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Ömercioğlu E, Mert Karakaya EN, Özdemir G, Şencan Karakuş B, Kılınç Ş, İskender HC, Cihan Çam E, Mete Yeşil A, Çelik HT, Karahan S, Özmert EN. Has the COVID-19 pandemic negatively impacted children's development? An assessment of the neurodevelopment of premature babies born during the pandemic. Turk J Pediatr 2024; 66:275-286. [PMID: 39024599 DOI: 10.24953/turkjpediatr.2024.4551] [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] [Received: 03/20/2024] [Accepted: 05/22/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND Pandemics, such as COVID-19, have the potential to adversely affect children's development due to a variety of negative factors at the level of children, families, and services. In this study the effect of the pandemic on the cognitive, language and motor development of premature babies who are among the most vulnerable group, were evaluated. METHODS The study included 236 premature infants who were followed at Hacettepe University Department of Developmental Pediatrics. The Bayley-Third Edition Developmental Assessment (Bayley III) was used to evaluate the neurodevelopment of 152 premature infants from the pre-pandemic group and 84 from the post-pandemic group at the corrected age of 18-24 months. The perinatal and sociodemographic risks were also evaluated. RESULTS No difference in Bayley III scores (cognitive, language, and motor) was found between the pre- and post-pandemic groups. Furthermore, the multivariate covariance analysis displayed that regardless of the pandemic, infants with higher maternal education consistently scored higher in the cognitive, language, and motor domains; and the motor area scores of infants with moderate perinatal risk were also significantly higher than infants with high perinatal risk. CONCLUSIONS It is crucial to monitor the development of vulnerable children who encounter developmental risks, such as premature babies. Fortunately, no significant effect was encountered during the COVID-19 pandemic. However, this does not underweigh the need for close supervision in extraordinary circumstances. Additionally, it should be noted that severe postnatal comorbidities, perinatal risks, and social factors, such as maternal education level, interact to influence the neurodevelopmental outcomes of preterm infants.
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Affiliation(s)
- Emel Ömercioğlu
- Division of Developmental Pediatrics, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Türkiye
| | - Ece Naz Mert Karakaya
- Division of Developmental Pediatrics, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Türkiye
| | - Gökçenur Özdemir
- Division of Developmental Pediatrics, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Türkiye
| | - Buse Şencan Karakuş
- Division of Developmental Pediatrics, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Türkiye
| | - Şeyma Kılınç
- Division of Developmental Pediatrics, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Türkiye
| | - H Ceren İskender
- Division of Developmental Pediatrics, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Türkiye
| | - Ebru Cihan Çam
- Division of Developmental Pediatrics, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Türkiye
| | - Ayşe Mete Yeşil
- Division of Developmental Pediatrics, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Türkiye
| | - Hasan Tolga Çelik
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Türkiye
| | - Sevilay Karahan
- Department of Biostatistics, Faculty of Medicine, Hacettepe University, Ankara, Türkiye
| | - Elif N Özmert
- Division of Developmental Pediatrics, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Türkiye
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Vanderhasselt T, Naeyaert M, Buls N, Allemeersch GJ, Raeymaeckers S, Raeymaekers H, Smeets N, Cools F, de Mey J, Dudink J. Synthetic magnetic resonance-based relaxometry and brain volume: cutoff values for predicting neurocognitive outcomes in very preterm infants. Pediatr Radiol 2024:10.1007/s00247-024-05981-x. [PMID: 38980354 DOI: 10.1007/s00247-024-05981-x] [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: 03/18/2024] [Revised: 06/20/2024] [Accepted: 06/23/2024] [Indexed: 07/10/2024]
Abstract
BACKGROUND Early neurorehabilitation can enhance neurocognitive outcomes in very preterm infants (<32 weeks), and conventional magnetic resonance imaging (MRI) is commonly used to assess neonatal brain injury; however, the predictive value for neurodevelopmental delay is limited. Timely predictive quantitative biomarkers are needed to improve early identification and management of infants at risk of neurodevelopmental delay. OBJECTIVE To evaluate the potential of quantitative synthetic MRI measurements at term-equivalent age as predictive biomarkers of neurodevelopmental impairment and establish practical cutoff values to guide clinical decision-making. MATERIALS AND METHODS This retrospective study included 93 very preterm infants who underwent synthetic MRI at term-equivalent age between January 2017 and September 2020. Clinical outcomes were assessed using the Bayley-III scale of infant development (mean age 2.1 years). The predictive value for impaired development was analyzed using receiver operating characteristic curves for synthetic MRI-based volumetry and T1 and T2 relaxation measurements. RESULTS The T1 relaxation time in the posterior limb of the internal capsule was a potent predictor of severe (sensitivity, 92%; specificity, 80%; area under the curve (AUC), 0.91) and mild or severe (AUC, 0.75) developmental impairment. T2 relaxation time in the posterior limb of the internal capsule was a significant predictor of severe impairment (AUC, 0.76), whereas the brain parenchymal volume was a significant predictor of severe (AUC, 0.72) and mild or severe impairment (AUC, 0.71) outperforming the reported qualitative MRI scores (AUC, 0.66). CONCLUSION The proposed cutoff values for T1 relaxation time in the posterior limb of the internal capsule and for total brain volume measurements, derived from synthetic MRI, show promise as predictors of both mild and severe neurodevelopmental impairment in very preterm infants.
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Affiliation(s)
- Tim Vanderhasselt
- Department of Radiology, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium.
| | - Maarten Naeyaert
- Department of Radiology, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Nico Buls
- Department of Radiology, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Gert-Jan Allemeersch
- Department of Radiology, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Steven Raeymaeckers
- Department of Radiology, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Hubert Raeymaekers
- Department of Radiology, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Nathalie Smeets
- Department of Pediatric Neurology, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Filip Cools
- Department of Neonatology, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Johan de Mey
- Department of Radiology, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Jeroen Dudink
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
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Künzel RG, Elgazzar M, Bain PA, Kirschbaum C, Papatheodorou S, Gelaye B. The association between maternal prenatal hair cortisol concentration and preterm birth: A systematic review and meta-analysis. Psychoneuroendocrinology 2024; 165:107041. [PMID: 38581747 DOI: 10.1016/j.psyneuen.2024.107041] [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: 02/02/2024] [Revised: 03/30/2024] [Accepted: 03/31/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND The risk of preterm birth (PTB) increases when experiencing stress during pregnancy. Chronic stress has been associated with a dysregulation of the hypothalamic-pituitary-adrenal axis, for which hair cortisol concentration (HCC) is a promising biomarker. However, previous studies on the association between HCC and PTB yielded inconsistent results. This systematic review and meta-analysis synthesized previous studies on the association between maternal HCC before and during pregnancy and spontaneous PTB. METHODS Data was extracted from N = 11 studies with k = 19 effect sizes retrieved from PubMed, Embase, Web of Science, CINAHL and citation searching by hand in June 2023 and updated in October 2023. Standardized mean differences were calculated, and a random-effects three-level meta-analysis was conducted. Effect heterogeneity was assessed using Q and I2. RESULTS HCC during pregnancy was higher among PTB than term groups, but effects were not statistically significant (z = 0.11, 95% CI: - 0.28, 0.51, p = .54) and total heterogeneity was high (Q16 = 60.01, p < .001, I2Total = 92.30%). After leaving out two possible outlier studies in sensitivity analyses, HCC was lower among preterm compared to term delivering groups, although not statistically significant (z = - 0.06, 95% CI: - 0.20, 0.08, p = .39) but with a substantially reduced total heterogeneity (Q12 = 16.45, p = .17, I2Total = 42.15%). No moderators affected the estimates significantly, but an effect of trimester and gestational age at delivery is likely. CONCLUSION There is currently no evidence of prenatal HCC differences between PTB and term groups as effects were small, imprecise, and not significant. Low statistical power and methodological weaknesses of the small-scale studies challenge possible biological inferences from the small effects, but further research on HCC during pregnancy is highly encouraged.
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Affiliation(s)
- Richard G Künzel
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA; Katholische Universität Eichstätt-Ingolstadt, Ostenstr. 28a, Eichstätt 85072, Germany.
| | | | - Paul A Bain
- Countway Library, Harvard Medical School, 10 Shattuck St, Boston, MA 02115, USA
| | - Clemens Kirschbaum
- Technische Universität Dresden, Zellescher Weg 19, Dresden 01062, Germany
| | - Stefania Papatheodorou
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA
| | - Bizu Gelaye
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA; The Chester M. Pierce M.D. Division of Global Psychiatry, Department of Psychiatry, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, USA
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Kg S, Balakrishnan U, Amboiram P, N U, Chandran R, V S. Risk Factors Associated with Long Term Adverse Neurodevelopmental Outcome in Very Preterm Infants. Indian J Pediatr 2024; 91:748. [PMID: 38175497 DOI: 10.1007/s12098-023-04990-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 12/11/2023] [Indexed: 01/05/2024]
Affiliation(s)
- Sachin Kg
- Department of Neonatology, Sri Ramachandra Medical College and Research Institute, Sri Ramachandra Institute of Higher Education and Research (SRIHER) (Deemed to be University), Chennai, 600116, Tamil Nadu, India
| | - Umamaheswari Balakrishnan
- Department of Neonatology, Sri Ramachandra Medical College and Research Institute, Sri Ramachandra Institute of Higher Education and Research (SRIHER) (Deemed to be University), Chennai, 600116, Tamil Nadu, India.
| | - Prakash Amboiram
- Department of Neonatology, Sri Ramachandra Medical College and Research Institute, Sri Ramachandra Institute of Higher Education and Research (SRIHER) (Deemed to be University), Chennai, 600116, Tamil Nadu, India
| | - Udayakumar N
- Department of Pediatrics, Sri Ramachandra Medical College and Research Institute, Sri Ramachandra Institute of Higher Education and Research (SRIHER) (Deemed to be University), Chennai, 600116, Tamil Nadu, India
| | - Rabindran Chandran
- Department of Neonatology, Sri Ramachandra Medical College and Research Institute, Sri Ramachandra Institute of Higher Education and Research (SRIHER) (Deemed to be University), Chennai, 600116, Tamil Nadu, India
| | - Sangeetha V
- Department of Pediatrics, Sri Ramachandra Medical College and Research Institute, Sri Ramachandra Institute of Higher Education and Research (SRIHER) (Deemed to be University), Chennai, 600116, Tamil Nadu, India
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Suresh S, Janakiraman A, Narasimhan U, Rajanandh MG, Liyakath Ali AN, Murugan S. Diagnostic Accuracy of Bayley III Screening Tool to Detect Developmental Delay in Moderate to High-Risk Indian Preterm Children. Indian J Pediatr 2024; 91:730-732. [PMID: 37796402 DOI: 10.1007/s12098-023-04855-8] [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: 03/20/2023] [Accepted: 08/22/2023] [Indexed: 10/06/2023]
Abstract
The present study aimed to evaluate the ability of the Bayley III screening tool to detect developmental delay in moderate to high-risk preterm children in India. In this cross-sectional study, 94 preterm babies were enrolled. The Bayley III screener (index test) and the gold-standard, Developmental assessment scale for Indian Infants (DASII) test were administered to all the enrolled children. Researchers were blinded while performing the tests. Diagnostic accuracy parameters were compared. The Bayley III screener's sensitivity and specificity for predicting the delay (with a DASII cut-off of <70) were 84.62% and 85.18% in the mental domain and 61.11% and 96.05% in the motor domain, respectively. When the DASII cut-off was raised to 85, the sensitivity and specificity in the mental domain were 60.61% and 95.08%, respectively, whereas they were 36.11% and 98.27%, respectively, in the motor domain. The Bayley III screener is found to have good specificity rather than sensitivity with good predictive values.
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Affiliation(s)
- Sanmathi Suresh
- Department of Pediatrics, Sri Ramachandra Institute of Higher Education and Research, Deemed to be University, Chennai, Tamil Nadu, India
| | - Abhinayaa Janakiraman
- Department of Developmental Pediatrics, Cloudnine Hospital, Chennai, Tamil Nadu, India
| | - Udayakumar Narasimhan
- Karthikeyan Child Developmental Unit, Sri Ramachandra Institute of Higher Education and Research, Deemed to be University, Chennai, Tamil Nadu, India
| | - Muhasaparur Ganesan Rajanandh
- Department of Pharmacy Practice, SRM College of Pharmacy, SRM Institute of Science and Technology, Deemed to be University, Chennai, Tamil Nadu, India.
| | - Ayesha Nabeela Liyakath Ali
- Department of Pediatrics, Sri Ramachandra Institute of Higher Education and Research, Deemed to be University, Chennai, Tamil Nadu, India
| | - Sreelekha Murugan
- Karthikeyan Child Developmental Unit, Sri Ramachandra Institute of Higher Education and Research, Deemed to be University, Chennai, Tamil Nadu, India
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Wile B, Skowronski K, Shariati K, Olagunju AT. Promoting mental well-being among parents in the neonatal intensive care unit: a perspective on the role of Physician Associates. J Perinatol 2024; 44:1069-1072. [PMID: 38499755 DOI: 10.1038/s41372-024-01936-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 03/08/2024] [Accepted: 03/11/2024] [Indexed: 03/20/2024]
Abstract
Emotional disorders in parents of infants admitted to the neonatal intensive care unit (NICU) carry the potential for serious ramifications in neonatal and childhood outcomes. Despite this, current NICU mental health supports are less than optimum; postpartum mental health screening is limited, often missed in parents of inpatient infants, and may not be applicable to all family structures. Current evidence demonstrates improved outcomes in neonates and family members with early identification and multidisciplinary approaches to managing mental health problems. Physician Associates/Assistants (PAs) are a skilled group of advanced practice providers who are often a point of first contact for parents in the NICU, helping maintain continuity of care. In this perspective, we underscore leveraging the skills of PAs to promote the emotional wellbeing of parents in the NICU by way of practice and policy involvement. We also included a generic set of recommendations to equip PAs in this role.
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Affiliation(s)
- Brooke Wile
- Neonatal Intensive Care Unit, McMaster Children's Hospital, 1200 Main Street West, Hamilton, ON, L8N 3Z5, Canada
- Physician Assistant Education Program, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Karolina Skowronski
- Neonatal Intensive Care Unit, McMaster Children's Hospital, 1200 Main Street West, Hamilton, ON, L8N 3Z5, Canada
| | - Khashayar Shariati
- Department of Psychiatry and Behavioral Neurosciences, McMaster University/St Joseph's Healthcare Hamilton, 100 West 5th Street, Hamilton, ON, L8N 3K7, Canada
| | - Andrew T Olagunju
- Department of Psychiatry and Behavioral Neurosciences, McMaster University/St Joseph's Healthcare Hamilton, 100 West 5th Street, Hamilton, ON, L8N 3K7, Canada.
- Discipline of Psychiatry, University of Adelaide, Adelaide, SA, 5000, Australia.
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Dewan MV, Jungilligens J, Kobus S, Diezel M, Dathe AK, Schweiger B, Hüning B, Felderhoff-Müser U, Bruns N. The effect of live music therapy on white matter microstructure in very preterm infants - A randomized controlled trial. Eur J Paediatr Neurol 2024; 51:132-139. [PMID: 38941879 DOI: 10.1016/j.ejpn.2024.06.009] [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: 07/30/2023] [Revised: 05/31/2024] [Accepted: 06/20/2024] [Indexed: 06/30/2024]
Abstract
OBJECTIVE Music therapy (MT) is proposed to enrich the acoustic environment of very preterm infants (VPT) on the neonatal intensive care unit during a vulnerable period of brain development. The objective of this study was to investigate the effect of MT on the white matter (WM) microstructure. It is hypothesized that MT affects WM integrity in VPT. METHODS Randomized controlled trial enrolling infants born <32 weeks' gestation. Infants were randomized to MT or standard care. Live MT was provided twice weekly from the second postnatal week onwards by a trained music therapist. At term equivalent age, participants underwent a cranial magnetic resonance imaging scan including sequences for diffusion tensor imaging analysis. Differences in WM microstructure were assessed using tract based spatial statistics with fractional anisotropy. RESULTS Of 80 infants enrolled, 42 were eligible for diffusion tensor imaging analysis (MT: n = 22, standard care: n = 20). While primary tract based spatial statistics analysis revealed no significant differences between groups, post hoc analysis with uncorrected p-values and a significance threshold of p < 0.01 revealed significant fractional anisotropy differences in several WM tracts including the bilateral superior longitudinal fasciculus, the left forceps minor and left fasciculus uncinatus, the corpus callosum, the left external capsule, and the right corticospinal tract. CONCLUSION Post hoc analysis results suggest an effect of MT on WM integrity in VPT. Larger studies including long-term outcome are necessary to confirm these effects of MT on WM microstructure and to assess its impact on clinical neurodevelopment. CLINICAL TRIAL REGISTRATION Clinical trial number DRKS00025753.
