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Ortelan N, de Almeida MF, Pinto Júnior EP, Bispo N, Fiaccone RL, Falcão IR, Rocha ADS, Ramos D, Paixão ES, de Cássia Ribeiro-Silva R, Rodrigues LC, Barreto ML, Ichihara MYT. Evaluating the relationship between conditional cash transfer programme on preterm births: a retrospective longitudinal study using the 100 million Brazilian cohort. BMC Public Health 2024; 24:713. [PMID: 38443875 PMCID: PMC10916064 DOI: 10.1186/s12889-024-18152-2] [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: 04/14/2023] [Accepted: 02/19/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Preterm births increase mortality and morbidity during childhood and later life, which is closely associated with poverty and the quality of prenatal care. Therefore, income redistribution and poverty reduction initiatives may be valuable in preventing this outcome. We assessed whether receipt of the Brazilian conditional cash transfer programme - Bolsa Familia Programme, the largest in the world - reduces the occurrence of preterm births, including their severity categories, and explored how this association differs according to prenatal care and the quality of Bolsa Familia Programme management. METHODS A retrospective cohort study was performed involving the first live singleton births to mothersenrolled in the 100 Million Brazilian Cohort from 2004 to 2015, who had at least one child before cohort enrollment. Only the first birth during the cohort period was included, but born from 2012 onward. A deterministic linkage with the Bolsa Familia Programme payroll dataset and a similarity linkage with the Brazilian Live Birth Information System were performed. The exposed group consisted of newborns to mothers who received Bolsa Familia from conception to delivery. Our outcomes were infants born with a gestational age < 37 weeks: (i) all preterm births, (ii) moderate-to-late (32-36), (iii) severe (28-31), and (iv) extreme (< 28) preterm births compared to at-term newborns. We combined propensity score-based methods and weighted logistic regressions to compare newborns to mothers who did and did not receive Bolsa Familia, controlling for socioeconomic conditions. We also estimated these effects separately, according to the adequacy of prenatal care and the index of quality of Bolsa Familia Programme management. RESULTS 1,031,053 infants were analyzed; 65.9% of the mothers were beneficiaries. Bolsa Familia Programme was not associated with all sets of preterm births, moderate-to-late, and severe preterm births, but was associated with a reduction in extreme preterm births (weighted OR: 0.69; 95%CI: 0.63-0.76). This reduction can also be observed among mothers receiving adequate prenatal care (weighted OR: 0.66; 95%CI: 0.59-0.74) and living in better Bolsa Familia management municipalities (weighted OR: 0.56; 95%CI: 0.43-0.74). CONCLUSIONS An income transfer programme for pregnant women of low-socioeconomic status, conditional to attending prenatal care appointments, has been associated with a reduction in extremely preterm births. These programmes could be essential in achieving Sustainable Development Goals.
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Affiliation(s)
- Naiá Ortelan
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute (IGM), Oswaldo Cruz Foundation (FIOCRUZ-BA), Salvador, Bahia, Brazil.
- Center for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation. Edifício Tecnocentro, Rua Mundo, 121, Trobogy, Salvador, Bahia, 41745-715, Brazil.
| | | | - Elzo Pereira Pinto Júnior
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute (IGM), Oswaldo Cruz Foundation (FIOCRUZ-BA), Salvador, Bahia, Brazil
| | - Nivea Bispo
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute (IGM), Oswaldo Cruz Foundation (FIOCRUZ-BA), Salvador, Bahia, Brazil
- Institute of Mathematics and Statistics, Federal University of Bahia (UFBA), Salvador, Bahia, Brazil
| | - Rosemeire L Fiaccone
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute (IGM), Oswaldo Cruz Foundation (FIOCRUZ-BA), Salvador, Bahia, Brazil
- Institute of Mathematics and Statistics, Federal University of Bahia (UFBA), Salvador, Bahia, Brazil
| | - Ila Rocha Falcão
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute (IGM), Oswaldo Cruz Foundation (FIOCRUZ-BA), Salvador, Bahia, Brazil
| | - Aline Dos Santos Rocha
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute (IGM), Oswaldo Cruz Foundation (FIOCRUZ-BA), Salvador, Bahia, Brazil
| | - Dandara Ramos
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute (IGM), Oswaldo Cruz Foundation (FIOCRUZ-BA), Salvador, Bahia, Brazil
- Collective Health Institute, Federal University of Bahia (UFBA), Salvador, Bahia, Brazil
| | - Enny S Paixão
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute (IGM), Oswaldo Cruz Foundation (FIOCRUZ-BA), Salvador, Bahia, Brazil
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Rita de Cássia Ribeiro-Silva
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute (IGM), Oswaldo Cruz Foundation (FIOCRUZ-BA), Salvador, Bahia, Brazil
- School of Nutrition, Federal University of Bahia (UFBA), Salvador, Bahia, Brazil
| | - Laura C Rodrigues
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute (IGM), Oswaldo Cruz Foundation (FIOCRUZ-BA), Salvador, Bahia, Brazil
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Mauricio L Barreto
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute (IGM), Oswaldo Cruz Foundation (FIOCRUZ-BA), Salvador, Bahia, Brazil
- Collective Health Institute, Federal University of Bahia (UFBA), Salvador, Bahia, Brazil
| | - Maria Yury T Ichihara
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute (IGM), Oswaldo Cruz Foundation (FIOCRUZ-BA), Salvador, Bahia, Brazil
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Egge JA, Anderson RH, Schimelpfenig MD. Care of the Well Newborn. Pediatr Rev 2022; 43:676-690. [PMID: 36450636 DOI: 10.1542/pir.2022-005511] [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] [Indexed: 12/04/2022]
Abstract
Care of the newborn infant is a critical skill for general pediatricians and other providers in the practice of pediatric medicine. Optimal care relies on a thorough understanding of risk factors that may be present during the pregnancy and delivery, as well as the ability to recognize and address unanticipated problems in the postnatal period. This article focuses on antenatal care of the newborn, issues that present in the immediate postdelivery period, and care of the newborn after discharge. It also includes updated information on current topics in pediatric practice, such as the importance of vaccination, parental hesitancy in accepting common medical interventions, and updated guidelines related to the coronavirus disease 2019 pandemic. At the conclusion of the article, the reader should have a general understanding of antenatal risk factors that could affect the transition from the intrauterine environment and have the knowledge to address common issues that arise in the care of newborn infants.
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Affiliation(s)
- Justin A Egge
- Sanford School of Medicine, University of South Dakota, Sioux Falls, SD
| | | | - Michelle D Schimelpfenig
- Sanford School of Medicine, University of South Dakota, Sioux Falls, SD.,Department of Pediatrics, Sanford School of Medicine, University of South Dakota, Sioux Falls, SD
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Khanijahani A, Sualp K. Adverse Childhood Experiences, Neighborhood Support, and Internalizing and Externalizing Mental Disorders among 6-17 years old US Children: Evidence from a Population-Based Study. Community Ment Health J 2022; 58:166-178. [PMID: 33709281 DOI: 10.1007/s10597-021-00808-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 02/23/2021] [Indexed: 11/24/2022]
Abstract
We pooled data from four years (2016-2019) of the National Survey of Children's Health (NSCH) and included a nationally representative sample of 6 to 17 years old US children (N = 94,369; Mean age = 11.53 years, Standard Deviation [SD] = 3.53). Among 6-17-year-old US children, about 48% had a lifelong exposure to at least one of nine Adverse Childhood Experiences (ACEs), and 18.7% had a current diagnosis of at least one of four mental disorders. We examined the association between ACEs, neighborhood support, and mental disorders using several logistic regression models. More types of lifelong ACEs and lower neighborhood support were associated with a higher diagnosis of internalizing (anxiety/depression) and externalizing (ADHD/behavior problems) mental disorders (odds ratio [OR] > 1, and p < .001 for all relationships). After controlling for neighborhood support in the models, the odds ratios for ACEs attenuated but remained significant in all models regardless of mental disorder type or age group. However, the odds ratios for neighborhood support were larger for the association with ADHD/behavior problems than anxiety/depression. Moreover, odds ratios for neighborhood support levels were higher for older children (12-17 years old) compared to younger (6-11 years old) children. Higher neighborhood support appears to mitigate the adverse effects of ACEs on mental disorders, especially externalizing mental disorders (anxiety/depression) among adolescents (12-17 years old).
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Affiliation(s)
- Ahmad Khanijahani
- Department of Health Administration and Public Health, John G. Rangos School of Health Sciences, Duquesne University, Pittsburgh, PA, USA.
| | - Kenan Sualp
- Department of Public Affairs, University of Central Florida, Orlando, FL, USA
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Sotiros A, Thornhill D, Post MD, Winn VD, Armstrong J. Inflammatory cytokines, placental pathology, and neurological outcomes in infants born to preterm preeclamptic mothers. PLoS One 2021; 16:e0260094. [PMID: 34780565 PMCID: PMC8592443 DOI: 10.1371/journal.pone.0260094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 11/02/2021] [Indexed: 02/04/2023] Open
Abstract
Preeclampsia is both a vascular and inflammatory disorder. Since the placenta is a conduit for fetal development, preeclampsia should be a presumed cause of adverse infant outcomes. Yet, the relationship of placental pathology, inflammation and neurological outcomes after preeclampsia are understudied. We prospectively examined a cohort of maternal-infant dyads with preeclampsia for maternal inflammatory cytokines at time of preeclampsia diagnosis and delivery, and fetal cord blood cytokines (IL-1β, IL-6, IL-8, and TNF-α). Placentas were analyzed for inflammatory and vascular pathologies. Neurodevelopmental assessment of infants utilizing the Pediatric Stroke Outcome Measure (PSOM) was conducted at 6-month corrected gestational age. Eighty-one maternal-newborn dyads were examined. Worse neurological outcomes were not associated with elevated maternal / fetal cytokines. Early preterm birth (gestational age ≤ 32 weeks) was associated with worse neurological outcomes at 6-months regardless of maternal/ fetal cytokine levels, placental pathology, or cranial ultrasound findings (OR 1.70, [1.16-2.48], p = 0.006). When correcting for gestational age, elevated IL-6 approached significance as a predictor for worse developmental outcome (OR 1.025 [0.985-1.066], p = 0.221). Pathological evidence of maternal malperfusion and worse outcomes were noted in early preterm, although our sample size was small. Our study did not demonstrate an obvious association of inflammation and placental pathology in preeclampsia and adverse neurodevelopmental outcome at 6-month corrected age but does suggest maternal malperfusion at earlier gestational age may be a risk factor for worse outcome.
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Affiliation(s)
- Alexandra Sotiros
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
| | - Dianne Thornhill
- Hemophilia and Thrombosis Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
| | - Miriam D. Post
- Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
| | - Virginia D. Winn
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California, United States of America
| | - Jennifer Armstrong
- Hemophilia and Thrombosis Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
- Department of Pediatrics, Section of Neurology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
- Department of Obstetrics and Gynecology, Division of Basic Reproductive Sciences, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
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Mukosha M, Kaonga P, Kapembwa KM, Musonda P, Vwalika B, Lubeya MK, Jacobs C. Modelling mortality within 28 days among preterm infants at a tertiary hospital in Lusaka, Zambia: a retrospective review of hospital-based records. Pan Afr Med J 2021; 39:69. [PMID: 34422192 PMCID: PMC8363965 DOI: 10.11604/pamj.2021.39.69.27138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 02/05/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction globally, almost half of all deaths in children under five years of age occur among neonates. We investigated the predictors of mortality within 28 days among preterm infants at a tertiary hospital in Lusaka, Zambia. Methods we reviewed admission records linked to birth, mortality, and hospital discharge from 1st January 2018 to 30th September 2019. Information was retrieved with a follow-up period of 28 days post-delivery to discharge/mortality. We used the Weibull hazards regression to establish the best predictor model for mortality among the neonates. Results a total of 3237 case records of women with a median age of 27 years (IQR, 22-33) were included in the study, of which 971 (30%) delivered term infants and 2267 (70%) preterm infants. The overall median survival time of the infants was 98 hours (IQR, 34-360). Preterm birth was not associated with increased hazards of mortality compared to term birth (p=0.078). Being in the Kangaroo Mother Care compared to Neonatal Intensive Care Unit (NICU), and a unit increase in birth weight were independently associated with reduced hazards of mortality. On the other hand, having hypoxic-ischemic encephalopathy, experiencing difficulty in feeding and vaginal delivery compared to caesarean section independently increased the hazards of mortality. Conclusion having hypoxic-ischemic encephalopathy, vaginal delivery, and experiencing difficulty in feeding increases the risk of mortality among neonates. Interventions to reduce neonatal mortality should be directed on these factors in this setting.
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Affiliation(s)
- Moses Mukosha
- Department of Pharmacy, University of Zambia, Lusaka, Zambia.,School of Public Health, University of Zambia, Lusaka, Zambia
| | - Patrick Kaonga
- School of Public Health, University of Zambia, Lusaka, Zambia
| | | | - Patrick Musonda
- School of Public Health, University of Zambia, Lusaka, Zambia
| | - Bellington Vwalika
- Department of Obstetrics and Gynecology, University of Zambia, Lusaka, Zambia
| | - Mwansa Ketty Lubeya
- Department of Obstetrics and Gynecology, University of Zambia, Lusaka, Zambia.,Young Emerging Scientists Zambia, Lusaka, Zambia
| | - Choolwe Jacobs
- School of Public Health, University of Zambia, Lusaka, Zambia
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Jantsch LB, Alves TF, Arrué AM, Toso BRGDO, Neves ET. Health care network (dis)articulation in late and moderate prematurity. Rev Bras Enferm 2021; 74:e20200524. [PMID: 34105598 DOI: 10.1590/0034-7167-2020-0524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 11/16/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to analyze the Health Care Network (dis)articulation of late and moderate premature infants in the first year of life. METHOD a qualitative study with semi-structured interview, which addressed the care network constitution in a municipality in southern Brazil. Fifteen mothers of infants participated. Thematic content analysis and flowchart were used to describe networks and services. RESULTS first contact in Primary Health Care is a decisive factor for the recognition and articulation of neonates/infants in the network and enables resolution, especially in childcare demands. Secondary and hospital care services support isolated acute events or chronic conditions, without articulation between levels of care and in a uniprofessional way. FINAL CONSIDERATIONS attention to health conditions is organized and structured in a uniprofessional, fragmented and disjointed way, which makes it impossible to form a Health Care Network premature infants' perspective.
