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Maeda T, Tanahashi Y, Asada H, Kidokoro H, Takahashi Y, Sato Y. High threshold of total developmental quotient at 3 years for follow-up in extremely preterm infants. Early Hum Dev 2024; 196:106098. [PMID: 39116725 DOI: 10.1016/j.earlhumdev.2024.106098] [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: 03/20/2024] [Revised: 07/10/2024] [Accepted: 07/30/2024] [Indexed: 08/10/2024]
Abstract
AIM To investigate the relationship between the developmental quotient (DQ) at age 3 years and the need for educational support at school age in extremely preterm infants. METHODS A total of 176 infants with a gestational age of <28 weeks were analyzed. The total DQ and subscales were evaluated using the Kyoto Scale of Psychological Development (KSPD) test. Neurodevelopment at age 3 years was stratified using total DQ in a conventional (DQ < 70 as developmental delay, DQ 70- <85 as subnormal, DQ ≥85 as normal) and a modified way (subdividing normal into DQ 85- <93 as low-normal and DQ ≥93 as high-normal). The prevalence of future educational support was compared for each stratum. Additionally, subscales were compared between those with and without educational support in each total DQ stratum. RESULTS In conventional stratification, the prevalence of educational support was 32 (63 %) for developmental delay, 14 (24 %) for subnormal, and 10 (15 %) for normal. In modified stratification, the prevalence was 8 (26 %) for low-normal and 2 (5 %) for high-normal. While there was no significant difference in the odds of educational support between the normal and subnormal, the low-normal had significantly higher odds compared to the high-normal (OR 6.00; 95 % CI, 1.16-30.95, p = 0.03). Among the low-normal stratum, the language-social subscale was significantly lower in those with educational support. CONCLUSION Setting high thresholds for total DQ and evaluating detailed subscales at age 3 years may be useful for developmental follow-up in extremely preterm infants.
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Affiliation(s)
- Takashi Maeda
- Division of Neonatology, Center for Maternal-Neonatal Care, Nagoya University Hospital, Nagoya, Japan
| | | | - Hideyuki Asada
- Department of Pediatrics, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, Aichi, Japan
| | - Hiroyuki Kidokoro
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Japan
| | - Yoshiyuki Takahashi
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Japan
| | - Yoshiaki Sato
- Division of Neonatology, Center for Maternal-Neonatal Care, Nagoya University Hospital, Nagoya, Japan.
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Santaularia NJ, Hunt SL, Bonilla Z. Exploring the Links Between Immigration and Birth Outcomes Among Latine Birthing Persons in the USA. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-01999-x. [PMID: 38713369 DOI: 10.1007/s40615-024-01999-x] [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: 10/10/2023] [Revised: 03/22/2024] [Accepted: 04/07/2024] [Indexed: 05/08/2024]
Abstract
BACKGROUND Birth outcomes are worse for birthing people and infants in the USA than other high-income economies and worse still for underprivileged communities. Historically, the Latine community has experienced positive birth outcomes, despite low socioeconomic status and other socio-political disadvantages, leading to what has been termed as the Hispanic birth paradox. However, this perinatal advantage and protective effect appears to have been shattered by unfavorable policies, structural conditions, societal attitudes, and traumatic events impacting Latine immigrants, leading to negative effects on the health and well-being of birthing Latines-regardless of citizenship status and increasing rates of preterm birth and low birth weight infants. METHODS AND RESULTS We conducted a comprehensive literature review and identified two pathways through which birth outcomes among Latine birthing persons may be compromised regardless of citizenship status: (1) a biological pathway as toxic levels of fear and anxiety created by racialized stressors accumulate in the bodies of Latines and (2) a social pathway as Latines disconnect from formal and informal sources of support including family, friends, health care, public health programs, and social services during the course of the pregnancy. CONCLUSION Future research needs to examine the impact of immigration climate and policies on health and racial equity in birth outcomes among Latines regardless of citizenship status. Attaining health and racial equity necessitates increased awareness among health providers, public health practitioners, and policy makers of the impact of larger socio-political pressures on the health of Latine birthing persons.
