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Smith-Longee A, Johnson S, Aubert AM, Seppänen AV, Pierrat V, Zemlin M, Lebeer J, Sarrechia I, Siljehav V, Zeitlin J, Sentenac M. The early educational environment at five years of age in a European cohort of children born very preterm: challenges and opportunities for research. BMC Pediatr 2024; 24:369. [PMID: 38807056 PMCID: PMC11134723 DOI: 10.1186/s12887-024-04792-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 04/25/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND Early childhood education offers opportunities for stimulation in multiple developmental domains and its positive impact on long-term outcomes and wellbeing for children is well documented. Few studies have explored early education in children born very preterm (VPT; <32 weeks of gestation) who are at higher risk of neurodevelopmental disorders and poor educational outcomes than their term-born peers. The purpose of the study is to describe and compare the educational environment of children born VPT in European countries at 5 years of age according to the degree of perinatal risk. METHODS Data originated from the population-based Screening to Improve Health In very Preterm infants (SHIPS) cohort of children born VPT in 2011/2012 in 19 regions from 11 European countries. Perinatal data were collected from medical records and the 5-year follow-up was conducted using parental questionnaires. Outcomes at 5 years were participation in early education (any, type, intensity of participation) and receipt of special educational support, which were harmonized across countries. RESULTS Out of 6,759 eligible children, 3,687 (54.6%) were followed up at 5 years (mean gestational age 29.3 weeks). At 5 years, almost all children (98.6%) were in an educational program, but type (preschool/primary), attendance (full-time/part-time) and use and type of school support/services differed by country. In some countries, children with high perinatal risk were more likely to be in full-time education than those with low risk (e.g. Estonia: 97.9% vs. 87.1%), while the inverse pattern was observed elsewhere (e.g. Poland: 78.5% vs. 92.8%). Overall, 22.8% of children received special educational support (country range: 12.4-34.4%) with more support received by children with higher perinatal risk. Large variations between countries remained after adjustment for socio-demographic characteristics. CONCLUSIONS There are marked variations in approaches to early education for children born VPT in Europe, raising opportunities to explore its impact on their neurodevelopment and well-being.
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Affiliation(s)
- Alyssa Smith-Longee
- Université Paris Cité, Inserm, INRAE, Centre for Research in Epidemiology and Statistics (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, Paris, France
| | - Samantha Johnson
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Adrien M Aubert
- Université Paris Cité, Inserm, INRAE, Centre for Research in Epidemiology and Statistics (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, Paris, France
| | - Anna-Veera Seppänen
- Université Paris Cité, Inserm, INRAE, Centre for Research in Epidemiology and Statistics (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, Paris, France
| | - Veronique Pierrat
- Université Paris Cité, Inserm, INRAE, Centre for Research in Epidemiology and Statistics (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, Paris, France
- Department of Neonatalogy, CHI Créteil, Créteil, F-94028, France
| | - Michael Zemlin
- Department of General Paediatrics and Neonatology, Saarland University, Saarland University Medical School, Homburg, Germany
| | - Jo Lebeer
- Department of Medicine & Population Health, Faculty of Medicine & Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Iemke Sarrechia
- Department of Medicine & Population Health, Faculty of Medicine & Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Veronica Siljehav
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Jennifer Zeitlin
- Université Paris Cité, Inserm, INRAE, Centre for Research in Epidemiology and Statistics (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, Paris, France
| | - Mariane Sentenac
- Université Paris Cité, Inserm, INRAE, Centre for Research in Epidemiology and Statistics (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, Paris, France.
