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Oommen H, Oddbjørn Tveit T, Eskedal LT, Myr R, Swanson DM, Vistad I. The association between intrapartum opioid fentanyl and early breastfeeding: A prospective observational study. Acta Obstet Gynecol Scand 2021; 100:2294-2302. [PMID: 34622936 DOI: 10.1111/aogs.14268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 08/23/2021] [Accepted: 08/30/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Intrapartum opioids in labor may interfere with the early breastfeeding phase and cause breastfeeding difficulties. This study examines the effects of intrapartum fentanyl given intravenously (IV) or through epidural analgesia (EDA) on early breastfeeding. MATERIAL AND METHODS This is a prospective observational study conducted in a regional maternity unit. We included 1101 healthy mothers of term singleton babies in vertex presentation born between 2016 and 2018 (468 nulliparous and 633 multiparous). The main data were collected prospectively, and additional data were retrieved from hospital records. The main outcome measures were exclusive breastfeeding at discharge, spontaneous suckling, and breastfeeding problems after birth. We assessed the outcomes in four groups categorized by intrapartum opioid exposure: none, IV fentanyl, EDA fentanyl and IV+EDA fentanyl. We also analyzed the dose-response relation of fentanyl administered by epidural or IV and early breastfeeding. Ultimately, we dichotomized the IV fentanyl group into two groups (≤200 µg and >200 µg) to further study the effect on early breastfeeding. RESULTS The odds of non-exclusive breastfeeding were doubled with EDA fentanyl (odds ratio [OR] 2.45, 95% CI 1.34-4.48, p = 0.004) and four times higher with IV+EDA fentanyl (OR 4.20, 95% CI 2.49-7.09, p < 0.001) compared with no opioid exposure. Spontaneous suckling was negatively associated with intrapartum fentanyl use (p < 0.001) irrespective of mode of administration. When the IV fentanyl doses exceeded 200 µg compared with less than 200 µg, we found a reduction in exclusive breastfeeding (81% vs. 89%; p = 0.014) and spontaneous suckling (68% vs. 83%; p < 0.001) and an increase in breastfeeding problems (41% vs. 27%; p = 0.004). CONCLUSIONS Fentanyl in labor is associated with breastfeeding difficulties. However, IV fentanyl in low doses (≤200 µg) seems to affect breastfeeding less than EDA fentanyl and is therefore a viable alternative when labor analgesia is needed. This could be most relevant for multiparous women, where a shorter labor is expected. More research is needed to determine the optimal dose and route of administration of fentanyl for labor analgesia.
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Affiliation(s)
- Hanna Oommen
- Department of Obstetrics and Gynecology, Sørlandet Hospital Kristiansand, Kristiansand, Norway.,Department of Life Science and Education, University of South Wales, Pontypridd, UK
| | - Tor Oddbjørn Tveit
- Department of Anesthesiology and Intensive Care, Sørlandet Hospital, Kristiansand, Norway.,Research Department, Sørlandet Hospital, Kristiansand, Norway.,Faculty of Health and Sport Science, University of Agder, Kristiansand, Norway
| | - Leif T Eskedal
- Research Department, Sørlandet Hospital, Kristiansand, Norway
| | - Rachel Myr
- Department of Obstetrics and Gynecology, Sørlandet Hospital Kristiansand, Kristiansand, Norway
| | - David M Swanson
- Oslo Center for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Ingvild Vistad
- Department of Obstetrics and Gynecology, Sørlandet Hospital Kristiansand, Kristiansand, Norway.,Research Department, Sørlandet Hospital, Kristiansand, Norway.,Faculty of Health and Sport Science, University of Agder, Kristiansand, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
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Hauge LJ, Nes RB, Kornstad T, Kristensen P, Irgens LM, Landolt MA, Eskedal LT, Vollrath ME. Maternal Sick Leave Due to Psychiatric Disorders Following the Birth of a Child With Special Health Care Needs. J Pediatr Psychol 2015; 40:804-13. [PMID: 25911588 PMCID: PMC4536848 DOI: 10.1093/jpepsy/jsv034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 03/26/2015] [Indexed: 11/19/2022] Open
Abstract
Objective Child-related stress following the birth of a child with special health care needs (SHCN) can take a toll on parental health. This study examined how the risk of sick leave due to psychiatric disorders (PD) among mothers of children with SHCN compares with that of mothers of children without SHCN during early motherhood. Methods Responses from 58,532 mothers participating in the Norwegian Mother and Child Cohort Study were linked to national registries and monitored for physician-certified sick leave from the month of their child’s first birthday until the month of their child’s fourth birthday. Results As compared with mothers of children without SHCN, mothers of children with mild and moderate/severe care needs were at substantial risk of a long-term sick leave due to PD in general and due to depression more specifically. Conclusions Extensive childhood care needs are strongly associated with impaired mental health in maternal caregivers during early motherhood.