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Affiliation(s)
- Monia Vanessa Dewan
- Department of Paediatrics I, University Hospital Essen, University of Duisburg-Essen, Essen, Germany; Center for Translational Neuro- and Behavioural Sciences, C-TNBS, Faculty of Medicine, University Duisburg-Essen, Essen, Germany.
| | - Johannes Jungilligens
- Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Bochum, Germany
| | - Susann Kobus
- Department of Paediatrics I, University Hospital Essen, University of Duisburg-Essen, Essen, Germany; Center for Translational Neuro- and Behavioural Sciences, C-TNBS, Faculty of Medicine, University Duisburg-Essen, Essen, Germany
| | - Marlis Diezel
- Department of Paediatrics I, University Hospital Essen, University of Duisburg-Essen, Essen, Germany; Center for Translational Neuro- and Behavioural Sciences, C-TNBS, Faculty of Medicine, University Duisburg-Essen, Essen, Germany
| | - Anne-Kathrin Dathe
- Department of Paediatrics I, University Hospital Essen, University of Duisburg-Essen, Essen, Germany; Center for Translational Neuro- and Behavioural Sciences, C-TNBS, Faculty of Medicine, University Duisburg-Essen, Essen, Germany; Department of Health and Nursing, Occupational Therapy, Ernst-Abbe-University of Applied Sciences Jena, Germany
| | - Bernd Schweiger
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Britta Hüning
- Department of Paediatrics I, University Hospital Essen, University of Duisburg-Essen, Essen, Germany; Center for Translational Neuro- and Behavioural Sciences, C-TNBS, Faculty of Medicine, University Duisburg-Essen, Essen, Germany
| | - Ursula Felderhoff-Müser
- Department of Paediatrics I, University Hospital Essen, University of Duisburg-Essen, Essen, Germany; Center for Translational Neuro- and Behavioural Sciences, C-TNBS, Faculty of Medicine, University Duisburg-Essen, Essen, Germany
| | - Nora Bruns
- Department of Paediatrics I, University Hospital Essen, University of Duisburg-Essen, Essen, Germany; Center for Translational Neuro- and Behavioural Sciences, C-TNBS, Faculty of Medicine, University Duisburg-Essen, Essen, Germany
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MacDonald S, Stratas A, Synnes AR, Sandila N, Campbell-Yeo M, Shah PS, Ghotra S. Parent-reported health outcomes at preschool age in preterm survivors: a population-based cohort study. Arch Dis Child Fetal Neonatal Ed 2024; 109:436-442. [PMID: 38135493 DOI: 10.1136/archdischild-2023-326136] [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: 07/28/2023] [Accepted: 12/10/2023] [Indexed: 12/24/2023]
Abstract
OBJECTIVE Literature on health status (HS) and health-related quality of life of preterm survivors at preschool age is sparse. Further, little is known about the relationship between parent-reported HS outcomes and standardised neurodevelopmental outcomes measured in preterm survivors at preschool age. Our objective was to evaluate parent-reported child HS outcomes and their relationship to neurodevelopmental outcomes at 36 months of age in very preterm survivors. DESIGN Prospective population-based cohort study. SETTING Perinatal follow-up programme. PATIENTS Infants <31 weeks' gestational age born from 2014 to 2016. OUTCOME MEASURES Parents completed the Health Status Classification System for Pre-School Children questionnaire at 36 months. At the same age, neurodevelopmental assessments were completed to determine neurodevelopmental impairment (NDI). NDI was categorised as none, 'mild' or 'significant' (moderate or severe cerebral palsy, Bayley Scales of Infant and Toddler Development - Third Edition <70, blind or required hearing aid). RESULTS Of 118 children, 87 (73.7%) parents reported their child had an HS concern (mild: 61 (51%); moderate: 16 (13.6%); and severe: 10 (8.5%)). Mild and significant NDIs were observed in 17 (14.4%) and 14 (11.9%) children, respectively. For the 14 (12%) children with significant NDI, 7 (50.0%) parents reported severe and 4 (28.6%) reported moderate concerns. Conversely, for 26 (22%) children with parent-reported moderate to severe concerns, 11 (42.3%) met the criteria for significant NDI. There was a moderate positive correlation between parental concern and NDI status (Spearman correlation=0.46, p<0.0001). CONCLUSIONS Parental HS concerns only moderately correlated with the NDI status. Of the 12% of children with significant NDI, only half of the parents reported severe HS concerns.
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Affiliation(s)
| | | | - Anne R Synnes
- Neonatology, BC Women's Hospital and Health Centre, Vancouver, British Columbia, Canada
| | - Navjot Sandila
- Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Marsha Campbell-Yeo
- Dalhousie University, Halifax, Nova Scotia, Canada
- IWK Health Centre, Halifax, Nova Scotia, Canada
| | | | - Satvinder Ghotra
- Dalhousie University, Halifax, Nova Scotia, Canada
- IWK Health Centre, Halifax, Nova Scotia, Canada
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9
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Das S, McClintock T, Cormack BE, Bloomfield FH, Harding JE, Lin L. High protein intake on later outcomes in preterm children: a systematic review and meta-analysis. Pediatr Res 2024:10.1038/s41390-024-03296-z. [PMID: 38858504 DOI: 10.1038/s41390-024-03296-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 04/30/2024] [Accepted: 05/13/2024] [Indexed: 06/12/2024]
Abstract
BACKGROUND Appropriate protein intake is crucial for growth and development in children born preterm. We assessed the effects of high (HP) versus low protein (LP) intake on neurodevelopment, growth, and biochemical anomalies in these children. METHODS Randomised and quasi-randomised trials providing protein to children born preterm (<37 completed weeks of gestation) were searched following PRISMA guideline in three databases and four registers (PROSPERO registration CRD42022325659). Random-effects model was used for assessing the effects of HP (≥3.5 g/kg/d) vs. LP (<3.5 g/kg/d). RESULTS Data from forty-four studies (n = 5338) showed HP might slightly reduce the chance of survival without neurodisability at ≥12 months (four studies, 1109 children, relative risk [RR] 0.95 [95% CI 0.90, 1.01]; P = 0.13; low certainty evidence) and might increase risk of cognitive impairment at toddler age (two studies; 436 children; RR 1.36 [0.89, 2.09]; P = 0.16; low certainty evidence). At discharge or 36 weeks, HP intake might result in higher weight and greater head circumference z-scores. HP intake probably increased the risk of hypophosphatemia, hypercalcemia, refeeding syndrome and high blood urea, but reduced risk of hyperglycaemia. CONCLUSIONS HP intake for children born preterm may be harmful for neonatal metabolism and later neurodisability and has few short-term benefits for growth. IMPACT STATEMENT Planned high protein intake after birth for infants born preterm might be harmful for survival, neurodisability and metabolism during infancy and did not improve growth after the neonatal period. Protein intake ≥3.5 g/kg/d should not be recommended for children born preterm.
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Affiliation(s)
- Subhasish Das
- Liggins Institute, University of Auckland, Auckland, New Zealand
- Nutrition Research Division, International Centre for Diarrhoeal Diseases Research, Bangladesh, Dhaka, Bangladesh
| | | | - Barbara E Cormack
- Liggins Institute, University of Auckland, Auckland, New Zealand
- Newborn Services, Starship Child Health, Auckland, New Zealand
| | | | - Jane E Harding
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Luling Lin
- Liggins Institute, University of Auckland, Auckland, New Zealand.
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Darilek U, Finley E, McGrath J. A Narrative Review of NICU Implementation of Evidence-Based Early Relational Health Interventions. Adv Neonatal Care 2024; 24:253-267. [PMID: 38815279 DOI: 10.1097/anc.0000000000001151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
BACKGROUND Early relational health (ERH) interventions in the neonatal intensive care unit (NICU) buffer infants from toxic stress effects. Implementation science (IS) can guide successful uptake of evidence-based practice (EBP) ERH interventions. It is unknown if implementors of ERH interventions currently use the resources of IS to improve implementation. PURPOSE A narrative review of recent literature on implementation of ERH EBPs was completed to understand (a) which ERH interventions are currently being implemented in NICUs globally, (b) whether clinical implementors of ERH interventions have adopted the resources of IS, (c) existence of implementation gaps, and (d) implementation outcomes of ERH interventions in contemporary literature. DATA SOURCES Scopus, PubMed, and CINHAL were searched for original research regarding implementation of dyadic ERH interventions using key words related to IS and ERH. STUDY SELECTION For inclusion, ERH EBPs had to have been implemented exclusively in NICU settings, contained data addressing an IS domain, printed in English within the last 5 years. Twenty-four studies met inclusion criteria. DATA EXTRACTION Studies were distilled for intervention, IS domains addressed, location, aims, design, sample, and outcomes. RESULTS Eleven ERH interventions were described in the literature. Few studies utilized the resources of IS, indicating variable degrees of success in implementation. Discussions of implementation cost were notably missing. IMPLICATIONS FOR PRACTICE AND RESEARCH Implementors of ERH interventions appear to be largely unfamiliar with IS resources. More work is needed to reach clinicians with the tools and resources of IS to improve implementation outcomes.
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Affiliation(s)
- Umber Darilek
- Department of Pediatrics, University of Texas Health Science Center at San Antonio, San Antonio, Texas (Dr Darilek); Departments of Medicine and Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas (Dr Finley); Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California (Dr Finley); and School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, Texas (Dr McGrath)
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11
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Capan N. How effective are musical and vocal interventions to improve neurodevelopmental outcomes in infants born preterm? A Cochrane Review summary with commentary. Dev Med Child Neurol 2024; 66:679-682. [PMID: 38468405 DOI: 10.1111/dmcn.15892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 02/06/2024] [Indexed: 03/13/2024]
Affiliation(s)
- Nalan Capan
- Department of Physical Medicine and Rehabilitation, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Türkiye
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12
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Amodei N, Nixon E, Zhang S, Hu Y, Vance A, Maye M. Associations between sociodemographic characteristics and neonatal length of the stay. J Perinatol 2024; 44:851-856. [PMID: 38773215 DOI: 10.1038/s41372-024-01976-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 03/29/2024] [Accepted: 04/16/2024] [Indexed: 05/23/2024]
Abstract
BACKGROUND Infants with past NICU admission have a significantly higher risk of developing neurodevelopmental disorders. Studies have demonstrated an iatrogenic effect of the NICU environment on neurodevelopmental outcomes, even while accounting for physical factors. It is, therefore, critical that an infant's LOS is driven by physical needs versus sociodemographic barriers. METHODS We leveraged electronic health records and a backward selection regression model to explore physical and sociodemographic predictors of infant LOS. RESULTS Our results demonstrated that physical predictors (birthweight and ventilator use) accounted for the majority of variance in our model but that a sociodemographic predictor, mean visits per day, was also significant. CONCLUSIONS Infants who were visited more frequently experienced a shorter LOS, possibly due to increased parental involvement resulting in more individualized care and directly impacting infant stability and morbidity. By supporting visitation, we can reduce the costs of lengthy NICU hospitalizations while improving infant and parent health and well-being.
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Affiliation(s)
- Natalie Amodei
- Wayne State University School of Medicine, Detroit, MI, USA
| | - Ellen Nixon
- American Hospital Association, Chicago, IL, USA
| | | | - Yong Hu
- Henry Ford Health, Detroit, MI, USA
| | - Ashlee Vance
- Henry Ford Health and Michigan State University Health Sciences (HFH+MSU Health Sciences), Center for Health Policy and Health Services Research, One Ford Place, Detroit, MI, USA
| | - Melissa Maye
- Henry Ford Health and Michigan State University Health Sciences (HFH+MSU Health Sciences), Center for Health Policy and Health Services Research, One Ford Place, Detroit, MI, USA.
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13
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Elkhouli M, Raghuram K, Elhanafy T, Asztalos E, Banihani R, Shah PS, Mohamed A. Association of low hemoglobin at birth and neurodevelopmental outcomes in preterm neonates ≤28 weeks' gestation: a retrospective cohort study. J Perinatol 2024; 44:880-885. [PMID: 38553601 DOI: 10.1038/s41372-024-01946-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 03/14/2024] [Accepted: 03/19/2024] [Indexed: 06/09/2024]
Abstract
OBJECTIVE To compare neurodevelopmental outcomes at 18-24 months corrected age (CA) for preterm infants who had hemoglobin levels <120 g/l versus those with hemoglobin level ≥120 g/l at birth. METHODS We included infants of ≤28 weeks gestational age (GA) born between January 2009 and June 2018. The primary outcome was neurodevelopmental impairment (NDI) at 18-24 months. Multivariable logistic regression was applied to determine the association. RESULTS Of the 2351 eligible neonates, 351 (14.9%) had hemoglobin levels <120 g/L at birth. Of the 2113 surviving infants, 1534 (72.5%) underwent developmental follow-up at 18-24 months CA. There was no statistically significant difference in ND outcomes between the two groups. The composite outcome of death or NDI was significantly higher in the low hemoglobin group. CONCLUSION In preterm infants ≤28 weeks GA, initial hemoglobin <120 g/L at birth was not associated with neurodevelopmental impairment at 18-24 months CA among survivors.
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Affiliation(s)
- Mohamed Elkhouli
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Department of Pediatrics, Scarborough Health Network, Toronto, Ontario, Canada
| | - Kamini Raghuram
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Department of Pediatrics, Sinai Health System, Toronto, Ontario, Canada
| | - Thanna Elhanafy
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Department of Pediatrics, Sinai Health System, Toronto, Ontario, Canada
| | - Elizabeth Asztalos
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- DAN Women & Babies Program, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
| | - Rudaina Banihani
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- DAN Women & Babies Program, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
| | - Prakesh S Shah
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Department of Pediatrics, Sinai Health System, Toronto, Ontario, Canada
| | - Adel Mohamed
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.
- Department of Pediatrics, Sinai Health System, Toronto, Ontario, Canada.
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Griffiths N, Laing S, Spence K, Foureur M, Popat H, Hickey L, Sinclair L. Developmental care education in Australian surgical neonatal intensive care units: A cross-sectional study of nurses' perceptions. Heliyon 2024; 10:e30572. [PMID: 38799751 PMCID: PMC11126797 DOI: 10.1016/j.heliyon.2024.e30572] [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: 11/06/2023] [Revised: 04/26/2024] [Accepted: 04/29/2024] [Indexed: 05/29/2024] Open
Abstract
Background Nurse perceptions of developmental care practices have been researched globally for almost 30 years. Yet, there is a lack of research exploring this subject in the specialised setting of the surgical neonatal intensive care unit (sNICU). This research explores the effect of developmental care education programs on sNICU nurses' perceptions of developmental care. Objective To determine perceptions and attitudes towards developmental care in a specialty neonatal setting. Design Cross-sectional study. Settings Two surgical neonatal intensive care units in Australia. Participants Registered nurses permanently employed at the study sites between May 2021 to April 2022. Methods A modified electronic survey explored sNICU nurse perceptions of developmental care organised around three themes: effects of developmental care on parents and infants, application of developmental care, and unit practices. Associations between site, nurse characteristics, developmental care education and nurses' perceptions were explored using logistic regression [odds ratios (OR) and 95 % confidence intervals (CI)]. Results Of 295 sNICU nurses, 117 (40 %) participated in the survey. Seventy-five percent of respondents had attended a formal developmental care education program. High levels of agreement (>90 %) were reported regarding the benefits of developmental care for parents and infants. Exposure to developmental care education influenced perceptions of its application. Nurses without formal developmental care education were more likely to agree that it was consistently applied [OR:3.3, 95%CI:1.3-8.6], developmental care skills are valued [OR:2.7, 95%CI:1.1-6.8], and that their nursing peers offered support in its application ([OR:2.5, 95%CI:1.1-6.2]. Conclusions The results from our research suggest sNICU nurses have a high level of awareness of developmental care and its positive impacts. Despite differences between the surveyed units' developmental care education programs, the value of developmental care in reducing stress for infants and supporting families was collectively recognised. Future research in this setting should focus on evaluating the application of developmental care in this setting.