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DeSerisy M, Wall MM, Goldberg TE, Batistuzzo MC, Keyes K, de Joode NT, Lochner C, Marincowitz C, Narayan M, Anand N, Rapp AM, Stein DJ, Simpson HB, Margolis AE. Assessing harmonized intelligence measures in a multinational study. Glob Ment Health (Camb) 2024; 11:e22. [PMID: 38572246 PMCID: PMC10988151 DOI: 10.1017/gmh.2024.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 01/23/2024] [Accepted: 02/11/2024] [Indexed: 04/05/2024] Open
Abstract
Studies examining the neurocognitive and circuit-based etiology of psychiatric illness are moving toward inclusive, global designs. A potential confounding effect of these associations is general intelligence; however, an internationally validated, harmonized intelligence quotient (IQ) measure is not available. We describe the procedures used to measure IQ across a five-site, multinational study and demonstrate the harmonized measure's cross-site validity. Culturally appropriate intelligence measures were selected: four short-form Wechsler intelligence tests (Brazil, Netherlands, South Africa, United States) and the Binet Kamat (India). Analyses included IQ scores from 255 healthy participants (age 18-50; 42% male). Regression analyses tested between-site differences in IQ scores, as well as expected associations with sociodemographic factors (sex, socioeconomic status, education) to assess validity. Harmonization (e.g., a priori selection of tests) yielded the compatibility of IQ measures. Higher IQ was associated with higher socioeconomic status, suggesting good convergent validity. No association was found between sex and IQ at any site, suggesting good discriminant validity. Associations between higher IQ and higher years of education were found at all sites except the United States. Harmonized IQ scores provide a measure of IQ with evidence of good validity that can be used in neurocognitive and circuit-based studies to control for intelligence across global sites.
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Affiliation(s)
- Mariah DeSerisy
- Columbia University Medical Center, Mailman School of Public Health, Columbia University, New York, NY, USA
- Columbia University Irving Medical Center, Columbia University, New York, NY, USA
| | - Melanie M. Wall
- Columbia University Irving Medical Center, Columbia University, New York, NY, USA
- Department of Psychiatry, The New York State Psychiatric Institute, New York, NY, USA
| | - Terry E. Goldberg
- Columbia University Irving Medical Center, Columbia University, New York, NY, USA
| | - Marcelo C. Batistuzzo
- Department of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
- Department of Methods and Techniques in Psychology, Pontifical Catholic University, São Paulo, Brazil
| | - Katherine Keyes
- Columbia University Medical Center, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Niels T. de Joode
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Department of Anatomy and Neuroscience, Amsterdam UMC, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Christine Lochner
- SAMRC Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry, Stellenbosch University, Stellenbosch, South Africa
| | - Clara Marincowitz
- SAMRC Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry, Stellenbosch University, Stellenbosch, South Africa
| | - Madhuri Narayan
- Department of Clinical Psychology, National Institute of Mental Health & Neuro Sciences (NIMHANS), Institute of National Importance (INI), Bangalore, India
| | - Nitin Anand
- Department of Clinical Psychology, National Institute of Mental Health & Neuro Sciences (NIMHANS), Institute of National Importance (INI), Bangalore, India
| | - Amy M. Rapp
- Columbia University Irving Medical Center, Columbia University, New York, NY, USA
- Department of Psychiatry, The New York State Psychiatric Institute, New York, NY, USA
| | - Dan J. Stein
- SAMRC Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry and Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - H. Blair Simpson
- Columbia University Irving Medical Center, Columbia University, New York, NY, USA
- Department of Psychiatry, The New York State Psychiatric Institute, New York, NY, USA
| | - Amy E. Margolis
- Columbia University Irving Medical Center, Columbia University, New York, NY, USA
- Department of Psychiatry, The New York State Psychiatric Institute, New York, NY, USA
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Seppänen AV, Barros H, Draper ES, Petrou S, Andronis L, Kim S, Maier RF, Pedersen P, Gadzinowski J, Pierrat V, Sarrechia I, Lebeer J, Ådén U, Toome L, Thiele N, van Heijst A, Cuttini M, Zeitlin J. Variation in follow-up for children born very preterm in Europe. Eur J Public Health 2024; 34:91-100. [PMID: 37978865 PMCID: PMC10843937 DOI: 10.1093/eurpub/ckad192] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Children born very preterm (<32 weeks of gestation) face high risks of neurodevelopmental and health difficulties compared with children born at term. Follow-up after discharge from the neonatal intensive care unit is essential to ensure early detection and intervention, but data on policy approaches are sparse. METHODS We investigated the characteristics of follow-up policy and programmes in 11 European countries from 2011 to 2022 using healthcare informant questionnaires and the published/grey literature. We further explored how one aspect of follow-up, its recommended duration, may be reflected in the percent of parents reporting that their children are receiving follow-up services at 5 years of age in these countries using data from an area-based cohort of very preterm births in 2011/12 (N = 3635). RESULTS Between 2011/12 and 22, the number of countries with follow-up policies or programmes increased from 6 to 11. The policies and programmes were heterogeneous in eligibility criteria, duration and content. In countries that recommended longer follow-up, parent-reported follow-up rates at 5 years of age were higher, especially among the highest risk children, born <28 weeks' gestation or with birthweight <1000 g: between 42.1% and 70.1%, vs. <20% in most countries without recommendations. CONCLUSIONS Large variations exist in follow-up policies and programmes for children born very preterm in Europe; differences in recommended duration translate into cross-country disparities in reported follow-up at 5 years of age.
