia
| | - Thomas R Sullivan
- From SAHMRI Women and Kids, South Australian Health and Medical Research Institute (J.F.G., M.M., R.A.G., T.R.S., A.J.M., K.P.B., J.M.B., C.T.C.), the Schools of Medicine (J.F.G., M.M., A.J.M., K.P.B., C.T.C.), Psychology (J.F.G.), Agriculture, Food, and Wine (R.A.G.), and Public Health (T.R.S.), University of Adelaide, and the Department of Neonatal Medicine, Women's and Children's Hospital (A.J.M.), Adelaide, SA, Newborn Research, Royal Women's Hospital (J.L.Y.C., P.G.D., L.W.D.), the Murdoch Children's Research Institute (P.J.A., J.L.Y.C., P.G.D., L.W.D.), and the Departments of Obstetrics and Gynaecology (J.L.Y.C., P.G.D., L.W.D.) and Paediatrics (L.W.D.), University of Melbourne, the School of Psychological Sciences, Monash University (P.J.A.), and the Department of Paediatrics, Mercy Hospital for Women (G.F.O.), Melbourne, VIC, King Edward Memorial Hospital, Subiaco, WA (M.S.), Newborn Medicine, Centre for Neonatal Research and Education, University of Western Australia, Perth, WA (M.S., K.S.), and the Neonatal Intensive Care Unit, John Hunter Children's Hospital, New Lambton Heights, NSW (J.T.) - all in Australia
| | - Andrew J McPhee
- From SAHMRI Women and Kids, South Australian Health and Medical Research Institute (J.F.G., M.M., R.A.G., T.R.S., A.J.M., K.P.B., J.M.B., C.T.C.), the Schools of Medicine (J.F.G., M.M., A.J.M., K.P.B., C.T.C.), Psychology (J.F.G.), Agriculture, Food, and Wine (R.A.G.), and Public Health (T.R.S.), University of Adelaide, and the Department of Neonatal Medicine, Women's and Children's Hospital (A.J.M.), Adelaide, SA, Newborn Research, Royal Women's Hospital (J.L.Y.C., P.G.D., L.W.D.), the Murdoch Children's Research Institute (P.J.A., J.L.Y.C., P.G.D., L.W.D.), and the Departments of Obstetrics and Gynaecology (J.L.Y.C., P.G.D., L.W.D.) and Paediatrics (L.W.D.), University of Melbourne, the School of Psychological Sciences, Monash University (P.J.A.), and the Department of Paediatrics, Mercy Hospital for Women (G.F.O.), Melbourne, VIC, King Edward Memorial Hospital, Subiaco, WA (M.S.), Newborn Medicine, Centre for Neonatal Research and Education, University of Western Australia, Perth, WA (M.S., K.S.), and the Neonatal Intensive Care Unit, John Hunter Children's Hospital, New Lambton Heights, NSW (J.T.) - all in Australia
| | - Peter J Anderson
- From SAHMRI Women and Kids, South Australian Health and Medical Research Institute (J.F.G., M.M., R.A.G., T.R.S., A.J.M., K.P.B., J.M.B., C.T.C.), the Schools of Medicine (J.F.G., M.M., A.J.M., K.P.B., C.T.C.), Psychology (J.F.G.), Agriculture, Food, and Wine (R.A.G.), and Public Health (T.R.S.), University of Adelaide, and the Department of Neonatal Medicine, Women's and Children's Hospital (A.J.M.), Adelaide, SA, Newborn Research, Royal Women's Hospital (J.L.Y.C., P.G.D., L.W.D.), the Murdoch Children's Research Institute (P.J.A., J.L.Y.C., P.G.D., L.W.D.), and the Departments of Obstetrics and Gynaecology (J.L.Y.C., P.G.D., L.W.D.) and Paediatrics (L.W.D.), University of Melbourne, the School of Psychological Sciences, Monash University (P.J.A.), and the Department of Paediatrics, Mercy Hospital for Women (G.F.O.), Melbourne, VIC, King Edward Memorial Hospital, Subiaco, WA (M.S.), Newborn Medicine, Centre for Neonatal Research and Education, University of Western Australia, Perth, WA (M.S., K.S.), and the Neonatal Intensive Care Unit, John Hunter Children's Hospital, New Lambton Heights, NSW (J.T.) - all in Australia
| | - Karen P Best
- From SAHMRI Women and Kids, South Australian Health and Medical Research Institute (J.F.G., M.M., R.A.G., T.R.S., A.J.M., K.P.B., J.M.B., C.T.C.), the Schools of Medicine (J.F.G., M.M., A.J.M., K.P.B., C.T.C.), Psychology (J.F.G.), Agriculture, Food, and Wine (R.A.G.), and Public Health (T.R.S.), University of Adelaide, and the Department of Neonatal Medicine, Women's and Children's Hospital (A.J.M.), Adelaide, SA, Newborn Research, Royal Women's Hospital (J.L.Y.C., P.G.D., L.W.D.), the Murdoch Children's Research Institute (P.J.A., J.L.Y.C., P.G.D., L.W.D.), and the Departments of Obstetrics and Gynaecology (J.L.Y.C., P.G.D., L.W.D.) and Paediatrics (L.W.D.), University of Melbourne, the School of Psychological Sciences, Monash University (P.J.A.), and the Department of Paediatrics, Mercy Hospital for Women (G.F.O.), Melbourne, VIC, King Edward Memorial Hospital, Subiaco, WA (M.S.), Newborn Medicine, Centre for Neonatal Research and Education, University of Western Australia, Perth, WA (M.S., K.S.), and the Neonatal Intensive Care Unit, John Hunter Children's Hospital, New Lambton Heights, NSW (J.T.) - all in Australia
| | - Mary Sharp
- From SAHMRI Women and Kids, South Australian Health and Medical Research Institute (J.F.G., M.M., R.A.G., T.R.S., A.J.M., K.P.B., J.M.B., C.T.C.), the Schools of Medicine (J.F.G., M.M., A.J.M., K.P.B., C.T.C.), Psychology (J.F.G.), Agriculture, Food, and Wine (R.A.G.), and Public Health (T.R.S.), University of Adelaide, and the Department of Neonatal Medicine, Women's and Children's Hospital (A.J.M.), Adelaide, SA, Newborn Research, Royal Women's Hospital (J.L.Y.C., P.G.D., L.W.D.), the Murdoch Children's Research Institute (P.J.A., J.L.Y.C., P.G.D., L.W.D.), and the Departments of Obstetrics and Gynaecology (J.L.Y.C., P.G.D., L.W.D.) and Paediatrics (L.W.D.), University of Melbourne, the School of Psychological Sciences, Monash University (P.J.A.), and the Department of Paediatrics, Mercy Hospital for Women (G.F.O.), Melbourne, VIC, King Edward Memorial Hospital, Subiaco, WA (M.S.), Newborn Medicine, Centre for Neonatal Research and Education, University of Western Australia, Perth, WA (M.S., K.S.), and the Neonatal Intensive Care Unit, John Hunter Children's Hospital, New Lambton Heights, NSW (J.T.) - all in Australia
| | - Jeanie L Y Cheong
- From SAHMRI Women and Kids, South Australian Health and Medical Research Institute (J.F.G., M.M., R.A.G., T.R.S., A.J.M., K.P.B., J.M.B., C.T.C.), the Schools of Medicine (J.F.G., M.M., A.J.M., K.P.B., C.T.C.), Psychology (J.F.G.), Agriculture, Food, and Wine (R.A.G.), and Public Health (T.R.S.), University of Adelaide, and the Department of Neonatal Medicine, Women's and Children's Hospital (A.J.M.), Adelaide, SA, Newborn Research, Royal Women's Hospital (J.L.Y.C., P.G.D., L.W.D.), the Murdoch Children's Research Institute (P.J.A., J.L.Y.C., P.G.D., L.W.D.), and the Departments of Obstetrics and Gynaecology (J.L.Y.C., P.G.D., L.W.D.) and Paediatrics (L.W.D.), University of Melbourne, the School of Psychological Sciences, Monash University (P.J.A.), and the Department of Paediatrics, Mercy Hospital for Women (G.F.O.), Melbourne, VIC, King Edward Memorial Hospital, Subiaco, WA (M.S.), Newborn Medicine, Centre for Neonatal Research and Education, University of Western Australia, Perth, WA (M.S., K.S.), and the Neonatal Intensive Care Unit, John Hunter Children's Hospital, New Lambton Heights, NSW (J.T.) - all in Australia
| | - Gillian F Opie
- From SAHMRI Women and Kids, South Australian Health and Medical Research Institute (J.F.G., M.M., R.A.G., T.R.S., A.J.M., K.P.B., J.M.B., C.T.C.), the Schools of Medicine (J.F.G., M.M., A.J.M., K.P.B., C.T.C.), Psychology (J.F.G.), Agriculture, Food, and Wine (R.A.G.), and Public Health (T.R.S.), University of Adelaide, and the Department of Neonatal Medicine, Women's and Children's Hospital (A.J.M.), Adelaide, SA, Newborn Research, Royal Women's Hospital (J.L.Y.C., P.G.D., L.W.D.), the Murdoch Children's Research Institute (P.J.A., J.L.Y.C., P.G.D., L.W.D.), and the Departments of Obstetrics and Gynaecology (J.L.Y.C., P.G.D., L.W.D.) and Paediatrics (L.W.D.), University of Melbourne, the School of Psychological Sciences, Monash University (P.J.A.), and the Department of Paediatrics, Mercy Hospital for Women (G.F.O.), Melbourne, VIC, King Edward Memorial Hospital, Subiaco, WA (M.S.), Newborn Medicine, Centre for Neonatal Research and Education, University of Western Australia, Perth, WA (M.S., K.S.), and the Neonatal Intensive Care Unit, John Hunter Children's Hospital, New Lambton Heights, NSW (J.T.) - all in Australia
| | - Javeed Travadi
- From SAHMRI Women and Kids, South Australian Health and Medical Research Institute (J.F.G., M.M., R.A.G., T.R.S., A.J.M., K.P.B., J.M.B., C.T.C.), the Schools of Medicine (J.F.G., M.M., A.J.M., K.P.B., C.T.C.), Psychology (J.F.G.), Agriculture, Food, and Wine (R.A.G.), and Public Health (T.R.S.), University of Adelaide, and the Department of Neonatal Medicine, Women's and Children's Hospital (A.J.M.), Adelaide, SA, Newborn Research, Royal Women's Hospital (J.L.Y.C., P.G.D., L.W.D.), the Murdoch Children's Research Institute (P.J.A., J.L.Y.C., P.G.D., L.W.D.), and the Departments of Obstetrics and Gynaecology (J.L.Y.C., P.G.D., L.W.D.) and Paediatrics (L.W.D.), University of Melbourne, the School of Psychological Sciences, Monash University (P.J.A.), and the Department of Paediatrics, Mercy Hospital for Women (G.F.O.), Melbourne, VIC, King Edward Memorial Hospital, Subiaco, WA (M.S.), Newborn Medicine, Centre for Neonatal Research and Education, University of Western Australia, Perth, WA (M.S., K.S.), and the Neonatal Intensive Care Unit, John Hunter Children's Hospital, New Lambton Heights, NSW (J.T.) - all in Australia
| | - Jana M Bednarz
- From SAHMRI Women and Kids, South Australian Health and Medical Research Institute (J.F.G., M.M., R.A.G., T.R.S., A.J.M., K.P.B., J.M.B., C.T.C.), the Schools of Medicine (J.F.G., M.M., A.J.M., K.P.B., C.T.C.), Psychology (J.F.G.), Agriculture, Food, and Wine (R.A.G.), and Public Health (T.R.S.), University of Adelaide, and the Department of Neonatal Medicine, Women's and Children's Hospital (A.J.M.), Adelaide, SA, Newborn Research, Royal Women's Hospital (J.L.Y.C., P.G.D., L.W.D.), the Murdoch Children's Research Institute (P.J.A., J.L.Y.C., P.G.D., L.W.D.), and the Departments of Obstetrics and Gynaecology (J.L.Y.C., P.G.D., L.W.D.) and Paediatrics (L.W.D.), University of Melbourne, the School of Psychological Sciences, Monash University (P.J.A.), and the Department of Paediatrics, Mercy Hospital for Women (G.F.O.), Melbourne, VIC, King Edward Memorial Hospital, Subiaco, WA (M.S.), Newborn Medicine, Centre for Neonatal Research and Education, University of Western Australia, Perth, WA (M.S., K.S.), and the Neonatal Intensive Care Unit, John Hunter Children's Hospital, New Lambton Heights, NSW (J.T.) - all in Australia
| | - Peter G Davis