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Affiliation(s)
- Nadine Griffiths
- Grace Centre for Newborn Intensive Care, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, 2145, NSW Australia, Australia
- University of Technology Sydney, Centre of Midwifery, Child and Family Health, 15 Broadway, Ultimo, NSW, 2007, Australia
| | - Sharon Laing
- Grace Centre for Newborn Intensive Care, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, 2145, NSW Australia, Australia
| | - Kaye Spence
- Grace Centre for Newborn Intensive Care, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, 2145, NSW Australia, Australia
- School of Nursing and Midwifery, Western Sydney University, Parramatta, NSW, Australia
| | - Maralyn Foureur
- Faculty of Health and Medicine, University of Newcastle, Callaghan Campus, 2308, NSW, Australia
| | - Himanshu Popat
- Grace Centre for Newborn Intensive Care, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, 2145, NSW Australia, Australia
- The University of Sydney, Jane Foss Russell Building Camperdown 2006, NSW Australia, Australia
| | - Leah Hickey
- The Royal Children's Hospital, 50 Flemington Rd, Parkville, 3052, Victoria Australia, Australia
- University of Melbourne, Grattan Street, Parkville Victoria, 3010, Australia
| | - Lynn Sinclair
- University of Technology Sydney, Centre of Midwifery, Child and Family Health, 15 Broadway, Ultimo, NSW, 2007, Australia
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15
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Tasuku O, Naoki N. Effects of the COVID-19 pandemic on the rates of adverse birth outcomes and fetal mortality in Japan: an analysis of national data from 2010 to 2022. BMC Public Health 2024; 24:1430. [PMID: 38807097 PMCID: PMC11134758 DOI: 10.1186/s12889-024-18905-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 05/21/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND Although the coronavirus disease 2019 (COVID-19) pandemic affected trends of multiple health outcomes in Japan, there is a paucity of studies investigating the effect of the pandemic on adverse birth outcomes and fetal mortality. This study aimed to investigate the effect of the onset of the pandemic on the trends in adverse birth outcomes and fetal mortality using national data in Japan. METHODS We used the 2010-2022 birth and fetal mortality data from the Vital Statistics in Japan. We defined the starting time of the effect of the pandemic as April 2020, and the period from January 2010 to March 2020 and that from April 2020 to December 2022 were defined as the pre- and post- pandemic period, respectively. The rates of preterm birth, term low birth weight (TLBW), small-for-gestational-age (SGA), large-for-gestational-age (LGA), spontaneous fetal mortality, and artificial fetal mortality were used as outcomes. An interrupted time series analysis was conducted using monthly time series data of the outcomes to evaluate the effects of the pandemic. In addition, a modified Poisson regression model was used to evaluate the effects of the pandemic on these outcomes using individual-level data, and the adjusted risk ratio of the effect was calculated. RESULTS The adverse birth and fetal mortality outcomes showed a decreasing trend over the years, except for preterm birth and LGA birth rates, and SGA birth rates tended to reach their lowest values after the onset of the pandemic. The interrupted time series analysis revealed that the pandemic decreased preterm birth, TLBW, and SGA birth rates. In addition, the regression analysis revealed that the pandemic decreased the TLBW, SGA, and artificial fetal mortality rates. CONCLUSIONS Analyses performed using national data suggested that the pandemic decreased the TLBW and SGA rates in Japan.
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Affiliation(s)
- Okui Tasuku
- Medical Information Center, Kyushu University Hospital, Maidashi3-1-1 Higashi-ku Fukuoka city Fukuoka prefecture, Fukuoka city, 812-8582, Japan.
| | - Nakashima Naoki
- Medical Information Center, Kyushu University Hospital, Maidashi3-1-1 Higashi-ku Fukuoka city Fukuoka prefecture, Fukuoka city, 812-8582, Japan
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16
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Fajardo-Martinez V, Ferreira F, Fuller T, Cambou MC, Kerin T, Paiola S, Mok T, Rao R, Mohole J, Paravastu R, Zhang D, Marschik P, Iyer S, Kesavan K, Borges Lopes MDC, Britto JAA, Moreira ME, Brasil P, Nielsen-Saines K. Neurodevelopmental delay in children exposed to maternal SARS-CoV-2 in-utero. Sci Rep 2024; 14:11851. [PMID: 38789553 PMCID: PMC11126599 DOI: 10.1038/s41598-024-61918-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 05/10/2024] [Indexed: 05/26/2024] Open
Abstract
It is unclear if SARS CoV-2 infection during pregnancy is associated with adverse neurodevelopmental repercussions to infants. We assessed pediatric neurodevelopmental outcomes in children born to mothers with laboratory-confirmed SARS CoV-2 infection during pregnancy. Neurodevelopmental outcomes of in-utero exposed children were compared to that of pre-pandemic control children in Los Angeles (LA), CA, USA and Rio de Janeiro, Brazil. Bayley Scales of Infant and Toddler Development, 3rd edition (Bayley-III), the gold standard tool for evaluating neurodevelopment until 36 months of age and Ages and Stages Questionnaires (ASQ-3), a frequently used screening instrument for evaluating neurodevelopment in this same age group were the assessment tools used. Developmental delay (DD) was defined as having a score < - 2 SD below the norm (< 70) in at least one of three Bayley-III domains, (cognitive, motor or language) or a score below the cut-off (dark zone) in at least one of five ASQ-3 domains (communication, gross motor, fine motor, problem solving, personal-social). Exposed children were born between April 2020 and December 2022 while control children were born between January 2016 to December 2019. Neurodevelopmental testing was performed in 300 children total: 172 COVID-19 exposed children between 5-30 months of age and 128 control children between 6-38 months of age. Bayley-III results demonstrated that 12 of 128 exposed children (9.4%) had DD versus 2 of 128 controls (1.6%), p = 0.0007. Eight of 44 additional exposed children had DD on ASQ-3 testing. Fully, 20 of 172 exposed children (11.6%) and 2 of 128 control children (1.6%), p = 0.0006 had DD. In Rio, 12% of exposed children versus 2.6% of controls, p = 0.02 had DD. In LA, 5.7% of exposed children versus 0 controls, p = 0.12 had DD. Severe/critical maternal COVID-19 predicted below average neurodevelopment in the exposed cohort (OR 2.6, 95% CI 1.1-6.4). Children exposed to antenatal COVID-19 have a tenfold higher frequency of DD as compared to controls and should be offered neurodevelopmental follow-up.
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Affiliation(s)
| | | | - Trevon Fuller
- UCLA Institute for the Environment and Sustainability, Los Angeles, CA, USA.
| | | | - Tara Kerin
- David Geffen, UCLA School of Medicine, Los Angeles, CA, USA
| | - Sophia Paiola
- David Geffen, UCLA School of Medicine, Los Angeles, CA, USA
| | - Thalia Mok
- David Geffen, UCLA School of Medicine, Los Angeles, CA, USA
| | - Rashmi Rao
- David Geffen, UCLA School of Medicine, Los Angeles, CA, USA
| | - Jyodi Mohole
- David Geffen, UCLA School of Medicine, Los Angeles, CA, USA
| | | | - Dajie Zhang
- Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany
- Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Göttingen and Leibniz ScienceCampus Primate Cognition, Göttingen, Germany
- Interdisciplinary Developmental Neuroscience (IDN), Division of Phoniatrics, Medical University of Graz, Graz, Austria
| | - Peter Marschik
- Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany
- Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Göttingen and Leibniz ScienceCampus Primate Cognition, Göttingen, Germany
- Interdisciplinary Developmental Neuroscience (IDN), Division of Phoniatrics, Medical University of Graz, Graz, Austria
| | - Sai Iyer
- David Geffen, UCLA School of Medicine, Los Angeles, CA, USA
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17
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Pavlyshyn H, Sarapuk I, Kozak K. The relationship between neonatal stress in preterm infants and developmental outcomes at the corrected age of 24-30 months. Front Psychol 2024; 15:1415054. [PMID: 38840740 PMCID: PMC11150848 DOI: 10.3389/fpsyg.2024.1415054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 05/10/2024] [Indexed: 06/07/2024] Open
Abstract
Aim The aim of research was to study the relationship between the stress experienced by preterm infants in the neonatal intensive care unit (NICU) and developmental status in the follow up, and to establish factors, associated with their neurodevelopment. Methods The first stage of research involved measuring stress markers (cortisol, melatonin) in infants (n = 56) during their NICU stay; the second phase assessed the developmental status at the corrected age of 24-30 months. Results The total ASQ-3 score, communication, problem solving, and personal-social skills scores at the corrected age of 24-30 months were positively correlated with melatonin level determined in the neonatal period (r = 0.31, p = 0.026; r = 0.36, p = 0.009; r = 0.30, p = 0.033, and r = 0.32; p = 0.022 respectively). In the same time, ASQ-3 communication and personal-social scores were negatively correlated with cortisol level (r = -0.31, p = 0.043; r = -0.35, p = 0.022). The ROC-curve analysis revealed that a decrease of melatonin below 3.44 ng/mL and 3.71 ng/mL during the neonatal period could predict communication and problem-solving delay, respectively. An increase in cortisol above 0.64 mcg/dl is predictive in personal-social delay. Negative correlation was identified between the NICU and total hospital stay duration and ASQ-3 communication scores in the follow-up (r = -0.27; p = 0.049 and r = -0.41; p = 0.002, respectively). The duration of mechanical ventilation was negatively correlated with gross motor scores (r = -0.46; p = 0.043). Apgar score was positively correlated with ASQ-3 communication (r = 0.29; p = 0.032) and personal-social scores (r = 0.28; p = 0.034); maternal age-with ASQ-3 total (r = 0.29; p = 0.034), communication (r = 0.37; p = 0.006), and personal-social scores (r = 0.29; p = 0.041). Positive correlations were observed between gestational age and communication scores (r = 0.28; p = 0.033). Infants who suffered neonatal sepsis had significantly often delay of communication (p = 0.014) and gross motor skills (p = 0.016). Children who required mechanical ventilation were more likely to have communication delay (p = 0.034). Conclusion Developmental outcomes in preterm infants at the corrected age of 24-30 months were associated with neonatal stress. Correlations between the communication, problem-solving and personal-social development in the follow up and cortisol and melatonin levels determined in the neonatal period supported this evidence. Factors as low gestational age, duration of hospital and NICU stay, mechanical ventilation, and sepsis were associated with more frequent delays in communication, gross motor and problems-solving skills.
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Affiliation(s)
- Halyna Pavlyshyn
- Department of Pediatrics, I. Horbachevsky Ternopil National Medical University, Ternopil, Ukraine
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18
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Störbeck C. Early Childhood Development Is Not Enough: In Defense of Children with Developmental Delays and Disabilities and Their Right to Family-Centered Early Childhood Intervention (In the Global South). CHILDREN (BASEL, SWITZERLAND) 2024; 11:606. [PMID: 38790601 PMCID: PMC11119497 DOI: 10.3390/children11050606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 04/10/2024] [Accepted: 05/03/2024] [Indexed: 05/26/2024]
Abstract
The international recognition of the critical importance of the early childhood phase has been firmly established through decades of rigorous research, evidence-based practices, and undeniable evidence of the returns on investment made during this formative period. Consequently, early childhood development has emerged as a top priority on both national and international agendas. This momentum reached a pinnacle in 2015 with the unanimous adoption of the 17 Sustainable Development Goals (SDGs) by the United Nations, which placed a particular emphasis on children under the age of five within the education-focused SDG 4, notably target 4.2, centered on ensuring that all girls and boys are ready for primary education through the provision of accessible "quality early childhood development, care and pre-primary education". However, the Global South reflects the glaring omission of addressing the needs of children at risk of poor development due to disabilities. This paper underscores the imperative for specialized early childhood intervention tailored to young children with disabilities and their families, commencing as early as possible following birth. It advocates for Early Childhood Intervention (ECI) as a service distinct from general Early Childhood Development (ECD), emphasizing the crucial role of families as active partners from the outset. Furthermore, the paper strengthens the case for Family-Centered Early Childhood Intervention (Fc-ECI) through the integration of evidence-based practices and an in-depth description of one such program in South Africa with specific reference to deaf and hard-of-hearing infants and their families. This model will be guided by core concepts outlined in WHO and UNICEF Early Childhood Intervention frameworks. Through this exploration, the paper aims to shed light on the urgent need for inclusive approaches to early childhood development, particularly for children with disabilities, and to advocate for the adoption of Family-Centered Early Childhood Intervention as a cornerstone of global efforts to ensure the holistic well-being and development of all children.
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Affiliation(s)
- Claudine Störbeck
- The Wits Centre for Deaf Studies, School of Education, Faculty of Humanities, University of the Witwatersrand, Johannesburg 2000, South Africa
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19
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Mahmoudian M, Lorigooini Z, Rahimi-Madiseh M, Shabani S, Amini-Khoei H. Protective effects of rosmarinic acid against autistic-like behaviors in a mouse model of maternal separation stress: behavioral and molecular amendments. NAUNYN-SCHMIEDEBERG'S ARCHIVES OF PHARMACOLOGY 2024:10.1007/s00210-024-03143-2. [PMID: 38730077 DOI: 10.1007/s00210-024-03143-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 05/02/2024] [Indexed: 05/12/2024]
Abstract
Autism spectrum disorder (ASD) is a neurodevelopmental disorder with worldwide increasing incidence. Maternal separation (MS) stress at the beginning of life with its own neuroendocrine changes can provide the basis for development of ASD. Rosmarinic acid (RA) is a phenolic compound with a protective effect in neurodegenerative diseases. The aim of this study was to determine the effect of RA on autistic-like behaviors in maternally separated mice focusing on its possible effects on neuroimmune response and nitrite levels in the hippocampus. In this study, 40 mice were randomly divided into five groups of control (received normal saline (1 ml/kg)) and MS that were treated with normal saline (1 ml/kg) or doses of 1, 2, and 4 mg/kg RA, respectively, for 14 days. Three-chamber sociability, shuttle box, and marble burying tests were used to investigate autistic-like behaviors. Nitrite level and gene expression of inflammatory cytokines including TNF-α, IL-1β, TLR4, and iNOS were assessed in the hippocampus. The results showed that RA significantly increased the social preference and social novelty indexes, as well as attenuated impaired passive avoidance memory and the occurrence of repetitive and obsessive behaviors in the MS mice. RA reduced the nitrite level and gene expression of inflammatory cytokines in the hippocampus. RA, probably via attenuation of the nitrite level as well as of the neuroimmune response in the hippocampus, mitigated autistic-like behaviors in maternally separated mice.
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Affiliation(s)
- Maziar Mahmoudian
- Student Research Committee, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Zahra Lorigooini
- Medical Plants Research Center, Basic Health Sciences Institute, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Mohammad Rahimi-Madiseh
- Medical Plants Research Center, Basic Health Sciences Institute, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Sahreh Shabani
- Medical Plants Research Center, Basic Health Sciences Institute, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Hossein Amini-Khoei
- Medical Plants Research Center, Basic Health Sciences Institute, Shahrekord University of Medical Sciences, Shahrekord, Iran.
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20
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Ribas-Prats T, Arenillas-Alcón S, Martínez SIF, Gómez-Roig MD, Escera C. The frequency-following response in late preterm neonates: a pilot study. Front Psychol 2024; 15:1341171. [PMID: 38784610 PMCID: PMC11112609 DOI: 10.3389/fpsyg.2024.1341171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 04/23/2024] [Indexed: 05/25/2024] Open
Abstract
Introduction Infants born very early preterm are at high risk of language delays. However, less is known about the consequences of late prematurity. Hence, the aim of the present study is to characterize the neural encoding of speech sounds in late preterm neonates in comparison with those born at term. Methods The speech-evoked frequency-following response (FFR) was recorded to a consonant-vowel stimulus /da/ in 36 neonates in three different groups: 12 preterm neonates [mean gestational age (GA) 36.05 weeks], 12 "early term neonates" (mean GA 38.3 weeks), and "late term neonates" (mean GA 41.01 weeks). Results From the FFR recordings, a delayed neural response and a weaker stimulus F0 encoding in premature neonates compared to neonates born at term was observed. No differences in the response time onset nor in stimulus F0 encoding were observed between the two groups of neonates born at term. No differences between the three groups were observed in the neural encoding of the stimulus temporal fine structure. Discussion These results highlight alterations in the neural encoding of speech sounds related to prematurity, which were present for the stimulus F0 but not for its temporal fine structure.