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Affiliation(s)
- Anna-Veera Seppänen
- Université de Paris Cité, Inserm, INRAE, Centre for Research in Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Paediatric Epidemiology Research Team (EPOPé), Paris, France
| | - Henrique Barros
- EPIUnit-Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal
| | | | - Stavros Petrou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Lazaros Andronis
- Division of Clinical Trials, Warwick Medical School, University of Warwick, Coventry, UK
| | - Sungwook Kim
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Rolf F Maier
- Children’s Hospital, University Hospital, Philipps University Marburg, Marburg, Germany
| | | | - Janusz Gadzinowski
- Department of Neonatology, Poznan University of Medical Sciences, Poznan, Poland
| | - Véronique Pierrat
- Université de Paris Cité, Inserm, INRAE, Centre for Research in Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Paediatric Epidemiology Research Team (EPOPé), Paris, France
| | - Iemke Sarrechia
- Department of Family Medicine & Population Health, Faculty of Medicine & Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Jo Lebeer
- Department of Family Medicine & Population Health, Faculty of Medicine & Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Ulrika Ådén
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
- Department of Neonatal Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Liis Toome
- Department of Neonatal and Infant Medicine, Tallinn Children's Hospital, Tallinn, Estonia
- Department of Paediatrics, University of Tartu, Tartu, Estonia
| | - Nicole Thiele
- European Foundation for the Care of Newborn Infants (EFCNI), Munich, Germany
| | - Arno van Heijst
- Department of Neonatology, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Neonatology, Erasmus MC—Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - Marina Cuttini
- Clinical Care and Management Innovation Research Area, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Jennifer Zeitlin
- Université de Paris Cité, Inserm, INRAE, Centre for Research in Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Paediatric Epidemiology Research Team (EPOPé), Paris, France
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Wege M, von Blanckenburg P, Maier RF, Seifart C. Does Educational Status Influence Parents' Response to Bad News in the NICU? CHILDREN (BASEL, SWITZERLAND) 2023; 10:1729. [PMID: 38002820 PMCID: PMC10670369 DOI: 10.3390/children10111729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 10/22/2023] [Accepted: 10/23/2023] [Indexed: 11/26/2023]
Abstract
Communication in neonatal intensive care units and the relationship between families and staff have been reported to influence parental mental well-being. Research has also shown an impact of parental educational level on their well-being. However, whether different educational levels result in different reactions to breaking bad news (BBN) by physicians remains unanswered so far. We therefore examined the impact of parental level of education on their mental state after a BBN conversation and their relation to physicians. A prospective quantitative survey was conducted amongst 54 parents whose preterm or term infants were hospitalized in three German neonatal units. Parental education was classified as low (lower secondary/less (1), n: 23) or high (higher secondary/more (2), n: 31). Parents answered questions about certain aspects of and their mental state after BBN and their trust in physicians. The two groups did not differ significantly in their mental condition after BBN, with both reporting high levels of exhaustion and worries, each (median (min;max): (1): 16 (6;20) vs. (2): 14 (5;20), (scaling: 5-20)). However, lower-educated parents reported a lower trust in physicians (median (min;max): (1): 2 (0;9) vs. (2): 1 (0;6), p < 0.05 (scaling: 0-10)) and felt less safe during BBN (median (min;max): (1): 15 (9;35) vs. (2): 13 (9;33), p < 0.05). Only among higher-educated parents was trust in physicians significantly correlated with the safety and orientation provided during BBN (r: 0.583, p < 0.05, r: 0.584, p < 0.01). Concurrently, only among less-educated parents was safety correlated with the hope conveyed during BBN (r: 0.763, p < 0.01). Therefore, in BBN discussions with less-educated parents, physicians should focus more on giving them hope to promote safety.