- From SAHMRI Women and Kids, South Australian Health and Medical Research Institute (J.F.G., M.M., R.A.G., T.R.S., A.J.M., K.P.B., J.M.B., C.T.C.), the Schools of Medicine (J.F.G., M.M., A.J.M., K.P.B., C.T.C.), Psychology (J.F.G.), Agriculture, Food, and Wine (R.A.G.), and Public Health (T.R.S.), University of Adelaide, and the Department of Neonatal Medicine, Women's and Children's Hospital (A.J.M.), Adelaide, SA, Newborn Research, Royal Women's Hospital (J.L.Y.C., P.G.D., L.W.D.), the Murdoch Children's Research Institute (P.J.A., J.L.Y.C., P.G.D., L.W.D.), and the Departments of Obstetrics and Gynaecology (J.L.Y.C., P.G.D., L.W.D.) and Paediatrics (L.W.D.), University of Melbourne, the School of Psychological Sciences, Monash University (P.J.A.), and the Department of Paediatrics, Mercy Hospital for Women (G.F.O.), Melbourne, VIC, King Edward Memorial Hospital, Subiaco, WA (M.S.), Newborn Medicine, Centre for Neonatal Research and Education, University of Western Australia, Perth, WA (M.S., K.S.), and the Neonatal Intensive Care Unit, John Hunter Children's Hospital, New Lambton Heights, NSW (J.T.) - all in Australia
| | - Karen Simmer
- From SAHMRI Women and Kids, South Australian Health and Medical Research Institute (J.F.G., M.M., R.A.G., T.R.S., A.J.M., K.P.B., J.M.B., C.T.C.), the Schools of Medicine (J.F.G., M.M., A.J.M., K.P.B., C.T.C.), Psychology (J.F.G.), Agriculture, Food, and Wine (R.A.G.), and Public Health (T.R.S.), University of Adelaide, and the Department of Neonatal Medicine, Women's and Children's Hospital (A.J.M.), Adelaide, SA, Newborn Research, Royal Women's Hospital (J.L.Y.C., P.G.D., L.W.D.), the Murdoch Children's Research Institute (P.J.A., J.L.Y.C., P.G.D., L.W.D.), and the Departments of Obstetrics and Gynaecology (J.L.Y.C., P.G.D., L.W.D.) and Paediatrics (L.W.D.), University of Melbourne, the School of Psychological Sciences, Monash University (P.J.A.), and the Department of Paediatrics, Mercy Hospital for Women (G.F.O.), Melbourne, VIC, King Edward Memorial Hospital, Subiaco, WA (M.S.), Newborn Medicine, Centre for Neonatal Research and Education, University of Western Australia, Perth, WA (M.S., K.S.), and the Neonatal Intensive Care Unit, John Hunter Children's Hospital, New Lambton Heights, NSW (J.T.) - all in Australia
| | - Lex W Doyle
- From SAHMRI Women and Kids, South Australian Health and Medical Research Institute (J.F.G., M.M., R.A.G., T.R.S., A.J.M., K.P.B., J.M.B., C.T.C.), the Schools of Medicine (J.F.G., M.M., A.J.M., K.P.B., C.T.C.), Psychology (J.F.G.), Agriculture, Food, and Wine (R.A.G.), and Public Health (T.R.S.), University of Adelaide, and the Department of Neonatal Medicine, Women's and Children's Hospital (A.J.M.), Adelaide, SA, Newborn Research, Royal Women's Hospital (J.L.Y.C., P.G.D., L.W.D.), the Murdoch Children's Research Institute (P.J.A., J.L.Y.C., P.G.D., L.W.D.), and the Departments of Obstetrics and Gynaecology (J.L.Y.C., P.G.D., L.W.D.) and Paediatrics (L.W.D.), University of Melbourne, the School of Psychological Sciences, Monash University (P.J.A.), and the Department of Paediatrics, Mercy Hospital for Women (G.F.O.), Melbourne, VIC, King Edward Memorial Hospital, Subiaco, WA (M.S.), Newborn Medicine, Centre for Neonatal Research and Education, University of Western Australia, Perth, WA (M.S., K.S.), and the Neonatal Intensive Care Unit, John Hunter Children's Hospital, New Lambton Heights, NSW (J.T.) - all in Australia
| | - Carmel T Collins
- From SAHMRI Women and Kids, South Australian Health and Medical Research Institute (J.F.G., M.M., R.A.G., T.R.S., A.J.M., K.P.B., J.M.B., C.T.C.), the Schools of Medicine (J.F.G., M.M., A.J.M., K.P.B., C.T.C.), Psychology (J.F.G.), Agriculture, Food, and Wine (R.A.G.), and Public Health (T.R.S.), University of Adelaide, and the Department of Neonatal Medicine, Women's and Children's Hospital (A.J.M.), Adelaide, SA, Newborn Research, Royal Women's Hospital (J.L.Y.C., P.G.D., L.W.D.), the Murdoch Children's Research Institute (P.J.A., J.L.Y.C., P.G.D., L.W.D.), and the Departments of Obstetrics and Gynaecology (J.L.Y.C., P.G.D., L.W.D.) and Paediatrics (L.W.D.), University of Melbourne, the School of Psychological Sciences, Monash University (P.J.A.), and the Department of Paediatrics, Mercy Hospital for Women (G.F.O.), Melbourne, VIC, King Edward Memorial Hospital, Subiaco, WA (M.S.), Newborn Medicine, Centre for Neonatal Research and Education, University of Western Australia, Perth, WA (M.S., K.S.), and the Neonatal Intensive Care Unit, John Hunter Children's Hospital, New Lambton Heights, NSW (J.T.) - all in Australia
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Stedall PM, Spencer-Smith MM, Mainzer RM, Treyvaud K, Burnett AC, Doyle LW, Spittle AJ, Anderson PJ. Thirteen-Year Outcomes of a Randomized Clinical Trial of Early Preventive Care for Very Preterm Infants and Their Parents. J Pediatr 2022; 246:80-88.e4. [PMID: 35304169 DOI: 10.1016/j.jpeds.2022.03.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 02/22/2022] [Accepted: 03/09/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To evaluate 13-year outcomes of a randomized controlled trial of preventive care (VIBeS Plus) for infants born very preterm and their parents and examine whether possible effects of intervention varied by family social risk. STUDY DESIGN Families were randomized to an intervention arm (n = 61) or a standard care arm (n = 59). The intervention was delivered at home by psychologists and physiotherapists over the infants' first year, focusing on infant development and parental mental health. At 13 years corrected age, cognitive, motor, and behavioral outcomes, and parental mental health were assessed. Primary estimands were between-group mean differences, estimated using multiple imputed regression models. RESULTS Follow-up included 81 surviving children (69%). There was little evidence of benefits of the intervention for IQ, attention, executive functioning, working memory, and academic skills regardless of level of social risk. Specifically, mean differences in adolescent cognitive outcomes ranged from -2.0 units (95% CI, -9.9 to 5.9) in favor of standard treatment to 5.1 units (95% CI, -2.3 to 12.5) favoring the intervention. A group-by-social risk interaction was observed only for adolescent motor outcomes, with mean differences favoring the intervention for those at higher social risk (balance, 4.9; 95% CI, 1.3-8.5; total motor, 3.2; 95% CI, 0.3-6.2), but not those at lower social risk (balance, -0.3; 95% CI, -2.4 to 1.9; total motor, 0.03; 95% CI, -1.9 to 2.0). Mean differences in adolescent behavior and parental mental health ranged from -6.6 (95% CI -13.8, 0.5) to -0.2 (95% CI, -1.9 to 1.4) and -1.8 (95% CI, -4.1 to 0.6) to -1.7 (95% CI, -4.3 to 1.0), respectively, indicating a pattern of fewer symptoms in the intervention group. CONCLUSIONS Benefits of the intervention persisted for adolescent behavior, with better motor outcomes observed in those from socially disadvantaged families. Replication with larger samples, multiple informant reports, and assessment of quality of life-related outcomes is warranted. TRIAL REGISTRATION http://www.anzctr.org.au/: ACTRN12605000492651.
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Affiliation(s)
- Paulina M Stedall
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia; Department of Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
| | - Megan M Spencer-Smith
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia; Department of Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
| | - Rheanna M Mainzer
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Melbourne, Australia
| | - Karli Treyvaud
- Department of Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia; Department of Psychology and Counselling, La Trobe University, Melbourne, Australia
| | - Alice C Burnett
- Department of Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia; Premature Infant Follow-up Program, Royal Women's Hospital, Parkville, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; Neonatal Medicine, Royal Children's Hospital, Parkville, Australia
| | - Lex W Doyle
- Department of Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia; Premature Infant Follow-up Program, Royal Women's Hospital, Parkville, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; Department of Obstetrics and Gynaecology, Royal Women's Hospital, Parkville, Australia
| | - Alicia J Spittle
- Department of Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia; Newborn Research, Royal Women's Hospital, Parkville, Australia; Department of Physiotherapy, University of Melbourne, Melbourne, Australia
| | - Peter J Anderson
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia; Department of Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia.
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13
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Lamond B, Roberts SD, Miller SP, Wade SL, Williams TS. Psychosocial Intervention Outcomes for Children with Congenital and Neonatal Conditions: Systematic Review. J Pediatr Psychol 2022; 47:1003-1018. [PMID: 35472174 DOI: 10.1093/jpepsy/jsac038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 03/28/2022] [Accepted: 03/30/2022] [Indexed: 11/14/2022] Open
Abstract
There has been a historic lack of psychosocially geared treatment studies for congenital and neonatal conditions that impact brain development, despite well-established knowledge that these conditions impact cognitive development, quality of life (QoL), mental health, and academic success. OBJECTIVE The aim of the present study was to systematically investigate the research literature focusing on the effects of interventions in psychosocially geared programs for children with neonatal brain injury on school and psychological outcomes. METHODS Psychosocially geared programs broadly refer to interventions to improve parenting and school functioning, or child behavior, as well as other interventions that have a psychological component but may be more physically oriented, such as goal-directed physiotherapy. A comprehensive search of PubMed, Medline, PsychINFO, and Embase was completed between June and July 2020. The methodological quality of included articles was assessed using the Cochrane Risk of Bias Tool for Randomized Trials (RoB-2). RESULTS AND CONCLUSION Twenty studies met the inclusion criteria and demonstrated adequate risk of bias (i.e., low risk of bias or some concerns). The studies included family (n = 2), parenting (n = 7), and child (n = 10) interventions. There is some evidence supporting the effectiveness of psychosocial interventions for children with neonatal brain injury and their families on academic outcomes, behavior, and QoL, indicated by positive intervention effects in 65% (n = 13) of studies.