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Affiliation(s)
- Teresa Ribas-Prats
- Brainlab–Cognitive Neuroscience Research Group. Department of Clinical Psychology and Psychobiology, University of Barcelona, Barcelona, Spain
- Institute of Neurosciences, University of Barcelona, Barcelona, Spain
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Sonia Arenillas-Alcón
- Brainlab–Cognitive Neuroscience Research Group. Department of Clinical Psychology and Psychobiology, University of Barcelona, Barcelona, Spain
- Institute of Neurosciences, University of Barcelona, Barcelona, Spain
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Silvia Irene Ferrero Martínez
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
- BCNatal–Barcelona Center for Maternal Fetal and Neonatal Medicine (Hospital Sant Joan de Déu and Hospital Clínic), University of Barcelona, Barcelona, Spain
| | - Maria Dolores Gómez-Roig
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
- BCNatal–Barcelona Center for Maternal Fetal and Neonatal Medicine (Hospital Sant Joan de Déu and Hospital Clínic), University of Barcelona, Barcelona, Spain
| | - Carles Escera
- Brainlab–Cognitive Neuroscience Research Group. Department of Clinical Psychology and Psychobiology, University of Barcelona, Barcelona, Spain
- Institute of Neurosciences, University of Barcelona, Barcelona, Spain
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
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21
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Barrett ES, Sullivan A, Workman T, Zhang Y, Loftus CT, Szpiro AA, Paquette A, MacDonald JW, Coccia M, Smith R, Bowman M, Smith A, Derefinko K, Nguyen RHN, Zhao Q, Sathyanarayana S, Karr C, LeWinn KZ, Bush NR. Sex-specific associations between placental corticotropin releasing hormone and problem behaviors in childhood. Psychoneuroendocrinology 2024; 163:106994. [PMID: 38387218 DOI: 10.1016/j.psyneuen.2024.106994] [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: 11/01/2023] [Revised: 02/13/2024] [Accepted: 02/14/2024] [Indexed: 02/24/2024]
Abstract
Placental corticotropin-releasing hormone (pCRH) is a neuroactive peptide produced in high concentrations in mid-late pregnancy, during key periods of fetal brain development. Some evidence suggests that higher pCRH exposure during gestation is associated with adverse neurodevelopment, particularly in female offspring. In 858 mother-child dyads from the sociodemographically diverse CANDLE cohort (Memphis, TN), we examined: (1) the slope of pCRH rise in mid-late pregnancy and (2) estimated pCRH at delivery as a measure of cumulative prenatal exposure. When children were 4 years-old, mothers reported on problem behaviors using the Child Behavior Checklist (CBCL) and cognitive performance was assessed by trained psychologists using the Stanford-Binet Intelligence Scales. We fitted linear regression models examining pCRH in relation to behavioral and cognitive performance measures, adjusting for covariates. Using interaction models, we evaluated whether associations differed by fetal sex, breastfeeding, and postnatal neighborhood opportunity. In the full cohort, log-transformed pCRH measures were not associated with outcomes; however, we observed sex differences in some models (interaction p-values≤0.01). In male offspring, an interquartile (IQR) increase in pCRH slope (but not estimated pCRH at delivery), was positively associated with raw Total (β=3.06, 95%CI: 0.40, 5.72), Internalizing (β=0.89, 95%CI: 0.03, 1.76), and Externalizing (β=1.25, 95%CI: 0.27, 2.22) Problem scores, whereas, in females, all associations were negative (Total Problems: β=-1.99, 95%CI: -3.89, -0.09; Internalizing: β=-0.82, 95%CI: -1.42, -0.23; Externalizing: β=-0.56, 95%CI: -1.34, 0.22). No associations with cognitive performance were observed nor did we observe moderation by breastfeeding or postnatal neighborhood opportunity. Our results provide further evidence that prenatal pCRH exposure may impact subsequent child behavior in sex-specific ways, however in contrast to prior studies suggesting adverse impacts in females, steeper mid-gestation pCRH rise was associated with more problem behaviors in males, but fewer in females.
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Affiliation(s)
- Emily S Barrett
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ, USA; Environmental and Occupational Health Sciences Institute, Rutgers University, Piscataway, NJ, USA.
| | - Alexandra Sullivan
- Center for Health and Community, University of California, San Francisco, CA, USA; Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA
| | - Tomomi Workman
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA
| | - Yuhong Zhang
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA
| | - Christine T Loftus
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA
| | - Adam A Szpiro
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Alison Paquette
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA; Seattle Children's Research Institute, Seattle, WA, USA; Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - James W MacDonald
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA
| | - Michael Coccia
- Center for Health and Community, University of California, San Francisco, CA, USA
| | - Roger Smith
- Mothers and Babies Research Centre, Hunter Medical Research Institute, University of Newcastle, Newcastle, Australia
| | - Maria Bowman
- Mothers and Babies Research Centre, Hunter Medical Research Institute, University of Newcastle, Newcastle, Australia
| | - Alicia Smith
- Department of Gynecology and Obstetrics, Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, USA
| | - Karen Derefinko
- Department of Preventive Medicine, University of Tennessee Health Sciences Center, Memphis, TN, USA
| | - Ruby H N Nguyen
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Qi Zhao
- Department of Preventive Medicine, University of Tennessee Health Sciences Center, Memphis, TN, USA
| | - Sheela Sathyanarayana
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA; Seattle Children's Research Institute, Seattle, WA, USA; Department of Pediatrics, University of Washington, Seattle, WA, USA; Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Catherine Karr
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA; Department of Pediatrics, University of Washington, Seattle, WA, USA; Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Kaja Z LeWinn
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA
| | - Nicole R Bush
- Center for Health and Community, University of California, San Francisco, CA, USA; Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA; Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
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22
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Chen Y, Künzel RG, Sanchez SE, Rondon MB, Pinto NI, Sanchez E, Kirschbaum C, Valeri L, Koenen KC, Gelaye B. The Association Between Pre-Pregnancy and First-Trimester Hair Cortisol and Preterm Birth: A Causal Inference Model. RESEARCH SQUARE 2024:rs.3.rs-4095921. [PMID: 38746291 PMCID: PMC11092793 DOI: 10.21203/rs.3.rs-4095921/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
Background Adverse life events and chronic psychological distress before and during pregnancy have frequently been associated with preterm birth (PTB) but the biological underpinnings remain unclear. We investigated the association between corticosteroid levels in pre-pregnancy and first-trimester hair and the risk of PTB. Methods We followed 1,808 pregnant women from a prospective pre-birth cohort study in Lima, Perú. Hair samples were taken at the end of the first pregnancy trimester. The two most proximal 3cm segments to the scalp (representing pre-pregnancy and first-trimester) were analyzed to obtain hair cortisol and cortisone concentrations (HCC and HCNC). PTB was defined as birth < 37 completed gestational weeks. We constructed four generalized propensity scores for pre-pregnancy and first-trimester HCC and HCNC to create corresponding inverse probability weights before fitting marginal structural models for estimating the effect of HCC and HCNC on PTB risk. Results Pre-pregnancy Log HCC was not independently associated with PTB risk (RR = 0.97; 95%CI: 0.79, 1.19). In contrast, one SD increase from the mean first-trimester Log HCC was independently associated with a 37% (95%CI: 1.11, 1.69) increased risk of PTB. Although imprecise, pre-pregnancy Log HCNC was negatively associated with PTB risk (RR = 0.84; 95%CI: 0.58, 1.20), whereas the association between first-trimester Log HCNC and PTB risk was positive (RR = 1.20; 95%CI: 0.87, 1.65). Conclusions Our findings show that chronic corticosteroid levels in early pregnancy are causally linked to PTB risk in pregnant Peruvian women. This finding contributes to understanding the biological underpinnings of PTB better to enhance PTB prevention.
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23
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van Beek PE, Rijken M, Broeders L, Ter Horst HJ, Koopman-Esseboom C, de Kort E, Laarman ARC, Mulder-de Tollenaer SM, Steiner K, Swarte RMC, van Westering-Kroon E, Oei G, Leemhuis AG, Andriessen P. Neurodevelopmental outcome at 5.5 years in Dutch preterm infants born at 24-26 weeks' gestational age: the EPI-DAF study. Arch Dis Child Fetal Neonatal Ed 2024; 109:272-278. [PMID: 38071564 DOI: 10.1136/archdischild-2023-325732] [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: 04/24/2023] [Accepted: 10/20/2023] [Indexed: 04/20/2024]
Abstract
OBJECTIVE After lowering the Dutch threshold for active treatment from 25 to 24 completed weeks' gestation, survival to discharge increased by 10% in extremely preterm live born infants. Now that this guideline has been implemented, an accurate description of neurodevelopmental outcome at school age is needed. DESIGN Population-based cohort study. SETTING All neonatal intensive care units in the Netherlands. PATIENTS All infants born between 240/7 and 266/7 weeks' gestation who were 5.5 years' corrected age (CA) in 2018-2020 were included. MAIN OUTCOME MEASURES Main outcome measure was neurodevelopmental outcome at 5.5 years. Neurodevelopmental outcome was a composite outcome defined as none, mild or moderate-to-severe impairment (further defined as neurodevelopmental impairment (NDI)), using corrected cognitive score (Wechsler Preschool and Primary Scale of Intelligence Scale-III-NL), neurological examination and neurosensory function. Additionally, motor score (Movement Assessment Battery for Children-2-NL) was assessed. All assessments were done as part of the nationwide, standardised follow-up programme. RESULTS In the 3-year period, a total of 632 infants survived to 5.5 years' CA. Data were available for 484 infants (77%). At 5.5 years' CA, most cognitive and motor (sub)scales were significantly lower compared with the normative mean. Overall, 46% had no impairment, 36% had mild impairment and 18% had NDI. NDI-free survival was 30%, 49% and 67% in live born children at 24, 25 and 26 weeks' gestation, respectively (p<0.001). CONCLUSIONS After lowering the threshold for supporting active treatment from 25 to 24 completed weeks' gestation, a considerable proportion of the surviving extremely preterm children did not have any impairment at 5.5 years' CA.
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Affiliation(s)
- Pauline E van Beek
- Department of Neonatology, Máxima Medical Center, Veldhoven, The Netherlands
| | - Monique Rijken
- Department of Neonatology, Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, The Netherlands
| | - Lisa Broeders
- The Netherlands Perinatal Registry, Utrecht, The Netherlands
| | - Hendrik J Ter Horst
- Department of Neonatology, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, The Netherlands
| | - Corine Koopman-Esseboom
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ellen de Kort
- Department of Neonatology, Máxima Medical Center, Veldhoven, The Netherlands
| | - A R C Laarman
- Department of Neonatology, Amsterdam University Medical Center location VUMC, Amsterdam, The Netherlands
| | | | - Katerina Steiner
- Department of Neonatology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Renate M C Swarte
- Department of Neonatology, Sophia Children's Hospital, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Guid Oei
- Department of Obstetrics and Gynaecology, Máxima Medical Center, Veldhoven, The Netherlands
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Aleid G Leemhuis
- Department of Neonatology, Emma Childrens' Hospital, Amsterdam University Medical Center location AMC, Amsterdam, The Netherlands
| | - Peter Andriessen
- Department of Neonatology, Máxima Medical Center, Veldhoven, The Netherlands
- Department of Applied Physics, School of Medical Physics and Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
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24
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Toma AI, Dima V, Alexe A, Bojan C, Nemeș AF, Gonț BF, Arghirescu A, Necula AI, Fieraru A, Stoiciu R, Mirea A, Calomfirescu Avramescu A, Isam AJ. Early Intervention Guided by the General Movements Examination at Term Corrected Age-Short Term Outcomes. Life (Basel) 2024; 14:480. [PMID: 38672751 PMCID: PMC11050901 DOI: 10.3390/life14040480] [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: 02/19/2024] [Revised: 03/17/2024] [Accepted: 04/03/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND AND AIM The early identification of the former premature neonates at risk of neurologic sequelae could lead to early intervention and a better prognosis. This pilot study aimed to investigate whether the General Movement patterns observed at term-equivalent age in former premature infants could serve as predictors for guiding early intervention and improving prognosis. MATERIALS AND METHODS In a population of 44 premature neonates (mean gestational age 33.59 weeks (+2.43 weeks)) examined at term-equivalent age, 10 neonates with a cramped-synchronized General Movements motor pattern were identified. These neonates were included in an early intervention program consisting of physiotherapy executed both by the therapist and by the parents at home. They were again examined at a corrected age of 12 weeks. The presence or absence of fidgety movements and the MOS-R (motor optimality score revised) was noted. The examinations were performed by certified specialists. RESULTS Normal fidgety movements and a MOS-R of 20-24 were presented in 9/10 of the former premature infants, with normal foot to foot contact present in 7/10, and normal hand to hand contact present in 5/10. The atypical patterns noted were side to side movements of the head in 5/10, a non-centered head in 9/10, asymmetric tonic neck reflex in 9/10 and jerky movements in 10/10. One patient presented with no fidgety movements and a MOS-R score of 9. CONCLUSION Early intervention in our group of patients allowed for an improvement in the neurologic status, demonstrated by the presence of fidgety movements. We suggest that early intervention should be indicated in all premature infants that present with a cramped-synchronized GM pattern during examination at term-equivalent age. However, due to the small sample size, the absence of statistical analysis and a control group, and the limited follow-up period, the conclusions must be approached with caution.
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Affiliation(s)
- Adrian Ioan Toma
- Life Memorial Hospital, 010719 Bucharest, Romania
- Faculty of Medicine, University Titu Maiorescu, 040441 Bucharest, Romania
| | - Vlad Dima
- Neonatology Department Filantropia Clinical Hospital, 011132 Bucharest, Romania
| | | | - Cristina Bojan
- Kinetotherapy Department, Pediatric Neurology Alexandru Obregia Hospital, 041914 Bucharest, Romania
| | - Alexandra Floriana Nemeș
- Life Memorial Hospital, 010719 Bucharest, Romania
- Faculty of Medicine, University Titu Maiorescu, 040441 Bucharest, Romania
| | | | | | | | | | | | - Andrada Mirea
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | | | - Al Jashi Isam
- Faculty of Medicine, University Titu Maiorescu, 040441 Bucharest, Romania
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25
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Zhang D, Lan Y, Zhang J, Cao M, Yang X, Wang X. Effects of early-life gut microbiota on the neurodevelopmental outcomes of preterm infants: a multi-center, longitudinal observational study in China. Eur J Pediatr 2024; 183:1733-1740. [PMID: 38231236 DOI: 10.1007/s00431-024-05423-8] [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: 10/20/2023] [Revised: 12/29/2023] [Accepted: 01/08/2024] [Indexed: 01/18/2024]
Abstract
To prospectively investigate associations between the features of gut microbiota at the fourth week after birth in preterm infants and neurodevelopment from 1 month of corrected age to 6 months of corrected age (MCA). Seventy-seven preterm infants were recruited from three NICUs of three tertiary hospitals between Apr 2021 to Sep 2022. Stool samples were collected during the fourth week after birth. Illumina MiSeq high-throughput sequencing technology was used to detect the composition and diversity of gut microbiota. Neurodevelopment assessments of preterm infants were conducted at 1, 3, and 6 MCA using the Ages and Stages Questionnaire, the third edition (ASQ-3). Spearman correlation, a generalized linear mixed model (GLMM), and permutational multivariate analysis of variance (PERMANOVA) analysis were used to horizontally and prospectively explore the associations between gut microbial and ASQ-3 dimension scores at each time point. The GLMM showed no significant associations between the alpha diversity and neurodevelopmental trajectory from 1 to 6 MCA. The beta diversity was significantly associated with gross motor scores at 1, 3, and 6 MCA (R2 = 0.067, p = 0.001; R2 = 0.039, p = 0.020; R2 = 0.031, p = 0.047); communication scores at 3 MCA (R2 = 0.030, p = 0.040); and fine motor scores at 6 MCA (R2 = 0.035, p = 0.022). After adjusting for covariates, the GLMM showed that the relative abundance of Klebsiella was negatively associated with gross motor score trajectory from 1 to 6 MCA (β = - 1.449; 95% CI, - 2.275 to - 0.572; p = 0.001), while the relative abundance of Lactobacillus displayed a positive association (β = 1.421; 95% CI, 0.139 to 2.702; p = 0.030). Moreover, the relative abundance of Streptococcus was negatively associated with fine motor trajectory from 1 to 6 MCA (β = - 1.669; 95% CI, - 3.305 to - 0.033; p = 0.046). CONCLUSION Our results suggest a possible association between the neonatal gut microbial diversity; the relative abundance of Klebsiella, Streptococcus, and Lactobacillus; and neurodevelopment from 1 to 6 MCA. In the future, clinical staff can focus on the window period of gut microbiota colonization, and implement probiotics targeted at the dominant genera to improve the neurodevelopment of preterm infants. WHAT IS KNOWN • In the fields of biology and medicine, current studies suggest that gut microbiota may play an important role in the critical window period of neurodevelopment through the gut-brain axis pathway. • Extensive preclinical research has implied the vital role of the initial gut colonization in the long-term neurodevelopment of children. WHAT IS NEW • The early-life gut microbiota was associated with neurodevelopment in preterm infants within 6 months of corrected age (MCA).