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Structural network performance for early diagnosis of spastic cerebral palsy in periventricular white matter injury. Brain Imaging Behav 2021; 15:855-864. [PMID: 32306282 DOI: 10.1007/s11682-020-00295-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Periventricular white matter injury (PWMI) is a common cause of spastic cerebral palsy (SCP). Diffusion tensor imaging (DTI) shows high sensitivity but moderate specificity for predicting SCP. The limited specificity may be due to the diverse and extensive brain injuries seen in infants with PWMI. We enrolled 72 infants with corrected age from 6 to 18 months in 3 groups: PWMI with SCP (n = 20), non-CP PWMI (n = 19), and control (n = 33) groups. We compared DTI-based brain network properties among the three groups and evaluated the diagnostic performance of brain network properties for SCP in PWMI infants. Our results show abnormal global parameters (reduced global and local efficiency, and increased shortest path length), and local parameters (reduced node efficiency) in the PWMI with SCP group. On logistic regression, the combined node efficiency of the bilateral precentral gyrus and right middle frontal gyrus had a high sensitivity (90%) and specificity (95%) for differentiating PWMI with SCP from non-CP PWMI, and significantly correlated with the Gross Motor Function Classification System scores. This study confirms that DTI-based brain network has great diagnostic performance for SCP in PWMI infants, and the combined node efficiency improves the diagnostic accuracy.
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Jacques IJAA, Katz L, Sena MA, Guimarães ABG, Silva YL, Albuquerque GDM, Pereira RO, de Albuquerque CAMC, Silva MAL, Oliveira PAS, Albuquerque MDFPM, Cordeiro MT, Marques ETA, França RFO, Martelli CMT, Castanha PMS, Braga C. High Incidence of Zika or Chikungunya Infection among Pregnant Women Hospitalized Due to Obstetrical Complications in Northeastern Brazil-Implications for Laboratory Screening in Arbovirus Endemic Area. Viruses 2021; 13:v13050744. [PMID: 33922819 PMCID: PMC8145990 DOI: 10.3390/v13050744] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/11/2021] [Accepted: 04/20/2021] [Indexed: 12/16/2022] Open
Abstract
The diagnostic of arbovirus-related obstetric complications in high-risk pregnancy and childbirth care is challenging, especially in endemic areas. We conducted a prospective study to track active or recent Zika (ZIKV), dengue (DENV), or chikungunya (CHIKV) virus infection among hospitalized pregnant women (PW) with obstetric complications in a hospital at the epicenter of Zika outbreak and ZIKV-related microcephaly in Brazil. Clinical data and blood samples were collected at enrollment and 10 days after the admission of study participants, between October 2018 and May 2019. Further clinical data were extracted from medical records. Samples were screened by molecular and serological tests. Out of 780 participants, 93.1% (95% CI: 91.1–94.7%) presented previous DENV exposure (IgG). ZIKV, CHIKV, and/or DENV laboratory markers of recent or active infection were detected in 130 PW, yielding a prevalence of 16.6% (95% CI: 14.2–19.5%); 9.4% (95% CI: 7.4–11.7%), 7.4% (95% CI: 5.7–9.7%), and 0.38% (95% CI: 0.1–1.2%) of CHIKV, ZIKV, and DENV infections, respectively. Most ZIKV infections were detected by molecular assays (89.6%), while CHIKV infections were detected by serology (95.9%). Our findings highlight the need for arbovirus infections screening in PW with obstetrical complications, potentially associated to these infections in endemic areas regardless of the signs or symptoms suggestive of arboviral disease.
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Affiliation(s)
- Iracema J. A. A. Jacques
- Instituto Aggeu Magalhães, Fundação Oswaldo Cruz Pernambuco, Recife CEP 50740-465, PE, Brazil; (I.J.A.A.J.); (M.A.S.); (A.B.G.G.); (Y.L.S.); (M.A.L.S.); (P.A.S.O.); (M.d.F.P.M.A.); (M.T.C.); (R.F.O.F.); (C.M.T.M.)
| | - Leila Katz
- Instituto de Medicina Integral Prof. Fernando Figueira, Recife CEP 50070-550, PE, Brazil; (L.K.); (G.D.M.A.); (R.O.P.); (C.A.M.C.d.A.)
| | - Marília A. Sena
- Instituto Aggeu Magalhães, Fundação Oswaldo Cruz Pernambuco, Recife CEP 50740-465, PE, Brazil; (I.J.A.A.J.); (M.A.S.); (A.B.G.G.); (Y.L.S.); (M.A.L.S.); (P.A.S.O.); (M.d.F.P.M.A.); (M.T.C.); (R.F.O.F.); (C.M.T.M.)
| | - Ana B. G. Guimarães
- Instituto Aggeu Magalhães, Fundação Oswaldo Cruz Pernambuco, Recife CEP 50740-465, PE, Brazil; (I.J.A.A.J.); (M.A.S.); (A.B.G.G.); (Y.L.S.); (M.A.L.S.); (P.A.S.O.); (M.d.F.P.M.A.); (M.T.C.); (R.F.O.F.); (C.M.T.M.)
| | - Yasmim L. Silva
- Instituto Aggeu Magalhães, Fundação Oswaldo Cruz Pernambuco, Recife CEP 50740-465, PE, Brazil; (I.J.A.A.J.); (M.A.S.); (A.B.G.G.); (Y.L.S.); (M.A.L.S.); (P.A.S.O.); (M.d.F.P.M.A.); (M.T.C.); (R.F.O.F.); (C.M.T.M.)
| | - Gabriela D. M. Albuquerque
- Instituto de Medicina Integral Prof. Fernando Figueira, Recife CEP 50070-550, PE, Brazil; (L.K.); (G.D.M.A.); (R.O.P.); (C.A.M.C.d.A.)
| | - Raisa O. Pereira
- Instituto de Medicina Integral Prof. Fernando Figueira, Recife CEP 50070-550, PE, Brazil; (L.K.); (G.D.M.A.); (R.O.P.); (C.A.M.C.d.A.)
| | - Camila A. M. C. de Albuquerque
- Instituto de Medicina Integral Prof. Fernando Figueira, Recife CEP 50070-550, PE, Brazil; (L.K.); (G.D.M.A.); (R.O.P.); (C.A.M.C.d.A.)
| | - Maria Almerice L. Silva
- Instituto Aggeu Magalhães, Fundação Oswaldo Cruz Pernambuco, Recife CEP 50740-465, PE, Brazil; (I.J.A.A.J.); (M.A.S.); (A.B.G.G.); (Y.L.S.); (M.A.L.S.); (P.A.S.O.); (M.d.F.P.M.A.); (M.T.C.); (R.F.O.F.); (C.M.T.M.)
| | - Paula A. S. Oliveira
- Instituto Aggeu Magalhães, Fundação Oswaldo Cruz Pernambuco, Recife CEP 50740-465, PE, Brazil; (I.J.A.A.J.); (M.A.S.); (A.B.G.G.); (Y.L.S.); (M.A.L.S.); (P.A.S.O.); (M.d.F.P.M.A.); (M.T.C.); (R.F.O.F.); (C.M.T.M.)
| | - Maria de Fátima P. M. Albuquerque
- Instituto Aggeu Magalhães, Fundação Oswaldo Cruz Pernambuco, Recife CEP 50740-465, PE, Brazil; (I.J.A.A.J.); (M.A.S.); (A.B.G.G.); (Y.L.S.); (M.A.L.S.); (P.A.S.O.); (M.d.F.P.M.A.); (M.T.C.); (R.F.O.F.); (C.M.T.M.)
| | - Marli T. Cordeiro
- Instituto Aggeu Magalhães, Fundação Oswaldo Cruz Pernambuco, Recife CEP 50740-465, PE, Brazil; (I.J.A.A.J.); (M.A.S.); (A.B.G.G.); (Y.L.S.); (M.A.L.S.); (P.A.S.O.); (M.d.F.P.M.A.); (M.T.C.); (R.F.O.F.); (C.M.T.M.)
| | - Ernesto T. A. Marques
- Department of Infectious Diseases and Microbiology, University of Pittsburgh, Pittsburgh, PA 15261, USA; (E.T.A.M.J.); (P.M.S.C.)
| | - Rafael F. O. França
- Instituto Aggeu Magalhães, Fundação Oswaldo Cruz Pernambuco, Recife CEP 50740-465, PE, Brazil; (I.J.A.A.J.); (M.A.S.); (A.B.G.G.); (Y.L.S.); (M.A.L.S.); (P.A.S.O.); (M.d.F.P.M.A.); (M.T.C.); (R.F.O.F.); (C.M.T.M.)
| | - Celina M. T. Martelli
- Instituto Aggeu Magalhães, Fundação Oswaldo Cruz Pernambuco, Recife CEP 50740-465, PE, Brazil; (I.J.A.A.J.); (M.A.S.); (A.B.G.G.); (Y.L.S.); (M.A.L.S.); (P.A.S.O.); (M.d.F.P.M.A.); (M.T.C.); (R.F.O.F.); (C.M.T.M.)
| | - Priscila M. S. Castanha
- Department of Infectious Diseases and Microbiology, University of Pittsburgh, Pittsburgh, PA 15261, USA; (E.T.A.M.J.); (P.M.S.C.)
- Faculdade de Ciências Médicas, Universidade de Pernambuco, Recife CEP 50100-130, PE, Brazil
| | - Cynthia Braga
- Instituto Aggeu Magalhães, Fundação Oswaldo Cruz Pernambuco, Recife CEP 50740-465, PE, Brazil; (I.J.A.A.J.); (M.A.S.); (A.B.G.G.); (Y.L.S.); (M.A.L.S.); (P.A.S.O.); (M.d.F.P.M.A.); (M.T.C.); (R.F.O.F.); (C.M.T.M.)
- Instituto de Medicina Integral Prof. Fernando Figueira, Recife CEP 50070-550, PE, Brazil; (L.K.); (G.D.M.A.); (R.O.P.); (C.A.M.C.d.A.)
- Correspondence: ; Tel.: +55-81-2101-2577
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Guo X, Li X, Qi T, Pan Z, Zhu X, Wang H, Dong Y, Yue H, Sun B. A birth population-based survey of preterm morbidity and mortality by gestational age. BMC Pregnancy Childbirth 2021; 21:291. [PMID: 33838659 PMCID: PMC8037918 DOI: 10.1186/s12884-021-03726-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 03/17/2021] [Indexed: 02/06/2023] Open
Abstract
Background Despite 15–17 millions of annual births in China, there is a paucity of information on prevalence and outcome of preterm birth. We characterized the outcome of preterm births and hospitalized preterm infants by gestational age (GA) in Huai’an in 2015, an emerging prefectural region of China. Methods Of 59,245 regional total births, clinical data on 2651 preterm births and 1941 hospitalized preterm neonates were extracted from Huai’an Women and Children’s Hospital (HWCH) and non-HWCH hospitals in 2018–2020. Preterm prevalence, morbidity and mortality rates were characterized and compared by hospital categories and GA spectra. Death risks of preterm births and hospitalized preterm infants in the whole region were analyzed with multivariable Poisson regression. Results The prevalence of extreme, very, moderate, late and total preterm of the regional total births were 0.14, 0.53, 0.72, 3.08 and 4.47%, with GA-specific neonatal mortality rates being 44.4, 15.8, 3.7, 1.5 and 4.3%, respectively. There were 1025 (52.8% of whole region) preterm admissions in HWCH, with significantly lower in-hospital death rate of inborn (33 of 802, 4.1%) than out-born (23 of 223, 10.3%) infants. Compared to non-HWCH, three-fold more neonates in HWCH were under critical care with higher death rate, including most extremely preterm infants. Significantly all-death risks were found for the total preterm births in birth weight < 1000 g, GA < 32 weeks, amniotic fluid contamination, Apgar-5 min < 7, and birth defects. For the hospitalized preterm infants, significantly in-hospital death risks were found in out-born of HWCH, GA < 32 weeks, birth weight < 1000 g, Apgar-5 min < 7, birth defects, respiratory distress syndrome, necrotizing enterocolitis and ventilation, whereas born in HWCH, antenatal glucocorticoids, cesarean delivery and surfactant use decreased the death risks. Conclusions The integrated data revealed the prevalence, GA-specific morbidity and mortality rate of total preterm births and their hospitalization, demonstrating the efficiency of leading referral center and whole regional perinatal-neonatal network in China. The concept and protocol should be validated in further studies for prevention of preterm birth. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-03726-4.