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Affiliation(s)
- Lars Johan Hauge
- Division of Mental Health, Norwegian Institute of Public Health,
| | | | - Tom Kornstad
- Division of Mental Health, Norwegian Institute of Public Health, Research Department, Statistics Norway
| | - Petter Kristensen
- Department of Occupational Medicine and Epidemiology, National Institute of Occupational Health, Institute of Health and Society, University of Oslo
| | - Lorentz M Irgens
- Department of Global Health and Primary Care, University of Bergen
| | - Markus A Landolt
- Department of Psychosomatics and Psychiatry, University Children's Hospital Zurich, Department of Child and Adolescent Health Psychology, Institute of Psychology, University of Zurich
| | | | - Margarete E Vollrath
- Division of Mental Health, Norwegian Institute of Public Health, Psychological Institute, University of Oslo
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Nes RB, Hauge LJ, Kornstad T, Kristensen P, Landolt MA, Eskedal LT, Irgens LM, Vollrath ME. The Impact of Child Behaviour Problems on Maternal Employment: A Longitudinal Cohort Study. J Fam Econ Issues 2014; 35:351-361. [PMID: 25165417 PMCID: PMC4141146 DOI: 10.1007/s10834-013-9378-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
This prospective population-based study examined associations between children's behaviour problems and maternal employment. Information on children's behaviour problems at 3 years from 22,115 mothers employed before pregnancy and participating in the Norwegian Mother and Child Cohort Study were linked to national register data on employment and relevant social background factors, mothers' self-reported susceptibility to anxiety/depression and mother-reports of day-care attendance and fathers' income. Mothers reporting their child to have severe (>2 SD) internalizing or severe combined behaviour problems (5 %) had excess risk of leaving paid employment irrespective of other important characteristics generally associated with maternal employment (RR 1.24-1.31). The attributable risk percent ranged from 30.3 % (internalizing problems) to 32.4 % (combined problems). Externalizing behaviour problems were not uniquely associated with mothers leaving employment.