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Affiliation(s)
- Dan Zhang
- School of Nursing, Wuhan University, No. 115, Donghu Road, Wuchang District, Wuhan, 430071, People's Republic of China
| | - Yancong Lan
- School of Nursing, Wuhan University, No. 115, Donghu Road, Wuchang District, Wuhan, 430071, People's Republic of China
| | - Jun Zhang
- School of Nursing, Wuhan University, No. 115, Donghu Road, Wuchang District, Wuhan, 430071, People's Republic of China.
| | - Mi Cao
- School of Nursing, Wuhan University, No. 115, Donghu Road, Wuchang District, Wuhan, 430071, People's Republic of China
| | - Xinyi Yang
- School of Nursing, Wuhan University, No. 115, Donghu Road, Wuchang District, Wuhan, 430071, People's Republic of China
| | - Xia Wang
- Department of Pediatrics, Women and Children's Hospital, Zhongnan Hospital, Wuhan University, Wuhan, People's Republic of China
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26
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Mao W, Chen Y, He Z, Wang Z, Xiao Z, Sun Y, He L, Zhou J, Guo W, Ma C, Zhao L, Kendrick KM, Zhou B, Becker B, Liu T, Zhang T, Jiang X. Brain Structural Connectivity Guided Vision Transformers for Identification of Functional Connectivity Characteristics in Preterm Neonates. IEEE J Biomed Health Inform 2024; 28:2223-2234. [PMID: 38285570 DOI: 10.1109/jbhi.2024.3355020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2024]
Abstract
Preterm birth is the leading cause of death in children under five years old, and is associated with a wide sequence of complications in both short and long term. In view of rapid neurodevelopment during the neonatal period, preterm neonates may exhibit considerable functional alterations compared to term ones. However, the identified functional alterations in previous studies merely achieve moderate classification performance, while more accurate functional characteristics with satisfying discrimination ability for better diagnosis and therapeutic treatment is underexplored. To address this problem, we propose a novel brain structural connectivity (SC) guided Vision Transformer (SCG-ViT) to identify functional connectivity (FC) differences among three neonatal groups: preterm, preterm with early postnatal experience, and term. Particularly, inspired by the neuroscience-derived information, a novel patch token of SC/FC matrix is defined, and the SC matrix is then adopted as an effective mask into the ViT model to screen out input FC patch embeddings with weaker SC, and to focus on stronger ones for better classification and identification of FC differences among the three groups. The experimental results on multi-modal MRI data of 437 neonatal brains from publicly released Developing Human Connectome Project (dHCP) demonstrate that SCG-ViT achieves superior classification ability compared to baseline models, and successfully identifies holistically different FC patterns among the three groups. Moreover, these different FCs are significantly correlated with the differential gene expressions of the three groups. In summary, SCG-ViT provides a powerfully brain-guided pipeline of adopting large-scale and data-intensive deep learning models for medical imaging-based diagnosis.
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27
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Reisi-Vanani V, Lorigooini Z, Bijad E, Amini-Khoei H. Maternal separation stress through triggering of the neuro-immune response in the hippocampus induces autistic-like behaviors in male mice. Int J Dev Neurosci 2024; 84:87-98. [PMID: 38110192 DOI: 10.1002/jdn.10310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 10/28/2023] [Accepted: 12/01/2023] [Indexed: 12/20/2023] Open
Abstract
Autism spectrum disorder (ASD) is the fastest-growing neurodevelopmental disease throughout the world. Neuro-immune responses from prenatal to adulthood stages of life induce developmental defects in synaptic signaling, neurotransmitter imbalance, and even structural changes in the brain. In this study, we aimed to focus on the possible role of neuroinflammatory response in the hippocampus in development of the autistic-like behaviors following maternal separation (MS) stress in mice. To do this, mice neonates daily separated from their mothers from postnatal day (PND) 2 to PND 14 for 3 h. During PND45-60, behavioral tests related to autistic-like behaviors including three-chamber sociability, Morris water maze (MWM), shuttle box, resident-intruder, and marble burying tests were performed. Then, hippocampi were dissected out, and the gene expression of inflammatory mediators including TNF-α, IL-1β, TLR4, HMGB1, and NLRP3 was assessed in the hippocampus using RT-PCR. Results showed that MS mice exerted impaired sociability preference, repetitive behaviors, impaired passive avoidance, and spatial memories. The gene expression of inflammatory mediators significantly increased in the hippocampi of MS mice. We concluded that MS stress probably via activating of the HMGB1/TLR4 signaling cascade in the hippocampus induced autistic-like behaviors in mice.
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Affiliation(s)
- Vahid Reisi-Vanani
- Student Research Committee, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Zahra Lorigooini
- Medical Plants Research Center, Basic Health Sciences Institute, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Elham Bijad
- Medical Plants Research Center, Basic Health Sciences Institute, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Hossein Amini-Khoei
- Medical Plants Research Center, Basic Health Sciences Institute, Shahrekord University of Medical Sciences, Shahrekord, Iran
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28
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Worrall S, Christiansen P, Khalil A, Silverio SA, Fallon V. Measurement invariance analysis of the Postpartum Specific Anxiety Scale - Research Short Form in mothers of premature and term infants. BMC Res Notes 2024; 17:75. [PMID: 38486271 PMCID: PMC10941354 DOI: 10.1186/s13104-024-06746-3] [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] [Received: 09/29/2023] [Accepted: 03/08/2024] [Indexed: 03/17/2024] Open
Abstract
OBJECTIVE Mothers of premature infants are more likely to develop anxiety during the first postpartum year than mothers of term infants. However, commonly used measures of anxiety were developed for general adult populations and may produce spurious, over-inflated scores when used in a postpartum context. Although perinatal-specific tools such as the Postpartum Specific Anxiety Scale [PSAS] offer a promising alternative form of measurement, it is not clear whether the measure performs similarly in mothers of premature infants as it does in mothers of term infants. The objective of the current study was to identify whether items on the Postpartum Specific Anxiety Scale - Research Short Form (PSAS-RSF) are being interpreted in the same manner in mothers of term infants and mothers of premature infants. Mothers (N = 320) participated in an international on-line survey between February 2022 and March 2023 (n = 160 mothers of premature infants, n = 160 mothers of term infants) where they completed the PSAS-RSF. Data were analysed using a measurement invariance analysis to assess whether constructs of the PSAS-RSF are performing in a similar manner across the two groups. RESULTS Whilst the PSAS-RSF achieved configural invariance and so retains its four-factor structure, metric invariance was not reached and so items are being interpreted differently in mothers of premature infants. Items concerning infant-separation, finance, and anxieties surrounding infant health are potentially problematic. Future research must now modify the PSAS-RSF for specific use in mothers of premature infants, to ensure measurement of anxiety in this population is valid.
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Affiliation(s)
- Semra Worrall
- Department of Psychology, Institute of Population Health, University of Liverpool, Liverpool, UK.
| | - Paul Christiansen
- Department of Psychology, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Asma Khalil
- Fetal Medicine Unit, Liverpool Women's NHS Foundation Trust, Liverpool, UK
- Fetal Medicine Unit, St. George's University Hospitals NHS Foundation Trust, University of London, London, UK
| | - Sergio A Silverio
- Department of Women & Children's Health, School of Life Course & Population Sciences, King's College London, London, UK
- School of Psychology, Faculty of Health, Liverpool John Moores University, Liverpool, UK
| | - Victoria Fallon
- Department of Psychology, Institute of Population Health, University of Liverpool, Liverpool, UK
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29
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Lester BM, Camerota M, Everson TM, Shuster CL, Marsit CJ. Toward a more holistic approach to the study of exposures and child outcomes. Epigenomics 2024; 16:635-651. [PMID: 38482639 PMCID: PMC11157992 DOI: 10.2217/epi-2023-0424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 02/27/2024] [Indexed: 06/09/2024] Open
Abstract
Aim: The current work was designed to demonstrate the application of the exposome framework in examining associations between exposures and children's long-term neurodevelopmental and behavioral outcomes. Methods: Longitudinal data were collected from birth through age 6 from 402 preterm infants. Three statistical methods were utilized to demonstrate the exposome framework: exposome-wide association study, cumulative exposure and machine learning models, with and without epigenetic data. Results: Each statistical approach answered a distinct research question regarding the impact of exposures on longitudinal child outcomes. Findings highlight associations between exposures, epigenetics and executive function. Conclusion: Findings demonstrate how an exposome-based approach can be utilized to understand relationships between internal (e.g., DNA methylation) and external (e.g., prenatal risk) exposures and long-term developmental outcomes in preterm children.
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Affiliation(s)
- Barry M Lester
- Department of Pediatrics, Brown Alpert Medical School & Women & Infants Hospital, Providence, RI 02905, USA
- Brown Center for the Study of Children at Risk, Brown Alpert Medical School & Women & Infants Hospital, Providence, RI 02905, USA
- Department of Psychiatry & Human Behavior, Brown Alpert Medical School, Providence, RI 02905, USA
| | - Marie Camerota
- Brown Center for the Study of Children at Risk, Brown Alpert Medical School & Women & Infants Hospital, Providence, RI 02905, USA
- Department of Psychiatry & Human Behavior, Brown Alpert Medical School, Providence, RI 02905, USA
| | - Todd M Everson
- Department of Environmental Health, Emory University Rollins School of Public Health, Atlanta, GA 30322, USA
| | - Coral L Shuster
- Department of Pediatrics, Brown Alpert Medical School & Women & Infants Hospital, Providence, RI 02905, USA
- Brown Center for the Study of Children at Risk, Brown Alpert Medical School & Women & Infants Hospital, Providence, RI 02905, USA
| | - Carmen J Marsit
- Department of Environmental Health, Emory University Rollins School of Public Health, Atlanta, GA 30322, USA
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30
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Smith LM, Harrison TM. Neurodevelopment in the Congenital Heart Disease Population as Framed by the Life Course Health Development Framework. J Cardiovasc Nurs 2024; 39:160-169. [PMID: 36752754 PMCID: PMC10406968 DOI: 10.1097/jcn.0000000000000977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND Adverse neurodevelopment is a common comorbidity associated with congenital heart disease (CHD). The consequences of adverse neurodevelopment are seen across the life course. The cause of adverse neurodevelopment is multifactorial, and use of a life course perspective can assist with understanding and enhancing neurodevelopment in individuals with CHD. PURPOSE The purposes of this article are to (1) apply the Life Course Health Development framework to neurodevelopment in the population with CHD and (2) discuss how exposure to the pediatric cardiac intensive care unit (PCICU) environment during infancy is a point of intervention for improving neurodevelopmental outcomes. CONCLUSION Individuals with CHD are at an increased risk for adverse neurodevelopment across the life course. The PCICU environment is a point of intervention for improving neurodevelopmental outcomes. Stress can lead to changes in brain structure and function that are associated with negative outcomes in terms of outward behavioral and functional capacity, and the PCICU environment is a source of stressful stimuli. Infancy is a period of rapid brain growth, and the brain is more susceptible to stress during this period of the life course, putting infants receiving care in the PCICU at an increased risk of adverse neurodevelopment. CLINICAL IMPLICATIONS Interventions to support optimal neurodevelopment should focus on the PCICU environment during infancy. Developmentally supportive care models should be explored as a means of modifying the PCICU environment. In addition, more research is needed on the relationship between the PCICU and neurodevelopment. The conceptual model introduced can serve as a starting point for this research.
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Mira A, Coo S, Bastías R. Mother's mental health and the interaction with her moderate preterm baby in the NICU. J Reprod Infant Psychol 2024; 42:299-314. [PMID: 35635499 DOI: 10.1080/02646838.2022.2077921] [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] [Received: 02/09/2021] [Accepted: 05/07/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Moderate preterm infants, born between 320/7 and 336/7 weeks, represent a significant number of preterm-born infants; however, they remain a poorly studied group despite their vulnerability. The objective of this correlational study is to describe the impact of having a moderate preterm infant hospitalised in the NICU on the mothers' mental health and how this relates to the interaction between the dyad. METHOD During the hospitalisation period, 85 moderate preterm mother-infant dyads participated in this study. The participants provided self-reports of depression, parental stress, and skin to skin and breastfeeding practices. Also, mother-infant interaction was assessed in the NICU with an observational scale. RESULTS Mothers evidenced high levels of stress and depressive symptoms during the hospitalization. The stress experienced by these women was significant, although weakly, associated with the interaction with their babies; and mothers of small for gestational age babies showed difficulties in this area. CONCLUSIONS The results of this study could represent a contribution to a better understanding of the relation between the characteristics of moderate preterm babies, maternal emotional wellbeing, and the quality of mother-infant interactions in NICU settings.
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Affiliation(s)
- Andrea Mira
- Facultad de Ciencias de la Rehabilitación, Universidad Andrés Bello, Santiago, Chile
- Facultad de Psicología, Universidad del Desarrollo (UDD), Santiago, Chile
| | - Soledad Coo
- Facultad de Psicología, Universidad del Desarrollo (UDD), Santiago, Chile
| | - Rodolfo Bastías
- Unidad de Neonatología, Hospital Luis Tisné T., Servicio de Salud Metropolitana Oriente, Santiago, Chile
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Dos Santos Engel J, Mota de Almeida MA, Costa R, Freitas AI. Late-onset neonatal sepsis was not associated with impaired neurodevelopmental outcome: Results from the EPICE/SHIPS-PT cohort. Acta Paediatr 2024. [PMID: 38415942 DOI: 10.1111/apa.17172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 02/06/2024] [Accepted: 02/15/2024] [Indexed: 02/29/2024]
Abstract
AIM To assess the impact of late-onset neonatal sepsis (LONS) on the cognitive and motor development of five-year-old children who were born very preterm (VPT). METHODS This study included 327 VPT children from the Portuguese EPICE/SHIPS cohort who attended the neurodevelopment assessment. Neuropsychological tests such as WPPSI-R, MABC-2 and NEPSY-II (language domain) were used to assess the children's cognitive and motor development. Statistical analysis was performed to compare the socio-demographic, clinical and neurodevelopment outcomes of VPT children with and without LONS. Regression analysis adjusted for confounding variables was performed when applicable. RESULTS Underperformance in intelligence quotient and language development was similar regardless of a neonatal diagnosis of LONS. In contrast, VPT children with LONS had a higher risk of movement difficulties than those without LONS (p = 0.02). However, the association was lost after adjusting for confounders (β = -0.25; p > 0.05). CONCLUSION LONS per se was not associated with the risk for poor long-term cognitive or motor outcomes in VPT children. Social-demographic and clinical characteristics assessed during the neonatal period and at the time of neurodevelopment assessment were similar between groups suggesting that social-related factors such as parents' educational level could have mitigated the LONS impact.
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Affiliation(s)
| | - Maria Alexandra Mota de Almeida
- Serviço de Neonatologia e Cuidados Intensivos Pediátricos, Centro Materno Infantil do Norte, Porto, Portugal
- The Portuguese National Network for Very Low Birthweight Infants, Lisboa, Portugal
| | - Raquel Costa
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Porto, Portugal
| | - Ana Isabel Freitas
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
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Fuertes M, Gonçalves JL. Continuity and discontinuity in infant and maternal behavior from 3 to 9 months according to prematurity status. Front Behav Neurosci 2024; 18:1303393. [PMID: 38450022 PMCID: PMC10915242 DOI: 10.3389/fnbeh.2024.1303393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 02/05/2024] [Indexed: 03/08/2024] Open
Affiliation(s)
- Marina Fuertes
- Escola Superior de Educação de Lisboa, Instituto Politécnico de Lisboa, Lisboa, Portugal
- Center for Psychology at University of Porto, Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
| | - Joana L. Gonçalves
- Center for Research in Psychology for Positive Development, Lusíada University, Porto, Portugal
- Department of Social and Behavioral Sciences, University of Maia, Maia, Portugal
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Fuertes M, Martelo I, Almeida R, Gonçalves JL, Barbosa M. Attachment and mother-infant interactions in dyads with infants born full-term, moderate-to-late preterm, and very-to-extreme preterm. Early Hum Dev 2024; 189:105943. [PMID: 38241790 DOI: 10.1016/j.earlhumdev.2024.105943] [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: 09/01/2023] [Revised: 12/27/2023] [Accepted: 01/11/2024] [Indexed: 01/21/2024]
Abstract
BACKGROUND The impact of prematurity status on attachment quality remains indeterminate. Some studies found no differences between infants born preterm (PT) and infants born full-term (FT), while other investigations present opposite results. AIMS We aim to contribute to this body of research by studying mother-infant interactive behaviors and quality of attachment in 3 independent samples: Full-Term (FT), Moderate-to-Late Preterm (MLPT) and Very-to-Extreme Preterm (VEPT). STUDY DESIGN This is a longitudinal laboratory study conducted from 3 to 12 months of age (corrected-age in the case of infants born PT). SUBJECTS The participants are 213 Portuguese infants (FT = 105; MLPT = 52; VEPT = 56) and their mothers. OUTCOME MEASURES Mother-infant interactive behavior was observed in free-play at 3 and 9 months (corrected-age). Infant attachment was observed in Strange Situation at 12 months. RESULTS Secure attachment is more prevalent in infants born FT, and ambivalent attachment is more prevalent in infants born VEPT. Infants with a secure attachment have higher gestational age and weight at birth. Infant and maternal interactive behavior quality is associated with attachment patterns and varies according to infant prematurity status. Last, the results indicate changes in maternal sensitivity and infant difficult behavior from 3 to 9 months of infant's age. CONCLUSIONS Our findings indicate that prematurity status impacts attachment quality. Changes in maternal and infant behavior from 3 to 9 months suggest a period of rapid non-linear development, supporting a transactional multilayered approach to the study of mother-infant relationship.