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Affiliation(s)
- Xiaojing Guo
- The NCH Key Laboratory of Neonatal Diseases, National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, 201102, China
| | - Xiaoqiong Li
- Department of Obstetrics, Huai'an Women and Children's Hospital, Huai'an, 223002, Jiangsu, China
| | - Tingting Qi
- Department of Obstetrics, Huai'an Women and Children's Hospital, Huai'an, 223002, Jiangsu, China
| | - Zhaojun Pan
- Department of Neonatology and Unit of Population Health Information, Huai'an Women and Children's Hospital, 104 South Ren Min Road, Huai'an, 223002, Jiangsu, China
| | - Xiaoqin Zhu
- Unit of Population Health Information, Huai'an Women and Children's Hospital, Huai'an, 223002, Jiangsu, China
| | - Hui Wang
- Unit of Population Health Information, Huai'an Women and Children's Hospital, Huai'an, 223002, Jiangsu, China
| | - Ying Dong
- The NCH Key Laboratory of Neonatal Diseases, National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, 201102, China
| | - Hongni Yue
- Department of Neonatology and Unit of Population Health Information, Huai'an Women and Children's Hospital, 104 South Ren Min Road, Huai'an, 223002, Jiangsu, China. .,Unit of Population Health Information, Huai'an Women and Children's Hospital, Huai'an, 223002, Jiangsu, China.
| | - Bo Sun
- The NCH Key Laboratory of Neonatal Diseases, National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, 201102, China.
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10
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Saito-Abe M, Yamamoto-Hanada K, Pak K, Sato M, Irahara M, Mezawa H, Sasaki H, Nishizato M, Ishitsuka K, Konishi M, Yang L, Ohya Y, Suzuki K. Association of Maternal History of Allergic Features with Preterm Pregnancy Outcomes in the Japan Environment and Children's Study. Int Arch Allergy Immunol 2021; 182:650-662. [PMID: 33601376 DOI: 10.1159/000513749] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 12/14/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Previous studies have reported that maternal asthma increases the risk of preterm birth. We hypothesized that inflammatory reactions caused by allergic diseases might affect the uterine environment and, subsequently, perinatal outcomes. The objective of this study was to examine the associations between allergic features among mothers and preterm pregnancy outcomes in a nationwide birth cohort. METHODS We analyzed data from pregnant women obtained from the Japanese Environment and Children's Study (JECS), a nationwide general birth cohort study. We used binomial and multinomial logistic regression models to examine the associations between maternal allergic features and preterm birth, threatened preterm labor (TPL), and preterm premature rupture of the membrane (PPROM). RESULTS A total of 97,683 pregnant women were included. Prevalence of preterm birth, TPL, and PPROM was 4.7, 19.6, and 1.2%, respectively. Maternal history of allergic diseases (asthma, allergic rhinitis, allergic conjunctivitis, food allergy, drug allergy, and contact dermatitis) increased the risk of TPL(adjusted odds ratio [aOR] = 1.11 [95% CI: 1.06-1.17], aOR = 1.12 [1.08-1.16], aOR = 1.10 [1.04-1.16], aOR = 1.17 [1.09-1.26], aOR = 1.35 [1.23-1.48], and aOR = 1.34 [1.20-1.49], respectively). Although some maternal allergic features showed a negative association with preterm birth, the variables affecting preterm birth differed according to the gestational age of the fetus (22-33 weeks vs. 34-36 weeks). There were no significant associations between maternal allergic features and PPROM. CONCLUSION Maternal allergic disease, except atopic dermatitis, may increase the risk of TPL. Comorbidity of maternal allergic disorders and perinatal adverse outcomes require further investigation.
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Affiliation(s)
- Mayko Saito-Abe
- Medical Support Center for the Japan Environment and Children's Study, National Center for Child Health and Development, Tokyo, Japan, .,Department of Health and Psychosocial Medicine, Aichi Medical University School of Medicine, Nagakute, Japan,
| | - Kiwako Yamamoto-Hanada
- Medical Support Center for the Japan Environment and Children's Study, National Center for Child Health and Development, Tokyo, Japan
| | - Kyongsun Pak
- Division of Biostatistics, Department of Data Management, Center for Clinical Research, National Center for Child Health and Development, Tokyo, Japan
| | - Miori Sato
- Medical Support Center for the Japan Environment and Children's Study, National Center for Child Health and Development, Tokyo, Japan.,Department of Health and Psychosocial Medicine, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Makoto Irahara
- Medical Support Center for the Japan Environment and Children's Study, National Center for Child Health and Development, Tokyo, Japan
| | - Hidetoshi Mezawa
- Medical Support Center for the Japan Environment and Children's Study, National Center for Child Health and Development, Tokyo, Japan
| | - Hatoko Sasaki
- Medical Support Center for the Japan Environment and Children's Study, National Center for Child Health and Development, Tokyo, Japan
| | - Minaho Nishizato
- Medical Support Center for the Japan Environment and Children's Study, National Center for Child Health and Development, Tokyo, Japan
| | - Kazue Ishitsuka
- Medical Support Center for the Japan Environment and Children's Study, National Center for Child Health and Development, Tokyo, Japan
| | - Mizuho Konishi
- Medical Support Center for the Japan Environment and Children's Study, National Center for Child Health and Development, Tokyo, Japan
| | - Limin Yang
- Medical Support Center for the Japan Environment and Children's Study, National Center for Child Health and Development, Tokyo, Japan
| | - Yukihiro Ohya
- Medical Support Center for the Japan Environment and Children's Study, National Center for Child Health and Development, Tokyo, Japan
| | - Kohta Suzuki
- Department of Health and Psychosocial Medicine, Aichi Medical University School of Medicine, Nagakute, Japan
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11
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Landmann E, Brugger M, Blank V, Wudy SA, Hartmann M, Strauch K, Rudloff S. Adrenal Steroid Metabolism and Blood Pressure in 5- to 7-Year-Old Children Born Preterm as Compared to Peers Born at Term. Front Pediatr 2021; 9:754989. [PMID: 34917560 PMCID: PMC8669960 DOI: 10.3389/fped.2021.754989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 10/27/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Previous studies indicated preterm birth to be a risk factor for hypertension in adolescence and adulthood. However, studies in children investigating the underlying mechanisms are scarce. Objective: We hypothesized children born preterm to have higher excretion of cortisol and/or androgen metabolites per day concomitantly with higher blood pressure as compared to peers born at term. We thus aimed to compare urinary steroid profiles and blood pressure between 5- to 7-year-old children born preterm and peers born at term. Furthermore, aldosterone precursor excretion per day was compared between both groups. Methods: Blood pressure was measured in 236 children (preterms n = 116; gestational age 29.8 ± 2.6 (30; 24-33) weeks [mean ± standard deviation (median; range)]) using an automatic oscillometric device. Urinary steroid profiles were determined in 24-h urine samples (preterms n = 109; terms n = 113) using gas chromatographic-mass spectrometric analysis. To assess excretion of cortisol and androgen metabolites per day, major cortisol and androgen metabolites were summed, respectively. To assess aldosterone excretion per day tetrahydrocorticosterone, 5α-tetrahydrocorticosterone, and tetrahydro-11-deydrocorticosterone were summed. Results: Multiple regression analyses showed prematurity to be associated with systolic but not with diastolic blood pressure. When adjusted for potential confounders (prematurity, gender, age at day of examination, being born small for gestational age, breastfeeding, accelerated weight gain during infancy, family history of cardiovascular disease, parental hypertension, and body mass index) prematurity was shown to be associated with an increase in systolic blood pressure by 2.87 mmHg (95% confidence interval 0.48-5.27; p = 0.02). Cortisol, androgen metabolite, and aldosterone precursor excretion per day were not higher in individuals born preterm. In contrast to our hypothesis, multiple regression analysis showed prematurity to independently decrease cortisol and aldosterone precursor excretion per day (p < 0.001 and 0.04, respectively). Conclusion: This study provides further evidence for systolic blood pressure to be higher after preterm birth as early as at the age of 5 to 7 years. However, this seems not to be explained by elevated excretion of cortisol and/or androgen metabolites.
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Affiliation(s)
- Eva Landmann
- Department of Pediatric Hematology and Oncology, Center of Child and Adolescent Medicine, Justus Liebig University Giessen, Giessen, Germany
| | - Markus Brugger
- Institute of Medical Biometry and Epidemiology, Philipps-University Marburg, Marburg, Germany.,Institute of Genetic Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany.,Institute of Medical Information Processing, Biometry and Epidemiology - IBE, Chair of Genetic Epidemiology, LMU Munich, Munich, Germany.,Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Verena Blank
- Department of Neuropediatrics, Center of Child and Adolescent Medicine, Justus Liebig University Giessen, Giessen, Germany
| | - Stefan A Wudy
- Department of Pediatrics and Neonatology, Justus Liebig University Giessen, Giessen, Germany.,Steroid Research and Mass Spectrometry Unit, Division of Pediatric Endocrinology and Diabetology, Center of Child and Adolescent Medicine, Justus-Liebig-University Giessen, Giessen, Germany
| | - Michaela Hartmann
- Department of Pediatrics and Neonatology, Justus Liebig University Giessen, Giessen, Germany.,Steroid Research and Mass Spectrometry Unit, Division of Pediatric Endocrinology and Diabetology, Center of Child and Adolescent Medicine, Justus-Liebig-University Giessen, Giessen, Germany
| | - Konstantin Strauch
- Institute of Medical Biometry and Epidemiology, Philipps-University Marburg, Marburg, Germany.,Institute of Genetic Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany.,Institute of Medical Information Processing, Biometry and Epidemiology - IBE, Chair of Genetic Epidemiology, LMU Munich, Munich, Germany.,Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Silvia Rudloff
- Department of Pediatrics and Neonatology, Justus Liebig University Giessen, Giessen, Germany.,Institute of Nutritional Science, Justus Liebig University Giessen, Giessen, Germany
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12
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Influence of perinatal complications on the development of a sample of 36-month-old premature infants. Infant Behav Dev 2020; 62:101507. [PMID: 33271470 DOI: 10.1016/j.infbeh.2020.101507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 11/05/2020] [Accepted: 11/06/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The lack of clear results in previous studies for this context makes us consider an exploratory study. The objective of this research is to examine the influence of certain perinatal factors on the development of premature infants over their first 36 months of life. METHOD The sample consisted of 59 preterm infants born between 25 and 34 weeks of gestational age in an NICU of a third-level hospital. At 36 months of age, the Bayley-III Infant Development Scale (Spanish adaptation) and a clinical history were collected. RESULTS The average scores on the Bayley-III Infant Development Scale were generally within the normal range, but significantly lower than normal for Fine Motor Function, Gross Motor Function, and Expressive Language. These differences remained when considering the degree of prematurity, gender, and perinatal complications. Infants who received mechanical ventilation, oxygen therapy or corticosteroid treatment due to bronchopulmonary dysplasia showed the greatest discrepancies from normal levels. CONCLUSION Our results support prior studies that show that a combination of perinatal risk factors constitutes the largest determinant for developmental issues at 36 months of age. This information establishes the need for a priority follow-up in this population beyond 24 months of corrected age.
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13
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Bedoyan JK, Hage R, Shin HK, Linard S, Ferren E, Ducich N, Wilson K, Lehman A, Schillaci L, Manickam K, Mori M, Bartholomew D, DeBrosse S, Cohen B, Parikh S, Kerr D. Utility of specific amino acid ratios in screening for pyruvate dehydrogenase complex deficiencies and other mitochondrial disorders associated with congenital lactic acidosis and newborn screening prospects. JIMD Rep 2020; 56:70-81. [PMID: 33204598 PMCID: PMC7653239 DOI: 10.1002/jmd2.12153] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 07/09/2020] [Accepted: 07/16/2020] [Indexed: 01/24/2023] Open
Abstract
Pyruvate dehydrogenase complex deficiencies (PDCDs) and other mitochondrial disorders (MtDs) can (a) result in congenital lactic acidosis with elevations of blood alanine (Ala) and proline (Pro), (b) lead to decreased ATP production, and (c) result in high morbidity and mortality. With ~140,000 live births annually in Ohio and ~1 in 9,000 overall prevalence of MtDs, we estimate 2 to 3 newborns will have PDCD and 13 to 14 others likely will have another MtD annually. We compared the sensitivities of plasma amino acids (AA) Alanine (Ala), Alanine:Leucine (Ala:Leu), Alanine:Lysine and the combination of Ala:Leu and Proline:Leucine (Pro:Leu), in subjects with known primary-specific PDCD due to PDHA1 and PDHB mutations vs controls. Furthermore, in collaboration with the Ohio newborn screening (NBS) laboratory, we determined Ala and Pro concentrations in dried blood spot (DBS) specimens using existing NBS analytic approaches and evaluated Ala:Leu and Pro:Leu ratios from DBS specimens of 123,414 Ohio newborns in a 12-month period. We used the combined Ala:Leu ≥4.0 and Pro:Leu ≥3.0 ratio criterion from both DBS and plasma specimens as a screening tool in our retrospective review of newborn data. The screening tool applied on DBS and/or plasma (or serum) AA specimens successfully identified three unrelated females with novel de novo PDHA1 mutations, one male with a novel de novo X-linked HSD17B10 mutation, and a female with VARS2 mutations. This work lays the first step for piloting an NBS protocol in Ohio for identifying newborns at high risk for primary-specific PDCD and other MtDs who might benefit from neonatal diagnosis and early institution of known therapy and/or potential novel therapies for such disorders.