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Affiliation(s)
- N Jeanie Santaularia
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA.
| | - Shanda Lee Hunt
- University Libraries, University of Minnesota, Minneapolis, MN, USA
| | - Zobeida Bonilla
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
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Lambiase CV, Mansi G, Salomè S, Conelli ML, Vendemmia M, Zurlo MC, Raimondi F, Capasso L. The financial burden experienced by families during NICU hospitalization and after discharge: A single center, survey-based study. Eur J Pediatr 2024; 183:903-913. [PMID: 38038769 PMCID: PMC10912114 DOI: 10.1007/s00431-023-05352-y] [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: 09/01/2023] [Revised: 11/17/2023] [Accepted: 11/24/2023] [Indexed: 12/02/2023]
Abstract
To investigate a broad array of costs and perceived financial burden (FB) faced by families of NICU graduates both during hospitalization and after discharge. Cross-sectional survey-based study design. A survey measuring socio-demographics, direct non-medical costs, indirect costs, social support and perceived FB was developed. One-hundred-twenty-two pairs of parents of NICU graduates participated in the study. Most of the families (87.7%) experienced FB due to NICU hospitalization. The median cost of visiting infant during NICU admission was 615 euros (range: 42,7320). FB correlated with cost for drugs (ρ = .271, p < .05, 95%CI:[.020, .490]), dietary supplement (ρ = .385, p < .05, CI:[.010, .665]), behavioral disorders (ρ = -.186, p < .05, 95%CI:[-.356, -.003]), language delay (ρ = .243, p < .01, CI:[-.408, -.063]) and comorbidities (ρ = -.206, p < .05, 95% CI:[-.374, -.024]). Transportation costs due to medical visits (ρ = .415, p < .01, 95% CI:[.239, .564]) and therapy sessions (ρ = .517, p < .05, CI:[.121, .771]) correlated with higher FB. Grandparents of the infant were the most frequent source of help (86.1%). Families having infants with adverse outcome experienced more hospitalizations after NICU discharge (p < .05) and higher FB (p < .01) than families with typically developing infant. Lack of government financial help was associated with higher perceived FB (CI:[1.117,29.127], p < .05). Conclusions: Our findings demonstrated that parents of NICU graduates experience high rates of FB, highlighting their sources (e.g., grandparents support) and difficulties (e.g., private therapy costs) through the lens of patient perspective. Our study promotes reflection on policies which should be adopted from the European health services that are similar to the Italian one to support NICU graduate families and reduce inequalities. What is Known: • Families of NICU graduates face several kinds of costs during hospitalization and after discharge. What is New: • NICU hospitalization is a multifaceted event that impact financial burden experienced by families. • NICU graduate families whose infant had adverse outcome and felt lack of financial help from local policy makers experience higher rates of financial burden.
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Affiliation(s)
- Carmine Vincenzo Lambiase
- Division of Neonatology, Department of Translational Medical Sciences, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy.
- Department of Humanities, University of Naples Federico II, Via Porta di Massa 1, 80133, Naples, Italy.