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Affiliation(s)
- Mirjam Wege
- Children’s Hospital, University Hospital, Philipps University of Marburg, 35033 Marburg, Germany;
| | - Pia von Blanckenburg
- Department of Clinical Psychology and Psychotherapy, Philipps University of Marburg, 35032 Marburg, Germany;
| | - Rolf Felix Maier
- Children’s Hospital, University Hospital, Philipps University of Marburg, 35033 Marburg, Germany;
| | - Carola Seifart
- Faculty of Medicine, Deans Office, Research Group Medical Ethics, Philipps University of Marburg, 35033 Marburg, Germany;
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Wang LW, Chu CH, Lin YC, Huang CC. Trends in Gestational Age-Related Intelligence Outcomes of School-Age Children Born Very Preterm from 2001 to 2015 in Taiwan. J Pediatr 2023; 261:113584. [PMID: 37354990 DOI: 10.1016/j.jpeds.2023.113584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 05/21/2023] [Accepted: 06/16/2023] [Indexed: 06/26/2023]
Abstract
OBJECTIVE To investigate whether gestational age (GA)-related intelligence outcomes of children born very preterm improved over time. STUDY DESIGN A multicenter cohort study recruited 4717 infants born at GA <31 weeks and admitted to neonatal intensive care units between 2001 and 2015 in Taiwan. Intelligence outcomes at age 5.5 years were classified by intelligent quotient (IQ) into no cognitive impairment (IQ > -1 SD), mild cognitive impairment (IQ = -1∼-2 SD), and moderate/severe cognitive impairment (IQ < -2 SD). Trends were assessed for neonatal morbidities, mortality, and intelligence outcomes by birth epoch (2001-2003, 2004-2006, 2007-2009, 2010-2012, 2013-2015) and GA (23-24, 25-26, 27-28, 29-30 weeks). RESULTS Maternal education levels increased and rates of brain injury and mortality decreased over time. Among the 2606 children who received IQ tests, the rates of no, mild, and moderate/severe cognitive impairment were 54.5%, 30.5%, and 15.0%, respectively. There were significant trends in the increasing rates of no cognitive impairment and declining rates of mild and moderate/severe cognitive impairment in all GA groups across the 5 birth epochs. Relative to the occurrence in 2001-2003, the odds were significantly reduced for moderate/severe cognitive impairment from 2007-2009 (aOR 0.49, 95% CI 0.30-0.81) to 2013-2015 (0.35, 0.21-0.56) and for mild cognitive impairment from 2010-2012 (0.54, 0.36-0.79) to 2013-2015 (0.36, 0.24-0.53). CONCLUSIONS For children born very preterm between 2001 and 2015 in Taiwan, the improvement of maternal education levels and improvements in neonatal brain injury and mortality were temporally associated with trends of decreasing intellectual impairment at school age across all GA groups.