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Affiliation(s)
- Jirair K. Bedoyan
- Departments of Genetics and Genome SciencesCase Western Reserve University (CWRU)ClevelandOhioUSA
- PediatricsCWRUClevelandOhioUSA
- Center for Human GeneticsUniversity Hospitals Cleveland Medical Center (UHCMC)ClevelandOhioUSA
- Center for Inherited Disorders of Energy Metabolism (CIDEM)UHCMCClevelandOhioUSA
| | - Rosemary Hage
- Newborn Screening and Radiation ChemistryOhio Department of Health LaboratoryColumbusOhioUSA
| | | | - Sharon Linard
- Newborn Screening and Radiation ChemistryOhio Department of Health LaboratoryColumbusOhioUSA
| | - Edwin Ferren
- PediatricsCWRUClevelandOhioUSA
- Center for Human GeneticsUniversity Hospitals Cleveland Medical Center (UHCMC)ClevelandOhioUSA
| | | | | | - April Lehman
- Nationwide Children's Hospital (NCH) and The Ohio State University College of MedicineSection of Genetic and Genomic MedicineColumbusOhioUSA
| | - Lori‐Anne Schillaci
- Departments of Genetics and Genome SciencesCase Western Reserve University (CWRU)ClevelandOhioUSA
- PediatricsCWRUClevelandOhioUSA
- Center for Human GeneticsUniversity Hospitals Cleveland Medical Center (UHCMC)ClevelandOhioUSA
| | - Kandamurugu Manickam
- Nationwide Children's Hospital (NCH) and The Ohio State University College of MedicineSection of Genetic and Genomic MedicineColumbusOhioUSA
| | - Mari Mori
- Nationwide Children's Hospital (NCH) and The Ohio State University College of MedicineSection of Genetic and Genomic MedicineColumbusOhioUSA
| | - Dennis Bartholomew
- Nationwide Children's Hospital (NCH) and The Ohio State University College of MedicineSection of Genetic and Genomic MedicineColumbusOhioUSA
| | - Suzanne DeBrosse
- Departments of Genetics and Genome SciencesCase Western Reserve University (CWRU)ClevelandOhioUSA
- PediatricsCWRUClevelandOhioUSA
- Center for Human GeneticsUniversity Hospitals Cleveland Medical Center (UHCMC)ClevelandOhioUSA
| | - Bruce Cohen
- Department of PediatricsAkron Children's Hospital (ACH) Rebecca D. Considine Research InstituteAkronOhioUSA
- Northeast Ohio Medical UniversityRootstownOhioUSA
| | - Sumit Parikh
- The Cleveland Clinic Foundation (CCF), Neurosciences InstituteClevelandOhioUSA
| | - Douglas Kerr
- PediatricsCWRUClevelandOhioUSA
- Center for Inherited Disorders of Energy Metabolism (CIDEM)UHCMCClevelandOhioUSA
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14
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Reanimação de bebês prematuros moderados e tardios em sala de parto: fatores associados. ACTA PAUL ENFERM 2020. [DOI: 10.37689/acta-ape/2020ao0134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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15
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Jang GJ. Influence of a Breastfeeding Coaching Program on the Breastfeeding Rates and Neonatal Morbidity in Late Preterm Infants. CHILD HEALTH NURSING RESEARCH 2020; 26:376-384. [PMID: 35004481 PMCID: PMC8650967 DOI: 10.4094/chnr.2020.26.3.376] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 06/15/2020] [Accepted: 06/20/2020] [Indexed: 11/17/2022] Open
Abstract
PURPOSE This study aimed to determine the influence of a breastfeeding coaching program (BCP) for mothers of late preterm infants (LPIs) on the breastfeeding rate and neonatal morbidity within 1 month after discharge. METHODS This was a non-randomized quasi-experimental study with a time series design. The participants were 40 LPIs and their mothers who were hospitalized in a neonatal intensive care unit at a university hospital. Nineteen LPIs were assigned to the control group, and 21 to the experimental group. The mothers of the LPIs in the experimental group received the BCP once on the discharge day and then once a week for 1 month. Neonatal morbidity was defined as an outpatient department or emergency room visit due to an LPI's health problem. RESULTS The breastfeeding rate in the experimental group was significantly higher than in the control group at the fourth week after discharge (x 2=7.17, p=.028). Five and two LPIs in the control group and the experimental group, respectively, visited a hospital due to neonatal jaundice. Neonatal morbidity was not significantly different between the two groups (x 2=1.95, p=.164). CONCLUSION The BCP was useful for improving the breastfeeding rates of LPIs and may have potential to reduce neonatal morbidity.
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Affiliation(s)
- Gun Ja Jang
- Associate Professor, Department of Nursing, Daegu University, Daegu, Korea
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16
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Menin D, Dondi M. Methodological Issues in the Study of the Development of Pain Responsivity in Preterm Neonates: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17103507. [PMID: 32429581 PMCID: PMC7277564 DOI: 10.3390/ijerph17103507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 05/14/2020] [Accepted: 05/16/2020] [Indexed: 11/16/2022]
Abstract
The study of the development of neonatal pain responses is of key importance, both for research and for clinical reasons, with particular regard to the population of preterm neonates, given the amount of painful procedures they are exposed to on a daily basis. The aim of this work was to systematize our knowledge about the development of pain responses in prematurely born neonates by focusing on some key methodological issues. Studies on the impact of age variables, namely gestational age (GA), postmenstrual age (PMA) and chronological age (CH), on pain responsivity in premature neonates were identified using Medline and Scopus. Studies (N = 42) were categorized based on terminological and methodological approaches towards age variables, and according to output variables considered (facial, nonfacial behavioral, physiological). Distinct multidimensional developmental patterns were found for each age-sampling strategy. Overall, each of the three age variables seems to affect pain responsivity, possibly differently across age windows. Targeted as well as integrated approaches, together with a renewed attention for methodological consistency, are needed to further our knowledge on this topic.
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Affiliation(s)
| | - Marco Dondi
- Correspondence: ; Tel.: +39-0532-293538; Fax: +39-0532-455234
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17
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Kenmoe S, Kengne-Nde C, Modiyinji AF, La Rosa G, Njouom R. Comparison of health care resource utilization among preterm and term infants hospitalized with Human Respiratory Syncytial Virus infections: A systematic review and meta-analysis of retrospective cohort studies. PLoS One 2020; 15:e0229357. [PMID: 32084214 PMCID: PMC7034889 DOI: 10.1371/journal.pone.0229357] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 02/04/2020] [Indexed: 12/26/2022] Open
Abstract
Introduction Data on the variation in the medical resource utilization rate of Human Respiratory Syncytial Virus (HRSV) infected children by gestational age have recently been made available. This review aimed to determine whether prematurity is independently associated with the use of medical resources in hospitalized children for HRSV infections. Methods We conducted this systematic review on cohort studies published on the medical resources use in preterm and full-term patients hospitalized for confirmed HRSV infections. We searched PubMed, Embase, and Global Index medicus for eligible studies. The standardized mean difference (SMD) and Risk Ratio (RR) with their 95% confidence intervals (95% CI) were estimated as summary statistics with random effects meta-analysis. The overall results were adjusted to the common confounders by stratified analyses. Results A total of 14 articles (20 studies) were included. Compared to full-term, preterm hospitalized with HRSV infections had more frequent intensive care unit admission (RR = 2.6, 95% CI = 1.9–3.5), increased length of stay in hospital (SMD = 0.6, 95% CI = 0.5–0.8) and intensive care unit (SMD = 0.6, 95% CI = 0.4–0.8) and increased case fatality rate (RR = 6.9, 95% CI = 2.0–23.8). Mechanical ventilation utilization was more frequent in preterm children ≤ 2 years (RR = 15.5, 95% CI = 8.9–26.4) and those who did not receive prophylaxis against HRSV (RR = 15.9, 95% CI = 9.1–27.9)] than in full-term children. No differences were identified in the frequency of emergency department visits, oxygen utilization, and the age at the first HRSV episode between preterm and full-term infants. Conclusions Regardless of gestational age, preterm infants hospitalized for HRSV infections, especially those ≤ 2 years, have an increased frequency of use of health resources and poor outcomes compared to full-term infants. HRSV vaccine development programs for pregnant women should be accelerated. Clinical trials registration Review registration PROSPERO, CRD42019124375.
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Affiliation(s)
- Sebastien Kenmoe
- Department of Virology, Centre Pasteur of Cameroon, Yaoundé, Cameroon
| | - Cyprien Kengne-Nde
- National AIDS Control Committee, Epidemiological Surveillance, Evaluation and Research Unit, Yaoundé, Cameroon
| | - Abdou Fatawou Modiyinji
- Department of Virology, Centre Pasteur of Cameroon, Yaoundé, Cameroon
- Department of Animals Biology and Physiology, Faculty of Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | | | - Richard Njouom
- Department of Virology, Centre Pasteur of Cameroon, Yaoundé, Cameroon
- * E-mail: ,
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18
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Lotterman JH, Lorenz JM, Bonanno GA. You Can't Take Your Baby Home Yet: A Longitudinal Study of Psychological Symptoms in Mothers of Infants Hospitalized in the NICU. J Clin Psychol Med Settings 2020; 26:116-122. [PMID: 29789995 DOI: 10.1007/s10880-018-9570-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Evidence suggests that mothers of infants hospitalized in the Neonatal Intensive Care Unit (NICU) experience elevated rates of psychological symptoms. However, previous studies of this population have been mainly cross-sectional and have focused on very preterm infants. Although moderate- to late-preterm infants generally thrive, the possible psychological toll on their mothers has not yet been sufficiently examined. In the current study, we used a longitudinal design to investigate whether mothers of moderate- to late-preterm infants experience elevated rates of psychological symptoms during the infant's hospitalization in the NICU and 6 months later. Results indicated that these mothers did show elevated depression, anxiety, and PTSD symptoms, and that symptom levels were similar in mothers of moderate- versus late-preterm infants. Mothers of moderate- to late-preterm infants hospitalized in the NICU appeared to experience these symptoms steadily over a 6-month period after giving birth. These findings suggest a need for greater support for these mothers while in the NICU.
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Affiliation(s)
- Jenny H Lotterman
- Teachers College, Columbia University, 525 West 120th Street, Box 102, New York, NY, 10027, USA.
| | - John M Lorenz
- Department of Pediatrics, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - George A Bonanno
- Teachers College, Columbia University, 525 West 120th Street, Box 102, New York, NY, 10027, USA
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19
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Bell AH, Miller SL, Castillo-Melendez M, Malhotra A. The Neurovascular Unit: Effects of Brain Insults During the Perinatal Period. Front Neurosci 2020; 13:1452. [PMID: 32038147 PMCID: PMC6987380 DOI: 10.3389/fnins.2019.01452] [Citation(s) in RCA: 82] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 12/30/2019] [Indexed: 12/31/2022] Open
Abstract
The neurovascular unit (NVU) is a relatively recent concept in neuroscience that broadly describes the relationship between brain cells and their blood vessels. The NVU incorporates cellular and extracellular components involved in regulating cerebral blood flow and blood-brain barrier function. The NVU within the adult brain has attracted strong research interest and its structure and function is well described, however, the NVU in the developing brain over the fetal and neonatal period remains much less well known. One area of particular interest in perinatal brain development is the impact of known neuropathological insults on the NVU. The aim of this review is to synthesize existing literature to describe structure and function of the NVU in the developing brain, with a particular emphasis on exploring the effects of perinatal insults. Accordingly, a brief overview of NVU components and function is provided, before discussion of NVU development and how this may be affected by perinatal pathologies. We have focused this discussion around three common perinatal insults: prematurity, acute hypoxia, and chronic hypoxia. A greater understanding of processes affecting the NVU in the perinatal period may enable application of targeted therapies, as well as providing a useful basis for research as it expands further into this area.
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Affiliation(s)
- Alexander H. Bell
- Department of Paediatrics, Monash University, Melbourne, VIC, Australia
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC, Australia
| | - Suzanne L. Miller
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC, Australia
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia
| | - Margie Castillo-Melendez
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC, Australia
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia
| | - Atul Malhotra
- Department of Paediatrics, Monash University, Melbourne, VIC, Australia
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC, Australia
- Monash Newborn, Monash Children’s Hospital, Melbourne, VIC, Australia
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Jang GJ, Hong YR. Effects of a Breastfeeding Support Program on the Prevalence of Exclusive Breastfeeding and Growth in Late Preterm Infants. CHILD HEALTH NURSING RESEARCH 2020; 26:90-97. [PMID: 35004454 PMCID: PMC8650884 DOI: 10.4094/chnr.2020.26.1.90] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 01/02/2020] [Accepted: 01/08/2020] [Indexed: 11/13/2022] Open
Abstract
Purpose The purpose of this study was to investigate the effects of a breastfeeding support program (BSP) on the prevalence of exclusive breastfeeding and growth in late-preterm infants. Methods A quasi-experimental study was conducted. The participants were 40 late preterm infants (LPIs), of whom 20 were assigned to the experimental group and 20 to the control group. For the mothers in the experimental group, a BSP was provided prior to the LPIs’ discharge and reinforced once a week for 4 weeks. Information on the feeding type was collected by observation and the LPIs’ body weight was measured. Results There were significant differences in feeding type by group and time. Exclusive breastfeeding was 5.18 times more common in the experimental group than in the control group (odds ratio=5.18, 95% confidence interval=1.11~16.70). However, weekly weight gain did not show a significant relationship with group and time (F=0.40, p=.712). Conclusion The BSP was helpful for increasing the rate of exclusive breastfeeding in LPIs. Furthermore, the LPIs in the experimental group, which had a higher likelihood of being exclusively breastfed, showed an equivalent amount of weight gain as the LPIs in the control group, in which infants were more likely to be formula-fed.