| | - Giuseppina Mansi
- Division of Neonatology, Department of Translational Medical Sciences, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Serena Salomè
- Division of Neonatology, Department of Translational Medical Sciences, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Maria Laura Conelli
- Division of Neonatology, Department of Translational Medical Sciences, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Maria Vendemmia
- Division of Neonatology, Department of Translational Medical Sciences, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Maria Clelia Zurlo
- Department of Humanities, University of Naples Federico II, Via Porta di Massa 1, 80133, Naples, Italy
- Dynamic Psychology Laboratory, Department of Political Sciences, University of Naples Federico II, Naples, Italy
| | - Francesco Raimondi
- Division of Neonatology, Department of Translational Medical Sciences, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Letizia Capasso
- Division of Neonatology, Department of Translational Medical Sciences, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
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Calcaterra V, Schneider L, Baresi S, Bodini F, Bona F, Chillemi C, De Silvestri A, Zanelli S, Zuccotti G. Specific Learning Disorders in Children and Adolescents with Obesity. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1595. [PMID: 37892258 PMCID: PMC10605066 DOI: 10.3390/children10101595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 08/28/2023] [Accepted: 09/23/2023] [Indexed: 10/29/2023]
Abstract
Specific learning disorders (SLDs) are the most frequently diagnosed developmental disorders in childhood. Different neurocognitive patterns have been found in patients with overweight and obesity, but no data on childhood obesity and SLDs have been reported. To increase our understanding of the relationship between neuropsychological developmental and obesity, we assessed the prevalence of SLD in a pediatric population with obesity. We retrospectively included 380 children and adolescents with obesity. For all participants, auxological, metabolic, demographic features, relationship and social skills, anamnestic data on pregnancy and the perinatal period, stages of development and family medical history were reviewed. SLD was defined according to the DSM-5 criteria. A group of 101 controls of normal weight was included. The overall prevalence of SLD was 10.8%, and SLD was more prevalent in patients with obesity (p < 0.001), with male predominance (p = 0.01). SGA was associated with SLD (p = 0.02). Speech retardation (p < 0.001), limited relationships with peers (p < 0.001) and didactic support (p < 0.001) were noted in the SLD group compared to the group without SLD. A higher prevalence of family history of neuropsychiatric disorders was observed in the SLD group (p = 0.04). A higher fasting glucose level was detected in patients with obesity and SLD compared to subjects without SLD (p = 0.01). An association between obesity and SLD could not be excluded, and an overlap of pathogenic factors for both conditions should be considered.
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Affiliation(s)
- Valeria Calcaterra
- Department of Internal Medicine and Therapeutics, University of Pavia, 27100 Pavia, Italy
- Pediatric Department, Buzzi Children’s Hospital, 20154 Milano, Italy; (L.S.); (F.B.); (F.B.); (C.C.); (S.Z.); (G.Z.)
| | - Laura Schneider
- Pediatric Department, Buzzi Children’s Hospital, 20154 Milano, Italy; (L.S.); (F.B.); (F.B.); (C.C.); (S.Z.); (G.Z.)
| | - Stefano Baresi
- Pediatric Department, Buzzi Children’s Hospital, 20154 Milano, Italy; (L.S.); (F.B.); (F.B.); (C.C.); (S.Z.); (G.Z.)
| | - Francesca Bodini
- Pediatric Department, Buzzi Children’s Hospital, 20154 Milano, Italy; (L.S.); (F.B.); (F.B.); (C.C.); (S.Z.); (G.Z.)
| | - Federica Bona
- Pediatric Department, Buzzi Children’s Hospital, 20154 Milano, Italy; (L.S.); (F.B.); (F.B.); (C.C.); (S.Z.); (G.Z.)
| | - Claudia Chillemi
- Pediatric Department, Buzzi Children’s Hospital, 20154 Milano, Italy; (L.S.); (F.B.); (F.B.); (C.C.); (S.Z.); (G.Z.)
| | - Annalisa De Silvestri
- Biometry & Clinical Epidemiology, Scientific Direction, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy;
| | - Sara Zanelli
- Pediatric Department, Buzzi Children’s Hospital, 20154 Milano, Italy; (L.S.); (F.B.); (F.B.); (C.C.); (S.Z.); (G.Z.)
| | - Gianvincenzo Zuccotti
- Pediatric Department, Buzzi Children’s Hospital, 20154 Milano, Italy; (L.S.); (F.B.); (F.B.); (C.C.); (S.Z.); (G.Z.)