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Affiliation(s)
- Marina Fuertes
- Centro de Psicologia, University of Porto, 4200-135 Porto, Portugal; Escola Superior de Educação de Lisboa, Instituto Politécnico de Lisboa, 1549-020 Lisboa, Portugal.
| | - Inês Martelo
- Escola Superior de Educação de Lisboa, Instituto Politécnico de Lisboa, 1549-020 Lisboa, Portugal
| | - Rita Almeida
- Research Center for Psychological Science (CICPSI), Faculty of Psychology, University of Lisbon, Lisbon, Portugal
| | - Joana L Gonçalves
- Centro de Investigação em Psicologia para o Desenvolvimento, Universidade Lusíada de Lisboa, Rua da Junqueira, 188-198, 1349-001 Lisboa, Portugal; inED - Centre for Research and Innovation in Education, School of Higher Education, Polytechnic Institute of Porto, Porto, Portugal; Department of Social and Behavior Sciences, University of Maia - ISMAI, Maia, Portugal
| | - Miguel Barbosa
- CICPSI, Faculdade de Psicologia, Instituto de Saúde Ambiental (ISAMB-FMUL), Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.
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Demirci GM, Kittler PM, Phan HTT, Gordon AD, Flory MJ, Parab SM, Tsai CL. Predicting mental and psychomotor delay in very pre-term infants using machine learning. Pediatr Res 2024; 95:668-678. [PMID: 37500755 PMCID: PMC10899098 DOI: 10.1038/s41390-023-02713-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 04/25/2023] [Accepted: 06/15/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND Very preterm infants are at elevated risk for neurodevelopmental delays. Earlier prediction of delays allows timelier intervention and improved outcomes. Machine learning (ML) was used to predict mental and psychomotor delay at 25 months. METHODS We applied RandomForest classifier to data from 1109 very preterm infants recruited over 20 years. ML selected key predictors from 52 perinatal and 16 longitudinal variables (1-22 mo assessments). SHapley Additive exPlanations provided model interpretability. RESULTS Balanced accuracy with perinatal variables was 62%/61% (mental/psychomotor). Top predictors of mental and psychomotor delay overlapped and included: birth year, days in hospital, antenatal MgSO4, days intubated, birth weight, abnormal cranial ultrasound, gestational age, mom's age and education, and intrauterine growth restriction. Highest balanced accuracy was achieved with 19-month follow-up scores and perinatal variables (72%/73%). CONCLUSIONS Combining perinatal and longitudinal data, ML modeling predicted 24 month mental/psychomotor delay in very preterm infants ½ year early, allowing intervention to start that much sooner. Modeling using only perinatal features fell short of clinical application. Birth year's importance reflected a linear decline in predicting delay as birth year became more recent. IMPACT Combining perinatal and longitudinal data, ML modeling was able to predict 24 month mental/psychomotor delay in very preterm infants ½ year early (25% of their lives) potentially advancing implementation of intervention services. Although cognitive/verbal and fine/gross motor delays require separate interventions, in very preterm infants there is substantial overlap in the risk factors that can be used to predict these delays. Birth year has an important effect on ML prediction of delay in very preterm infants, with those born more recently (1989-2009) being increasing less likely to be delayed, perhaps reflecting advances in medical practice.
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Affiliation(s)
- Gözde M Demirci
- Computer Science Department, The Graduate Center of the City University of NY, New York, NY, USA
| | - Phyllis M Kittler
- Department of Infant Development, NYS Institute for Basic Research in Developmental Disabilities, Staten Island, NY, USA
- Pediatrics, Richmond University Medical Center, Staten Island, NY, USA
| | - Ha T T Phan
- Department of Infant Development, NYS Institute for Basic Research in Developmental Disabilities, Staten Island, NY, USA
- Pediatrics, Richmond University Medical Center, Staten Island, NY, USA
| | - Anne D Gordon
- Department of Infant Development, NYS Institute for Basic Research in Developmental Disabilities, Staten Island, NY, USA
- Pediatrics, Richmond University Medical Center, Staten Island, NY, USA
| | - Michael J Flory
- Department of Infant Development, NYS Institute for Basic Research in Developmental Disabilities, Staten Island, NY, USA
| | - Santosh M Parab
- Pediatrics, Richmond University Medical Center, Staten Island, NY, USA
| | - Chia-Ling Tsai
- Computer Science Department, Queens College of the City University of NY, Flushing, NY, USA.
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Mynarek M, Vik T, Andersen GL, Brigtsen AK, Hollung SJ, Larose TL, Lydersen S, Olsen LC, Strøm MS, Afset JE. Mortality and neurodevelopmental outcome after invasive group B streptococcal infection in infants. Dev Med Child Neurol 2024; 66:125-133. [PMID: 37306102 DOI: 10.1111/dmcn.15643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 04/27/2023] [Accepted: 04/28/2023] [Indexed: 06/13/2023]
Abstract
AIM To assess case fatality rate (CFR), infant mortality, and long-term neurodevelopmental disorders (NDDs) after invasive group B streptococcal (GBS; Streptococcus agalactiae) infection in infants. METHOD Children born in Norway between 1996 and 2019 were included. Data on pregnancies/deliveries, GBS infection, NDDs, and causes of death were retrieved from five national registries. The exposure was culture-confirmed invasive GBS infection during infancy. Outcomes were mortality and NDDs, the latter at a mean age of 12 years 10 months. RESULTS Among 1 415 625 live-born children, 866 (87%) of 1007 infants diagnosed with GBS infection (prevalence 0.71 per 1000) were included. The CFR was 5.0% (n = 43). GBS infection was associated with higher infant mortality (relative risk 19.41; 95% confidence interval [CI] 14.79-25.36) than the general population. Among survivors, 169 (20.7%) children were diagnosed with any NDD (relative risk 3.49; 95% CI 3.05-3.98). In particular, GBS meningitis was associated with high risks of attention-deficit/hyperactivity disorder, cerebral palsy, epilepsy, hearing impairment, and pervasive and specific developmental disorder. INTERPRETATION The burden of invasive GBS infection during infancy is considerable and continues to affect children beyond infancy. These findings emphasize the need for new preventive strategies for disease reduction, and the need for survivors to be directly included into early detection pathways to access early intervention if required. WHAT THIS PAPER ADDS The burden of invasive group B streptococcal (GBS) infection in Norway is considerable. Of GBS infection survivors, 20.7% were diagnosed with neurodevelopmental disorders (NDDs) at mean age 12 years 10 months. Infants with GBS meningitis were more often diagnosed with NDDs. Absolute risks associated with GBS infections were highest for pervasive and specific developmental disorder, cerebral palsy, and attention-deficit/hyperactivity disorder.
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Affiliation(s)
- Maren Mynarek
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Torstein Vik
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Guro L Andersen
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Norwegian Quality and Surveillance Registry for Cerebral Palsy (NorCP), Vestfold Hospital Trust, Tønsberg, Norway
| | - Anne K Brigtsen
- Department of Neonatal Intensive Care, Clinic of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Sandra Julsen Hollung
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Norwegian Quality and Surveillance Registry for Cerebral Palsy (NorCP), Vestfold Hospital Trust, Tønsberg, Norway
| | - Tricia L Larose
- Department of Health Registries, Division Digitalization and Health Registries, Norwegian Directorate of Health, Oslo, Norway
| | - Stian Lydersen
- Regional Centre for Child and Youth Health and Child Welfare, Norwegian University of Science and Technology, Trondheim, Norway
| | - Lene C Olsen
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- BioCore Bioinformatics Core Facility, Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Medical Microbiology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Marianne S Strøm
- Department of Health Registry Research and Development, Norwegian Institute of Public Health, Bergen, Norway
| | - Jan E Afset
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Medical Microbiology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
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Jamaluddine Z, Sharara E, Helou V, El Rashidi N, Safadi G, El-Helou N, Ghattas H, Sato M, Blencowe H, Campbell OMR. Effects of size at birth on health, growth and developmental outcomes in children up to age 18: an umbrella review. Arch Dis Child 2023; 108:956-969. [PMID: 37339859 DOI: 10.1136/archdischild-2022-324884] [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: 10/02/2022] [Accepted: 05/04/2023] [Indexed: 06/22/2023]
Abstract
BACKGROUND Size at birth, an indicator of intrauterine growth, has been studied extensively in relation to subsequent health, growth and developmental outcomes. Our umbrella review synthesises evidence from systematic reviews and meta-analyses on the effects of size at birth on subsequent health, growth and development in children and adolescents up to age 18, and identifies gaps. METHODS We searched five databases from inception to mid-July 2021 to identify eligible systematic reviews and meta-analyses. For each meta-analysis, we extracted data on the exposures and outcomes measured and the strength of the association. FINDINGS We screened 16 641 articles and identified 302 systematic reviews. The literature operationalised size at birth (birth weight and/or gestation) in 12 ways. There were 1041 meta-analyses of associations between size at birth and 67 outcomes. Thirteen outcomes had no meta-analysis.Small size at birth was examined for 50 outcomes and was associated with over half of these (32 of 50); continuous/post-term/large size at birth was examined for 35 outcomes and was consistently associated with 11 of the 35 outcomes. Seventy-three meta-analyses (in 11 reviews) compared risks by size for gestational age (GA), stratified by preterm and term. Prematurity mechanisms were the key aetiologies linked to mortality and cognitive development, while intrauterine growth restriction (IUGR), manifesting as small for GA, was primarily linked to underweight and stunting. INTERPRETATION Future reviews should use methodologically sound comparators to further understand aetiological mechanisms linking IUGR and prematurity to subsequent outcomes. Future research should focus on understudied exposures (large size at birth and size at birth stratified by gestation), gaps in outcomes (specifically those without reviews or meta-analysis and stratified by age group of children) and neglected populations. PROSPERO REGISTRATION NUMBER CRD42021268843.
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Affiliation(s)
- Zeina Jamaluddine
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Eman Sharara
- Center for Research On Population and Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Vanessa Helou
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Nadine El Rashidi
- Center for Research On Population and Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Gloria Safadi
- Center for Research On Population and Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Nehmat El-Helou
- Center for Research On Population and Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Hala Ghattas
- Center for Research On Population and Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
- Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Miho Sato
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Hannah Blencowe
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Oona M R Campbell
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
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Gillenson CJ, Bagner DM, Darcy Mahoney A, Baralt M. A Preliminary Study of Executive Functioning in Preterm-Born Children: A Bilingual Advantage. Adv Neonatal Care 2023; 23:E121-E128. [PMID: 37788334 DOI: 10.1097/anc.0000000000001106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
BACKGROUND Preterm-born children are at increased risk for deficits in executive function (EF). EF is a set of cognitive processes including inhibition, attention, memory, and decision-making, among others. Bilingualism, operationalized as productive capacity in 2 languages (ie, English and Spanish), may enhance EF in children born preterm and in term-born children. PURPOSE The purpose of this study was to examine the impact of bilingualism on executive functioning in bilingual and monolingual preterm and term-born children using a robust measure of bilingualism. METHODS This study examined the impact of bilingualism on EF in 17 monolingual or bilingual preterm-born children, aged 6 to 7. The preterm-born sample was also compared with a normed, term-born sample of 38 monolingual, typically developing 6- to 7-year-olds. RESULTS On the Creature Counting task of EF, bilingual preterm-born children performed with more accuracy and total switches than monolingual preterm-born children. There was no difference in accuracy between the term-born and entire preterm-born samples. The bilingual, preterm-born children performed more accurately than the term-born sample. IMPLICATIONS FOR PRACTICE AND RESEARCH This preliminarily suggests bilingualism confers an advantage to preterm-born children's EF. Further research is needed on bilingual advantage of preterm-born children.
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Affiliation(s)
- Caroline J Gillenson
- Department of Psychology and Center for Children and Families (Ms Gillenson and Dr Bagner) and Department of Modern Languages and Center for Children and Families (Dr Baralt), Florida International University, Miami; and School of Nursing, George Washington University, Washington, District of Columbia (Dr Darcy Mahoney)
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Ermarth A, Brinker K, Ostrander B. Feeding dysfunction in NICU patients with cramped synchronized movements. Early Hum Dev 2023; 187:105879. [PMID: 37875030 DOI: 10.1016/j.earlhumdev.2023.105879] [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: 08/29/2023] [Revised: 10/16/2023] [Accepted: 10/17/2023] [Indexed: 10/26/2023]
Abstract
Patients admitted to the neonatal intensive care unit (NICU) have higher association for neurodevelopment deficits, specifically cerebral palsy (CP). We identified patients with risk for CP using abnormal Pretchl's General Movement Assessment (GMA) and sub-category of cramped synchronized movements (CSM) and reported their feeding outcomes at discharge. Over 75 % of these patients required either nasogastric (NGT) or gastrostomy tube (GT) at discharge. Of these, 57 % weaned off their NGT or GT at home and 43 % of patients still needed a GT one year after discharge. Of those that could not wean off their NGT or GT, these patients had longer hospital stay, took lower percentage by mouth, and an older post-menstrual age at discharge. We did not find a difference in NGT or GT use between patients with IVH, ELBW, nor between their birthweight or gestation age at birth. This study provides further clinical characteristics in NICU patients who have higher risk of CP, and supports the need for skilled feeding therapy and resources both during and after NICU admission.
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Affiliation(s)
- Anna Ermarth
- University of Utah School of Medicine, Salt Lake City, UT, USA; Division of Pediatric Gastroenterology, Hepatology & Nutrition, Department of Pediatrics, USA.
| | - Kristin Brinker
- Primary Children's Hospital, Intermountain Health, Salt Lake City, UT, USA
| | - Betsy Ostrander
- University of Utah School of Medicine, Salt Lake City, UT, USA; Division of Pediatric Neurology, Department of Pediatrics, USA
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Charlier C, Barrault Z, Rousseau J, Kermorvant-Duchemin E, Meyzer C, Semeraro M, Fall M, Coulpier G, Leclercq A, Charles MA, Ancel PY, Lecuit M. Long-term neurological and neurodevelopmental outcome of neonatal listeriosis in France: a prospective, matched, observational cohort study. THE LANCET. CHILD & ADOLESCENT HEALTH 2023; 7:875-885. [PMID: 37871603 DOI: 10.1016/s2352-4642(23)00195-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 06/20/2023] [Accepted: 07/24/2023] [Indexed: 10/25/2023]
Abstract
BACKGROUND Maternal-neonatal listeriosis is a rare and serious infection. The long-term outcome of surviving infants with early-onset or late-onset listeriosis remains unknown. We aimed to determine the long-term neurological and neurodevelopmental outcome of neonatal listeriosis. METHODS In this prospective, matched, observational cohort study, we evaluated children born with microbiologically confirmed maternal-neonatal listeriosis in the French MONALISA cohort. At age 5 years, children underwent neurological and neurodevelopmental assessments of sensory deficits, executive function, adaptive behaviour, and cognitive and motor coordination function. The cognitive domain was assessed using the French version of the Wechsler Preschool and Primary Scale of Intelligence, fourth edition, and scored by Full Scale Intelligence Quotient (FSIQ). The motor domain was assessed by physical examination designed to screen for cerebral palsy and developmental coordination disorder. Executive functioning was assessed using the statue and inhibition subtests of Neuropsychological Assessment, second version. The sensory domain was assessed by parental interview, medical report, and clinical assessment. Adaptive behaviour was measured using the Vineland-II behaviour scale from parent-reported assessments of functional communication, socialisation, daily living, and motor skills. Results were compared with gestational age-matched children from two national prospective cohorts: EPIPAGE-2 (preterm infants) and ELFE (term infants from a general population of infants >32 weeks gestation). This study is registered with ClinicalTrials.gov (NCT02580812). FINDINGS Of 59 children who were alive and eligible to participate in the study, 53 (median age 5 years, IQR 5-6) were enrolled for neurodevelopmental assessments between Oct 26, 2016, and Oct 29, 2019. Of 53 children, 31 (58%) had been born preterm, 22 (42%) had early-onset systemic infection, 18 (34%) had early-onset non-systemic infection, and six (11%) had late-onset systemic infection, all with meningitis. 29 (66%) of 44 children, in whom neurodevelopmental disabilities scores were available, developed at least one disability; eight (18%) children had severe neurodevelopmental disabilities. Of four children with late-onset infection and in whom neurodevelopmental disabilities scores were available, three developed at least one neurodevelopmental disability. Neurological and neurodevelopmental outcomes of children with neonatal listeriosis did not differ from those of gestational age-matched control children without infection (relative risk [RR] of at least one disability 0·99 [95% CI 0·65-1·51; p=0·97]; RR of FSIQ less than -1 SD 0·92 [0·54-1·54; p=0·74]). INTERPRETATION These results highlight the burden of persistent disability and dominant contribution of prematurity to long-term outcomes in children born with neonatal listeriosis. The findings support the implementation of systematic long-term screening and provision of tailored education and special needs support. FUNDING Institut Pasteur, Inserm, French Public Health Agency, Contrat de Recherche Clinique, and Assistance Publique-Hôpitaux de Paris.