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Affiliation(s)
- Gun Ja Jang
- Associate Professor, Department of Nursing, Daegu University, Daegu, Korea
| | - Yeon Ran Hong
- Professor, Department of Nursing, Sunchon National University, Sunchon, Korea
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21
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Jang EH, Ju HO. Effects of an Infant Care Education Program for Mothers of Late-preterm Infants on Parenting Confidence, Breastfeeding Rates, and Infants' Growth and Readmission Rates. CHILD HEALTH NURSING RESEARCH 2020; 26:11-22. [PMID: 35004446 PMCID: PMC8650883 DOI: 10.4094/chnr.2020.26.1.11] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 09/19/2019] [Accepted: 11/05/2019] [Indexed: 11/06/2022] Open
Abstract
Purpose The purpose of this study was to evaluate the effects of an education program for mothers of late-preterm infants on parenting confidence, breastfeeding rate, and infants’ growth and readmission rate. Methods The participants were 53 mothers of late-preterm infants (26 in the experimental group and 27 in the control group). The experimental group was administered the late-preterm care education program while the control group received standard care. The program consisted of two sessions during hospitalization after birth, one session at the time of discharge, and telephone and social networking service consultations at weekly intervals for the month following discharge. The collected data were analyzed using the t-test, χ2 test, and repeated-measures analysis of variance. Results Parenting confidence and the breastfeeding rate were significantly higher in the experimental group than in the control group. However, there was no significant difference in the late-preterm infants’ growth and readmission rates between the experimental and control groups. Conclusion A care education program for mothers of late-preterm infants can be a useful nursing intervention in clinical practice.
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Affiliation(s)
- Eun Hye Jang
- Doctoral Candidate, Department of Nursing, Dong-A University ․ Registered Nurse, Pusan National University Hospital, Busan, Korea
| | - Hyeon Ok Ju
- Professor, Department of Nursing, Dong-A University, Busan, Korea
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22
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Vanin LK, Zatti H, Soncini T, Nunes RD, Siqueira LBSD. MATERNAL AND FETAL RISK FACTORS ASSOCIATED WITH LATE PRETERM INFANTS. ACTA ACUST UNITED AC 2019; 38:e2018136. [PMID: 31778408 PMCID: PMC6909261 DOI: 10.1590/1984-0462/2020/38/2018136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 09/26/2018] [Indexed: 01/26/2023]
Abstract
Objective: To determine maternal and fetal risk factors associated with the birth of late preterm infants in comparison to those born at term. Methods: A case-control study was carried out in a tertiary center for high-risk pregnancies. For the cases, the study enrolled post-partum mothers and their respective newborns with gestational ages equal or greater than 34 weeks and less than 37 weeks. As controls, the post-partum mothers and their newborns with gestational ages of 37 weeks or greater were selected. The sample was calculated with a ratio of two controls for each case, resulting in 423 patients. Association studies were performed using the chi-square test or Fisher’s exact test and logistic regression analysis. Results: The variables associated with late prematurity were inadequate prenatal (Odds Ratio [OR] 1.23; confidence interval of 95% [95%CI] 1.12-1.34; p≤0.001), premature rupture of membranes (OR 4.98; 95%CI 2.66-9.31; p≤0.001), length of hospital stay ≥24 hours until birth (OR 0.18; 95%CI 0.06-0.52; p≤0.001), cesarean section (OR 2.74; 95%CI 1.69-4.44; p≤0.001) and small for gestational age newborn (OR 3.02; 95%CI 1.80-5.05; p≤0.001). Conclusions: Inadequate prenatal care and membranes’ premature rupture were found as factors associated with the late preterm birth. It is important to identify the factors that allow intervention with adequate prenatal care in order to reduce poor outcomes due to late prematurity.
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Affiliation(s)
| | - Helen Zatti
- Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
| | - Thaise Soncini
- Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
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Kreko E, Kola E, Sadikaj F, Dardha B, Tushe E. Neonatal Morbidity in Late Preterm Infants Associated with Intrauterine Growth Restriction. Open Access Maced J Med Sci 2019; 7:3592-3595. [PMID: 32010382 PMCID: PMC6986514 DOI: 10.3889/oamjms.2019.832] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 09/12/2019] [Accepted: 09/13/2019] [Indexed: 11/05/2022] Open
Abstract
AIM This study aims to compare the neonatal morbidity of Intrauterine growth restricted (IUGR) Late Preterm (LP) babies, to those born Late Preterm but evaluated as Appropriate for Gestational Age (AGA). METHODS The study is a 2-year prospective one that used data from the Neonatal Intensive Care Unit (NICU) charts of LP neonates born in our tertiary maternity hospital "Koço Gliozheni" in Tirana. Congenital anomalies and genetical syndromes are excluded. Neonatal morbidity of IUGR Late Preterm is compared to those born Late Preterm but evaluated as AGA. OR and CI, 95% is calculated. RESULTS Out of 336 LP babies treated in NICU, 88 resulted with IUGR and 206 AGA used as a control group. We found significantly higher morbidity in the IUGR group for hypoglycemia, polycythemia, feeding intolerance, birth asphyxia and seizures, secondary sepsis have higher morbidity but the difference is not significant. No differences were found for hyperbilirubinemia in both groups. No neonatal deaths were observed in both groups. CONCLUSION Our study showed that late preterm IUGR has a significantly higher risk for neonatal morbidity when compared to late preterm AGA babies.
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Affiliation(s)
- Evelina Kreko
- Service of Neonatology, University Hospital of Obstetrics and Gynecology "Koço Gliozheni", Tirana, Albania
| | - Ermira Kola
- Department of Pediatrics, University Hospital Center "Nene Tereza", Tirana, Albania
| | - Festime Sadikaj
- Department of Pediatrics, University Hospital Center "Nene Tereza", Tirana, Albania
| | - Blerta Dardha
- Department of Pediatrics, University Hospital Center "Nene Tereza", Tirana, Albania
| | - Eduard Tushe
- Service of Neonatology, University Hospital of Obstetrics and Gynecology "Koço Gliozheni", Tirana, Albania
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Mahurin-Smith J, Genna CW. Assessing the Breastfeeding Dyad: A Guide for Speech-Language Pathologists. ACTA ACUST UNITED AC 2019. [DOI: 10.1044/2019_pers-sig13-2018-0018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Purpose
More than 80% of U.S. mothers initiate breastfeeding; for many of them, direct breastfeeding is an important goal. Speech-language pathologists (SLPs) who assess infants with feeding concerns, however, are generally much more familiar with assessing bottle-feeding. The purpose of this tutorial is to assist SLPs in building on their existing assessment skills in order to provide effective, evidence-based options for mothers who wish to breastfeed their infants.
Conclusion
SLPs can assist families in meeting their breastfeeding goals through effective assessment of breastfeeding dyads.
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Nishizaki N, Obinata K, Kantake M, Yoshida N, Ohtomo Y, Niijima S, Yanagisawa N, Nishizaki Y, Shoji H, Shimizu T. Association between the frequency of bedwetting and late preterm birth in children aged ≥5 years. Acta Paediatr 2019; 108:282-287. [PMID: 29953662 DOI: 10.1111/apa.14481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 06/23/2018] [Accepted: 06/26/2018] [Indexed: 11/28/2022]
Abstract
AIM We examined the associations between late preterm (LPT) birth children aged ≥5 years and the frequency of bedwetting. Moreover, those who were born full-term/low birthweight (BW), LPT/low BW, LPT/normal BW and LPT/low BW were compared. METHODS In total, we evaluated 614 patients who underwent assessments for frequent bedwetting at the three hospitals from January 2014 to December 2016. Data at the initial visit were collected from the electronic medical records. We assessed the patients' bladder diaries and questionnaires containing detailed information on demographics and frequency of bedwetting per month. Neonatal data were collected from the Maternal and Child Health Handbook. RESULTS Frequency of bedwetting in the LPT/low BW group was higher than in the term/low BW group (28 vs. 22.5, p < 0.05). However, the frequency between the LPT/normal BW group and the LPT/low BW group was not significantly different (28 vs. 28, p = 1.00). Multiple regression analyses were conducted to eliminate potential confounding factors, attention-deficit/hyperactivity disorder and intellectual disability, but results were not changed. CONCLUSION This study revealed that LPT/low BW was associated with increased frequency of bedwetting in children. The results suggest that gestational age should be considered when examining patients with severe bedwetting.
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Affiliation(s)
- Naoto Nishizaki
- Department of Pediatrics; Juntendo University Urayasu Hospital; Chiba Japan
| | - Kaoru Obinata
- Department of Pediatrics; Juntendo University Urayasu Hospital; Chiba Japan
| | - Masato Kantake
- Department of Pediatrics; Juntendo University Shizuoka Hospital; Shizuoka Japan
| | - Noboru Yoshida
- Department of Pediatrics; Juntendo University Nerima Hospital; Tokyo Japan
| | - Yoshiyuki Ohtomo
- Department of Pediatrics; Juntendo University Nerima Hospital; Tokyo Japan
| | - Shinichi Niijima
- Department of Pediatrics; Juntendo University Nerima Hospital; Tokyo Japan
| | - Naotake Yanagisawa
- Clinical Research and Trial Center; Juntendo University Hospital; Tokyo Japan
| | - Yuji Nishizaki
- Clinical Research and Trial Center; Juntendo University Hospital; Tokyo Japan
- Medical Technology Innovation Center; Juntendo University; Tokyo Japan
| | - Hiromichi Shoji
- Department of Pediatrics and Adolescent Medicine; Juntendo University Graduate School of Medicine; Tokyo Japan
| | - Toshiaki Shimizu
- Department of Pediatrics and Adolescent Medicine; Juntendo University Graduate School of Medicine; Tokyo Japan
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26
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Williams LZJ, McNamara D, Alsweiler JM. Intermittent Hypoxemia in Infants Born Late Preterm: A Prospective Cohort Observational Study. J Pediatr 2019; 204:89-95.e1. [PMID: 30287066 DOI: 10.1016/j.jpeds.2018.08.048] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 08/22/2018] [Accepted: 08/23/2018] [Indexed: 02/09/2023]
Abstract
OBJECTIVE To determine if late preterm infants are at increased risk of intermittent hypoxemic events compared with term infants. STUDY DESIGN Prospective, cohort, observational study of late preterm infants (340/7-366/7 weeks gestational age) and term infants (390/7-416/7 weeks gestational age). Overnight pulse oximetry recordings were performed on days 2-3 after birth, at term equivalent age, and at 45 weeks postmenstrual age. The primary outcome was the frequency of intermittent hypoxemic events per hour (desaturation ≥10% below the preceding baseline SpO2) on the oximetry recording on days 2-3 after birth. Data were analyzed by the Student t test and general linear mixed model. RESULTS Eighty-five infants were enrolled (late preterm n = 43; term infants n = 42). On days 2-3 after birth, late preterm infants had more intermittent hypoxemic events than term infants (events per hour, mean ± standard error of the mean, 2.5 ± 1.2 vs 1.0 ± 1.2; P < .0001). On mixed model analysis, late preterm infants had a higher frequency of intermittent hypoxemic events at term equivalent age, which decreased to a similar frequency as in term infants by 45 weeks postmenstrual age (events per hour; term equivalent age, late preterm: least squares mean, 3.7 [95% CI, 2.7-5.1] vs term: least squares mean, 1.7 [95% CI, 1.2-2.3]; 45 weeks postmenstrual age, late preterm: least squares mean, 1.5 [95% CI, 1.1-2.1] vs term: least squares mean, 1.9 [95% CI, 1.4-2.6]; P < .0005). CONCLUSIONS Late preterm infants are at greater risk of intermittent hypoxemia than term infants soon after birth. We speculate that preventing intermittent hypoxemia in late preterm infants may improve neurodevelopmental outcomes.
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Affiliation(s)
- Logan Zane John Williams
- Department of Paediatrics: Child and Youth Health, The University of Auckland, Auckland, New Zealand
| | - David McNamara
- Newborn Services, Auckland City Hospital, Auckland, New Zealand
| | - Jane Marie Alsweiler
- Department of Paediatrics: Child and Youth Health, The University of Auckland, Auckland, New Zealand; Newborn Services, Auckland City Hospital, Auckland, New Zealand.
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Thompson DK, Kelly CE, Chen J, Beare R, Alexander B, Seal ML, Lee KJ, Matthews LG, Anderson PJ, Doyle LW, Cheong JLY, Spittle AJ. Characterisation of brain volume and microstructure at term-equivalent age in infants born across the gestational age spectrum. NEUROIMAGE-CLINICAL 2018; 21:101630. [PMID: 30555004 PMCID: PMC6411910 DOI: 10.1016/j.nicl.2018.101630] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 12/03/2018] [Accepted: 12/07/2018] [Indexed: 01/23/2023]
Abstract
Background Risk of morbidity differs between very preterm (VP; <32 weeks' gestational age (GA)), moderate preterm (MP; 32–33 weeks' GA), late preterm (LP; 34–36 weeks' GA), and full-term (FT; ≥37 weeks' GA) infants. However, brain structure at term-equivalent age (TEA; 38–44 weeks) remains to be characterised in all clinically important GA groups. We aimed to compare global and regional brain volumes, and regional white matter microstructure, between VP, MP, LP and FT groups at TEA, in order to establish the magnitude and anatomical locations of between-group differences. Methods Structural images from 328 infants (91 VP, 63 MP, 104 LP and 70 FT) were segmented into white matter, cortical grey matter, cerebrospinal fluid (CSF), subcortical grey matter, brainstem and cerebellum. Global tissue volumes were analysed, and additionally, cortical grey matter and white matter volumes were analysed at the regional level using voxel-based morphometry. Fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD) and radial diffusivity (RD) images from 361 infants (92 VP, 69 MP, 120 LP and 80 FT) were analysed using Tract-Based Spatial Statistics. Statistical analyses involved examining the overall effect of GA group on global volumes (using linear regressions) and regional volumes and microstructure (using non-parametric permutation testing), as well performing post-hoc comparisons between the GA sub-groups. Results On global analysis, cerebrospinal fluid (CSF) volume was larger in all preterm sub-groups compared with the FT group. On regional analysis, volume was smaller in parts of the temporal cortical grey matter, and parts of the temporal white matter and corpus callosum, in all preterm sub-groups compared with the FT group. FA was lower, and RD and MD were higher in voxels located in much of the white matter in all preterm sub-groups compared with the FT group. The anatomical locations of group differences were similar for each preterm vs. FT comparison, but the magnitude and spatial extent of group differences was largest for the VP, followed by the MP, and then the LP comparison. Comparing within the preterm groups, the VP sub-group had smaller frontal and temporal grey and white matter volume, and lower FA and higher MD and RD within voxels in the approximate location of the corpus callosum compared with the MP sub-group. There were few volume and microstructural differences between the MP and LP sub-groups. Conclusion All preterm sub-groups had atypical brain volume and microstructure at TEA when compared with a FT group, particularly for the CSF, temporal grey and white matter, and corpus callosum. In general, the groups followed a gradient, where the differences were most pronounced for the VP group, less pronounced for the MP group, and least pronounced for the LP group. The VP sub-group was particularly vulnerable compared with the MP and LP sub-groups. The very, moderate, and late preterm brain differed from full-term at term. Differences were seen for CSF, temporal grey and white, and corpus callosum volumes. Differences were also found in the microstructure of many major white matter tracts. Differences were most pronounced for very and least for late preterm infants.