- Department of Biomedical and Clinical Science, University of Milano, 20157 Milano, Italy
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Dunne TF, Chandna J, Majo F, Tavengwa N, Mutasa B, Chasekwa B, Ntozini R, Prendergast AJ, Humphrey JH, Gladstone MJ. Performance of the UNICEF/UN Washington Group tool for identifying functional difficulty in rural Zimbabwean children. PLoS One 2022; 17:e0274664. [PMID: 36112574 PMCID: PMC9480986 DOI: 10.1371/journal.pone.0274664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 08/09/2022] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Over one billion people live with disability worldwide, of whom 80% are in developing countries. Robust childhood disability data are limited, particularly as tools for identifying disability function poorly at young ages. METHODS A subgroup of children enrolled in the Sanitation Hygiene Infant Nutrition Efficacy (SHINE) trial (a cluster-randomised, community-based, 2x2 factorial trial in two rural districts in Zimbabwe) had neurodevelopmental assessments at 2 years of age. We evaluated functional difficulty prevalence in HIV-exposed and HIV-unexposed children using the Washington Group Child Functioning Module (WGCFM), comparing absolute difference using chi-squared or Fisher's exact tests. Concurrent validity with the Malawi Developmental Assessment Tool (MDAT) was assessed using logistic regression with cohort MDAT score quartiles, linear regression for unit-increase in raw scores and a Generalised Estimating Equation approach (to adjust for clusters) to compare MDAT scores of those with and without functional difficulty. A 3-step, cluster-adjusted multivariable regression model was then carried out to examine risk factors for functional difficulty. FINDINGS Functional Difficulty prevalence was 4.2% (95%CI: 3.2%, 5.2%) in HIV-unexposed children (n = 1606) versus 6.1% (95%CI: 3.5%, 8.9%) in HIV-exposed children (n = 314) (absolute difference 1.9%, 95%CI: -0.93%, 4.69%; p = 0.14). Functional difficulty score correlated negatively with MDAT: for each unit increase in WGCFM score, children completed 2.6 (95%CI: 2.2, 3.1) fewer MDAT items (p = 0.001). Children from families with food insecurity and poorer housing were more at risk of functional difficulty. INTERPRETATION Functional difficulty was identified in approximately 1-in-20 children in rural Zimbabwe, which is comparable to prevalence in previous studies. WGCFM showed concurrent validity with the MDAT, supporting its use in early childhood.
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Affiliation(s)
- Thomas Frederick Dunne
- Department of Women and Children’s Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
- * E-mail:
| | - Jaya Chandna
- Department of Women and Children’s Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Florence Majo
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Naume Tavengwa
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Batsirai Mutasa
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Bernard Chasekwa
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Robert Ntozini
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Andrew J. Prendergast
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
- Blizard Institute, Queen Mary University of London, London, United Kingdom
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Jean H. Humphrey
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Melissa J. Gladstone
- Department of Women and Children’s Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
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Diagnosing Autism Spectrum Disorder in Toddlers Born Very Preterm: Estimated Prevalence and Usefulness of Screeners and the Autism Diagnostic Observation Schedule (ADOS). J Autism Dev Disord 2020; 51:1508-1527. [DOI: 10.1007/s10803-020-04573-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Hallamaa L, Cheung YB, Maleta K, Luntamo M, Ashorn U, Gladstone M, Kulmala T, Mangani C, Ashorn P. Child Health Outcomes After Presumptive Infection Treatment in Pregnant Women: A Randomized Trial. Pediatrics 2018; 141:peds.2017-2459. [PMID: 29472491 DOI: 10.1542/peds.2017-2459] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/18/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES We showed earlier that presumptive infection treatment in pregnancy reduced the prevalence of neonatal stunting in a rural low-income setting. In this article, we assess how these gains were sustained and reflected in childhood growth, development, and mortality. METHODS We enrolled 1320 pregnant Malawian women in a randomized trial and treated them for malaria and other infections with either 2 doses of sulfadoxine-pyrimethamine (SP) (control), monthly SP, or monthly sulfadoxine-pyrimethamine and 2 doses of azithromycin (AZI-SP). Child height or length and mortality were recorded at 1, 6, 12, 24, 