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Affiliation(s)
- Bronwyn Lamond
- Department of Psychology, Division of Neurology, The Hospital for Sick Children, Canada.,Department of Applied Psychology and Human Development, The University of Toronto, Canada
| | - Samantha D Roberts
- Department of Psychology, Division of Neurology, The Hospital for Sick Children, Canada.,Department of Psychology, York University, Canada
| | - Steven P Miller
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Canada.,BC Children's Hospital & Sunny Hill Health Centre, Canada
| | - Shari L Wade
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, USA
| | - Tricia S Williams
- Department of Psychology, Division of Neurology, The Hospital for Sick Children, Canada.,Department of Pediatrics, The University of Toronto, Canada
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14
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Abstract
Neonatal follow-up studies traditionally report on long-term neurodevelopmental outcomes as a metric of success of neonatal intensive care. Research endpoints are also typically deficit-based, assessing whether disabilities, such as cerebral palsy, cognitive impairment, deafness or blindness, are present or not. These historical approaches have resulted in neonatal follow-up programs that narrowly focus on the early identification of neurodevelopmental problems, possibly to the detriment of other outcomes that matter to parents. This focus on neurodevelopmental disability may also contribute to the negative stereotypes associated with extreme preterm birth. In this article, we discuss parental perspectives regarding important long-term outcomes. We examine limitations with current definitions of outcomes and propose a strength-based approach to generate meaningful findings both for clinicians and families.
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15
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Dür M, Röschel A, Oberleitner-Leeb C, Herrmanns V, Pichler-Stachl E, Mattner B, Pernter SD, Wald M, Urlesberger B, Kurz H, Frischer T, Zwiauer K, Matter IS, Berger A. Associations Between Parental Occupational Balance, Subjective Health, and Clinical Characteristics of VLBW Infants. Front Pediatr 2022; 10:816221. [PMID: 35299673 PMCID: PMC8922994 DOI: 10.3389/fped.2022.816221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 02/03/2022] [Indexed: 11/23/2022] Open
Abstract
Objective Very low birthweight (VLBW) infants have an increased risk of mortality and frequently suffer from complications, which affects parental occupational balance. Occupational balance is the satisfaction with one's meaningful activities, which include everyday activities that people need to, want to, and are expected to do. In contrast to work-life balance, the construct of occupational balance addresses different activities equally and it applies to all persons, regardless of whether they are working or not. Parental occupational balance might be related to parents' and VLBW infants' health. Therefore, the objective of this study was to investigate associations between parental occupational balance, subjective health, and clinical characteristics of VLBW infants. Methods A cross-sectional multicenter study was conducted in six Austrian neonatal intensive care units. Occupational balance and subjective health of parents of VLBW infants were assessed with six self-reported questionnaires. The following clinical characteristics of VLBW infants were extracted from medical records: gestational age, birthweight, Apgar scores, Clinical Risk for Babies II Score, and complications of prematurity. Spearman's rank coefficients were calculated. Results In total, 270 parents, 168 (62%) female and their VLBW infants, 120 (44%) female, were included in this study. Parents' mean age was 33.7 (±6.0) years, mean gestational age of VLBW infants was 27 + 3 (±2) weeks. Associations between parental occupational balance, subjective health, and clinical characteristics of VLBW infants were identified (r s = 0.13 - 0.56; p ≤ 0.05), such as the correlation between occupational areas (r s = 0.22, p ≤ 0.01), occupational characteristics (r s = 0.17, p = 0.01), and occupational resilience (r s = 0.18, p ≤ 0.01) with bronchopulmonary dysplasia of VLBW infants. Conclusion Occupational balance is associated with parents' and VLBW infants' health. Interventions to strengthen parental occupational balance might increase parental health and thereby also improve health and developmental outcomes of their VLBW infants.
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Affiliation(s)
- Mona Dür
- Department of Health Sciences, IMC University of Applied Sciences Krems, Krems, Austria
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
- Duervation, Krems, Austria
| | - Anna Röschel
- Department of Health Sciences, IMC University of Applied Sciences Krems, Krems, Austria
| | - Christiane Oberleitner-Leeb
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Verena Herrmanns
- Department of Pediatrics, Clinic Donaustadt, Gesundheitsverbund Vienna, Vienna, Austria
- Department of Pediatrics With Neonatology, St. Josef Hospital Vienna, Vienna, Austria
| | - Elisabeth Pichler-Stachl
- Division of Neonatology, Department for Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Barbara Mattner
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Pediatric Intensive Care, Wilhelminen Hospital, Vienna, Austria
| | - Silvia-Desiree Pernter
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, University Hospital Salzburg, Salzburg, Austria
| | - Martin Wald
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, University Hospital Salzburg, Salzburg, Austria
| | - Berndt Urlesberger
- Division of Neonatology, Department for Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Herbert Kurz
- Department of Pediatrics, Clinic Donaustadt, Gesundheitsverbund Vienna, Vienna, Austria
| | - Thomas Frischer
- Faculty for Medicine, Sigmund Freud University, Vienna, Austria
| | - Karl Zwiauer
- University Hospital for Pediatrics and Adolescent Medicine, University Hospital St. Pölten, Sankt Pölten, Austria
- Karl Landsteiner University for Health Sciences, Krems, Austria
| | - Inu Sarah Matter
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Angelika Berger
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
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16
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PreEMPT (Preterm infant Early intervention for Movement and Participation Trial): Feasibility outcomes of a randomised controlled trial. Early Hum Dev 2022; 166:105551. [PMID: 35152175 DOI: 10.1016/j.earlhumdev.2022.105551] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 01/06/2022] [Accepted: 01/31/2022] [Indexed: 11/22/2022]
Abstract
PURPOSE Investigate feasibility of PreEMPT: a novel participation-focused, early physiotherapy intervention for preterm infants in regional Australia. MATERIALS AND METHODS Participants were infants born <35 weeks, residing in regional Australia. Sixteen infants were recruited then randomised to usual physiotherapy care (UPC: n = 8) or PreEMPT (n = 8). PreEMPT involved 14-weeks of alternating clinic- or telehealth-based, participation-focused intervention. Feasibility was evaluated by: demand, practicality, acceptability, implementation and limited efficacy testing for infants (motor, participation) and parents (mental well-being, self-efficacy). RESULTS Demand was lower than expected (45% recruitment rate). For practicality, attrition was high in the PreEMPT group (mean assessment attendance 3.8/5 sessions, range 2-5) compared to UPC (4.8/5 sessions, range 4-5). In addition, mean PreEMPT treatment dose received was approximately half intended (overall: 7.3/14 sessions, range 0-12; equivalent for face-to-face: 3.9/7, range 0-6, versus telehealth 3.4/7, range 0-6). The most common reason cited for treatment non-attendance was maternal mental health (22 sessions). Treatment acceptability for parents was high, with PreEMPT parents reporting they were offered choices in sessions (p = .02), and increased their knowledge (p = .01) and confidence (p = .009). There was a large effect size in favour of PreEMPT for increased parental self-efficacy (p = .021, ES = 1.34). CONCLUSION Early post-discharge physiotherapy for preterm infants in regional Australia is beneficial according to families but logistically challenging.
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17
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Salavati S, Bos AF, Doyle LW, Anderson PJ, Spittle AJ. Very Preterm Early Motor Repertoire and Neurodevelopmental Outcomes at 8 Years. Pediatrics 2021; 148:peds.2020-049572. [PMID: 34452979 DOI: 10.1542/peds.2020-049572] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/28/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Children born very preterm (<32 weeks' gestation) have more neurodevelopmental problems compared with term-born peers. Aberrant fidgety movements (FMs) are associated with adverse motor outcomes in children born very preterm. However, associations of aberrant FMs combined with additional movements and postures to give a motor optimality score-revised (MOS-R) with school-aged cognitive and motor outcomes are unclear. Our aim with this study was to determine those associations. METHODS Of 118 infants born <30 weeks' gestation recruited into a randomized controlled trial of early intervention, 97 had a general movements assessment at 3 months' corrected age and were eligible for this study. Early motor repertoire including FMs and MOS-R were scored from videos of infant's spontaneous movement at 3 months' corrected age. At 8 years' corrected age, cognitive and motor performances were evaluated. Associations of early FMs and MOS-R with outcomes at 8 years were determined using linear regression. RESULTS Seventy-eight (80%) infants with early motor repertoire data had neurodevelopmental assessments at 8 years. A higher MOS-R, and favorable components of the individual subscales of the MOS-R, including the presence of normal FMs, were associated with better performance for general cognition, attention, working memory, executive function and motor function at 8 years; eg, presence of normal FMs was associated with a 21.6 points higher general conceptual ability score (95% confidence interval: 12.8-30.5; P < .001) compared with absent FMs. CONCLUSIONS Favorable early motor repertoire of infants born <30 weeks is strongly associated with improved cognitive and motor performance at 8 years.
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Affiliation(s)
- Sahar Salavati
- Division of Neonatology, Department of Pediatrics, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Arend F Bos
- Division of Neonatology, Department of Pediatrics, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Lex W Doyle
- Victorian Infant Brain Studies, Murdoch Children's Research Institute, Melbourne, Australia.,Obstetrics and Gynaecology.,Paediatrics, University of Melbourne, Melbourne, Australia.,Newborn Research, Royal Women's Hospital, Melbourne, Australia
| | - Peter J Anderson
- Victorian Infant Brain Studies, Murdoch Children's Research Institute, Melbourne, Australia.,Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria, Australia
| | - Alicia J Spittle
- Victorian Infant Brain Studies, Murdoch Children's Research Institute, Melbourne, Australia.,Departments of Physiotherapy.,Newborn Research, Royal Women's Hospital, Melbourne, Australia
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18
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Frolek Clark G, Niblock J, Crane Vos T, Lieberman D, Hunter EG. Systematic Review of Occupational Therapy Interventions to Enhance Cognitive Development in Children 0–5 Years: Part 1, Identified Diagnoses. JOURNAL OF OCCUPATIONAL THERAPY, SCHOOLS, & EARLY INTERVENTION 2021. [DOI: 10.1080/19411243.2021.1959480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
| | | | | | - Deborah Lieberman
- Vice President Practice Improvement, American Occupational Therapy Association, Inc, USA
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19
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Orkin J, Major N, Esser K, Parmar A, Couture E, Daboval T, Kieran E, Ly L, O'Brien K, Patel H, Synnes A, Robson K, Barreira L, Smith WL, Rizakos S, Willan AR, Yaskina M, Moretti ME, Ungar WJ, Ballantyne M, Church PT, Cohen E. Coached, Coordinated, Enhanced Neonatal Transition (CCENT): protocol for a multicentre pragmatic randomised controlled trial of transition-to-home support for parents of high-risk infants. BMJ Open 2021; 11:e046706. [PMID: 34233983 PMCID: PMC8264914 DOI: 10.1136/bmjopen-2020-046706] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Having an infant admitted to the neonatal intensive care unit (NICU) is associated with increased parental stress, anxiety and depression. Enhanced support for parents may decrease parental stress and improve subsequent parent and child outcomes. The Coached, Coordinated, Enhanced Neonatal Transition (CCENT) programme is a novel bundled intervention of psychosocial support delivered by a nurse navigator that includes Acceptance and Commitment Therapy-based coaching, care coordination and anticipatory education for parents of high-risk infants in the NICU through the first year at home. The primary objective is to evaluate the impact of the intervention on parent stress at 12 months. METHODS AND ANALYSIS This is a multicentre pragmatic randomised controlled superiority trial with 1:1 allocation to the CCENT model versus control (standard neonatal follow-up). Parents of high-risk infants (n=236) will be recruited from seven NICUs across three Canadian provinces. Intervention participants are assigned a nurse navigator who will provide the intervention for 12 months. Outcomes are measured at baseline, 6 weeks, 4, 12 and 18 months. The primary outcome measure is the total score of the Parenting Stress Index Fourth Edition Short Form at 12 months. Secondary outcomes include parental mental health, empowerment and health-related quality of life for calculation of quality-adjusted life years (QALYs). A cost-effectiveness analysis will examine the incremental cost of CCENT versus usual care per QALY gained. Qualitative interviews will explore parent and healthcare provider experiences with the intervention. ETHICS AND DISSEMINATION Research ethics approval was obtained from Clinical Trials Ontario, Children's Hospital of Eastern Ontario Research Ethics Board (REB), The Hospital for Sick Children REB, UBC Children's and Women's REB and McGill University Health Centre REB. Results will be shared with Canadian level III NICUs, neonatal follow-up programmes and academic forums. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT03350243).