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Affiliation(s)
- Lan-Wan Wang
- Department of Pediatrics, Chi Mei Medical Center, Tainan, Taiwan; Department of Biotechnology and Food Technology, Southern Taiwan University of Science and Technology, Tainan, Taiwan
| | - Chi-Hsiang Chu
- Department of Statistics, Tunghai University, Taichung, Taiwan
| | - Yung-Chieh Lin
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chao-Ching Huang
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Pediatrics, College of Medicine, Taipei Medical University, Taipei, Taiwan
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Ehrhardt H, Aubert AM, Ådén U, Draper ES, Gudmundsdottir A, Varendi H, Weber T, Zemlin M, Maier RF, Zeitlin J. Apgar Score and Neurodevelopmental Outcomes at Age 5 Years in Infants Born Extremely Preterm. JAMA Netw Open 2023; 6:e2332413. [PMID: 37672271 PMCID: PMC10483322 DOI: 10.1001/jamanetworkopen.2023.32413] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 07/29/2023] [Indexed: 09/07/2023] Open
Abstract
Importance The Apgar score is used worldwide as an assessment tool to estimate the vitality of newborns in their first minutes of life. Its applicability to estimate neurodevelopmental outcomes in infants born extremely preterm (EPT; <28 weeks' gestation) is not well established. Objective To investigate the association between the Apgar score and neurodevelopmental outcomes in infants born EPT. Design, Setting, and Participants This cohort study was conducted using data from the Effective Perinatal Intensive Care in Europe-Screening to Improve Health in Very Preterm Infants in Europe (EPICE-SHIPS) study, a population-based cohort in 19 regions of 11 European countries in 2011 to 2012. Clinical assessments of cognition and motor function at age 5 years were performed in infants born EPT and analyzed in January to July 2023. Exposures Apgar score at 5 minutes of life categorized into 4 groups (0-3, 4-6, 7-8, and 9-10 points). Main Outcomes and Measures Cognitive and motor outcomes were assessed using the Wechsler Preschool and Primary Scale of Intelligence test of IQ derived from locally normed versions by country and the Movement Assessment Battery for Children-Second Edition. Parents additionally provided information on communication and problem-solving skills using the Ages and Stages Questionnaire, third edition (ASQ-3). All outcomes were measured as continuous variables. Results From the total cohort of 4395 infants born EPT, 2522 infants were live born, 1654 infants survived to age 5 years, and 996 infants (478 females [48.0%]) followed up had at least 1 of 3 outcome measures. After adjusting for sociodemographic variables, perinatal factors, and severe neonatal morbidities, there was no association of Apgar score with IQ, even for scores of 3 or less (β = -3.3; 95% CI, -10.5 to 3.8) compared with the score 9 to 10 category. Similarly, no association was found for ASQ-3 (β = -2.1; 95% CI, -24.6 to 20.4). Congruent results for Apgar scores of 3 or less were obtained for motor function scores for all children (β = -4.0; 95% CI, -20.1 to 12.1) and excluding children with a diagnosis of cerebral palsy (β = 0.8, 95% CI -11.7 to 13.3). Conclusions and Relevance This study found that low Apgar scores were not associated with longer-term outcomes in infants born EPT. This finding may be associated with high interobserver variability in Apgar scoring, reduced vitality signs and poorer responses to resuscitation after birth among infants born EPT, and the association of more deleterious exposures in the neonatal intensive care unit or of socioeconomic factors with greater changes in outcomes during the first 5 years of life.
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Affiliation(s)
- Harald Ehrhardt
- Division of Neonatology and Pediatric Intensive Care Medicine, Department of Pediatrics and Adolescent Medicine, University Medical Center Ulm, Ulm, Germany
| | - Adrien M. Aubert
- Université Paris Cité, Inserm, National Research Institute for Agriculture, Food and the Environment, Centre for Research in Epidemiology and Statistics, Obstetrical Perinatal and Pediatric Epidemiology Research Team, Paris, France
| | - Ulrika Ådén
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
| | - Elizabeth S. Draper
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom
| | - Anna Gudmundsdottir
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
| | - Heili Varendi
- University of Tartu, Tartu University Hospital, Tartu, Estonia
| | - Tom Weber
- University of Copenhagen, Copenhagen, Denmark
| | - Michael Zemlin
- Saarland University Medical Center, Hospital for General Pediatrics and Neonatology, Homburg, Germany
| | - Rolf F. Maier
- Children’s Hospital, University Hospital, Philipps University Marburg, Marburg, Germany
| | - Jennifer Zeitlin
- Université Paris Cité, Inserm, National Research Institute for Agriculture, Food and the Environment, Centre for Research in Epidemiology and Statistics, Obstetrical Perinatal and Pediatric Epidemiology Research Team, Paris, France