36, 48, and 60 months and development at 60 months by using Griffith's Mental Development Scales. RESULTS Throughout follow-up, the mean child length was 0.4 to 0.7 cm higher (P < .05 at 1-12 months), the prevalence of stunting was 6 to 11 percentage points lower (P < .05 at 12-36 months), and the 5-year cumulative incidence of stunting was 13 percentage points lower (hazard ratio: 0.70, 95% confidence interval [CI]: 0.60 to 0.83, P < .001) in the AZI-SP group than in the control group. The mean developmental score was 3.8 points higher in the AZI-SP group than in the control group (95% CI: 1.1 to 6.4, P = .005). Total mortality during pregnancy and childhood was 15.3%, 15.1%, and 13.1% (P = .60) in the control, monthly SP, and AZI-SP groups, respectively. Postneonatal mortality (secondary outcome) was 5.5%, 3.3%, and 1.9%, respectively (risk ratio of AZI-SP versus control: 0.34, 95% CI: 0.15 to 0.76, P = .008). CONCLUSIONS Provision of AZI-SP rather than 2 doses of SP during pregnancy reduced the incidence of stunting in childhood. AZI-SP during pregnancy also had a positive effect on child development and may have reduced postneonatal mortality.
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Affiliation(s)
- Lotta Hallamaa
- Center for Child Health Research, Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland;
| | - Yin Bun Cheung
- Center for Quantitative Medicine, Duke-NUS Medical School, National University of Singapore, Singapore
| | - Kenneth Maleta
- Department of Public Health, School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Mari Luntamo
- Center for Child Health Research, Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - Ulla Ashorn
- Center for Child Health Research, Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - Melissa Gladstone
- Department of Neurodevelopmental Paediatrics, Women and Children's Health, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom; and
| | - Teija Kulmala
- Center for Child Health Research, Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - Charles Mangani
- Department of Public Health, School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Per Ashorn
- Center for Child Health Research, Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland.,Department of Paediatrics, Tampere University Hospital, Tampere, Finland
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Janet S, Carrara VI, Simpson JA, Thin NWW, Say WW, Paw NTM, Chotivanich K, Turner C, Crawley J, McGready R. Early neonatal mortality and neurological outcomes of neonatal resuscitation in a resource-limited setting on the Thailand-Myanmar border: A descriptive study. PLoS One 2018; 13:e0190419. [PMID: 29304139 PMCID: PMC5755780 DOI: 10.1371/journal.pone.0190419] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 12/14/2017] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Of the 4 million neonatal deaths worldwide yearly, 98% occur in low and middle-income countries. Effective resuscitation reduces mortality and morbidity but long-term outcomes in resource-limited settings are poorly described. This study reports on newborn neurological outcomes following resuscitation at birth in a resource-limited setting where intensive newborn care including intubation is unavailable. METHODS Retrospective analysis of births records from 2008 to 2015 at Shoklo Malaria Research Unit (SMRU) on the Thailand-Myanmar border. FINDINGS From 21,225 newbonrs delivered, 15,073 (71%) met the inclusion criteria (liveborn, singleton, ≥28 weeks' gestation, delivered in SMRU). Neonatal resuscitation was performed in 460 (3%; 422 basic, 38 advanced) cases. Overall early neonatal mortality was 6.6 deaths per 1000 live births (95% CI 5.40-8.06). Newborns receiving basic and advanced resuscitation presented an adjusted rate for death of 1.30 (95%CI 0.66-2.55; p = 0.442), and 6.32 (95%CI 3.01-13.26; p<0.001) respectively, compared to newborns given routine care. Main factors related to increased need for resuscitation were breech delivery, meconium, and fetal distress (p<0.001). Neurodevelopmental follow-up to one year was performed in 1,608 (10.5%) of the 15,073 newborns; median neurodevelopmental scores of non-resuscitated newborns and those receiving basic resuscitation were similar (64 (n = 1565) versus 63 (n = 41); p = 0.732), while advanced resuscitation scores were significantly lower (56 (n = 5); p = 0.017). INTERPRETATIONS Newborns requiring basic resuscitation at birth have normal neuro-developmental outcomes at one year of age compared to low-risk newborns. Identification of risk factors (e.g., breech delivery) associated with increased need for neonatal resuscitation may facilitate allocation of staff to high-risk deliveries. This work endorses the use of basic resuscitation in low-resource settings, and supports on-going staff training to maintain bag-and-mask ventilation skills.