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Affiliation(s)
- Deanne K Thompson
- Murdoch Children's Research Institute, Melbourne, VIC, Australia; Florey Institute of Neuroscience and Mental Health, Melbourne, VIC, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia.
| | - Claire E Kelly
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Jian Chen
- Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Medicine, Monash University, Melbourne, Australia
| | - Richard Beare
- Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Medicine, Monash University, Melbourne, Australia
| | - Bonnie Alexander
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Marc L Seal
- Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
| | - Katherine J Lee
- Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
| | - Lillian G Matthews
- Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia; Department of Newborn Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Peter J Anderson
- Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia; Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Melbourne, VIC, Australia
| | - Lex W Doyle
- Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia; Neonatal Services, The Royal Women's Hospital, Melbourne, VIC, Australia; Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, VIC, Australia
| | - Jeanie L Y Cheong
- Murdoch Children's Research Institute, Melbourne, VIC, Australia; Neonatal Services, The Royal Women's Hospital, Melbourne, VIC, Australia; Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, VIC, Australia
| | - Alicia J Spittle
- Murdoch Children's Research Institute, Melbourne, VIC, Australia; Neonatal Services, The Royal Women's Hospital, Melbourne, VIC, Australia; Department of Physiotherapy, The University of Melbourne, Melbourne, VIC, Australia
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Estalella I, San Millán J, Trincado MJ, Maquibar A, Martínez-Indart L, San Sebastián M. Evaluation of an intervention supporting breastfeeding among late-preterm infants during in-hospital stay. Women Birth 2018; 33:e33-e38. [PMID: 30527733 DOI: 10.1016/j.wombi.2018.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 11/07/2018] [Accepted: 11/08/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Late-preterm infants show lower breastfeeding rates when compared with term infants. Current practice is to keep them in low-risk wards where clinical guidelines to support breastfeeding are well established for term infants but can be insufficient for late-preterm. OBJECTIVE The aim of this study was to evaluate an intervention supporting breastfeeding among late-preterm infants in a maternity service in the Basque Country, Spain. METHODS The intervention was designed to promote parents' education and involvement, provide a multidisciplinary approach and decision-making, and avoid separation of the mother-infant dyad. A quasi-experimental study was conducted with a control (n=212) and an intervention group (n=161). Data was collected from clinical records from November 2012 to January 2015. Feeding rate at discharge, breast-pump use, incidence of morbidities, infant weight loss and hospital stay length were compared between the two groups. RESULTS Infants in the control group were 50.7% exclusive breastfeeding, 37.8% breastfeeding, and, 11.5% formula feeding at discharge, whereas in the intervention group, frequencies were 68.4%, 25.9%, and 5.7%, respectively (p=0.002). Mothers in the intervention group were 2.66 times more likely to use the breast-pump after almost all or all feeds and 2.09 times more likely to exclusively breastfeed at discharge. There were no significant differences in morbidities and infant weight loss between groups. Hospital stay was longer for infants who required phototherapy in the intervention group (p=0.009). CONCLUSION The intervention resulted in a higher breastfeeding rate at discharge. Interventions aimed to provide specific support among late-pretem infants in maternity services are effective.
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Affiliation(s)
- Itziar Estalella
- Nursing Department I, Faculty of Medicine and Nursing, University of the Basque Country UPV/EHU, Barrio Sarriena s/n, 48940 Leioa, Spain; Maternal-fetal group, Biocruces Health Research Institute, Cruces University Hospital, Plaza de Cruces 12, 48903 Barakaldo, Spain.
| | - Jaione San Millán
- Nursing Department I, Faculty of Medicine and Nursing, University of the Basque Country UPV/EHU, Barrio Sarriena s/n, 48940 Leioa, Spain
| | - María José Trincado
- Maternal-fetal group, Biocruces Health Research Institute, Cruces University Hospital, Plaza de Cruces 12, 48903 Barakaldo, Spain
| | - Amaia Maquibar
- Nursing Department I, Faculty of Medicine and Nursing, University of the Basque Country UPV/EHU, Barrio Sarriena s/n, 48940 Leioa, Spain
| | - Lorea Martínez-Indart
- Bioinformatics and Statistical Support Unit, Biocruces Health Research Institute, Plaza de Cruces 12, 48903, Barakaldo, Bizkaia, Spain
| | - Miguel San Sebastián
- Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Sweden
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Lozano NA, Lozano A, Marini V, Saranz RJ, Blumberg RS, Baker K, Agresta MF, Ponzio MF. Expression of FcRn receptor in placental tissue and its relationship with IgG levels in term and preterm newborns. Am J Reprod Immunol 2018; 80:e12972. [PMID: 29745444 DOI: 10.1111/aji.12972] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 04/06/2018] [Indexed: 01/09/2023] Open
Abstract
PROBLEM IgG is the only antibody class, that is, actively transferred from the mother to the fetus across the placenta by an active, neonatal Fc receptor (FcRn) mediated process during pregnancy, conferring passive immunity and protection against infections to the newborn during the first months of life. Preterm infants may not receive sufficient titers of protective antibodies, as most of them are transferred only after the 34th week of gestation. Because of the great importance of this process, we investigated in a clinical setting the placental transmission of IgG antibodies in term and preterm newborns. METHOD OF STUDY This work was conducted in 85 woman and their newborns, divided into four groups according to their clinical gestational age (≤37 weeks were considered as preterm). Blood samples were collected from the mothers and their newborns' umbilical cords to analyze total serum IgG concentrations, and a subgroup of 32 placentas was analyzed by immunohistochemistry to quantify the expression of the FcRn receptor. RESULTS Total IgG levels in both mothers and neonates increased significantly through the third trimester of gestation. Regarding the newborns, in all groups, IgG levels exceeded their mother's values by a ~2.4%. A higher expression of FcRn was detected in placentas from newborns at week 36 of gestation onwards. CONCLUSION Our results obtained from clinical samples, were in line with previous descriptions in model systems and confirmed that the IgG transfer from maternal serum to the fetus is positively correlated with FcRn expression in placental tissue throughout gestation.
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Affiliation(s)
- Natalia A Lozano
- Servicio de Alergia e Inmunologia, Clínica Universitaria Reina Fabiola, Facultad de Ciencias de la Salud, Universidad Católica de Córdoba, Córdoba, Argentina
| | - Alejandro Lozano
- Servicio de Alergia e Inmunologia, Clínica Universitaria Reina Fabiola, Facultad de Ciencias de la Salud, Universidad Católica de Córdoba, Córdoba, Argentina
| | - Vanina Marini
- Servicio de Alergia e Inmunologia, Clínica Universitaria Reina Fabiola, Facultad de Ciencias de la Salud, Universidad Católica de Córdoba, Córdoba, Argentina
| | - Ricardo J Saranz
- Servicio de Alergia e Inmunologia, Clínica Universitaria Reina Fabiola, Facultad de Ciencias de la Salud, Universidad Católica de Córdoba, Córdoba, Argentina
| | - Richard S Blumberg
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, MA, USA
| | - Kristi Baker
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, MA, USA
| | - Maria F Agresta
- Servicio de Alergia e Inmunologia, Clínica Universitaria Reina Fabiola, Facultad de Ciencias de la Salud, Universidad Católica de Córdoba, Córdoba, Argentina
| | - Marina F Ponzio
- Instituto de Investigaciones en Ciencias de la Salud (INICSA)-CONICET, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Córdoba, Argentina
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Abajobir AA, Kisely S, Williams G, Strathearn L, Najman JM. Risky Sexual Behaviors and Pregnancy Outcomes in Young Adulthood Following Substantiated Childhood Maltreatment: Findings From a Prospective Birth Cohort Study. JOURNAL OF SEX RESEARCH 2018; 55:106-119. [PMID: 28972390 DOI: 10.1080/00224499.2017.1368975] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Childhood maltreatment is associated with a range of adverse mental and physical health outcomes, including increased rates of sexually transmitted infections (STIs) later in life. However, the impact on risky sexual behaviors and pregnancy outcomes has not been adequately studied. This is particularly true for physical abuse, emotional abuse, and neglect. We examined associations between prospectively substantiated childhood maltreatment and reports of risky sexual behaviors by men and women, as well as selected pregnancy outcomes in women. We followed up 3,081 (45.7% female) participants from the Mater-University of Queensland Study of Pregnancy, a prospective Australian birth cohort study. Using logistic regression, we examined the association between substantiated childhood maltreatment from birth to 14 years, and self-reported risky sexual behaviors and youth pregnancy outcomes at the 21-year follow-up. In adjusted analyses, children who had experienced multiple childhood maltreatment exhibited more risky sexual behaviors than their nonmaltreated counterparts. In specific models, those exposed to each form of childhood maltreatment, independent of co-occurring forms of childhood maltreatment, had an increased likelihood of risky sexual behaviors, particularly an early sexual debut and, for women, youth pregnancy. Neglect was also associated with multiple sexual partners, and emotional abuse with higher rates of miscarriage. There was no difference between men and women in how different forms of childhood maltreatment predicted risky sexual behaviors in young adulthood. All forms of substantiated childhood maltreatment, including multiple substantiations, were associated with risky sexual behavior in both sexes as well as higher rates of youth pregnancy in women. Moreover, emotional abuse persistently predicted miscarriages in young adult women. Understanding the association between childhood maltreatment and risky sexual behaviors and youth pregnancy outcomes may help suggest preventive strategies.
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Affiliation(s)
- Amanuel A Abajobir
- a Faculty of Medicine, School of Public Health , The University of Queensland
| | - Steve Kisely
- b Faculty of Medicine, School of Medicine , University of Queensland, Princess Alexandra Hospital
- c Faculty of Medicine, Departments of Psychiatry, Community Health and Epidemiology , Dalhousie University
| | - Gail Williams
- d Faculty of Medicine, School of Medicine , University of Queensland
| | - Lane Strathearn
- e Stead Family Department of Pediatrics, Division of Developmental and Behavioral Pediatrics , University of Iowa
- f Center for Disabilities and Development , University of Iowa Stead Family Children's Hospital
| | - Jake M Najman
- a Faculty of Medicine, School of Public Health , The University of Queensland
- g Queensland Alcohol and Drug Research and Education Centre , The University of Queensland
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31
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Mallory DJ. Postdates Pregnancy. Integr Med (Encinitas) 2018. [DOI: 10.1016/b978-0-323-35868-2.00053-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Aragona E, Conroy R. Newborn Care Curriculum: The Late Preterm Infant in the Level II Neonatal Intensive Care Unit. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2017; 13:10657. [PMID: 30800858 PMCID: PMC6338143 DOI: 10.15766/mep_2374-8265.10657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 11/25/2017] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Late preterm births represent the largest category of preterm deliveries. Although these infants are frequently managed in normal newborn nurseries, they have an increased risk of readmissions and mortality. Thus, we designed this PowerPoint-based learning module to provide learners with a computer-based educational resource on late preterm infants in the level II neonatal intensive care unit. METHODS This module can be completed using the included pretest and posttest to assess for change in knowledge. The module should take approximately 20 to 30 minutes to complete. RESULTS Between May and June of 2016, members of the pediatric hospitalist division at Children's National Health System in Washington, DC participated in a study of the module as a self-directed learning tool and completed the pretest, posttest, and postmodule evaluation forms. There was an overall increase in knowledge, with an increase in posttest score from 64% to 94%. Furthermore, this module was well-received by learners, as 55% of learners agreed or strongly agreed that the material presented in the module would change their clinical practice, and 100% agreed or strongly agreed that the module increased their comfort with teaching on this topic. DISCUSSION Initial implementation of the module indicates it could be a valuable tool to address a perceived educational need in the area of late preterm infant care in the level II neonatal intensive care unit.