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Affiliation(s)
- Ragnhild Bang Nes
- Division of Mental Health, Norwegian Institute of Public Health, PO Box 4404, Nydalen, 0403 Oslo, Norway
| | - Lars Johan Hauge
- Division of Mental Health, Norwegian Institute of Public Health, PO Box 4404, Nydalen, 0403 Oslo, Norway
| | - Tom Kornstad
- Division of Mental Health, Norwegian Institute of Public Health, PO Box 4404, Nydalen, 0403 Oslo, Norway
- Statistics Norway, Oslo, Norway
| | - Petter Kristensen
- Department of Occupational Medicine and Epidemiology, National Institute of Occupational Health, Oslo, Norway
- Institute of Health and Society, University of Oslo, Oslo, Norway
| | | | - Leif T. Eskedal
- Department of Pediatrics, Sørlandet Hospital, Kristiansand, Norway
| | - Lorentz M. Irgens
- Medical Birth Registry of Norway, Norwegian Institute of Public Health, Bergen, Norway
- Department of Global Public Health and Primary Health Care, University of Bergen, Bergen, Norway
| | - Margarete E. Vollrath
- Division of Mental Health, Norwegian Institute of Public Health, PO Box 4404, Nydalen, 0403 Oslo, Norway
- Institute of Psychology, University of Oslo, Oslo, Norway
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Hauge LJ, Kornstad T, Nes RB, Kristensen P, Irgens LM, Eskedal LT, Landolt MA, Vollrath ME. The impact of a child's special health care needs on maternal work participation during early motherhood. Paediatr Perinat Epidemiol 2013; 27:353-60. [PMID: 23772937 DOI: 10.1111/ppe.12063] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Many women temporarily reduce work hours or stop working when caring for small children. However, mothers of children with special health care needs may face particular challenges balancing childrearing responsibilities and employment demands. This study examines how the work participation among mothers of children with special health care needs compares with that of mothers in general during early motherhood, focusing in particular on the extent of the child's additional health care needs. METHODS By linkage of the population-based Norwegian Mother and Child Cohort Study with national registers on employment, child health care needs, and social background factors, 41,255 mothers employed prior to childbirth were followed until child age 3 years to investigate associations between the child's care needs and mother's dropping out of employment. RESULTS In total, 16.3% of the formerly employed mothers were no longer employed at child age 3 years. Mothers of children with mild care needs did not differ from mothers in general, whereas mothers of children with moderate [Risk Ratio (RR) 1.45; 95% confidence interval (CI) 1.17, 1.80] and severe care needs [RR 2.19; 95% CI 1.67, 2.87] were at substantial risk of not being employed at follow-up. The impact of the child's health care needs remained strong also after adjusting for several factors associated with employment in general. CONCLUSIONS Extensive childhood health care needs are associated with reduced short-term employment prospects and remain a substantial influence on mothers' work participation during early motherhood, irrespective of other important characteristics associated with maternal employment.
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Affiliation(s)
- Lars Johan Hauge
- Division of Mental Health, Norwegian Institute of Public Health, Oslo.
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Dale MTG, Solberg O, Holmstrøm H, Landolt MA, Eskedal LT, Vollrath ME. Relationship satisfaction among mothers of children with congenital heart defects: a prospective case-cohort study. J Pediatr Psychol 2013; 38:915-26. [PMID: 23792348 DOI: 10.1093/jpepsy/jst038] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To assess the level of partner relationship satisfaction among mothers of children with different severity of congenital heart defects (CHD) compared with mothers in the cohort. METHODS Mothers of children with mild, moderate, or severe CHD (n = 182) and a cohort of mothers of children without CHD (n = 46,782) from the Norwegian Mother and Child Cohort Study were assessed at 5 time points from pregnancy to 36 months postpartum. A 5-item version of the Relationship Satisfaction scale was used, and relevant covariates were explored. RESULTS The trajectories of relationship satisfaction among mothers of children with varying CHD severity did not differ from the trajectories in the cohort. All women in the cohort experienced decreasing relationship satisfaction from 18 months after delivery up to 36 months after delivery. CONCLUSIONS Having a child with CHD, regardless of severity, does not appear to exacerbate the decline in relationship satisfaction.
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Affiliation(s)
- Maria T G Dale
- Department of Psychosomatics and Health Behavior, Norwegian Institute of Public Health, Oslo, Norway.