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Affiliation(s)
- Julia Orkin
- Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Nathalie Major
- Department of Paediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Kayla Esser
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Arpita Parmar
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Elise Couture
- Division of Neonatology, Montreal Children's Hospital, Montreal, Québec, Canada
| | - Thierry Daboval
- Department of Paediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Emily Kieran
- Division of Neonatology, BC Women's Hospital and Health Centre, Vancouver, British Columbia, Canada
| | - Linh Ly
- Division of Neonatology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Karel O'Brien
- Division of Neonatology, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Hema Patel
- Division of General Pediatrics, Montreal Children's Hospital, Montreal, Québec, Canada
| | - Anne Synnes
- Division of Neonatology, BC Women's Hospital and Health Centre, Vancouver, British Columbia, Canada
| | - Kate Robson
- Neonatal Follow Up Clinic, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Lesley Barreira
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Wanda L Smith
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Sara Rizakos
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Andrew R Willan
- Clinical Research Services, SickKids Research Institute, Toronto, Ontario, Canada
| | - Maryna Yaskina
- Women and Children's Health Research Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Myla E Moretti
- Clinical Trials Unit, The Hospital for Sick Children, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Wendy J Ungar
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Marilyn Ballantyne
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Paige Terrien Church
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
- Division of Neonatology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Eyal Cohen
- Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
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20
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Bejarano-Martín Á, Canal-Bedia R, Magán-Maganto M, Hernández Fabián A, Calvarro Castañeda AL, Manso de Dios S, Malmierca García P, Díez Villoria E, Jenaro Río C, Posada de la Paz M. Effect of a Focused Social and Communication Intervention on Preterm Children with ASD: A Pilot Study. J Autism Dev Disord 2021; 52:1725-1740. [PMID: 33991290 DOI: 10.1007/s10803-021-05068-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2021] [Indexed: 11/26/2022]
Abstract
While advances in intensive neonatal care have greatly improved survival rates among preterm infants, incidence of neurodevelopmental disorders in this group is still high, with autism spectrum disorder (ASD) being one of the most frequent. To this end, we conducted a social-communication intervention aimed at investigating efficacy in social-communicative skills. Eighteen children (preterm and full-term with ASD and preterm children) aged 18 through 20 months participated in the study. Our findings indicate that most participants in the intervention groups registered significant improvements in terms of socio-communicative skills, cognitive development, and language. Accordingly, these pilot data underscore the need for further research and implementation of early interventions in young preterm children with ASD.
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Affiliation(s)
- Álvaro Bejarano-Martín
- INICO, Instituto Universitario de Integración en La Comunidad, Universidad de Salamanca, 37008, Salamanca, Spain
| | - Ricardo Canal-Bedia
- INICO, Instituto Universitario de Integración en La Comunidad, Universidad de Salamanca, 37008, Salamanca, Spain.
- Centro de Atención Integral Al Autismo (INFOAUTISMO), Facultad de Educación, Universidad de Salamanca, Paseo Canalejas, 169, 37008, Salamanca, España.
| | - María Magán-Maganto
- INICO, Instituto Universitario de Integración en La Comunidad, Universidad de Salamanca, 37008, Salamanca, Spain
| | | | | | - Sara Manso de Dios
- INICO, Instituto Universitario de Integración en La Comunidad, Universidad de Salamanca, 37008, Salamanca, Spain
| | - Patricia Malmierca García
- INICO, Instituto Universitario de Integración en La Comunidad, Universidad de Salamanca, 37008, Salamanca, Spain
| | - Emiliano Díez Villoria
- INICO, Instituto Universitario de Integración en La Comunidad, Universidad de Salamanca, 37008, Salamanca, Spain
| | - Cristina Jenaro Río
- INICO, Instituto Universitario de Integración en La Comunidad, Universidad de Salamanca, 37008, Salamanca, Spain
| | - Manuel Posada de la Paz
- Instituto de Investigación de Enfermedades Raras, Instituto de Salud Carlos III, 28029, Madrid, Spain
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21
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Ma RH, Zhang Q, Ni ZH, Lv HT. Transitional care experiences of caregivers of preterm infants hospitalized in a neonatal intensive care unit: A qualitative descriptive study. Nurs Open 2021; 8:3484-3494. [PMID: 33951349 PMCID: PMC8510728 DOI: 10.1002/nop2.899] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 02/18/2021] [Accepted: 03/29/2021] [Indexed: 11/08/2022] Open
Abstract
Aim To describe the transitional care experiences and nursing needs of caregivers of preterm infants hospitalized in neonatal intensive care units (NICUs). Design A qualitative descriptive study. Methods We conducted semi‐structured interviews with the 24 caregivers of preterm infants admitted to Children's Hospital, Soochow University. All data were collected by a trained and experienced interviewer. The caregivers' experiences were described using qualitative content analysis. Results Six Five themes emerged from the analysis: (a) uncertainty about the disease; (b) anxiety due to restricted visitation; (c) exhaustion from overwork; (d) emotional depression; (e) low care ability; (f) a variety of channels for help and a positive response. This study provides a basis for understanding the needs of their caregivers so that effective coping strategies can be implemented. Nurses' education and practice should focus on understanding the real experiences of the parents of preterm infants during transitional nursing.
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Affiliation(s)
- Ruo Han Ma
- Neonatal Intensive Care Unit, Children's Hospital of Soochow University, Suzhou, China.,Medical College of Soochow University, Suzhou, China
| | - Qing Zhang
- Neonatal Intensive Care Unit, Children's Hospital of Soochow University, Suzhou, China
| | - Zhi Hong Ni
- Nursing Department, Children's Hospital of Soochow University, Suzhou, China
| | - Hai Tao Lv
- Neonatal Intensive Care Unit, Children's Hospital of Soochow University, Suzhou, China
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22
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Preventive Intervention Program on the Outcomes of Very Preterm Infants and Caregivers: A Multicenter Randomized Controlled Trial. Brain Sci 2021; 11:brainsci11050575. [PMID: 33946995 PMCID: PMC8145332 DOI: 10.3390/brainsci11050575] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/25/2021] [Accepted: 04/26/2021] [Indexed: 11/25/2022] Open
Abstract
Increased survival in the very preterm population results in a higher risk of developing neurodevelopmental and behavioral disabilities among survivors. We examined the outcomes of very preterm infants and parents after a preventive intervention program of four home visits by a specialized nurse, 5 days, 2 weeks, and 1 month after discharge, respectively, and at CA 2 months, followed by up to 12 times of group sessions between CA 3 and 6 months. Our multicenter randomized controlled trial assessed 138 preterm infants (gestational age ≤30 weeks or birth weight ≤1500 g) enrolled from the three participating hospitals. We randomly allocated the preterm babies to either the intervention or the control group. The primary outcome was the neurodevelopmental outcomes of Bayley-III scores at CA 10 and 24 months. At CA 10 months and 24 months, there were no significant differences between the intervention and control groups in the cognitive, motor, and language domains of Bayley-III scores. In addition, there were no significant differences in the mother’s depression scale, mother–child attachment, and the modified Infant and Toddler Social and Emotional Assessment.
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23
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Camden C, Zwicker JG, Morin M, Schuster T, Couture M, Poder TG, Maltais DB, Battista MC, Baillargeon JP, Goyette M, Pratte G, Hurtubise K, Phoenix M, Nguyen T, Berbari J, Tousignant M. Web-based early intervention for children with motor difficulties aged 3–8 years old using multimodal rehabilitation (WECARE): protocol of a patient-centred pragmatic randomised trial of paediatric telerehabilitation to support families. BMJ Open 2021. [PMCID: PMC8039274 DOI: 10.1136/bmjopen-2020-046561] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Introduction Mild motor difficulties in children are underdiagnosed despite being highly prevalent, leaving such children often underserved and at higher risk for secondary consequences such as cardiovascular disease and anxiety. Evidence suggests that early patient-oriented interventions, coaching parents and providing children with early stimulation should be provided, even in the absence of a diagnosis. Such interventions may be effectively delivered via telerehabilitation. Methods and analysis A family-centred, pragmatic randomised controlled trial will be carried out to evaluate the real-world effectiveness of a Web-based Early intervention for Children using multimodAl REhabilitation (WECARE). Families of children with motor difficulties, 3–8 years of age, living in Quebec, Canada, and receiving no public rehabilitation services (n=118) will be asked to determine up to 12 performance goals, evaluated using the Canadian Occupational Performance Measure (COPM, the primary outcome). Families will be randomised to receive either usual care or the WECARE intervention. The WECARE intervention will be delivered for 1 year via a web-based platform. Families will have access to videoconferences with an assigned rehabilitation therapist using a collaborative coaching approach, a private chat function, a forum open to all intervention arm participants and online resources pertaining to child development. Participants will be asked to re-evaluate the child’s COPM performance goals every 3 months up to 1 year post allocation. The COPM results will be analysed using a mixed Poisson regression model. Secondary outcomes include measures of the child’s functional ability, parental knowledge and skills and health-related quality of life, as well as qualitative outcomes pertaining to parental satisfaction and service delivery trajectories. Investigators and quantitative data analysts will be blinded to group allocation. Ethics and dissemination The CIUSSS de l’Estrie—CHUS ethics committee approved this trial (2020-3429). Study results will be communicated via peer-reviewed journal publications, conference presentations and stakeholder-specific knowledge transfer activities. Trial registration number NCT04254302.