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Affiliation(s)
- Sophie Janet
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Old Road Campus, Oxford, United Kingdom
| | - Verena I. Carrara
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Julie A. Simpson
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Nant War War Thin
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Wah Wah Say
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Naw Ta Mlar Paw
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Kesinee Chotivanich
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Claudia Turner
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Old Road Campus, Oxford, United Kingdom
- Cambodia-Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, Cambodia
- Angkor Hospital for Children, Siem Reap, Cambodia
| | - Jane Crawley
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Old Road Campus, Oxford, United Kingdom
| | - Rose McGready
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Old Road Campus, Oxford, United Kingdom
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
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9
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Fumagalli M, Provenzi L, De Carli P, Dessimone F, Sirgiovanni I, Giorda R, Cinnante C, Squarcina L, Pozzoli U, Triulzi F, Brambilla P, Borgatti R, Mosca F, Montirosso R. From early stress to 12-month development in very preterm infants: Preliminary findings on epigenetic mechanisms and brain growth. PLoS One 2018; 13:e0190602. [PMID: 29304146 PMCID: PMC5755830 DOI: 10.1371/journal.pone.0190602] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 12/18/2017] [Indexed: 12/21/2022] Open
Abstract
Very preterm (VPT) infants admitted to Neonatal Intensive Care Unit (NICU) are at risk for altered brain growth and less-than-optimal socio-emotional development. Recent research suggests that early NICU-related stress contributes to socio-emotional impairments in VPT infants at 3 months through epigenetic regulation (i.e., DNA methylation) of the serotonin transporter gene (SLC6A4). In the present longitudinal study we assessed: (a) the effects of NICU-related stress and SLC6A4 methylation variations from birth to discharge on brain development at term equivalent age (TEA); (b) the association between brain volume at TEA and socio-emotional development (i.e., Personal-Social scale of Griffith Mental Development Scales, GMDS) at 12 months corrected age (CA). Twenty-four infants had complete data at 12-month-age. SLC6A4 methylation was measured at a specific CpG previously associated with NICU-related stress and socio-emotional stress. Findings confirmed that higher NICU-related stress associated with greater increase of SLC6A4 methylation at NICU discharge. Moreover, higher SLC6A4 discharge methylation was associated with reduced anterior temporal lobe (ATL) volume at TEA, which in turn was significantly associated with less-than-optimal GMDS Personal-Social scale score at 12 months CA. The reduced ATL volume at TEA mediated the pathway linking stress-related increase in SLC6A4 methylation at NICU discharge and socio-emotional development at 12 months CA. These findings suggest that early adversity-related epigenetic changes might contribute to the long-lasting programming of socio-emotional development in VPT infants through epigenetic regulation and structural modifications of the developing brain.