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Grønning Dale MT, Solberg Ø, Holmstrøm H, Landolt MA, Eskedal LT, Vollrath ME. Well-being in mothers of children with congenital heart defects: a 3-year follow-up. Qual Life Res 2012. [DOI: 10.1007/s11136-012-0326-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Solberg Ø, Grønning Dale MT, Holmstrøm H, Eskedal LT, Landolt MA, Vollrath ME. Trajectories of maternal mental health: a prospective study of mothers of infants with congenital heart defects from pregnancy to 36 months postpartum. J Pediatr Psychol 2012; 37:687-96. [PMID: 22408057 DOI: 10.1093/jpepsy/jss044] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE To chart mothers' trajectories of mental health from pregnancy to 36 months postpartum in order to investigate the association between infants' congenital heart defects (CHD) and compromised maternal mental health. METHODS Mothers of infants with mild, moderate, or severe CHD (n = 141) and mothers (n = 36,437) enrolled in the Norwegian Mother and Child Cohort Study were assessed at regular intervals from pregnancy up to 36 months postpartum, including measurements at 6 and 18 months, using an 8-item version of the Hopkins Symptom Checklist-25. RESULTS Mean score trajectories of SCL-8 for mothers of infants with severe CHD deviated significantly from cohort controls 6, 18, and 36 months postpartum, indicating heightened symptoms of depression and anxiety. CONCLUSIONS Mothers of infants with severe CHD are at risk of compromised mental health from delivery to 36 months postpartum. Strain due to CHD-related interventions is identified as a possible partial mediator of the distress.
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Affiliation(s)
- Øivind Solberg
- Department of Psychosomatics and Health Behaviour, Norwegian Institute of Public Health, Box 4404 Nydalen, 0403 Oslo, Norway.
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Solberg Ø, Dale MTG, Holmstrøm H, Eskedal LT, Landolt MA, Vollrath ME. Emotional reactivity in infants with congenital heart defects and maternal symptoms of postnatal depression. Arch Womens Ment Health 2011; 14:487-92. [PMID: 22020995 DOI: 10.1007/s00737-011-0243-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2011] [Accepted: 10/05/2011] [Indexed: 10/16/2022]
Abstract
The object of this study was to examine the role of emotional reactivity in infants with congenital heart defects (CHD) in relation to their mothers' symptoms of postnatal depression. The study population was drawn from the Norwegian country-wide CHD registry from the Department of Pediatric Cardiology at Oslo University Hospital and the Norwegian Mother and Child Cohort Study. Mother-infant dyads with mild/moderate or severe CHD (n=242) were assessed with a 6-item short version (EPDS-6) of the Edinburgh Postnatal Depression Scale and the Infant Characteristic Questionnaire's fussy/difficult subscale (ICQ-D/F-7) at 6 months postpartum. When adjusting for infant emotional reactivity, mothers of infants with severe CHD showed significantly elevated symptoms of postnatal depression 6 months postpartum (odds ratio=2.22) compared to the mothers of infants with mild/moderate CHD. The results identify severe CHD in infants as a predictor of heightened symptoms of postnatal depression in mothers, independent of the infant's emotional reactivity. Although a causal direction underlying the association could not be determined, the possible, negative reciprocal relationships between severe CHD in infants, high levels of emotional reactivity in infants, and symptoms of maternal postnatal depression are considered.
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Affiliation(s)
- Øivind Solberg
- Department of Psychosomatics and Health Behaviour, Norwegian Institute of Public Health, Nydalen, Box 4404, 0403, Oslo, Norway.