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Zeitlin J, Philibert M, Estupiñán-Romero F, Loghi M, Sakkeus L, Draušnik Ž, Alcaide AR, Durox M, Cap J, Dimnjakovic J, Misins J, Bernal Delgado E, Thissen M, Gissler M. Developing and testing a protocol using a common data model for federated collection and analysis of national perinatal health indicators in Europe. OPEN RESEARCH EUROPE 2023; 3:54. [PMID: 37830050 PMCID: PMC10565425 DOI: 10.12688/openreseurope.15701.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 09/01/2023] [Indexed: 10/14/2023]
Abstract
Context: International comparisons of the health of mothers and babies provide essential benchmarks for guiding health practice and policy, but statistics are not routinely compiled in a comparable way. These data are especially critical during health emergencies, such as the coronavirus disease (COVID-19) pandemic. The Population Health Information Research Infrastructure (PHIRI) project aimed to promote the exchange of population data in Europe and included a Use Case on perinatal health. Objective: To develop and test a protocol for federated analysis of population birth data in Europe. Methods: The Euro-Peristat network with participants from 31 countries developed a Common Data Model (CDM) and R scripts to exchange and analyse aggregated data on perinatal indicators. Building on recommended Euro-Peristat indicators, complemented by a three-round consensus process, the network specified variables for a CDM and common outputs. The protocol was tested using routine birth data for 2015 to 2020; a survey was conducted assessing data provider experiences and opinions. Results: The CDM included 17 core data items for the testing phase and 18 for a future expanded phase. 28 countries and the four UK nations created individual person-level databases and ran R scripts to produce anonymous aggregate tables. Seven had all core items, 17 had 13-16, while eight had ≤12. Limitations were not having all items in the same database, required for this protocol. Infant death and mode of birth were most frequently missing. Countries took from under a day to several weeks to set up the CDM, after which the protocol was easy and quick to use. Conclusion: This open-source protocol enables rapid production and analysis of perinatal indicators and constitutes a roadmap for a sustainable European information system. It also provides minimum standards for improving national data systems and can be used in other countries to facilitate comparison of perinatal indicators.
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Affiliation(s)
- Jennifer Zeitlin
- Université Paris Cité, INRAE, Centre for Research in Epidemiology and StatisticS (CRESS), Obstetrical, Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, Paris, 75004, France
| | - Marianne Philibert
- Université Paris Cité, INRAE, Centre for Research in Epidemiology and StatisticS (CRESS), Obstetrical, Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, Paris, 75004, France
| | - Francisco Estupiñán-Romero
- Data Sciences for Health Services and Policy Research, Institute for Health Sciences in Aragon (IACS), Zaragoza, Spain
| | - Marzia Loghi
- Directorate for Social Statistics and Welfare, Italian Statistical Institute (ISTAT), Rome, Italy
| | - Luule Sakkeus
- Estonian Institute for Population Studies, Tallin University, Tallin, Estonia
| | | | | | - Mélanie Durox
- Université Paris Cité, INRAE, Centre for Research in Epidemiology and StatisticS (CRESS), Obstetrical, Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, Paris, 75004, France
| | - Jan Cap
- National Health Information Center, Bratislava, Slovakia
| | | | - Janis Misins
- Centre for Disease Prevention and Control of Latvia, Riga, Latvia
| | - Enrique Bernal Delgado
- Data Sciences for Health Services and Policy Research, Institute for Health Sciences in Aragon (IACS), Zaragoza, Spain
| | - Martin Thissen
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Mika Gissler
- Department of Knowledge Brokers, THL Finnish Institute for Health and Welfare, Helsinki, Finland
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | - Euro-Peristat Research Group
- Université Paris Cité, INRAE, Centre for Research in Epidemiology and StatisticS (CRESS), Obstetrical, Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, Paris, 75004, France
- Data Sciences for Health Services and Policy Research, Institute for Health Sciences in Aragon (IACS), Zaragoza, Spain
- Directorate for Social Statistics and Welfare, Italian Statistical Institute (ISTAT), Rome, Italy
- Estonian Institute for Population Studies, Tallin University, Tallin, Estonia
- Croatian Institute of Public Health, Zagreb, Croatia
- University of Alcala, Madrid, Spain
- National Health Information Center, Bratislava, Slovakia
- Centre for Disease Prevention and Control of Latvia, Riga, Latvia
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
- Department of Knowledge Brokers, THL Finnish Institute for Health and Welfare, Helsinki, Finland
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
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8