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Affiliation(s)
- Chantal Camden
- École de réadaptation, Universite de Sherbrooke Faculté de Médecine et des Sciences de la Santé, Sherbrooke, Québec, Canada
- Centre de recherche du Centre hospitalier universitaire de Sherbrooke, CIUSSS de l'Estrie—CHUS, Sherbrooke, Québec, Canada
| | - Jill G Zwicker
- Occupational Science & Occupational Therapy, The University of British Columbia, Vancouver, British Columbia, Canada
- BC Children’s Hospital, Vancouver, British Columbia, Canada
| | - Melanie Morin
- École de réadaptation, Universite de Sherbrooke Faculté de Médecine et des Sciences de la Santé, Sherbrooke, Québec, Canada
- Centre de recherche du Centre hospitalier universitaire de Sherbrooke, CIUSSS de l'Estrie—CHUS, Sherbrooke, Québec, Canada
| | - Tibor Schuster
- Department of Family Medicine, McGill University, Montreal, Québec, Canada
| | - Melanie Couture
- École de réadaptation, Universite de Sherbrooke Faculté de Médecine et des Sciences de la Santé, Sherbrooke, Québec, Canada
- Centre de recherche du Centre hospitalier universitaire de Sherbrooke, CIUSSS de l'Estrie—CHUS, Sherbrooke, Québec, Canada
| | - Thomas G Poder
- School of Public Health, Université de Montréal, Montreal, Québec, Canada
- Centre de recherche de l’Institut universitaire en santé mentale de Montréal, Montreal, Québec, Canada
| | - Desiree B Maltais
- Département de réadaptation, Universite Laval, Québec City, Québec, Canada
| | - Marie-Claude Battista
- Department of Medicine, Universite de Sherbrooke Faculté de Médecine et des Sciences de la Santé, Sherbrooke, Quebec, Canada
| | - Jean-Patrice Baillargeon
- Centre de recherche du Centre hospitalier universitaire de Sherbrooke, CIUSSS de l'Estrie—CHUS, Sherbrooke, Québec, Canada
- Universite de Sherbrooke Faculté de Médecine et des Sciences de la Santé, Sherbrooke, Quebec, Canada
| | - Mathieu Goyette
- Département de sexologie, Université du Québec à Montréal, Montreal, Québec, Canada
| | - Gabrielle Pratte
- École de réadaptation, Universite de Sherbrooke Faculté de Médecine et des Sciences de la Santé, Sherbrooke, Québec, Canada
| | - Karen Hurtubise
- École de réadaptation, Universite de Sherbrooke Faculté de Médecine et des Sciences de la Santé, Sherbrooke, Québec, Canada
| | - Michelle Phoenix
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Tram Nguyen
- School of Epidemiology & Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Jade Berbari
- Centre de recherche du Centre hospitalier universitaire de Sherbrooke, CIUSSS de l'Estrie—CHUS, Sherbrooke, Québec, Canada
| | - Michel Tousignant
- École de réadaptation, Universite de Sherbrooke Faculté de Médecine et des Sciences de la Santé, Sherbrooke, Québec, Canada
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Banihani R, Seesahai J, Asztalos E, Terrien Church P. Neuroimaging at Term Equivalent Age: Is There Value for the Preterm Infant? A Narrative Summary. CHILDREN (BASEL, SWITZERLAND) 2021; 8:227. [PMID: 33809745 PMCID: PMC8002329 DOI: 10.3390/children8030227] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 03/10/2021] [Accepted: 03/10/2021] [Indexed: 11/17/2022]
Abstract
Advances in neuroimaging of the preterm infant have enhanced the ability to detect brain injury. This added information has been a blessing and a curse. Neuroimaging, particularly with magnetic resonance imaging, has provided greater insight into the patterns of injury and specific vulnerabilities. It has also provided a better understanding of the microscopic and functional impacts of subtle and significant injuries. While the ability to detect injury is important and irresistible, the evidence for how these injuries link to specific long-term outcomes is less clear. In addition, the impact on parents can be profound. This narrative summary will review the history and current state of brain imaging, focusing on magnetic resonance imaging in the preterm population and the current state of the evidence for how these patterns relate to long-term outcomes.
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Affiliation(s)
- Rudaina Banihani
- Newborn & Developmental Paediatrics, Sunnybrook Health Science Centre, 2075 Bayview Ave, The University of Toronto, Toronto, ON M4N 3M5, Canada; (J.S.); (E.A.); (P.T.C.)
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Clark GF, Kingsley KL. Occupational Therapy Practice Guidelines for Early Childhood: Birth-5 Years. Am J Occup Ther 2020; 74:7403397010p1-7403397010p42. [PMID: 32365324 DOI: 10.5014/ajot.2020.743001] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE This Practice Guideline provides stakeholders with a condensed summary of a large number of effectiveness studies. It is a valuable tool for facilitating decision making related to occupational therapy interventions for children ages birth-5 yr. OBJECTIVE Early childhood (birth-5 yr) is a critical period in which the foundation of key life occupations is developed (e.g., eating, dressing, play, learning, social participation, rest and sleep, and chores). The development of cognitive, motor, social-emotional, and self-care skills is important to support these occupations. This Practice Guideline synthesizes recent systematic reviews (SRs) on these areas of development to promote decision making for and high-quality interventions with this population. METHOD Four SRs related to cognition, mental health, motor function, and ADLs analyzed studies published from 2010 to 2017 retrieved from six electronic databases (MEDLINE, PsycINFO, CINAHL, ERIC, OTseeker, and Cochrane). RESULTS A total of 196 articles were included in the SRs, which served as a guide to final clinical recommendations. Case studies describe translation and application to practice. CONCLUSION and Recommendations: A variety of interventions within the domain of occupational therapy were found to support the development of cognitive, social-emotional, motor, and self-care skills. Although some of these interventions are typically implemented by occupational therapy practitioners, others can be implemented by parents after training or by teams working in preschool settings. These findings should be used to inform evidence-based practice provided by occupational therapy practitioners working in various early childhood settings. WHAT THIS ARTICLE ADDS This Practice Guideline gives occupational therapy practitioners clear information about which interventions will be effective for specific outcomes. Better intervention choices mean better outcomes for young children and their families.
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Affiliation(s)
- Gloria Frolek Clark
- Gloria Frolek Clark, PhD, OTR/L, BCP, FAOTA, is an occupational therapist in private practice, Adel, Iowa;
| | - Karrie L Kingsley
- Karrie L. Kingsley, OTD, OTR/L, is Associate Professor, Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles
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Dickinson C, Whittingham K, Sheffield J, Wotherspoon J, Boyd RN. Efficacy of interventions to improve psychological adjustment for parents of infants with or at risk of neurodevelopmental disability: A systematic review. Infant Ment Health J 2020; 41:697-722. [DOI: 10.1002/imhj.21871] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Corrine Dickinson
- Faculty of Medicine Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre The University of Queensland South Brisbane Australia
- Queensland Children's Hospital Children's Health Queensland South Brisbane Australia
| | - Koa Whittingham
- Faculty of Medicine Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre The University of Queensland South Brisbane Australia
| | - Jeanie Sheffield
- The School of Psychology The University of Queensland Brisbane Australia
| | - Jane Wotherspoon
- Faculty of Medicine Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre The University of Queensland South Brisbane Australia
| | - Roslyn N Boyd
- Faculty of Medicine Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre The University of Queensland South Brisbane Australia
- Queensland Children's Hospital Children's Health Queensland South Brisbane Australia
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Buck CO, Tucker R, Vohr B, McGowan EC. Predictors of Parenting Readiness in Fathers of High-Risk Infants in the Neonatal Intensive Care Unit. J Pediatr 2020; 217:192-195.e1. [PMID: 31704051 DOI: 10.1016/j.jpeds.2019.09.078] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 08/28/2019] [Accepted: 09/27/2019] [Indexed: 11/15/2022]
Abstract
To evaluate discharge readiness perceptions among mother-father dyads, parents of infants in the neonatal intensive care unit completed a parenting readiness survey. Fathers had more favorable perceptions than their partners. Maternal perceptions and social risk, but not infant morbidities, predicted paternal perceptions. Discharge support should focus on the mother-father dyad.
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Affiliation(s)
- Catherine O Buck
- Department of Pediatrics, Yale School of Medicine, New Haven, CT.
| | - Richard Tucker
- Department of Pediatrics, Brown University/Women and Infants Hospital of Rhode Island, Providence, RI
| | - Betty Vohr
- Department of Pediatrics, Brown University/Women and Infants Hospital of Rhode Island, Providence, RI
| | - Elisabeth C McGowan
- Department of Pediatrics, Brown University/Women and Infants Hospital of Rhode Island, Providence, RI
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Fourdain S, Caron-Desrochers L, Simard MN, Provost S, Doussau A, Gagnon K, Dagenais L, Presutto É, Prud'homme J, Boudreault-Trudeau A, Constantin IM, Desnous B, Poirier N, Gallagher A. Impacts of an Interdisciplinary Developmental Follow-Up Program on Neurodevelopment in Congenital Heart Disease: The CINC Study. Front Pediatr 2020; 8:539451. [PMID: 33123502 PMCID: PMC7573208 DOI: 10.3389/fped.2020.539451] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 08/18/2020] [Indexed: 11/13/2022] Open
Abstract
Objectives: This study investigates the impact of an early systematic interdisciplinary developmental follow-up and individualized intervention program on the neurodevelopment of children with complex congenital heart disease (CHD) who required cardiac surgery. Study Design: We prospectively enrolled 80 children with CHD: 41 were already followed at our neurocardiac developmental follow-up clinic from the age of 4 months, while 39 were born before the establishment of the program and therefore received standard health care. We conducted cognitive, motor, and behavioral assessments at 3 years of age. We used one-way multivariate analyses of variance to compare the neurodevelopmental outcome of both groups. Results: Between-group analyses revealed a distinct neurodevelopmental profile with clinically significant effect size (P < 0.001, partial η2 = 0.366). Children followed at our clinic demonstrated better receptive language performances (P = 0.048) and tended to show higher scores on visuo-constructive tasks (P = 0.080). Children who received standard health care exhibited greater performances in working memory tasks (P = 0.032). We found no group differences on global intellectual functioning, gross and fine motor skills, and behaviors. Referral rates for specific remedial services were higher in patients followed at our neurocardiac clinic compared to the historical cohort (P < 0.005). Conclusions: Overall, the impact of the developmental follow-up and individualized intervention program on neurodevelopmental outcomes remains subtle. Nevertheless, results, although limited by several factors, point toward an advantage for the children who took part in the program regarding receptive language skills over children who received standard health care. We hypothesize that group differences may be greater with growing age. Further research involving larger cohorts is needed to clearly assess the effectiveness of neurocardiac developmental follow-up programs at school age.