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Affiliation(s)
- Elena Aragona
- Assistant Professor, Department of Pediatrics, Tufts University School of Medicine
| | - Rebekah Conroy
- Assistant Professor, Department of Pediatrics, George Washington School of Medicine and Health Sciences
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Mughal MK, Ginn CS, Magill-Evans J, Benzies KM. Parenting stress and development of late preterm infants at 4 months corrected age. Res Nurs Health 2017; 40:414-423. [DOI: 10.1002/nur.21809] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 06/06/2017] [Indexed: 01/13/2023]
Affiliation(s)
| | | | - Joyce Magill-Evans
- Department of Occupational Therapy; University of Alberta; Edmonton Alberta Canada
| | - Karen M. Benzies
- Faculty of Nursing, Department of Paediatrics; University of Calgary; Calgary Alberta Canada
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Iughetti L, Lucaccioni L, Ferrari F. Challenges in the development and growth of small for gestational age newborns. Expert Rev Endocrinol Metab 2017; 12:253-260. [PMID: 30058882 DOI: 10.1080/17446651.2017.1338137] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Being born with low birth weight (less than 2.500 gr) is considered a public health problem, with an overall world rate of about 14%. Low birth weight may result from a premature birth (< 37 weeks of gestation), from several causes of intra-uterine growth restriction or from a combination of both. Areas covered: We described how, if weight and/or length at birth are not adequate for gestational age, the newborn is considered 'small for gestational age' and may present several growth, hormonal and developmental peculiarities, possibly due to the growth restriction developed during pregnancy. Expert commentary: We provide a description of the possible mid-term consequences of being born small for gestational age and how to follow and provide care for these babies from a multidisciplinary point of view.
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Affiliation(s)
- Lorenzo Iughetti
- a Post-graduate School of Paediatrics, Department of Medical and Surgical Sciences of the Mother, Children and Adults , University of Modena and Reggio Emilia , Modena , Italy
| | - Laura Lucaccioni
- b Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences of the Mother, Children and Adults , University of Modena and Reggio Emilia , Modena , Italy
| | - Fabrizio Ferrari
- b Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences of the Mother, Children and Adults , University of Modena and Reggio Emilia , Modena , Italy
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Novak NL, Geronimus AT, Martinez-Cardoso AM. Change in birth outcomes among infants born to Latina mothers after a major immigration raid. Int J Epidemiol 2017; 46:839-849. [PMID: 28115577 PMCID: PMC5837605 DOI: 10.1093/ije/dyw346] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2016] [Indexed: 12/30/2022] Open
Abstract
Background Growing evidence indicates that immigration policy and enforcement adversely affect the well-being of Latino immigrants, but fewer studies examine 'spillover effects' on USA-born Latinos. Immigration enforcement is often diffuse, covert and difficult to measure. By contrast, the federal immigration raid in Postville, Iowa, in 2008 was, at the time, the largest single-site federal immigration raid in US history. Methods We employed a quasi-experimental design, examining ethnicity-specific patterns in birth outcomes before and after the Postville raid. We analysed Iowa birth-certificate data to compare risk of term and preterm low birthweight (LBW), by ethnicity and nativity, in the 37 weeks following the raid to the same 37-week period the previous year ( n = 52 344). We model risk of adverse birth outcomes using modified Poisson regression and model distribution of birthweight using quantile regression. Results Infants born to Latina mothers had a 24% greater risk of LBW after the raid when compared with the same period 1 year earlier [risk ratio (95% confidence interval) = 1.24 (0.98, 1.57)]. No such change was observed among infants born to non-Latina White mothers. Increased risk of LBW was observed for USA-born and immigrant Latina mothers. The association between raid timing and LBW was stronger among term than preterm births. Changes in birthweight after the raid primarily reflected decreased birthweight below the 5th percentile of the distribution, not a shift in mean birthweight. Conclusions Our findings highlight the implications of racialized stressors not only for the health of Latino immigrants, but also for USA-born co-ethnics.
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Affiliation(s)
- Nicole L Novak
- Department of Epidemiology, University of Michigan School of Public Health,
Ann Arbor, MI, USA
| | - Arline T Geronimus
- Department of Health Behavior and Health Education, University of Michigan
School of Public Health, Ann Arbor, MI, USA
- Population Studies Center, Institute for Social Research, University of
Michigan, Ann Arbor, MI, USA
| | - Aresha M Martinez-Cardoso
- Department of Health Behavior and Health Education, University of Michigan
School of Public Health, Ann Arbor, MI, USA
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Safety, dosing, and pharmaceutical quality for studies that evaluate medicinal products (including biological products) in neonates. Pediatr Res 2017; 81:692-711. [PMID: 28248319 DOI: 10.1038/pr.2016.221] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 08/21/2016] [Indexed: 12/13/2022]
Abstract
The study of medications among pediatric patients has increased worldwide since 1997 in response to new legislation and regulations, but these studies have not yet adequately addressed the therapeutic needs of neonates. Additionally, extant guidance developed by regulatory agencies worldwide does not fully address the specificities of neonatal drug development, especially among extremely premature newborns who currently survive. Consequently, an international consortium from Canada, Europe, Japan, and the United States was organized by the Critical Path Institute to address the content of guidance. This group included neonatologists, neonatal nurses, parents, regulators, ethicists, clinical pharmacologists, specialists in pharmacokinetics, specialists in clinical trials and pediatricians working in the pharmaceutical industry. This group has developed a comprehensive, referenced White Paper to guide neonatal clinical trials of medicines - particularly early phase studies. Key points include: the need to base product development on neonatal physiology and pharmacology while making the most of knowledge acquired in other settings; the central role of families in research; and the value of the whole neonatal team in the design, implementation and interpretation of studies. This White Paper should facilitate successful clinical trials of medicines in neonates by informing regulators, sponsors, and the neonatal community of existing good practice.
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Khalak R, Rijhsinghani A, McCallum SE. Impact of maternal obesity on very preterm infants. Obesity (Silver Spring) 2017; 25:945-949. [PMID: 28332298 DOI: 10.1002/oby.21812] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 01/04/2017] [Accepted: 01/26/2017] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Infants born at less than 34 weeks' gestational age are at higher risk for morbidity and mortality. Data are limited on the impact of maternal obesity on the very preterm infant. This study reviewed whether maternal obesity further increases the intensive care needs of very preterm infants of less than 34 weeks' gestation. METHODS Maternal and neonatal data for live-born singleton births of 23 0/7 to 33 6/7 weeks' gestation delivering in upstate New York were reviewed. BMI categorization followed the National Institutes of Health BMI classification that subdivides obesity into three ascending BMI groups. RESULTS Records were obtained on 1,224 women, of whom 31.6% were classified with obesity. Despite similar mean gestational age (31 to 31.6 weeks, P = 0.57) and birth weight (1,488 to 1,569 g, P = 0.51) of the infants in the BMI categories, delivery room (DR) resuscitation was more common for infants of women with level III obesity (63.2%, P = 0.04) with a trend toward the continued need for assisted ventilation (54.7%, P = 0.06). CONCLUSIONS Preterm infants of women with level III obesity were more likely to require DR resuscitation with a trend to continued need for ventilatory support beyond 6 hours of age. This could impact utilization of DR resources at delivering hospitals.
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Affiliation(s)
- Rubia Khalak
- Department of Pediatrics/Neonatology Division, Albany Medical Center, Albany, New York, USA
| | - Asha Rijhsinghani
- Department of Obstetrics and Gynecology/Division of Maternal-Fetal Medicine, Albany Medical Center, Albany, New York, USA
| | - Sarah E McCallum
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, New York, USA
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Boguszewski MCDS, Cardoso-Demartini ADA. MANAGEMENT OF ENDOCRINE DISEASE: Growth and growth hormone therapy in short children born preterm. Eur J Endocrinol 2017; 176:R111-R122. [PMID: 27803030 DOI: 10.1530/eje-16-0482] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Revised: 10/25/2016] [Accepted: 11/01/2016] [Indexed: 11/08/2022]
Abstract
Approximately 15 million babies are born preterm across the world every year, with less than 37 completed weeks of gestation. Survival rates increased during the last decades with the improvement of neonatal care. With premature birth, babies are deprived of the intense intrauterine growth phase, and postnatal growth failure might occur. Some children born prematurely will remain short at later ages and adult life. The risk of short stature increases if the child is also born small for gestational age. In this review, the effects of being born preterm on childhood growth and adult height and the hormonal abnormalities possibly associated with growth restriction are discussed, followed by a review of current information on growth hormone treatment for those who remain with short stature during infancy and childhood.
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The Relationship Between Behavioral States and Oral Feeding Efficiency in Preterm Infants. Adv Neonatal Care 2017; 17:E12-E19. [PMID: 27649302 DOI: 10.1097/anc.0000000000000318] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The relationship between behavioral states (alert, sleep, drowsy, and crying) and oral feeding efficiency in preterm infants is not well understood. PURPOSE To determine the relationship between behavioral states and feeding efficiency in preterm infants. METHODS This correlational study was conducted as a secondary analysis from a randomized controlled trial. Medically stable preterm infants born between 29 and 34 weeks' gestational age participated. Baseline data from the randomized controlled trial (week 0), 1 minute prior to feeding, were used. Behavioral states were coded by 2 blinded coders. Oral feeding efficiency (mL/min) was calculated as the amount of intake over the first 10 minutes of feeding. RESULTS Data from 147 infants were included. The proportion of time spent in alert states (β = .76, F = 11.29, P ≤ .05), sleep states (β = -1.08, F = 25.26, P ≤ .05), and crying (β = 1.50, F = 12.51, P ≤ .05) uniquely predicted oral feeding efficiency. IMPLICATIONS FOR PRACTICE Comprehensive assessment of behavioral states and infant characteristics for oral feeding readiness is crucial. Alert states are optimal for oral feeding. Forced oral feeding when infants are sleeping should be avoided. Infants in crying or drowsy states prior to feeding should be closely evaluated. Sleeping or drowsy infants may benefit from interventions (eg, oral sensory stimulation, nonnutritive sucking, or multisensory intervention) to support transition to alert states prior to feeding. IMPLICATIONS FOR RESEARCH Future research should evaluate behavioral states prior to and during feeding and their relationship to oral feeding efficiency.
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Rennó C, Nadaf MIV, Zago CA, Carneiro-Sampaio M, Palmeira P. Healthy Preterm Newborns Show an Increased Frequency of CD4(+) CD25(high) CD127(low) FOXP3(+) Regulatory T Cells with a Naive Phenotype and High Expression of Gut-Homing Receptors. Scand J Immunol 2017; 83:445-55. [PMID: 27007547 DOI: 10.1111/sji.12435] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 03/16/2016] [Indexed: 12/13/2022]
Abstract
Treg cells are crucial to prevent immune dysregulation, but little is known about the frequency of these cells in neonates, particularly in very/moderate and late preterm newborns studied as separate groups. The CD4(+) CD25(hi) CD127(lo) FOXP3(+) Treg population was phenotypically characterized to assess maturation markers and gut-homing integrins by flow cytometry in the cord blood of healthy preterm newborns born at 30-33(6/7) gestation weeks (Group 1), at 34-36(6/7) gestation weeks (Group 2) and term newborns born at 37-41 gestation weeks (Group 3), compared to healthy adults. An inverse correlation of the Treg percentage and gestational age was found, with significantly higher frequencies in Group 1 compared to Groups 2 and 3 and in Group 2 compared to Group 3, and significantly higher Treg frequencies and numbers in the neonates compared to the adults. All of the newborns exhibited increased Treg frequencies with a naive phenotype compared to adults. Cytotoxic T-lymphocyte-associated protein 4 CTLA-4 expression in the naive Treg was decreased in both preterm groups compared with those from term newborns and adults, and in the memory Treg from Group 1 compared with the other groups. The frequencies of Treg expressing α4β7 and α4β1 integrins were higher in both preterm groups, but significantly different only in Group 1, when compared with those from the term newborns and the adults. In conclusion, although a high frequency of Treg is present in newborns, an immature phenotype with a higher expression of CD45RA and α4β7/α4β1 and a lower expression of CTLA-4 is found, particularly in the very preterm group.
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Affiliation(s)
- C Rennó
- Department of Pediatrics, Medical School, University of São Paulo, São Paulo, Brazil
| | - M I V Nadaf
- Department of Pediatrics, Medical School, University of São Paulo, São Paulo, Brazil.,Department of Pediatrics, Federal University of Mato Grosso (UFMT), Cuiabá, Mato Grosso, Brazil
| | - C A Zago
- Department of Pediatrics, Medical School, University of São Paulo, São Paulo, Brazil
| | - M Carneiro-Sampaio
- Department of Pediatrics, Medical School, University of São Paulo, São Paulo, Brazil
| | - P Palmeira
- Department of Pediatrics, Medical School, University of São Paulo, São Paulo, Brazil.,Laboratory of Medical Investigation (LIM-36), Instituto da Criança, Hospital das Clínicas, São Paulo, Brazil
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Gross I, Siedner-Weintraub Y, Abu Ahmad W, Bar-Oz B, Eventov-Friedman S. National Evidence in Israel Supporting Reevaluation of Respiratory Syncytial Virus Prophylactic Guidelines. Neonatology 2017; 111:240-246. [PMID: 27898422 DOI: 10.1159/000452196] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 10/03/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND The American Academy of Pediatrics (AAP) recently narrowed the indications for respiratory syncytial virus (RSV) prophylaxis, while in Israel the guidelines have not changed. OBJECTIVE To compare the prevalence and severity of RSV infection among preterm infants born earlier than 340/7 weeks of gestation (PI), late preterm infants born at 340/7-366/7 weeks (LPTI), and term infants born after 370/7 weeks of gestation (TI) and to determine whether the results support a change in local policy. METHODS Data of all children aged 0-14 years hospitalized with PCR-positive RSV in a single tertiary center from 2010 to 2014 were collected. A total of 793 children were included and divided into 3 groups: 637 were TI, 105 were LPTI, and 50 were PI. These groups were compared regarding incidence of hospitalization due to RSV infection, intensive care unit (ICU) hospitalization, and length of hospitalization. RESULTS The hospitalization rate due to RSV infection was 5.2, 3.5, and 1.3% among PI, LPTI, and TI, respectively (p < 0.01). The hospitalization rate in the ICU was 24, 7.6, and 3% among PI, LPTI, and TI, respectively (p < 0.001). The length (days) of hospitalization was significantly longer among PI compared with LPTI and TI (p < 0.001). Overall, the hospitalization rate and disease severity were significantly higher for infants born earlier than 35 weeks of gestation compared with more maturely born infants. CONCLUSION RSV infection remains a major cause of morbidity among children born prematurely even after RSV prophylaxis and would probably be greater were prophylaxis curtailed. Our results do not support applying the current AAP guidelines in Israel. Further local studies are needed to optimize prophylaxis for both PI and LPTI.