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Dale MTG, Solberg Ø, Holmstrøm H, Landolt MA, Eskedal LT, Vollrath ME. Mothers of infants with congenital heart defects: well-being from pregnancy through the child’s first six months. Qual Life Res 2011; 21:115-22. [DOI: 10.1007/s11136-011-9920-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2011] [Indexed: 11/27/2022]
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Stene-Larsen K, Brandlistuen RE, Holmstrøm H, Landolt MA, Eskedal LT, Engdahl B, Vollrath ME. Longitudinal findings from a Norwegian case-cohort study on internalizing problems in children with congenital heart defects. Acta Paediatr 2011; 100:236-41. [PMID: 20854393 DOI: 10.1111/j.1651-2227.2010.02015.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM To examine the association of the severity of congenital heart defects (CHDs) with internalizing problems in 18-month-olds and to explore the extent to which the internalizing problems are influenced by maternal distress and emotional reactivity in the child at age 6 months. METHODS We linked prospective data from the Norwegian Mother and Child Cohort Study, conducted by the Norwegian Institute of Public Health, with a nationwide CHD registry and identified 198 18-month-olds with CHDs in a cohort of 47 692 toddlers. Maternal reports on the children's emotional reactivity at age 6 months, the children's internalizing problems (anxiety, sleep problems, emotional reactivity) at age 18 months and maternal distress were assessed by questionnaires. RESULTS We found an association at age 18 months between the severity of the CHD and anxiety but not sleep problems or emotional reactivity. Children with severe but not with mild or moderate CHDs were twice as likely to experience the symptoms of anxiety compared with controls. These symptoms are not merely sequelae of earlier psychological reactions or concurrent maternal distress. CONCLUSION Should these findings be replicated, future studies ought to investigate the mechanisms leading to elevated anxiety in toddlers with CHDs. In addition, clinical interventions should address the child's anxiety as well as the interaction between the parents and the child.
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Affiliation(s)
- Kim Stene-Larsen
- Department of Psychosomatics and Health Behavior, Norwegian Institute of Public Health, Oslo, Norway.
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Brandlistuen RE, Stene-Larsen K, Holmstrøm H, Landolt MA, Eskedal LT, Vollrath ME. Symptoms of communication and social impairment in toddlers with congenital heart defects. Child Care Health Dev 2011; 37:37-43. [PMID: 20825422 DOI: 10.1111/j.1365-2214.2010.01148.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND With the advances in congenital cardiac surgery and medical management, mortality rates for congenital heart defects (CHD) have declined remarkably. As the number of CHD survivors have increased there is a growing focus on developmental morbidity. The objective of the current study is to compare symptoms of communication and social impairment in 18-month-old children with different severity of CHD with those of controls. METHOD We linked prospective data from the Norwegian Mother and Child Cohort Study, conducted by the Norwegian Institute of Public Health, with a nationwide medical CHD registry and identified 198 18-month-olds with CHD in a cohort of 47,692. Three groups of CHD were distinguished: mild/moderate (n= 122), severe (n= 54) and CHD with comorbidity (n= 22). Mothers reported on the child's communication and social skills by completing items from the Ages and Stages Questionnaire as part of the Norwegian Mother and Child Cohort Study. RESULTS Children aged 18 months old with CHD differed significantly from controls in levels of symptoms of communication impairment (P≤ 0.0001) and social impairment (P≤ 0.0001). The largest differences were found in children with CHD and comorbidity. Children with severe CHD also showed higher levels of both symptoms of communication and social impairment. Children with mild/moderate CHD showed a small difference only in symptoms of communication impairment. CONCLUSION Children with severe CHD and CHD with comorbidity show more symptoms of communication and social impairment compared with a large cohort at the age of 18 months. It is important to broaden the scope of inquiry to involve communication and social developmental domains.
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Affiliation(s)
- R E Brandlistuen
- Department of Psychosomatics and Health Behavior, Norwegian Institute of Public Health, Nydalen, Oslo, Norway.
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Solberg Ø, Dale MTG, Holmstrøm H, Eskedal LT, Landolt MA, Vollrath ME. Long-term symptoms of depression and anxiety in mothers of infants with congenital heart defects. J Pediatr Psychol 2010; 36:179-87. [PMID: 20558484 DOI: 10.1093/jpepsy/jsq054] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To examine the relationship between the severity of infants' congenital heart defects (CHD) and their mothers' symptoms of depression and anxiety from pregnancy to 18 months postpartum. METHODS Mothers of infants with mild, moderate, or severe CHD (n=162) and mothers (n=44,400) within the Norwegian Mother and Child Cohort Study were assessed with an eight-item short version (SCL-8) of the Hopkins Symptom Checklist-25 at the 30th week of gestation and at 6 and 18 months postpartum. RESULTS Only the postpartum mental health trajectory of mothers of infants with severe CHD deviated from the mental health trajectory of the cohort at 6 and 18 months postpartum, showing significantly elevated levels of depression and anxiety symptoms. CONCLUSIONS The results elucidate the relationship between infants' CHD severity and maternal symptoms of depression and anxiety, possibly identifying a specifically vulnerable patient dyad in need of postoperative interventions.