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Affiliation(s)
- Solène Fourdain
- Sainte-Justine University Hospital Research Center, Montreal, QC, Canada.,Department of Psychology, Université de Montréal, Montreal, QC, Canada
| | - Laura Caron-Desrochers
- Sainte-Justine University Hospital Research Center, Montreal, QC, Canada.,Department of Psychology, Université de Montréal, Montreal, QC, Canada
| | - Marie-Noëlle Simard
- Sainte-Justine University Hospital Research Center, Montreal, QC, Canada.,School of Rehabilitation, Université de Montréal, Montreal, QC, Canada.,Clinique d'Investigation Neurocardiaque (CINC), Sainte-Justine University Hospital Center, Montreal, QC, Canada
| | - Sarah Provost
- Sainte-Justine University Hospital Research Center, Montreal, QC, Canada.,Department of Psychology, Université de Montréal, Montreal, QC, Canada
| | - Amélie Doussau
- Clinique d'Investigation Neurocardiaque (CINC), Sainte-Justine University Hospital Center, Montreal, QC, Canada
| | - Karine Gagnon
- Clinique d'Investigation Neurocardiaque (CINC), Sainte-Justine University Hospital Center, Montreal, QC, Canada
| | - Lynn Dagenais
- Clinique d'Investigation Neurocardiaque (CINC), Sainte-Justine University Hospital Center, Montreal, QC, Canada
| | - Émilie Presutto
- Clinique d'Investigation Neurocardiaque (CINC), Sainte-Justine University Hospital Center, Montreal, QC, Canada
| | - Joëlle Prud'homme
- Clinique d'Investigation Neurocardiaque (CINC), Sainte-Justine University Hospital Center, Montreal, QC, Canada
| | | | - Ioana Medeleine Constantin
- Sainte-Justine University Hospital Research Center, Montreal, QC, Canada.,Department of Psychology, Université de Montréal, Montreal, QC, Canada
| | - Béatrice Desnous
- Division of Neurology, Department of Pediatrics, La Timone Hospital, Marseille, France
| | - Nancy Poirier
- Sainte-Justine University Hospital Research Center, Montreal, QC, Canada.,Clinique d'Investigation Neurocardiaque (CINC), Sainte-Justine University Hospital Center, Montreal, QC, Canada.,Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Anne Gallagher
- Sainte-Justine University Hospital Research Center, Montreal, QC, Canada.,Department of Psychology, Université de Montréal, Montreal, QC, Canada.,Clinique d'Investigation Neurocardiaque (CINC), Sainte-Justine University Hospital Center, Montreal, QC, Canada
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Filippa M, Lordier L, De Almeida JS, Monaci MG, Adam-Darque A, Grandjean D, Kuhn P, Hüppi PS. Early vocal contact and music in the NICU: new insights into preventive interventions. Pediatr Res 2020; 87:249-264. [PMID: 31266053 DOI: 10.1038/s41390-019-0490-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 06/14/2019] [Indexed: 12/11/2022]
Abstract
It is now clearly established that the environment and the sensory stimuli, particularly during the perinatal period, have an impact on infant's development. During the last trimester of gestation, activity-dependent plasticity shapes the fetal brain, and prematurity has been shown to alter the typical developmental trajectories. In this delicate period, preventive interventions aiming at modulating these developmental trajectories through activity-inducing interventions are currently underway to be tested. The purpose of this review paper is to describe the potentialities of early vocal contact and music on the preterm infant's brain development, and their potential beneficial effect on early development. Scientific evidence supports a behavioral orientation of the newborn to organized sounds, such as those of voice and music, and recent neuroimaging studies further confirm full cerebral processing of music as multisensory stimuli. However, the impact of long-term effects of music exposure and early vocal contact on preterm infants' long-term neurodevelopment needs be further investigated. To conclude, it is necessary to establish the neuroscientific bases of the early perception and the long-term effects of music and early vocal contact on the premature newborns' development. Scientific projects are currently on the way to fill this gap in knowledge.
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Affiliation(s)
- Manuela Filippa
- Department of Women, Infants and Adolescents, Division of Development and Growth, University Children Hospital, University of Geneva, Geneva, Switzerland. .,University of Valle d'Aosta, Aosta, Italy. .,Neuroscience of Emotion and Affective Dynamics, Swiss Center for Affective Sciences, and Department of Psychology, Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland.
| | - Lara Lordier
- Department of Women, Infants and Adolescents, Division of Development and Growth, University Children Hospital, University of Geneva, Geneva, Switzerland
| | - Joana Sa De Almeida
- Department of Women, Infants and Adolescents, Division of Development and Growth, University Children Hospital, University of Geneva, Geneva, Switzerland
| | | | - Alexandra Adam-Darque
- Laboratory of Cognitive Neurorehabilitation, Department of Clinical Neuroscience, Division of Neurorehabilitation, University Hospital of Geneva and University of Geneva, Geneva, Switzerland
| | - Didier Grandjean
- Neuroscience of Emotion and Affective Dynamics, Swiss Center for Affective Sciences, and Department of Psychology, Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland
| | - Pierre Kuhn
- Service de Médecine et réanimation du nouveau-né, Hôpital de Hautepierre, CHU Strasbourg, Strasbourg, France
| | - Petra S Hüppi
- Department of Women, Infants and Adolescents, Division of Development and Growth, University Children Hospital, University of Geneva, Geneva, Switzerland
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Amani B, Schmidt LA, Saigal S, Van Lieshout RJ. Exposure to caring parenting and adult mental health in extremely low birthweight survivors. J Paediatr Child Health 2019; 55:1481-1486. [PMID: 31016801 DOI: 10.1111/jpc.14476] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 03/04/2019] [Accepted: 03/28/2019] [Indexed: 01/05/2023]
Abstract
AIM Individuals born at extremely low birthweight (ELBW; <1000 g) are exposed to early adversities that increase the risk of mental health problems in later life. Caring parenting has been shown to offset the negative effects of early adversity in general population samples. However, the long-term impact of caring parenting on the mental health of preterm survivors in adulthood is not known. METHODS Using data from the world's oldest longitudinally followed cohort of ELBW survivors (n = 179) and matched normal birthweight (NBW) control participants (n = 145), we examined if caring parenting moderated the link between preterm birth and mental health at 30-35 years of age. Participants reported on the parenting they received from their mothers using the parental bonding instrument. Self-esteem and internalising problems (i.e. depression, anxiety) were self-reported at 30-35 years of age using the Coopersmith Self-Esteem Inventory and Young Adult Self-Report questionnaire, respectively. RESULTS A statistically significant interaction was found between birthweight status and caring maternal parenting on self-esteem and internalising psychopathology in adulthood. Stratified analyses demonstrated that caring parenting was associated with better self-esteem (P < 0.001) and lower levels of internalising symptoms (P = 0.001), but in NBW participants only. CONCLUSIONS While the receipt of caring maternal parenting promoted mental health in adults born at NBW, it did not have the same protective effect on ELBW survivors. More research is needed to elucidate the aspects of parenting and the family environment that promote the long-term mental health of preterm survivors.
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Affiliation(s)
- Bahar Amani
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Louis A Schmidt
- Department of Psychology, Neuroscience, and Behaviour, McMaster University, Hamilton, Ontario, Canada
| | - Saroj Saigal
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Ryan J Van Lieshout
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
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The Pooled Diagnostic Accuracy of Neuroimaging, General Movements, and Neurological Examination for Diagnosing Cerebral Palsy Early in High-Risk Infants: A Case Control Study. J Clin Med 2019; 8:jcm8111879. [PMID: 31694305 PMCID: PMC6912336 DOI: 10.3390/jcm8111879] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 10/23/2019] [Accepted: 10/24/2019] [Indexed: 11/17/2022] Open
Abstract
Introduction: Clinical guidelines recommend using neuroimaging, Prechtls’ General Movements Assessment (GMA), and Hammersmith Infant Neurological Examination (HINE) to diagnose cerebral palsy (CP) in infancy. Previous studies provided excellent sensitivity and specificity for each test in isolation, but no study has examined the pooled predictive power for early diagnosis. Methods: We performed a retrospective case-control study of 441 high-risk infants born between 2003 and 2014, from three Italian hospitals. Infants with either a normal outcome, mild disability, or CP at two years, were matched for birth year, gender, and gestational age. Three-month HINE, GMA, and neuroimaging were retrieved from medical records. Logistic regression was conducted with log-likelihood and used to determine the model fit and Area Under the Curve (AUC) for accuracy. Results: Sensitivity and specificity for detecting CP were 88% and 62% for three-month HINE, 95% and 97% for absent fidgety GMs, and 79% and 99% for neuroimaging. The combined predictive power of all three assessments gave sensitivity and specificity values of 97.86% and 99.22% (PPV 98.56%, NPV 98.84%). Conclusion: CP can be accurately detected in high-risk infants when these test findings triangulate. Clinical implementation of these tools is likely to reduce the average age when CP is diagnosed, and intervention is started.
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Abstract
There is increasing evidence of ongoing changes occurring in short-term and long-term motor and language outcomes in former premature infants. As rates of moderate to severe cerebral palsy (CP) have decreased, there has been increased awareness of the impact of mild CP and of developmental coordination disorder on the preterm population. Language delays and disorders continue to be among the most common outcomes. In conjunction with medical morbidities, there is increased awareness of the negative impact of family psycho-socioeconomic adversities on preterm outcomes and of the importance of intervention for these adversities beginning in the neonatal ICU.
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Novak I, Morgan C. High-risk follow-up: Early intervention and rehabilitation. HANDBOOK OF CLINICAL NEUROLOGY 2019; 162:483-510. [PMID: 31324326 DOI: 10.1016/b978-0-444-64029-1.00023-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Early detection of childhood disability is possible using clinically available tools and procedures. Early detection of disability enables early intervention that maximizes the child's outcome, prevents the onset of complications, and supports parents. In this chapter, first we summarize the best-available tools for accurately predicting major childhood disabilities early, including autism spectrum disorder, cerebral palsy, developmental coordination disorder, fetal alcohol spectrum disorder, intellectual disability, hearing impairment, and visual impairment. Second, we provide an overview of the preclinical and clinical evidence for inducing neuroplasticity following brain injury. Third, we describe and appraise the evidence base for: (a) training-based interventions that induce neuroplasticity, (b) rehabilitation interventions not focused on inducing neuroplasticity, (c) complementary and alternative interventions, (d) environmental enrichment interventions in the neonatal intensive care and community settings, and (e) parent-child interaction interventions in the neonatal intensive care and community settings. Fourth, we explore emergent treatment options at clinical trial, designed to induce brain repair following injury. In conclusion, early diagnosis enables early intervention, which improves child and parent outcomes. We now know which interventions provide the biggest gains and the information can be used to help inform parental decision making when designing treatment plans for their children.
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Affiliation(s)
- Iona Novak
- Cerebral Palsy Alliance, Discipline of Child and Adolescent Health, University of Sydney, Sydney, NSW, Australia.
| | - Catherine Morgan
- Cerebral Palsy Alliance, Discipline of Child and Adolescent Health, University of Sydney, Sydney, NSW, Australia
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Hirst JJ, Palliser HK, Shaw JC, Crombie G, Walker DW, Zakar T. Birth and Neonatal Transition in the Guinea Pig: Experimental Approaches to Prevent Preterm Birth and Protect the Premature Fetus. Front Physiol 2018; 9:1802. [PMID: 30618814 PMCID: PMC6297273 DOI: 10.3389/fphys.2018.01802] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 11/29/2018] [Indexed: 11/13/2022] Open
Abstract
The guinea pig (Cavia porcellus) displays many features of gestational physiology that makes it the most translationally relevant rodent species. Progesterone production undergoes a luteal to placental shift as in human pregnancy with levels rising during gestation and with labor and delivery occurring without a precipitous decline in maternal progesterone levels. In contrast to other laboratory rodents, labor in guinea pigs is triggered by a functional progesterone withdrawal, which involves the loss of uterine sensitivity to progesterone like in women. In both species the amnion membrane is a major source of labor-inducing prostaglandins, which promote functional progesterone withdrawal by modifying myometrial progesterone receptor expression. These similar features appear to result from convergent evolution rather than closer evolutionally relationship to primates compared to other rodents. Nevertheless, the similarities in the production, metabolism and actions of progesterone and prostaglandins allow information gained in pregnant guinea pigs to be extended to pregnant women with confidence. This includes exploring the effects of pregnancy complications including growth restriction and the mechanisms by which stressful conditions increase the incidence of preterm labor. The relatively long gestation of the guinea pig and the maturity of the pups at birth particularly in brain development means that a greater proportion of brain development happens in utero. This allows adverse intrauterine conditions to make a sustained impact on the developing brain like in compromised human pregnancies. In addition, the brain is exposed to a protective neurosteroid environment in utero, which has been suggested to promote development in the guinea pig and the human. Moreover, in utero stresses that have been shown to adversely affect long term neurobehavioral outcomes in clinical studies, can be modeled successfully in guinea pigs. Overall, these parallels to the human have led to increasing interest in the guinea pig for translational studies of treatments and therapies that potentially improve outcomes following adverse events in pregnancy and after preterm birth.