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Affiliation(s)
- Caroline Charlier
- Biology of Infection Unit, Inserm U1117, Institut Pasteur-Université Paris Cité, Paris, France; Université Paris Cité, Paris, France; French National Reference Centre and WHO Collaborating Centre Listeria, Institut Pasteur, Paris, France; Department of Infectious Diseases and Tropical Medicine, Cochin Port Royal University Hospital, AP-HP, Paris, France.
| | - Zoé Barrault
- French National Reference Centre and WHO Collaborating Centre Listeria, Institut Pasteur, Paris, France
| | - Jessica Rousseau
- CRESS, Obstetrical Perinatal and Paediatric Epidemiology Research Team, EPOPé, INSERM, INRAE, Paris, France; Clinical Research Unit, Centre for Clinical Investigation P1419, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Elsa Kermorvant-Duchemin
- Université Paris Cité, Paris, France; Department of Neonatology, Necker-Enfants Malades University Hospital, AP-HP, Paris, France
| | - Candice Meyzer
- Clinical Research Unit, Centre for Clinical Investigation P1419, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Michaela Semeraro
- Université Paris Cité, Paris, France; Clinical Research Unit, Centre for Clinical Investigation P1419, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Magatte Fall
- French National Reference Centre and WHO Collaborating Centre Listeria, Institut Pasteur, Paris, France
| | - Gabrielle Coulpier
- French National Reference Centre and WHO Collaborating Centre Listeria, Institut Pasteur, Paris, France
| | - Alexandre Leclercq
- French National Reference Centre and WHO Collaborating Centre Listeria, Institut Pasteur, Paris, France
| | - Marie-Aline Charles
- CRESS, Obstetrical Perinatal and Paediatric Epidemiology Research Team, EPOPé, INSERM, INRAE, Paris, France; Unité Mixte Inserm-Ined-EFS ELFE, Ined, 93300 Aubervilliers, France
| | - Pierre-Yves Ancel
- CRESS, Obstetrical Perinatal and Paediatric Epidemiology Research Team, EPOPé, INSERM, INRAE, Paris, France; Université Paris Cité, Paris, France
| | - Marc Lecuit
- Biology of Infection Unit, Inserm U1117, Institut Pasteur-Université Paris Cité, Paris, France; Université Paris Cité, Paris, France; French National Reference Centre and WHO Collaborating Centre Listeria, Institut Pasteur, Paris, France; Department of Infectious Diseases and Tropical Medicine, Necker-Enfants Malades University Hospital, AP-HP, Paris, France.
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Cook KM, De Asis-Cruz J, Kim JH, Basu SK, Andescavage N, Murnick J, Spoehr E, Liggett M, du Plessis AJ, Limperopoulos C. Experience of early-life pain in premature infants is associated with atypical cerebellar development and later neurodevelopmental deficits. BMC Med 2023; 21:435. [PMID: 37957651 PMCID: PMC10644599 DOI: 10.1186/s12916-023-03141-w] [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: 06/27/2023] [Accepted: 10/30/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Infants born very and extremely premature (V/EPT) are at a significantly elevated risk for neurodevelopmental disorders and delays even in the absence of structural brain injuries. These risks may be due to earlier-than-typical exposure to the extrauterine environment, and its bright lights, loud noises, and exposures to painful procedures. Given the relative underdeveloped pain modulatory responses in these infants, frequent pain exposures may confer risk for later deficits. METHODS Resting-state fMRI scans were collected at term equivalent age from 148 (45% male) infants born V/EPT and 99 infants (56% male) born at term age. Functional connectivity analyses were performed between functional regions correlating connectivity to the number of painful skin break procedures in the NICU, including heel lances, venipunctures, and IV placements. Subsequently, preterm infants returned at 18 months, for neurodevelopmental follow-up and completed assessments for autism risk and general neurodevelopment. RESULTS We observed that V/EPT infants exhibit pronounced hyperconnectivity within the cerebellum and between the cerebellum and both limbic and paralimbic regions correlating with the number of skin break procedures. Moreover, skin breaks were strongly associated with autism risk, motor, and language scores at 18 months. Subsample analyses revealed that the same cerebellar connections strongly correlating with breaks at term age were associated with language dysfunction at 18 months. CONCLUSIONS These results have significant implications for the clinical care of preterm infants undergoing painful exposures during routine NICU care, which typically occurs without anesthesia. Repeated pain exposures appear to have an increasingly detrimental effect on brain development during a critical period, and effects continue to be seen even 18 months later.
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Affiliation(s)
- Kevin M Cook
- Developing Brain Institute, Children's National Hospital, 111 Michigan Ave NW, Washington, DC, 20010, USA
| | - Josepheen De Asis-Cruz
- Developing Brain Institute, Children's National Hospital, 111 Michigan Ave NW, Washington, DC, 20010, USA
| | - Jung-Hoon Kim
- Developing Brain Institute, Children's National Hospital, 111 Michigan Ave NW, Washington, DC, 20010, USA
| | - Sudeepta K Basu
- Developing Brain Institute, Children's National Hospital, 111 Michigan Ave NW, Washington, DC, 20010, USA
| | - Nickie Andescavage
- Developing Brain Institute, Children's National Hospital, 111 Michigan Ave NW, Washington, DC, 20010, USA
| | - Jonathan Murnick
- Dept. of Diagnostic Imaging & Radiology, Children's National Hospital, 111 Michigan Ave. NW, Washington, D.C, 20010, USA
| | - Emma Spoehr
- Developing Brain Institute, Children's National Hospital, 111 Michigan Ave NW, Washington, DC, 20010, USA
| | - Melissa Liggett
- Division of Psychology, Children's National Hospital, 111 Michigan Ave. NW, Washington, DC, 20010, USA
| | - Adré J du Plessis
- Prenatal Pediatrics Institute, Children's National Hospital, 111 Michigan Ave NW, Washington, DC, 20010, USA
| | - Catherine Limperopoulos
- Developing Brain Institute, Children's National Hospital, 111 Michigan Ave NW, Washington, DC, 20010, USA.
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Yakoub N, Reinelt T, Natalucci G. Behavioural outcomes of children born with intrauterine growth restriction: protocol for a systematic review and meta-analysis. BMJ Open 2023; 13:e074417. [PMID: 37914302 PMCID: PMC10626825 DOI: 10.1136/bmjopen-2023-074417] [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: 04/06/2023] [Accepted: 08/30/2023] [Indexed: 11/03/2023] Open
Abstract
INTRODUCTION Intrauterine growth restriction (IUGR) is a pregnancy condition, which is associated with poor perinatal outcomes and long-term neurodevelopmental impairment. Several studies also investigated the impact of IUGR on child behaviour (eg, internalising and externalising behaviour, social competencies). However, so far, no systematic review or meta-analysis has been conducted that summarises these effects while considering relevant third variables such as type of IUGR diagnosis and control group, or concurrent cognitive abilities. The objective of this study is to summarise the current evidence regarding the relationship between IUGR and behavioural outcomes from early childhood to young adulthood. Additionally, to explore how third variables such as type of control group, or cognitive abilities, relate to this association. METHODS Search strategy: The following electronic databases will be searched-Web of Science, Medline Ovid, PsycInfo, Cochrane Library, Scopus and Embase. INCLUSION CRITERIA observational (eg, cohort studies and case-control studies) and intervention studies (if standard care is used and norm values are reported for the control group) will be included if they quantitatively compare children with and without IUGR from the age of 2 to 18 years. The main outcomes are internalising and externalising behaviour, and social competencies. ETHICS AND DISSEMINATION No ethics approval was necessary for this protocol. Dissemination of findings will be done by publishing the results in peer-reviewed journals. The results of this systematic review will provide guidance for practice and counselling for clinicians and therapists facing patients affected by IUGR and their families. PROSPERO REGISTRATION NUMBER CRD42022347467.
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Affiliation(s)
- Ninib Yakoub
- Family Larsson-Rosenquist Foundation Center for Neurodevelopment, Growth and Nutrition of the Newborn, Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Tilman Reinelt
- Family Larsson-Rosenquist Foundation Center for Neurodevelopment, Growth and Nutrition of the Newborn, Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Giancarlo Natalucci
- Family Larsson-Rosenquist Foundation Center for Neurodevelopment, Growth and Nutrition of the Newborn, Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Herkert D, Sullivan C, Zhu Y, Dawson G. Prevalence and nature of prior developmental and medical concerns in toddlers who screen positive for autism in primary care. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023; 27:2361-2371. [PMID: 37838915 PMCID: PMC10593482 DOI: 10.1177/13623613231162146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2023]
Abstract
LAY ABSTRACT The American Academy of Pediatrics recommends that all children be screened for autism at their 18- and 24-month well-child visit. For children who screen positive for autism, it is unknown whether this usually represents the first time a developmental concern has been raised or if other developmental concerns typically precede a positive autism screen. Such knowledge could help guide providers in how to appropriately convey feedback regarding autism screening. This study found that, for close to 80% of children with a positive autism screen, caregivers or providers had a prior autism, language, motor, or other developmental concern documented in the electronic health record. Many also had other prior concerns frequently linked to autism, such as sleep and gastrointestinal problems, and received physical or speech therapy. On average, prior to screening children who received a positive Modified-Checklist for Autism in Toddlers had two documented concerns by at 1 year of age and three concerns by 2 years of age. These findings imply that screening for autism as a part of routine pediatric care likely takes place in the context of larger conversations regarding existing developmental concerns, allowing for a less stigmatizing discussion of autism. Framing the presence of prior concerns in the setting of a positive screen in this context may create a reaffirming space for existing caregiver concerns and a lessened emotional burden on caregivers.
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Affiliation(s)
- Darby Herkert
- Duke University School of Medicine, 8 Searle Center Dr, Durham, NC 27710
| | - Connor Sullivan
- Duke Center for Autism and Brain Development, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, 2608 Erwin Road, Suite 300, Durham, NC 27705, U.S.A
| | - YiQin Zhu
- Duke University School of Medicine, 8 Searle Center Dr, Durham, NC 27710
| | - Geraldine Dawson
- Duke Center for Autism and Brain Development, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, 2608 Erwin Road, Suite 300, Durham, NC 27705, U.S.A
- Duke University School of Medicine, 8 Searle Center Dr, Durham, NC 27710
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Cortez Ferreira M, Mafra J, Dias A, Santos Silva I, Taborda A. Impact of early-onset fetal growth restriction on the neurodevelopmental outcome of very preterm infants at 24 months: a retrospective cohort study. BMC Pediatr 2023; 23:533. [PMID: 37884935 PMCID: PMC10601105 DOI: 10.1186/s12887-023-04361-y] [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: 07/19/2023] [Accepted: 10/13/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND The association between fetal growth restriction (FGR) and childhood neurodevelopmental delay is unclear and the evidence available to the present date shows conflicting results. Our aim was to analyse the impact of early-onset FGR on the neurodevelopmental outcome at 24 months of corrected age in very preterm infants. METHODS Retrospective cohort study of very preterm infants (≤ 32 weeks' gestation) admitted to a neonatal intensive care unit between 1 January 2013-31 December 2019. The control group comprised appropriate for gestational age (AGA) newborns. Griffiths III Mental Development Scale was performed at 24 months of corrected age. RESULTS 132 infants were included: 44 FGR and 88 AGA. Mean Global Development Quotient (GDQ) was lower for FGR infants (p = 0.004) even after adjusting for maternal and perinatal factors (βadjusted -16.703; p = 0.009). The average scores for the neurodevelopmental domains were highest for personal-social-emotional skills (107.02 ± 16.34), followed by eye/hand coordination (105.61 ± 14.20) and foundation of learning skills (102.23 ± 13.74) and were lowest for gross motor (97.90 ± 11.88) and language/communication skills (96.39 ± 18.88). FGR had a significant negative impact on all domains except for gross motor skills. After adjustment, FGR continued to have a significant adverse impact on language/communication (βadjusted -21.924; p = 0.013), eye/hand coordination (βadjusted -15.446; p = 0.015) and foundation of learning skills (βadjusted -15.211; p = 0.013). CONCLUSIONS In very preterm infants, FGR was associated with a significantly increased risk of poor neurodevelopmental outcome at 24 months of corrected age compared to age-matched AGA infants.
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Affiliation(s)
- Mariana Cortez Ferreira
- Neonatology Department, Maternidade Bissaya Barreto, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
| | - Joana Mafra
- Obstetrics Department, Maternidade Bissaya Barreto, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Ana Dias
- Neonatology Department, Maternidade Bissaya Barreto, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Isabel Santos Silva
- Obstetrics Department, Maternidade Bissaya Barreto, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Adelaide Taborda
- Neonatology Department, Maternidade Bissaya Barreto, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
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Tuyisenge V, Mushimiyimana F, Kanyamuhunga A, Rukabyarwema JP, Patel AA, O'Callahan C. Screening for developmental delay in urban Rwandan children: a cross sectional study. BMC Pediatr 2023; 23:522. [PMID: 37864138 PMCID: PMC10588090 DOI: 10.1186/s12887-023-04332-3] [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: 03/09/2023] [Accepted: 09/27/2023] [Indexed: 10/22/2023] Open
Abstract
BACKGROUND Systematic or targeted screening for developmental delay (DD) is critical to the early identification of developmental disabilities. With limited available information for urban Rwandan children, this study aimed to determine the prevalence of DD and associated risk factors in infants aged 9 to 16 months living in the urban Rwandan city of Kigali. METHODS A cross-sectional study was conducted in Rwanda from August to November 2019. A convenience sample of 376 Rwandan parents/caregivers and their children attending urban health centers for their routine immunization visits at 9 and 15 months of age was studied. Parents/caregivers completed the official Kinyarwandan version of the Ages and Stages Questionnaire (ASQ-3) and established cutoffs were used to identify DD. Frequency and percentages were used to summarise the data. Logistic regression analysis was used to identify factors associated with DD. RESULTS Of the 358 children screened using the ASQ-3, the overall prevalence of DD was 24.6%, with a 27.2% prevalence among 9-10-month old children and 22.4% prevalence among 15-16-month old children. Delays in the combined group among the domains of gross motor, communication, fine motor, personal social, and problem solving were 12.8%, 2.5%, 8.4%, 1.7% and 7.5%, respectively. Gestational age at delivery and district of origin were most highly associated with DD, with preterm children at significantly higher risk of having DD compared to term children (Adjusted Odd Ratio AOR = 8.3; 95% CI = 2.5-27.4) and children from Nyarugenge District at high risk of DD compared to children from Gasabo district (AOR = 2.15; 95% CI = 1.2-3.9). CONCLUSIONS The prevalence of ASQ-detectable DD among urban Rwandan children between 9 and 16 months of age was 24.6%, with a high correlation to a history of prematurity and district of origin. This study demonstrates the need for thoughtful health planning regarding integrated developmental surveillance for children, particularly those at high risk, to allow for earlier identification and intervention in the urban area of Kigali, Rwanda.
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Affiliation(s)
- Victoire Tuyisenge
- College of Medicine and Health sciences, University of Rwanda, Kigali, Rwanda.