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Affiliation(s)
- Øivind Solberg
- Department of Psychosomatics and Health Behaviour, Norwegian Institute of Public Health, Box 4404 Nydalen, 0403 Oslo, Norway.
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Brandlistuen RE, Stene-Larsen K, Holmstrom H, Landolt MA, Eskedal LT, Vollrath ME. Motor and social development in 6-month-old children with congenital heart defects. J Pediatr 2010; 156:265-9.e1. [PMID: 19880142 DOI: 10.1016/j.jpeds.2009.08.035] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2009] [Revised: 06/05/2009] [Accepted: 08/14/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To assess whether the development of children with varying severity of congenital heart defect (CHD) differs from that of children without CHD at age 6 months. STUDY DESIGN A total of 236 children with CHD were compared with 61 032 children from the Norwegian Mother and Child Cohort Study conducted by the Norwegian Institute of Public Health. Diagnostic and treatment information was retrieved from a nationwide CHD registry. Four groups of CHD were distinguished: mild (n = 92), moderate (n = 50), severe (n = 70), and CHD with comorbidity (n = 24). At child age 6 months, the children's mothers reported on motor and social development by using the Mother and Child Questionnaire. RESULTS After adjusting for confounders (ie, birth weight), severe CHD increased the odds of gross motor impairment (odds ratio [OR], 3.78; 95% CI, 1.97-7.25) and fine motor impairment (OR, 2.04; 95% CI, 0.96-4.33). CHD with co-morbidity (eg, intestinal malformations) increased the odds of gross motor impairment (OR, 3.00; 95% CI, 0.95-9.51), fine motor impairment (OR, 5.47; 95% CI, 2.03-14.74), and social impairment (OR, 3.43; 95% CI, 1.40-8.41). CONCLUSION Increased odds of motor impairment are present already in infancy in severe CHD and CHD with comorbidity. CHD with comorbidity increases the odds of social impairment.
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Affiliation(s)
- Ragnhild Eek Brandlistuen
- Department of Psychosomatics and Health Behavior, Norwegian Institute of Public Health, Post Box 4404,Nydalen, 0403 Oslo, Norway.
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Stene-Larsen K, Brandlistuen RE, Holmstrøm H, Landolt MA, Eskedal LT, Vollrath ME. Emotional reactivity in infants with congenital heart defects: findings from a large case-cohort study in Norway. Acta Paediatr 2010; 99:52-5. [PMID: 19785633 DOI: 10.1111/j.1651-2227.2009.01515.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM Advances in medical treatment in recent years have led to dramatically improved survival rates of children with severe congenital heart defects (CHD). However, very little is known about the psychological consequences for these children, particularly during and after the early period of invasive treatment. In this study, we investigated the extent to which the severity of the CHD affects the child's emotional reactivity at 6 months of age. METHOD We linked prospective data from the Norwegian Mother and Child Cohort Study, conducted by the Norwegian Institute of Public Health with a nationwide medical CHD registry and identified 212 infants with CHD in a cohort of 61 299 infants. Mothers reported on their child's emotional reactivity at age 6 months by means of a standardized questionnaire. RESULTS Infants with severe to moderate CHD had 60% higher odds for severe emotional reactivity (cut-off at the 85 percentile) compared with healthy infants, after controlling for important maternal and child confounders. CONCLUSION Our study is the first to show elevated emotional reactivity in children with moderate to severe CHD, suggesting a need for special parental attention to soothe their distress. Follow-up studies will show whether this emotional reactivity is transient or an early marker of continuing emotional or behavioural problems.