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Affiliation(s)
- Itai Gross
- Department of Pediatrics, Hadassah and Hebrew University Hospital, Jerusalem, Israel
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Boies EG, Vaucher YE. ABM Clinical Protocol #10: Breastfeeding the Late Preterm (34-36 6/7 Weeks of Gestation) and Early Term Infants (37-38 6/7 Weeks of Gestation), Second Revision 2016. Breastfeed Med 2016; 11:494-500. [PMID: 27830934 DOI: 10.1089/bfm.2016.29031.egb] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
A central goal of the Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient.
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Affiliation(s)
- Eyla G Boies
- Department of Pediatrics, University of California , San Diego, California
| | - Yvonne E Vaucher
- Department of Pediatrics, University of California , San Diego, California
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Sung JH, Kim SH, Kim YM, Kim JH, Kim MN, Lee HR, Lee HJ, Lee EJ, Choi SJ, Oh SY, Roh CR, Kim JH. Neonatal outcomes of twin pregnancies delivered at late-preterm versus term gestation based on chorionicity and indication for delivery. J Perinat Med 2016; 44:903-911. [PMID: 27149198 DOI: 10.1515/jpm-2015-0401] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 03/31/2016] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To investigate the neonatal outcomes of twin pregnancies delivered at late-preterm versus term gestation based on chorionicity and indication for delivery. STUDY DESIGN This is a retrospective cohort study of women with twin pregnancies delivered at ≥34 weeks of gestation from 1995 to 2014. Subjects were categorized into two groups according to gestational age at delivery: late-preterm group (34-36 weeks) and term group (≥37 weeks). Neonatal outcome measures including neonatal intensive care unit (NICU) admission, mechanical ventilator support, and respiratory distress syndrome (RDS) were compared between the late-preterm and term group based on chorionicity (monochorionic or dichorionic) and delivery indication (elective or non-elective). RESULTS A total of 1198 twin pregnancies were included in the study: 679 in the late-preterm group and 519 in the term group. Late-preterm twin infants had higher rates of NICU admission, mechanical ventilator support, and RDS than did term twin infants, regardless of the chorionicity and indication for delivery. In the multivariable analysis, late-preterm birth, monochorionicity, and non-elective delivery were independently associated with a significantly higher risk of NICU admission and mechanical ventilator support. CONCLUSION The late-preterm birth was associated with a higher risk of adverse neonatal outcome regardless of chorionicity and indication for delivery, and showed significantly increased risk by monochorionicity and non-elective delivery.
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Simchen MJ, Okrent Smolar AL, Dulitzky M, Sivan E, Morag I. Neonatal morbidities and need for intervention in twins and singletons born at 34-35 weeks of gestation. J Perinat Med 2016; 44:887-892. [PMID: 26677882 DOI: 10.1515/jpm-2015-0113] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 11/17/2015] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To compare indications for delivery and neonatal morbidities between twins and singletons born between 34 and 35 weeks of gestation. STUDY DESIGN A prospective observational study was performed in which all infants born between January and August 2008, at Sheba Medical Center at 34 0/7-35 6/7 weeks of gestational age were included. Indications for delivery, infants' morbidities and medical interventions were documented. Twins and singletons were compared for antenatal maternal characteristics, risks of short-term neonatal complications and interventions. RESULTS One hundred and seventy-three mothers and 229 neonates (114 twins and 115 singletons) were included. Background maternal characteristics as well as the use of antenatal steroids and MgSO4 were similar between the groups. Only 44% of all deliveries were spontaneous, while the rest were indicated deliveries. Twins were born lighter and 31.9% of them were SGA. Nevertheless, singletons were significantly more likely to receive medical interventions such as prolonged oxygen use (>1 day) and phototherapy. All late preterm infants (n=5) needing surfactant administration were singletons. Overall, the risk of needing any medical intervention was significantly higher for singletons compared with twins (OR 1.8, 95% CI 1.02-3.2). CONCLUSIONS A significant proportion of late preterm births is iatrogenic. Twins and singletons are dissimilar with regards to risks of short-term complications. Despite being born smaller and more SGA, twins are at lower risk of requiring medical intervention in the immediate neonatal period compared with singletons.
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Gedik E, Yücel N, Sahin T, Koca E, Colak YZ, Togal T. Hemolysis, elevated liver enzymes, and low platelet syndrome: Outcomes for patients admitted to intensive care at a tertiary referral hospital. Hypertens Pregnancy 2016; 36:21-29. [DOI: 10.1080/10641955.2016.1218505] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Ender Gedik
- Department of Anesthesiology and Reanimation, Baskent University School of Medicine, Ankara, Turkey
| | - Neslihan Yücel
- Department of Emergency Medicine, Inonu University School of Medicine, Malatya, Turkey
| | - Taylan Sahin
- Department of Anesthesiology and Reanimation, Ersin Arslan State Hospital, Gaziantep, Turkey
| | - Erdinc Koca
- Department of Anesthesiology and Reanimation, Malatya State Hospital, Malatya, Turkey
| | - Yusuf Ziya Colak
- Department of Anesthesiology and Reanimation, Inonu University School of Medicine, Malatya, Turkey
| | - Turkan Togal
- Department of Anesthesiology and Reanimation, Inonu University School of Medicine, Malatya, Turkey
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Shah P, Kaciroti N, Richards B, Oh W, Lumeng JC. Developmental Outcomes of Late Preterm Infants From Infancy to Kindergarten. Pediatrics 2016; 138:peds.2015-3496. [PMID: 27456513 PMCID: PMC4960722 DOI: 10.1542/peds.2015-3496] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/23/2016] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To compare developmental outcomes of late preterm infants (34-36 weeks' gestation) with infants born at early term (37-38 weeks' gestation) and term (39-41 weeks' gestation), from infancy through kindergarten. METHODS Sample included 1000 late preterm, 1800 early term, and 3200 term infants ascertained from the Early Childhood Longitudinal Study, Birth Cohort. Direct assessments of development were performed at 9 and 24 months by using the Bayley Short Form-Research Edition T-scores and at preschool and kindergarten using the Early Childhood Longitudinal Study, Birth Cohort reading and mathematics θ scores. Maternal and infant characteristics were obtained from birth certificate data and parent questionnaires. After controlling for covariates, we compared mean developmental outcomes between late preterm and full-term groups in serial cross-sectional analyses at each timepoint using multilinear regression, with pairwise comparisons testing for group differences by gestational age categories. RESULTS With covariates controlled at all timepoints, at 9 months late preterm infants demonstrated less optimal developmental outcomes (T = 47.31) compared with infants born early term (T = 49.12) and term (T = 50.09) (P < .0001). This association was not seen at 24 months, (P = .66) but reemerged at preschool. Late preterm infants demonstrated less optimal scores in preschool reading (P = .0006), preschool mathematics (P = .0014), and kindergarten reading (P = .0007) compared with infants born at term gestation. CONCLUSIONS Although late preterm infants demonstrate comparable developmental outcomes to full-term infants (early term and full-term gestation) at 24 months, they demonstrate less optimal reading outcomes at preschool and kindergarten timepoints. Ongoing developmental surveillance for late preterm infants is warranted into preschool and kindergarten.
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Affiliation(s)
- Prachi Shah
- Division of Developmental Behavioral Pediatrics, Department of Pediatrics, School of Medicine, Center for Human Growth and Development, and
| | | | | | - Wonjung Oh
- Department of Human Development and Family Studies, College of Human Sciences, Texas Tech University, Lubbock, Texas
| | - Julie C. Lumeng
- Division of Developmental Behavioral Pediatrics, Department of Pediatrics, School of Medicine,,Center for Human Growth and Development, and,Department of Nutritional Sciences, School of Public of Health, University of Michigan, Ann Arbor, Michigan; and
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Machado AKF, Marmitt LP, Cesar JA. Late preterm birth in the far south of Brazil: a population based study. REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2016. [DOI: 10.1590/1806-93042016000200003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Abstract Objectives: to describe the prevalence of late preterm birth (LPB) and identify factors associated with its occurrence in the municipality of Rio Grande, RS. Methods: a standardized questionnaire was applied to allpuerperal women resident in the municipality who had children in theyear 2013. Preterm birth was defined as birth occur-ring between the 34th and 36th week of gestation, preferably evaluated by means of ultra-sonography in the 6th to 20th weeks. The analysis used Poisson regression with robust adjustment of variance, following the hierarchical model.The effect measure used was the preva-lence ratio (PR). Results: of the 2286 births included in the study, 11.8% (CI95%: 10.5-13.1) were LPBs. After adjusted analysis, the PRfor occurrence of LPB among black-skinned motherswas 1.40 (1.01-1.96) in relation to white-skinned women; 1.74 (1.23-2.45) among those who attended less than sixprenatal consults compared to those who attended nine or more; the PR was 1.36 (1.11-1.68) for those classified as depressives compared to others and 1.29 (1.01-1.65) for those undergoing caesarian. Conclusions: the results suggest the existence of inequality in relation to skin color and the important impact of the number ofprenatal consults on the outcome. More appropriately designed studies are needed to confirm the causal relation among maternal depression, caesarian and LPB.
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Lee SY, Jang GJ. Prevalence and Predictors of Exclusive Breastfeeding in Late Preterm Infants at 12 Weeks. CHILD HEALTH NURSING RESEARCH 2016. [DOI: 10.4094/chnr.2016.22.2.79] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Hernandez-Andrade E, Garcia M, Ahn H, Korzeniewski SJ, Saker H, Yeo L, Chaiworapongsa T, Hassan SS, Romero R. Strain at the internal cervical os assessed with quasi-static elastography is associated with the risk of spontaneous preterm delivery at ≤34 weeks of gestation. J Perinat Med 2015; 43:657-66. [PMID: 25781664 PMCID: PMC5625351 DOI: 10.1515/jpm-2014-0382] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 02/06/2015] [Indexed: 01/31/2023]
Abstract
AIM To evaluate the association between cervical strain assessed with quasi-static elastography and spontaneous preterm delivery. METHODS Quasi-static elastography was used to estimate cervical strain in 545 pregnant women with singleton pregnancies from 11 weeks to 28 weeks of gestation. Cervical strain was evaluated in one sagittal plane and in the cross-sectional planes of the internal cervical os and external cervical os. The distribution of strain values was categorized into quartiles for each studied region and their association with spontaneous preterm delivery at ≤34 weeks and at <37 weeks of gestation was evaluated using logistic regression. RESULTS The prevalence of spontaneous preterm delivery at <37 weeks of gestation was 8.2% (n=45), and that at ≤34 weeks of gestation was 3.8% (n=21). Strain in the internal cervical os was the only elastography value associated with spontaneous preterm delivery. Women with strain values in the 3rd and 4th quartiles had a significantly higher risk of spontaneous preterm delivery at ≤34 weeks and at <37 weeks of gestation when compared to women with strain values in the lowest quartile. When adjusting for a short cervix (<25 mm) and gestational age at examination, women with strain values in the 3rd quartile maintained a significant association with spontaneous preterm delivery at ≤34 weeks (OR 9.0; 95% CI, 1.1-74.0; P=0.02), whereas women with strain values in the highest quartile were marginally more likely than women with lowest quartile strain values to deliver spontaneously at ≤37 weeks of gestation (OR 95% CI: 2.8; [0.9-9.0]; P=0.08). CONCLUSION Increased strain in the internal cervical os is associated with higher risk of spontaneous preterm delivery both at ≤34 and <37 weeks of gestation.
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Affiliation(s)
- Edgar Hernandez-Andrade
- Perinatology Research Branch, NICHD/NIH/DHHS, Detroit, MI, and Bethesda, MD, USA,Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Maynor Garcia
- Perinatology Research Branch, NICHD/NIH/DHHS, Detroit, MI, and Bethesda, MD, USA,Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Hyunyoung Ahn
- Perinatology Research Branch, NICHD/NIH/DHHS, Detroit, MI, and Bethesda, MD, USA,Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Steven J. Korzeniewski
- Perinatology Research Branch, NICHD/NIH/DHHS, Detroit, MI, and Bethesda, MD, USA,Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA,Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA
| | - Homam Saker
- Perinatology Research Branch, NICHD/NIH/DHHS, Detroit, MI, and Bethesda, MD, USA,Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Lami Yeo
- Perinatology Research Branch, NICHD/NIH/DHHS, Detroit, MI, and Bethesda, MD, USA,Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Tinnakorn Chaiworapongsa
- Perinatology Research Branch, NICHD/NIH/DHHS, Detroit, MI, and Bethesda, MD, USA,Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Sonia S. Hassan
- Perinatology Research Branch, NICHD/NIH/DHHS, Detroit, MI, and Bethesda, MD, USA,Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Roberto Romero
- Perinatology Research Branch, NICHD/NIH/DHHS, Detroit, MI, and Bethesda, MD, USA,Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA,Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
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Jang GJ. Comparing Factors Associated with Breastfeeding in Late Preterm Infants of Different Gestational Ages. CHILD HEALTH NURSING RESEARCH 2015. [DOI: 10.4094/chnr.2015.21.4.302] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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