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Burger RJ, Roseboom TJ, Ganzevoort W, Gordijn SJ, Pajkrt E, Abu-Hanna A, Eskes M, Leemhuis AG, Mol BW, de Groot CJM, Ravelli ACJ. Gestational age and socio-demographic factors associated with school performance at the age of 12 years, a population-based study. Paediatr Perinat Epidemiol 2023; 37:643-651. [PMID: 37259868 DOI: 10.1111/ppe.12990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 05/11/2023] [Accepted: 05/12/2023] [Indexed: 06/02/2023]
Abstract
BACKGROUND Gestational age is positively associated with cognitive development, but socio-demographic factors also influence school performance. Previous studies suggested possible interaction, putting children with low socio-economic status (SES) at increased risk of the negative effects of prematurity. OBJECTIVES To investigate the association between gestational age in weeks, socio-demographic characteristics, and school performance at the age of 12 years among children in regular primary education. METHODS Population-based cohort study among liveborn singletons (N = 860,332) born in the Netherlands in 1999-2006 at 25-42 weeks' gestation, with school performance from 2011 to 2019. Regression analyses were conducted investigating the association of gestational age and sociodemographic factors with school performance and possible interaction. RESULTS School performance increased with gestational age up to 40 weeks. This pattern was evident across socio-demographic strata. Children born at 25 weeks had -0.57 SD (95% confidence interval -0.79, -0.35) lower school performance z-scores and lower secondary school level compared to 40 weeks. Low maternal education, low maternal age, and non-European origin were strongly associated with lower school performance. Being born third or later and low socioeconomic status (SES) were also associated with lower school performance, but differences were smaller than among other factors. When born preterm, children from mothers with low education level, low or high age, low SES or children born third or later were at higher risk for lower school performance compared to children of mothers with intermediate education level, aged 25-29 years, with intermediate SES or first borns (evidence of interaction). CONCLUSIONS Higher gestational age is associated with better school performance at the age of 12 years along the entire spectrum of gestational age, beyond the cut-off of preterm birth and across socio-demographic differences. Children in socially or economically disadvantaged situations might be more vulnerable to the negative impact of preterm birth. Other important factors in school performance are maternal education, maternal age, ethnicity, birth order and SES. Results should be interpreted with caution due to differential loss to follow-up.
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Affiliation(s)
- Renée J Burger
- Department of Obstetrics and Gynaecology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development, Pregnancy and Birth, Amsterdam, The Netherlands
| | - Tessa J Roseboom
- Department of Obstetrics and Gynaecology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development, Pregnancy and Birth, Amsterdam, The Netherlands
| | - Wessel Ganzevoort
- Department of Obstetrics and Gynaecology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development, Pregnancy and Birth, Amsterdam, The Netherlands
| | - Sanne J Gordijn
- Department of Obstetrics and Gynecology, University Medical Center Groningen, Groningen, The Netherlands
| | - Eva Pajkrt
- Department of Obstetrics and Gynaecology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development, Pregnancy and Birth, Amsterdam, The Netherlands
| | - Ameen Abu-Hanna
- Department of Medical Informatics, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health, Methodology, Amsterdam, The Netherlands
| | - Martine Eskes
- Department of Medical Informatics, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Aleid G Leemhuis
- Amsterdam Reproduction and Development, Pregnancy and Birth, Amsterdam, The Netherlands
- Department of Neonatology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Ben W Mol
- Department of Obstetrics and Gynecology, Monash University, Clayton, Victoria, Australia
| | - Christianne J M de Groot
- Amsterdam Reproduction and Development, Pregnancy and Birth, Amsterdam, The Netherlands
- Department of Obstetrics and Gynaecology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Anita C J Ravelli
- Department of Obstetrics and Gynaecology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development, Pregnancy and Birth, Amsterdam, The Netherlands
- Department of Medical Informatics, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
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9
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Sentenac M, Twilhaar S, Benhammou V, Morgan AS, Johnson S, Chaimani A, Zeitlin J. Heterogeneity of design features in studies included in systematic reviews with meta-analysis of cognitive outcomes in children born very preterm. Paediatr Perinat Epidemiol 2023; 37:254-262. [PMID: 36744822 DOI: 10.1111/ppe.12957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 12/30/2022] [Accepted: 01/09/2023] [Indexed: 02/07/2023]