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Affiliation(s)
- K Stene-Larsen
- Department of Psychosomatics and Health Behavior, Norwegian Institute of Public Health, Oslo, Norway.
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Eskedal LT, Hagemo PS, Seem E, Eskild A, Cvancarova M, Seiler S, Thaulow E. Impaired weight gain predicts risk of late death after surgery for congenital heart defects. Arch Dis Child 2008; 93:495-501. [PMID: 18230653 DOI: 10.1136/adc.2007.126219] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To describe long-term somatic growth in terms of weight for age in children operated on for congenital heart defects who die late (after the first 30 postoperative days) and to study the relationship between postoperative weight gain and survival after surgery for congenital heart defects. METHODS This was a nested case-control study of 80 children born in 1990-2002 who died late after surgery for congenital heart defects at Rikshospitalet, Norway. Weight data were obtained for 74 children, of whom 31 with no extra-cardiac anomalies were defined as cases and 31 surviving children with similar surgical complexity were defined as controls. RESULTS In the 74 children who died late, mean weight for age converted to z scores at birth, at last operation and at last recorded weight were 0.12, -1.31 and -2.09. In the 31 children defined as cases, the same weight z scores were 0.07, -1.21 and -2.01 compared with 0.05, -1.10 and -0.99 in the 31 matched controls. The odds ratio (OR) for death was 13.5 (95% CI 3.6 to 51.0) if there was a decrease in weight z score of >0.67 after the last operation. Median follow-up time after operation was 5.7 months. CONCLUSIONS A decrease in weight for age during the first months after surgery for congenital heart defects of more than 0.67 z scores, corresponding to a downward percentile crossing through at least one of the displayed percentile lines on standard growth charts, is strongly related to late mortality in children operated on for congenital heart defects.
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Affiliation(s)
- L T Eskedal
- Department of Paediatrics, Sørlandet Regional Hospital, Kristiansand, Norway.
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Eskedal LT, Hagemo PS, Eskild A, Frøslie KF, Seiler S, Thaulow E. A population-based study relevant to seasonal variations in causes of death in children undergoing surgery for congenital cardiac malformations. Cardiol Young 2007; 17:423-31. [PMID: 17583596 DOI: 10.1017/s1047951107000881] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Our objectives were, first, to study seasonal distribution of perioperative deaths within 30 days after surgery, and late death, in children undergoing surgery for congenitally malformed hearts, and second, to study the causes of late death. METHODS We analysed a retrospective cohort of 1,753 children with congenital cardiac malformations born and undergoing surgery in the period from 1990 through 2002 with a special focus on the causes of late death. The data was obtained from the registry of congenital cardiac malformations at Rikshospitalet, Oslo, and the Norwegian Medical Birth Registry. The mean follow-up from birth was 8.1 years, with a range from zero to 15.2 years. RESULTS During the period of follow-up, 204 (11.6%) of the children died having undergone previous surgery. Of these 124 (7.1%) died in the perioperative period, and 80 (4.5%) were late deaths. There were 56 late deaths during the 6 coldest months, compared with 24 during the 6 warmest months (p < 0.01). There was no significant seasonal variation in perioperative deaths. Respiratory infection was the most common cause of late death, and occurred in 25 children, of whom 24 died during the 6 coldest months. Of the 8 sudden late deaths, 7 occurred during the 6 coldest months. There was no seasonal variation for the other causes of death. CONCLUSIONS In children undergoing surgery for congenital cardiac malformations in Norway, there is a seasonal variation in late death, with a higher proportion occurring in the coldest months. Death related to respiratory infections predominantly occurs in the winter season, and is the overall most common cause of late death.
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Affiliation(s)
- Leif T Eskedal
- Department of Paediatrics, Sørlandet Regional Hospital, Kristiansand, Norway.
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