- Pediatrics and Child Health Department, University Teaching Hospital of Kigali, Kigali, Rwanda.
| | - Febronie Mushimiyimana
- Pediatrics and Child Health Department, University Teaching Hospital of Kigali, Kigali, Rwanda
| | - Aimable Kanyamuhunga
- College of Medicine and Health sciences, University of Rwanda, Kigali, Rwanda
- Pediatrics and Child Health Department, University Teaching Hospital of Kigali, Kigali, Rwanda
| | | | - Archana A Patel
- Department of Neurology, Harvard Medical School, Boston, USA
| | - Cliff O'Callahan
- Middlesex Health/University of Connecticut, Middletown and Hartford Connecticut, Middletown, USA
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Nagel E, Elgersma KM, Gallagher TT, Johnson KE, Demerath E, Gale CA. Importance of human milk for infants in the clinical setting: Updates and mechanistic links. Nutr Clin Pract 2023; 38 Suppl 2:S39-S55. [PMID: 37721461 PMCID: PMC10513735 DOI: 10.1002/ncp.11037] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 05/15/2023] [Accepted: 06/10/2023] [Indexed: 09/19/2023] Open
Abstract
INTRODUCTION Human milk (HM) is the optimal source of nutrition for infants and has been implicated in multiple aspects of infant health. Although much of the existing literature has focused on the individual components that drive its nutrition content, examining HM as a biological system is needed for meaningful advancement of the field. Investigation of the nonnutritive bioactive components of HM and the maternal, infant, and environmental factors which affect these bioactives is important to better understand the importance of HM provision to infants. This information may inform care of clinical populations or infants who are critically ill, hospitalized, or who have chronic diseases and may benefit most from receiving HM. METHODS In this narrative review, we reviewed literature examining maternal and infant influences on HM composition with a focus on studies published in the last 10 years that were applicable to clinical populations. RESULTS We found multiple studies examining HM components implicated in infant immune and gut health and neurodevelopment. Additional work is needed to understand how donor milk and formula may be used in situations of inadequate maternal HM. Furthermore, a better understanding of how maternal factors such as maternal genetics and metabolic health influence milk composition is needed. CONCLUSION In this review, we affirm the importance of HM for all infants, especially clinical populations. An understanding of how HM composition is modulated by maternal and environmental factors is important to progress the field forward with respect to mechanistic links between HM biology and infant health outcomes.
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Affiliation(s)
- Emily Nagel
- School of Public Health, University of Minnesota-Twin Cities, Minnesota, USA
| | | | | | - Kelsey E Johnson
- Department of Genetics, Cell Biology, and Development, University of Minnesota-Twin Cities, Minnesota, USA
| | - Ellen Demerath
- School of Public Health, University of Minnesota-Twin Cities, Minnesota, USA
| | - Cheryl A. Gale
- Department of Pediatrics, University of Minnesota-Twin Cities, Minnesota, USA
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Piris-Borregas S, Bellón-Vaquerizo B, Muñoz-López O, Cuadrado-Obregón N, Melchor-Muñoz P, Niño-Díaz L, González-Mora FJ, Barroso-Santiago M, Martín-Arriscado C, Pallás-Alonso CR. Parents who spent more hours in intensive care units with their low birthweight newborn infant did not achieve autonomous care faster. Acta Paediatr 2023; 112:2104-2112. [PMID: 37332100 DOI: 10.1111/apa.16878] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 06/02/2023] [Accepted: 06/15/2023] [Indexed: 06/20/2023]
Abstract
AIM We examined the correlation between how long it took the parents of very low birthweight infants, born weighing up to 1500 g, to provide different kinds of autonomous care in a neonatal intensive care unit (NICU). METHODS This prospective observational was conducted in the NICU of a Spanish hospital from 10 January 2020 to 3 May 2022. The unit had 11 beds single-family rooms and provided eight beds in an open bay room. The study examined breastfeeding, patient safety, participation in rounds, pain prevention and cleanliness. RESULTS We studied 96 patients and their parents and there was no correlation between any type of care and the time it took parents to provide it autonomously. Parents in the single-family room cohort spent a median of 9.5 h per day between them in the NICU, while the parents in the open bay room spent 7.0 h with their infants (p = 0.03). However, parents in the single-family room group were able to recognise pain faster (p = 0.02). CONCLUSION Parents in single-family rooms spent more time in the NICU and recognised pain faster but did not achieve autonomous care faster than parents in the open bay group.
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Affiliation(s)
- Salvador Piris-Borregas
- Department of Neonatology, 12 de Octubre University Hospital, Madrid, Spain
- i+12 Research Institute, Madrid, Spain
| | | | - Olga Muñoz-López
- Department of Neonatology, 12 de Octubre University Hospital, Madrid, Spain
| | | | | | - Lidia Niño-Díaz
- Department of Neonatology, 12 de Octubre University Hospital, Madrid, Spain
| | | | | | | | - Carmen Rosa Pallás-Alonso
- Department of Neonatology, 12 de Octubre University Hospital, Madrid, Spain
- i+12 Research Institute, Madrid, Spain
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Lintao RCV, Kammala AK, Radnaa E, Bettayeb M, Vincent KL, Patrikeev I, Yaklic J, Bonney EA, Menon R. Characterization of fetal microchimeric immune cells in mouse maternal hearts during physiologic and pathologic pregnancies. Front Cell Dev Biol 2023; 11:1256945. [PMID: 37808080 PMCID: PMC10556483 DOI: 10.3389/fcell.2023.1256945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 09/13/2023] [Indexed: 10/10/2023] Open
Abstract
Introduction: During pregnancy, fetal cells can be incorporated into maternal tissues (fetal microchimerism), where they can persist postpartum. Whether these fetal cells are beneficial or detrimental to maternal health is unknown. This study aimed to characterize fetal microchimeric immune cells in the maternal heart during pregnancy and postpartum, and to identify differences in these fetal microchimeric subpopulations between normal and pregnancies complicated by spontaneous preterm induced by ascending infection. Methods: A Cre reporter mouse model, which when mated with wild-type C57BL/6J females resulted in cells and tissues of progeny expressing red fluorescent protein tandem dimer Tomato (mT+), was used to detect fetal microchimeric cells. On embryonic day (E)15, 104 colony-forming units (CFU) E. coli was administered intravaginally to mimic ascending infection, with delivery on or before E18.5 considered as preterm delivery. A subset of pregnant mice was sacrificed at E16 and postpartum day 28 to harvest maternal hearts. Heart tissues were processed for immunofluorescence microscopy and high-dimensional mass cytometry by time-of-flight (CyTOF) using an antibody panel of immune cell markers. Changes in cardiac physiologic parameters were measured up to 60 days postpartum via two-dimensional echocardiography. Results: Intravaginal E. coli administration resulted in preterm delivery of live pups in 70% of the cases. mT + expressing cells were detected in maternal uterus and heart, implying that fetal cells can migrate to different maternal compartments. During ascending infection, more fetal antigen-presenting cells (APCs) and less fetal hematopoietic stem cells (HSCs) and fetal double-positive (DP) thymocytes were observed in maternal hearts at E16 compared to normal pregnancy. These HSCs were cleared while DP thymocytes persisted 28 days postpartum following an ascending infection. No significant changes in cardiac physiologic parameters were observed postpartum except a trend in lowering the ejection fraction rate in preterm delivered mothers. Conclusion: Both normal pregnancy and ascending infection revealed distinct compositions of fetal microchimeric immune cells within the maternal heart, which could potentially influence the maternal cardiac microenvironment via (1) modulation of cardiac reverse modeling processes by fetal stem cells, and (2) differential responses to recognition of fetal APCs by maternal T cells.
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Affiliation(s)
- Ryan C. V. Lintao
- Division of Basic Science and Translational Research, Department of Obstetrics and Gynecology, The University of Texas Medical Branch at Galveston, Galveston, TX, United States
- Department of Biochemistry and Molecular Biology, College of Medicine, University of the Philippines Manila, Manila, Philippines
| | - Ananth Kumar Kammala
- Division of Basic Science and Translational Research, Department of Obstetrics and Gynecology, The University of Texas Medical Branch at Galveston, Galveston, TX, United States
| | - Enkhtuya Radnaa
- Division of Basic Science and Translational Research, Department of Obstetrics and Gynecology, The University of Texas Medical Branch at Galveston, Galveston, TX, United States
| | - Mohamed Bettayeb
- Division of Basic Science and Translational Research, Department of Obstetrics and Gynecology, The University of Texas Medical Branch at Galveston, Galveston, TX, United States
| | - Kathleen L. Vincent
- Division of Basic Science and Translational Research, Department of Obstetrics and Gynecology, The University of Texas Medical Branch at Galveston, Galveston, TX, United States
- Biomedical Engineering and Imaging Sciences Group, The University of Texas Medical Branch at Galveston, Galveston, TX, United States
| | - Igor Patrikeev
- Biomedical Engineering and Imaging Sciences Group, The University of Texas Medical Branch at Galveston, Galveston, TX, United States
| | - Jerome Yaklic
- Department of Obstetrics and Gynecology, The University of Texas Medical Branch at Galveston, Galveston, TX, United States
| | - Elizabeth A. Bonney
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Larner College of Medicine, The University of Vermont, Burlington, VT, United States
| | - Ramkumar Menon
- Division of Basic Science and Translational Research, Department of Obstetrics and Gynecology, The University of Texas Medical Branch at Galveston, Galveston, TX, United States
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Zheng S, Fang J, Bai G, He X, Hua M, Zhu B, Chen W, Dong W, Wang L, Huang X, Wang H, Shao J. The association between parental risks and childhood development: findings from a community-based survey in East China. BMC Public Health 2023; 23:878. [PMID: 37173709 PMCID: PMC10176942 DOI: 10.1186/s12889-023-15702-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 04/18/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Nurturing care is necessary for optimal early childhood development. This study aimed to investigate the prevalence of parental risks in rural East China and assess their impacts on early development in children younger than three years old. METHODS This community-based cross-sectional survey was conducted among 3852 caregiver-child pairs in Zhejiang Province from December 2019 to January 2020. Children aged 0 to 3 years were recruited from China's Early Childhood Development Program (ECD). Local child health care providers conducted face-to-face interviews with the primary caregivers. Demographic information of the participants was collected by questionnaire. Each child was screened for parental risk through the Parental Risk Checklist designed by the ECD program. The Ages and Stages Questionnaire (ASQ) was used to identify children with potential developmental delays. Multinomial logistic regression model and linear trend test were applied to assess the association between parental risks and suspected developmental delays. RESULTS Among the 3852 children included in the analyses, 46.70% had at least one parental risk and 9.01% presented suspected developmental delays in any domain of ASQ. Parental risk was statistically associated with the overall suspected developmental delay in young children (Relative Risk Ratio (RRR): 1.36; 95% confidence interval (CI): 1.08, 1.72; P = 0.010) after adjusting potential confounders. Compared with children with no parental risk, children exposed to 3 or more parental risks had 2.59, 5.76, 3.95, and 2.84 times higher risk of the suspected developmental delay in overall ASQ, communication, problem-solving, and personal-social domain, respectively (P values < 0.05). The linear trend tests found that the more parental risks, the higher possibility of developmental delay (P values < 0.05). CONCLUSIONS Parental risks are prevalent among children under three years in rural East China, which may increase the risk of developmental delays in children. Meanwhile, parental risk screening can be used to recognize poor nurturing care in primary health care settings. Targeted interventions are warranted to improve nurturing care for optimal early childhood development.
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Affiliation(s)
- Shuangshuang Zheng
- Department of Child Health Care, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, 57 Zhu-Gan Road, Gongshu District, 310003, Hangzhou, China
| | - Jianing Fang
- Department of Child Health Care, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, 57 Zhu-Gan Road, Gongshu District, 310003, Hangzhou, China
| | - Guannan Bai
- Department of Child Health Care, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, 57 Zhu-Gan Road, Gongshu District, 310003, Hangzhou, China
| | - Xinyu He
- Department of Child Health Care, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, 57 Zhu-Gan Road, Gongshu District, 310003, Hangzhou, China
| | - Mengdi Hua
- Department of Child Health Care, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, 57 Zhu-Gan Road, Gongshu District, 310003, Hangzhou, China
| | - Bingquan Zhu
- Department of Child Health Care, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, 57 Zhu-Gan Road, Gongshu District, 310003, Hangzhou, China
| | - Weijun Chen
- Department of Child Health Care, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, 57 Zhu-Gan Road, Gongshu District, 310003, Hangzhou, China
| | - Wenhong Dong
- Department of Child Health Care, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, 57 Zhu-Gan Road, Gongshu District, 310003, Hangzhou, China
| | - Lei Wang
- Department of Child Health Care, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, 57 Zhu-Gan Road, Gongshu District, 310003, Hangzhou, China
| | - Xiaona Huang
- Section of Child Health and Development, the United Nations Children's Fund, UNICEF Office for China, Beijing, China
| | - Huishan Wang
- Department of Children Health, National Center for Maternal and Children Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jie Shao
- Department of Child Health Care, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, 57 Zhu-Gan Road, Gongshu District, 310003, Hangzhou, China.
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Kapito EM, Chirwa EM, Chodzaza E, Norr KF, Patil C, Maluwa AO, White-Traut R. The H-HOPE behavioral intervention plus Kangaroo Mother Care increases mother-preterm infant responsivity in Malawi: a prospective cohort comparison. BMC Pediatr 2023; 23:187. [PMID: 37085764 PMCID: PMC10120231 DOI: 10.1186/s12887-023-04015-z] [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: 09/10/2022] [Accepted: 04/16/2023] [Indexed: 04/23/2023] Open
Abstract
BACKGROUND Early behavioral intervention to promote development is recommended as the standard of care for preterm infants, yet is not provided in Malawi. One such intervention is H-HOPE (Hospital to Home: Optimizing the Premature Infant's Environment). In US studies, H-HOPE increased mother-preterm infant responsivity at 6-weeks corrected age (CA). Kangaroo Mother Care (KMC) improves infant survival and is the standard of care for preterm infants in Malawi. This is the first study to examine whether H-HOPE is feasible and promotes mother-preterm infant responsivity in Malawi, and the first to examine the impact of H-HOPE when KMC is the standard of care. METHOD This pilot was conducted in a KMC unit using a prospective cohort comparison design. Because the unit is an open room without privacy, random assignment would have led to contamination of the control cohort. H-HOPE includes participatory guidance for mothers and Massage + , a 15 min multisensory session provided by mothers twice daily. H-HOPE began when infants were clinically stable and at least 32 weeks postmenstrual age. Mothers participated if they were physically stable and willing to return for follow-up. Mother-preterm infant dyads were video-recorded during a play session at 6-weeks CA. Responsivity was measured using the Dyadic Mutuality Code (DMC). RESULTS The final sample included 60 H-HOPE + KMC and 59 KMC only mother-preterm infant dyads. Controlling for significant maternal and infant characteristics, the H-HOPE + KMC dyads were over 11 times more likely to have higher responsivity than those in the KMC only dyads (AOR = 11.51, CI = 4.56, 29.04). The only other factor related to higher responsivity was vaginal vs. Caesarian delivery (AOR = 5.44, CI = .096, 30.96). CONCLUSION This study demonstrated that H-HOPE can be provided in Malawi. Mother-infant dyads receiving both H-HOPE and KMC had higher responsivity at 6-weeks CA than those receiving KMC only. H-HOPE was taught by nurses in this study, however the nursing shortage in Malawi makes H-HOPE delivery by nurses challenging. Training patient attendants in the KMC unit is a cost-effective alternative. H-HOPE as the standard of care offers benefits to preterm infants and mothers that KMC alone does not provide.
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Affiliation(s)
- Esnath M Kapito
- School of Maternal, Neonatal and Reproductive Health Studies, Kamuzu University of Health Sciences, Private Bag 360, Blantyre, Malawi.
| | - Ellen M Chirwa
- School of Maternal, Neonatal and Reproductive Health Studies, Kamuzu University of Health Sciences, Private Bag 360, Blantyre, Malawi
| | - Elizabeth Chodzaza
- School of Maternal, Neonatal and Reproductive Health Studies, Kamuzu University of Health Sciences, Private Bag 360, Blantyre, Malawi
| | - Kathleen F Norr
- Children's Hospital of Wisconsin, Children's Research Institute, 9000 Winsconsin Avenue, Milwaukee, Winsconsin, 53226, USA
- College of Nursing, University of Illinois Chicago, 845 S. Damen Avenue (M/C 806), Chicago, IL, 60612, USA
| | - Crystal Patil
- College of Nursing, University of Illinois Chicago, 845 S. Damen Avenue (M/C 806), Chicago, IL, 60612, USA
| | - Alfred O Maluwa
- Malawi University of Science and Technology, P. O Box 5196, Limbe, Malawi
| | - Rosemary White-Traut
- Children's Hospital of Wisconsin, Children's Research Institute, 9000 Winsconsin Avenue, Milwaukee, Winsconsin, 53226, USA
- College of Nursing, University of Illinois Chicago, 845 S. Damen Avenue (M/C 806), Chicago, IL, 60612, USA
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