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Affiliation(s)
- Jonathan J Hirst
- Mothers and Babies Research Centre, Hunter Medical Research Institute, Newcastle, NSW, Australia.,School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, NSW, Australia
| | - Hannah K Palliser
- Mothers and Babies Research Centre, Hunter Medical Research Institute, Newcastle, NSW, Australia.,School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, NSW, Australia
| | - Julia C Shaw
- Mothers and Babies Research Centre, Hunter Medical Research Institute, Newcastle, NSW, Australia.,School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, NSW, Australia
| | - Gabrielle Crombie
- Mothers and Babies Research Centre, Hunter Medical Research Institute, Newcastle, NSW, Australia.,School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, NSW, Australia
| | - David W Walker
- School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC, Australia
| | - Tamas Zakar
- Mothers and Babies Research Centre, Hunter Medical Research Institute, Newcastle, NSW, Australia.,School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
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Dür M, Brückner V, Oberleitner-Leeb C, Fuiko R, Matter B, Berger A. Clinical relevance of activities meaningful to parents of preterm infants with very low birth weight: A focus group study. PLoS One 2018; 13:e0202189. [PMID: 30153266 PMCID: PMC6112625 DOI: 10.1371/journal.pone.0202189] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 07/30/2018] [Indexed: 11/25/2022] Open
Abstract
Introduction Parents have a major impact on the outcome of health care of preterm infants. Parents’ engagement in meaningful activities could have an impact on their own health and wellbeing and therefore be relevant in neonatal intensive care. The aim of this study was to explore meaningful activities of parents of very low birth weight (VLBW) preterm infants with the purpose to further the understanding of their clinical relevance and to foster their consideration in clinical practice and research of neonatal intensive care. Methods A total of 36 parents of preterm infants born prior to complete 37 weeks of gestation with VLBW (≤1.500 grams) were asked to participate in a focus group interview. Interview transcripts were used to analyse the content of the focus group interviews using meaning condensation method by Steinar Kvale. Results Thirty-six parents participated in a total of twelve focus groups. Parents reported that the meaning of certain activities changed due to preterm birth. Meaningful activities, like bathing the baby and gardening, could foster a transition from a feeling of parental immaturity to a feeling of maturity, following health care instructions to possessing health care skills, and a functioning-only state to a balance of activities. Conclusions In neonatal intensive care, nurses contribute to delivering parental education and thereby facilitate experiences of being a mature parent and of possessing health care skills. Occupational therapy could be used to help re-engage in meaningful activities and maintain a balance of activities in parents of VLBW preterm infants.
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Affiliation(s)
- Mona Dür
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Medical University of Vienna, Austria
- Department of Health Sciences, Master Degree Programme of Applied Health Sciences and Bachelor Degree Programme of Occupational Therapy, IMC University of Applied Sciences Krems, Austria
- * E-mail: ,
| | - Victoria Brückner
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Medical University of Vienna, Austria
| | - Christiane Oberleitner-Leeb
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Medical University of Vienna, Austria
| | - Renate Fuiko
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Medical University of Vienna, Austria
| | - Barbara Matter
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Wilhelminenspital, Vienna, Austria
| | - Angelika Berger
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Medical University of Vienna, Austria
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Spittle AJ, Treyvaud K, Lee KJ, Anderson PJ, Doyle LW. The role of social risk in an early preventative care programme for infants born very preterm: a randomized controlled trial. Dev Med Child Neurol 2018; 60:54-62. [PMID: 29058313 DOI: 10.1111/dmcn.13594] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/09/2017] [Indexed: 12/01/2022]
Abstract
AIM To examine the differential effects of an early intervention programme for infants born preterm on neurodevelopment and parental mental health according to family social risk. METHOD One hundred and twenty infants born earlier than 30 weeks' gestation were randomized to early intervention (n=61) or control groups (n=59). Cognitive, language, and motor outcomes were assessed by blinded assessors at 2 years, 4 years, and 8 years, and primary caregivers completed questionnaires on their anxiety and depression. Outcomes at each time point were compared between groups using linear regression with an interaction term for social risk (higher/lower). RESULTS There was evidence of interactions between intervention group and social risk for cognition at 2 years and 4 years, motor function at 4 years, and language at 8 years, with a greater intervention effect in children from higher social risk environments. In contrast, the impact of early intervention on parental depressive symptoms was greater for parents of lower social risk than for those of higher social risk. INTERPRETATION Effects of early intervention on outcomes for children born preterm and their caregivers varied according to family social risk. Family social risk should be considered when implementing early intervention programmes for children born preterm and their families. WHAT THIS PAPER ADDS Intervention is associated with better early cognitive functioning for children in higher social risk families. Positive effects of intervention for the high risk group were not sustained at school-age. Intervention has a greater effect on primary caregiver mental health in the lower social risk group compared with higher social risk.
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Affiliation(s)
- Alicia J Spittle
- Department of Physiotherapy, University of Melbourne, Melbourne, Australia.,Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia.,Newborn Research, Royal Women's Hospital, Melbourne, Australia
| | - Karli Treyvaud
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia.,Newborn Research, Royal Women's Hospital, Melbourne, Australia.,Department of Psychology and Counselling, La Trobe University, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Katherine J Lee
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Peter J Anderson
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia.,Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Lex W Doyle
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia.,Newborn Research, Royal Women's Hospital, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Australia
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Luu TM, Xie LF, Peckre P, Cote S, Karsenti T, Walker CD, Gosselin J. Web-Based Intervention to Teach Developmentally Supportive Care to Parents of Preterm Infants: Feasibility and Acceptability Study. JMIR Res Protoc 2017; 6:e236. [PMID: 29191797 PMCID: PMC5730819 DOI: 10.2196/resprot.8289] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 08/22/2017] [Accepted: 08/23/2017] [Indexed: 11/23/2022] Open
Abstract
Background Preterm birth affects 8% to 11% of the population and conveys a significant risk of developmental delays. Intervention programs that support child development have been shown to have a positive impact on early motor and cognitive development and on parental well-being. However, these programs are often difficult to implement in a real-life setting due to lack of resources. Hence, our multidisciplinary team developed Mieux Agir au Quotidien (MAQ) to teach developmentally supportive care to parents of preterm infants with the goal of improving child development and parental outcomes. Our intervention included 3 in-person workshops that occurred prior to hospital discharge and a Web-based platform with written and videotaped materials that addressed 5 main themes: (1) infant behavioral cues, (2) flexion positioning; (3) oral feeding support, (4) parent-infant interactions, and (5) anticipation of developmental milestones. Objective This study aimed to test the feasibility and acceptability of the intervention by parents of preterm infants and assess clinical benefits on child neurodevelopment and parental outcomes during the first year of life. Methods A total of 107 infants born at <30 weeks and admitted to Sainte-Justine Hospital neonatal intensive care unit and their parents were enrolled in a nonrandomized controlled before-and-after interventional study (intervention n=55, comparison n=52). Acceptability of the program was assessed with a user satisfaction questionnaire. When the infants were at 4 months’ corrected age, all parents completed questionnaires on infant temperament, parenting stress, sense of competence, and parenting satisfaction. At 12 months’ corrected age, neurodevelopmental testing was performed on infants using the Alberta Infant Motor Scale and the Bayley Scales of Infant and Toddler Development, Third Edition. Comparisons between the 2 groups were done using independent t tests, Wilcoxon rank-sum tests, and Fisher exact tests. Results The majority of parents (43/45) were satisfied with the intervention program and all would recommend MAQ to others. MAQ met their need for evidence-based information that proved useful to support their child development. No difference in parental or child neurodevelopmental outcomes was detected in this pilot study for most outcomes except for higher median scores for parental coercive behaviors in the intervention group, although proportions scoring in the coercive range did not differ. Conclusions Acceptability of the program was high among parents thus supporting the relevance of such intervention. A larger study using a randomized controlled trial design is needed to better document impact on parent and children and investigate how Web-based technologies can efficiently complement individualized intervention to alleviate the burden on health care resources.
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Affiliation(s)
- Thuy Mai Luu
- Research Center, Centre Hospitalier Universitaire Sainte-Justine, Montreal, QC, Canada.,Department of Pediatrics, University of Montreal, Montreal, QC, Canada
| | - Li Feng Xie
- Research Center, Centre Hospitalier Universitaire Sainte-Justine, Montreal, QC, Canada
| | - Perrine Peckre
- Research Center, Centre Hospitalier Universitaire Sainte-Justine, Montreal, QC, Canada
| | - Sylvana Cote
- Research Center, Centre Hospitalier Universitaire Sainte-Justine, Montreal, QC, Canada.,Department of Social and Preventive Medicine, University of Montreal, Montreal, QC, Canada
| | - Thierry Karsenti
- Faculty of Teaching and Education Sciences, University of Montreal, Montreal, QC, Canada
| | - Claire-Dominique Walker
- Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Julie Gosselin
- School of Rehabilitation, University of Montreal, Montreal, QC, Canada
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Zohsel K, Hohm E, Schmidt MH, Brandeis D, Banaschewski T, Laucht M. Die langfristigen Auswirkungen von Frühgeburtlichkeit auf kognitive Entwicklung und Schulerfolg. KINDHEIT UND ENTWICKLUNG 2017. [DOI: 10.1026/0942-5403/a000235] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Zusammenfassung. In einer prospektiven Längsschnittstudie wurde der Zusammenhang zwischen früher Responsivität der Mutter und kognitiver Entwicklung ihrer früh- bzw. reifgeborenen Kinder untersucht. Im Alter von drei Monaten wurde dafür die Mutter-Kind-Interaktion mittels Verhaltensbeobachtung erfasst. Bei n=351 der teilnehmenden Kinder (101 frühgeboren) wurde die allgemeine Intelligenz (IQ) im Alter von 11 Jahren und bei n=313 (85 frühgeboren) zusätzlich der höchste erreichte Schulabschluss bis 25 Jahren erhoben. Frühgeborene wiesen mit 11 Jahren einen signifikant niedrigeren IQ als Reifgeborene auf, nachdem für mögliche konfundierende Faktoren kontrolliert worden war. Nur bei Früh-, nicht aber bei Reifgeborenen zeigte sich ein signifikanter positiver Zusammenhang zwischen mütterlicher Responsivität und IQ. Für die Wahrscheinlichkeit einen höheren Schulabschluss (mind. Fachabitur) zu erreichen, fand sich weder ein signifikanter Effekt von Frühgeburtlichkeit noch von mütterlicher Responsivität.