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Affiliation(s)
- Monica Fumagalli
- NICU, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Livio Provenzi
- 0–3 Centre for the at-Risk Infant, Scientific Institute, IRCCS Eugenio Medea, Bosisio Parini, LC, Italy
| | - Pietro De Carli
- 0–3 Centre for the at-Risk Infant, Scientific Institute, IRCCS Eugenio Medea, Bosisio Parini, LC, Italy
| | - Francesca Dessimone
- NICU, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Ida Sirgiovanni
- NICU, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Roberto Giorda
- Molecular Biology Lab, Scientific Institute, IRCCS Eugenio Medea, Bosisio Parini, LC, Italy
| | - Claudia Cinnante
- Neuroradiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Letizia Squarcina
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milano, Italy
| | - Uberto Pozzoli
- Bioinformatics Lab, Scientific Institute, IRCCS Eugenio Medea, Bosisio Parini, LC, Italy
| | - Fabio Triulzi
- Neuroradiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Paolo Brambilla
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milano, Italy
- Department of Psychiatry and Behavioral Neurosciences, University of Texas at Houston, Houston, TX, United States of America
| | - Renato Borgatti
- Neuropsychiatry and Neurorehabilitation Unit, Scientific Institute, IRCCS Eugenio Medea, Bosisio Parini, LC, Italy
| | - Fabio Mosca
- NICU, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Rosario Montirosso
- 0–3 Centre for the at-Risk Infant, Scientific Institute, IRCCS Eugenio Medea, Bosisio Parini, LC, Italy
- * E-mail:
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Squarza C, Picciolini O, Gardon L, Ravasi M, Giannì ML, Porro M, Bonzini M, Gangi S, Mosca F. Seven Years Cognitive Functioning and Early Assessment in Extremely Low Birth Weight Children. Front Psychol 2017; 8:1257. [PMID: 28785236 PMCID: PMC5519617 DOI: 10.3389/fpsyg.2017.01257] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 07/10/2017] [Indexed: 01/09/2023] Open
Abstract
Infants born preterm are at high risk for the onset of cognitive dysfunctions at school age. The aim of this study was to investigate the association between early neurodevelopmental assessment and the risk of adverse cognitive outcome in extremely low birth weight children. We enrolled all newborns (January 2002 – April 2007) consecutively admitted to our Institution, with a birthweight < 1000 g. Exclusion criteria were genetic abnormalities, severe neurofunctional impairment, and/or neurosensory disabilities. Ninety-nine children were assessed at 1 year of corrected age using the Griffiths Mental Development Scales Revised. The same children were re-assessed at school age through the Wechsler Intelligence Scale for Children. Children with impaired Griffiths General Quotient (i.e., <1 SD) at 1 year of corrected age showed a significantly lower Full Scale Intelligence Quotient at 7 years of chronological age when compared to children who scored in the normal range at 1 year (p < 0.01). Considering the Griffiths Sub-quotients separately, a poor score in the Performance or in the Personal-Social Sub-quotients at 1 year was associated with significantly worse cognitive outcomes both in the Verbal and in the Performance Intelligence Quotients at 7 years (p < 0.01 and p < 0.05, respectively). A score <1 SD in the Locomotor or in the Eye and Hand Coordination Sub-quotients were specifically associated with poorer Performance or Verbal Intelligence Quotients, respectively (p < 0.05). Our findings suggest that a poor score on the Griffiths Scales at 1 year is associated with a higher risk of cognitive impairment at school age. Larger confirmation studies are needed.
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Affiliation(s)
- Chiara Squarza
- Neonatal Intensive Care Unit, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di MilanoMilan, Italy
| | - Odoardo Picciolini
- Neonatal Intensive Care Unit, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di MilanoMilan, Italy
| | - Laura Gardon
- Neonatal Intensive Care Unit, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di MilanoMilan, Italy
| | - Maura Ravasi
- Neonatal Intensive Care Unit, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di MilanoMilan, Italy
| | - Maria L Giannì
- Neonatal Intensive Care Unit, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di MilanoMilan, Italy
| | - Matteo Porro
- Neonatal Intensive Care Unit, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di MilanoMilan, Italy
| | - Matteo Bonzini
- Protection and Promotion of Workers Health Unit, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di MilanoMilan, Italy
| | - Silvana Gangi
- Neonatal Intensive Care Unit, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di MilanoMilan, Italy
| | - Fabio Mosca
- Neonatal Intensive Care Unit, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di MilanoMilan, Italy
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