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Affiliation(s)
- Katrin Zohsel
- Klinik für Psychiatrie und Psychotherapie des Kindes- und Jugendalters, Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim/Universität Heidelberg
| | - Erika Hohm
- Klinik für Psychiatrie und Psychotherapie des Kindes- und Jugendalters, Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim/Universität Heidelberg
| | - Martin H. Schmidt
- Klinik für Psychiatrie und Psychotherapie des Kindes- und Jugendalters, Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim/Universität Heidelberg
| | - Daniel Brandeis
- Klinik für Psychiatrie und Psychotherapie des Kindes- und Jugendalters, Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim/Universität Heidelberg
- Zentrum für Kinder- und Jugendpsychiatrie und Psychotherapie, Psychiatrische Universitätsklinik, Universität Zürich
- Zürcher Zentrum für Integrative Humanphysiologie, Universität Zürich
- Zentrum für Neurowissenschaften, Universität und ETH Zürich
| | - Tobias Banaschewski
- Klinik für Psychiatrie und Psychotherapie des Kindes- und Jugendalters, Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim/Universität Heidelberg
| | - Manfred Laucht
- Klinik für Psychiatrie und Psychotherapie des Kindes- und Jugendalters, Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim/Universität Heidelberg
- Department Psychologie, Universität Potsdam
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Pierrat V, Marchand-Martin L, Arnaud C, Kaminski M, Resche-Rigon M, Lebeaux C, Bodeau-Livinec F, Morgan AS, Goffinet F, Marret S, Ancel PY. Neurodevelopmental outcome at 2 years for preterm children born at 22 to 34 weeks' gestation in France in 2011: EPIPAGE-2 cohort study. BMJ 2017; 358:j3448. [PMID: 28814566 PMCID: PMC5558213 DOI: 10.1136/bmj.j3448] [Citation(s) in RCA: 288] [Impact Index Per Article: 41.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Objectives To describe neurodevelopmental outcomes at 2 years corrected age for children born alive at 22-26, 27-31, and 32-34 weeks' gestation in 2011, and to evaluate changes since 1997.Design Population based cohort studies, EPIPAGE and EPIPAGE-2.Setting France.Participants 5567 neonates born alive in 2011 at 22-34 completed weeks' gestation, with 4199 survivors at 2 years corrected age included in follow-up. Comparison of outcomes reported for 3334 (1997) and 2418 (2011) neonates born alive in the nine regions participating in both studies.Main outcome measures Survival; cerebral palsy (2000 European consensus definition); scores below threshold on the neurodevelopmental Ages and Stages Questionnaire (ASQ; at least one of five domains below threshold) if completed between 22 and 26 months corrected age, in children without cerebral palsy, blindness, or deafness; and survival without severe or moderate neuromotor or sensory disabilities (cerebral palsy with Gross Motor Function Classification System levels 2-5, unilateral or bilateral blindness or deafness). Results are given as percentage of outcome measures with 95% confidence intervals.Results Among 5170 liveborn neonates with parental consent, survival at 2 years corrected age was 51.7% (95% confidence interval 48.6% to 54.7%) at 22-26 weeks' gestation, 93.1% (92.1% to 94.0%) at 27-31 weeks' gestation, and 98.6% (97.8% to 99.2%) at 32-34 weeks' gestation. Only one infant born at 22-23 weeks survived. Data on cerebral palsy were available for 3599 infants (81.0% of the eligible population). The overall rate of cerebral palsy at 24-26, 27-31, and 32-34 weeks' gestation was 6.9% (4.7% to 9.6%), 4.3% (3.5% to 5.2%), and 1.0% (0.5% to 1.9%), respectively. Responses to the ASQ were analysed for 2506 children (56.4% of the eligible population). The proportion of children with an ASQ result below threshold at 24-26, 27-31, and 32-34 weeks' gestation were 50.2% (44.5% to 55.8%), 40.7% (38.3% to 43.2%), and 36.2% (32.4% to 40.1%), respectively. Survival without severe or moderate neuromotor or sensory disabilities among live births increased between 1997 and 2011, from 45.5% (39.2% to 51.8%) to 62.3% (57.1% to 67.5%) at 25-26 weeks' gestation, but no change was observed at 22-24 weeks' gestation. At 32-34 weeks' gestation, there was a non-statistically significant increase in survival without severe or moderate neuromotor or sensory disabilities (P=0.61), but the proportion of survivors with cerebral palsy declined (P=0.01).Conclusions In this large cohort of preterm infants, rates of survival and survival without severe or moderate neuromotor or sensory disabilities have increased during the past two decades, but these children remain at high risk of developmental delay.
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Affiliation(s)
- Véronique Pierrat
- Obstetrical, Perinatal, and Pediatric Epidemiology Team, Epidemiology and Biostatistics Sorbonne Paris Cité Research Center (U1153), INSERM, Paris, France; Paris Descartes University, Paris, France
- CHU Lille, Department of Neonatal Medicine, Jeanne de Flandre Hospital, F-59000 Lille, France
| | - Laetitia Marchand-Martin
- Obstetrical, Perinatal, and Pediatric Epidemiology Team, Epidemiology and Biostatistics Sorbonne Paris Cité Research Center (U1153), INSERM, Paris, France; Paris Descartes University, Paris, France
| | - Catherine Arnaud
- INSERM UMR 1027, Université Toulouse III Paul Sabatier, Toulouse, France
| | - Monique Kaminski
- Obstetrical, Perinatal, and Pediatric Epidemiology Team, Epidemiology and Biostatistics Sorbonne Paris Cité Research Center (U1153), INSERM, Paris, France; Paris Descartes University, Paris, France
| | - Matthieu Resche-Rigon
- Biostatistics and Medical Information Department, AP-HP Saint-Louis Hospital, Paris, France
| | - Cécile Lebeaux
- Obstetrical, Perinatal, and Pediatric Epidemiology Team, Epidemiology and Biostatistics Sorbonne Paris Cité Research Center (U1153), INSERM, Paris, France; Paris Descartes University, Paris, France
| | - Florence Bodeau-Livinec
- Obstetrical, Perinatal, and Pediatric Epidemiology Team, Epidemiology and Biostatistics Sorbonne Paris Cité Research Center (U1153), INSERM, Paris, France; Paris Descartes University, Paris, France
- École des Hautes Études en Santé Publique (EHESP), Rennes, France
| | - Andrei S Morgan
- Obstetrical, Perinatal, and Pediatric Epidemiology Team, Epidemiology and Biostatistics Sorbonne Paris Cité Research Center (U1153), INSERM, Paris, France; Paris Descartes University, Paris, France
| | - François Goffinet
- Obstetrical, Perinatal, and Pediatric Epidemiology Team, Epidemiology and Biostatistics Sorbonne Paris Cité Research Center (U1153), INSERM, Paris, France; Paris Descartes University, Paris, France
- Maternité Port-Royal, Université Paris Descartes, Groupe Hospitalier Cochin Broca Hôtel-Dieu, Assistance Publique-Hôpitaux de Paris, DHU Risques et Grossesse, Paris, France
| | - Stéphane Marret
- Department of Neonatal Pediatrics, Intensive care, and Neuropediatrics, Rouen University Hospital, Rouen, France
- Research Unit U1245, Institute for Research and Innovation in Biomedicine, Rouen, France
| | - Pierre-Yves Ancel
- Obstetrical, Perinatal, and Pediatric Epidemiology Team, Epidemiology and Biostatistics Sorbonne Paris Cité Research Center (U1153), INSERM, Paris, France; Paris Descartes University, Paris, France
- Clinical Research Unit, Center for Clinical Investigation P1419, Cochin Broca Hôtel-Dieu Hospital, Paris, France
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Casey PH, Irby C, Withers S, Dorsey S, Li J, Rettiganti M. Home Visiting and the Health of Preterm Infants. Clin Pediatr (Phila) 2017; 56:828-837. [PMID: 28720035 DOI: 10.1177/0009922817715949] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The results of home visiting programs which target medically fragile low-birth-weight preterm infants (LBWPT) have been inconsistent. We provided nurse/social worker home visits to families of LBWPT infants on a regular schedule. Teams were trained in approaches to improve the health and development of the infants. The completion of immunization series was sigmificantly higher and the infant mortality rates of the home visits childen were significanly lower compared to national and state rates. We used state Medicaid data and examined frequency of hospitalization, emergency department visits, routine and nonscheduled visits to primary care physician, and pharmacy use of the home-visited subjects compared with a propensity-matched group. The home-visited group had more routine and nonscheduled visits but no more hospitalizations or E.D. visits. Home visiting teams improved important markers of child health, including completed immunizations and mortality rate, perhaps by the careful monitoring of health status and assuring health care when needed.
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Affiliation(s)
- Patrick H Casey
- 1 University of Arkansas for Medical Sciences, Little Rock, AR, USA.,2 Arkansas Children's Research Institute, Little Rock, AR, USA
| | - Carmen Irby
- 1 University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Sandra Withers
- 1 University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Susan Dorsey
- 1 University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Jingyun Li
- 1 University of Arkansas for Medical Sciences, Little Rock, AR, USA.,2 Arkansas Children's Research Institute, Little Rock, AR, USA
| | - Malik Rettiganti
- 1 University of Arkansas for Medical Sciences, Little Rock, AR, USA.,2 Arkansas Children's Research Institute, Little Rock, AR, USA
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Griffiths A, Morgan P, Anderson PJ, Doyle LW, Lee KJ, Spittle AJ. Predictive value of the Movement Assessment Battery for Children - Second Edition at 4 years, for motor impairment at 8 years in children born preterm. Dev Med Child Neurol 2017; 59:490-496. [PMID: 28066897 DOI: 10.1111/dmcn.13367] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/03/2016] [Indexed: 11/27/2022]
Abstract
AIM To assess the predictive validity at 4 years of the Movement Assessment Battery for Children - Second Edition (MABC-2) for motor impairment at 8 years in children born preterm. We also aimed to determine if sex, cognition, medical, or social risks were associated with motor impairment at 8 years or with a change in MABC-2 score between 4 years and 8 years. METHOD Ninety-six children born at less than 30 weeks' gestation were assessed with the MABC-2 at 4 years and 8 years of age. Motor impairment was defined as less than or equal to the 5th centile. The Differential Ability Scales - Second Edition (DAS-II) was used to measure General Conceptual Ability (GCA) at 4 years, with a score <90 defined as 'below average'. RESULTS There was a strong association between the MABC-2 total standard scores at 4 years and 8 years (59% variance explained, regression coefficient=0.80, 95% confidence interval [CI] 0.69-0.91, p<0.001). The MABC-2 at 4 years had high sensitivity (79%) and specificity (93%) for predicting motor impairment at 8 years. Below average cognition and higher medical risk were associated with increased odds of motor impairment at 8 years (odds ratio [OR]=15.3, 95% CI 4.19-55.8, p<0.001, and OR=3.77, 95% CI 1.28-11.1, p=0.016 respectively). Sex and social risk did not appear to be associated with motor impairment at 8 years. There was little evidence that any variables were related to change in MABC-2 score between 4 years and 8 years. INTERPRETATION The MABC-2 at 4 years is predictive of motor functioning in middle childhood. Below average cognition and higher medical risk may be predictors of motor impairment.
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Affiliation(s)
- Alison Griffiths
- Monash University, Clayton, Vic., Australia.,Royal Children's Hospital, Parkville, Vic., Australia.,Murdoch Childrens Research Institute, Parkville, Vic., Australia
| | | | - Peter J Anderson
- Murdoch Childrens Research Institute, Parkville, Vic., Australia.,University of Melbourne, Parkville, Vic., Australia
| | - Lex W Doyle
- Murdoch Childrens Research Institute, Parkville, Vic., Australia.,University of Melbourne, Parkville, Vic., Australia.,The Royal Women's Hospital, Parkville, Vic., Australia
| | - Katherine J Lee
- Murdoch Childrens Research Institute, Parkville, Vic., Australia.,University of Melbourne, Parkville, Vic., Australia
| | - Alicia J Spittle
- Murdoch Childrens Research Institute, Parkville, Vic., Australia.,University of Melbourne, Parkville, Vic., Australia.,The Royal Women's Hospital, Parkville, Vic., Australia
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42
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McCormick MC, Litt JS. Strengthening Early Intervention for Very Preterm Infants. Pediatrics 2016; 138:peds.2016-2207. [PMID: 27940712 DOI: 10.1542/peds.2016-2207] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/12/2016] [Indexed: 11/24/2022] Open
Affiliation(s)
- Marie C McCormick
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts; .,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; and.,Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Jonathan S Litt
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; and.,Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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