Abstract
BACKGROUND Meta-analyses of the voluminous scientific literature on the impact of very preterm (VPT, <32 weeks' gestation) birth on cognition find a marked deficit in intelligence quotient (IQ) among children born VPT relative to term-born peers, but with unexplained between-study heterogeneity in effect size. OBJECTIVES To conduct an umbrella review to describe the design and methodology of primary studies and to assess whether methodological heterogeneity affects the results of meta-analyses. DATA SOURCES Primary studies from five systematic reviews with meta-analysis on VPT birth and childhood IQ. STUDY SELECTION AND DATA EXTRACTION Information on study design, sample characteristics and results was extracted from studies. Study features covered study type, sample size, follow-up rates, adjustment for social context, management of severe impairments and test type. SYNTHESIS We used random-effects subgroup meta-analyses and meta-regressions to investigate the contribution of study features to between-study variance in standardised mean differences (SMD) in IQ between groups. RESULTS In 58 cohorts (56%), children with severe impairments were excluded, while 23 (22%) cohorts accounted for social factors. The least reported feature was the follow-up rate (missing in 38 cohorts). The largest difference in SMDs was between studies using full scale IQ tests (61 cohorts, SMD -0.89, 95% CI -0.96, -0.82) versus short-form tests (27 cohorts, SMD -0.68, 95% CI -0.79, -0.57). The proportion of between-study variance explained by the type of test was 14%; the other features explained less than 1% of the variance. CONCLUSIONS Study design and methodology varied across studies, but most of them did not affect the variance in effect size, except the type of cognitive test. Key features, such as the follow-up rate, were not consistently reported limiting the evaluation of their potential contribution. Incomplete reporting limited the evaluation of the full impact of this methodological diversity.
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Affiliation(s)
- Mariane Sentenac
- Centre of Research in Epidemiology and Statistic (CRESS), Inserm, INRAE, Université Paris Cité, Paris, France
| | - Sabrina Twilhaar
- Centre of Research in Epidemiology and Statistic (CRESS), Inserm, INRAE, Université Paris Cité, Paris, France
| | - Valérie Benhammou
- Centre of Research in Epidemiology and Statistic (CRESS), Inserm, INRAE, Université Paris Cité, Paris, France
| | - Andrei S Morgan
- Centre of Research in Epidemiology and Statistic (CRESS), Inserm, INRAE, Université Paris Cité, Paris, France
- Department of Neonatal Medicine, Maternité Port-Royal, Paris, France
| | - Samantha Johnson
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Anna Chaimani
- Centre of Research in Epidemiology and Statistic (CRESS), Inserm, INRAE, Université Paris Cité, Paris, France
| | - Jennifer Zeitlin
- Centre of Research in Epidemiology and Statistic (CRESS), Inserm, INRAE, Université Paris Cité, Paris, France
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10
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Kvaratskhelia N, Rurua N, Vadachkoria SG. Biomedical and Psychosocial Determinants of Early Neurodevelopment After Preterm Birth. Glob Pediatr Health 2023; 10:2333794X231160366. [PMID: 36968456 PMCID: PMC10037732 DOI: 10.1177/2333794x231160366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 02/09/2023] [Indexed: 03/29/2023] Open
Abstract
Prematurity and them related conditions are subject of scientific discussion. From the point of view optimization of postpartum processes, timely assessment of individual biomedical and psychosocial conditions and management of preventive intervention is very important, because of its linkage to issues of preterm infants and their families in long-term perspectives. The goal of the literature review is to bring together existing body of knowledge on biomedical, psychological, and social issues of premature infants related to early neurodevelopment in order to achieve better systemic vision. For this goal scientific articles related to neurological development delay of premature children and the possibilities of their timely identification were processed using electronic scientific search systems. Diagnostic tools to identify at-risk children and early intervention programs discussed in the article, significantly improve the chances of premature child development. In the article Introduced materials are to support: Clinicians to make correct decisions regarding important components of premature infants; Healthcare policy makers to plan targeted programs and activities; Public to better understand prematurity issues, especially in case of prematurely-born family members.
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Affiliation(s)
- Natia Kvaratskhelia
- University of Georgia, Tbilisi,
Georgia
- Natia Kvaratskhelia, School of Health
Sciences and Public Health, University of Georgia, Merab Kostava Street, 77a,
Tbilisi GE 0171, Georgia.
| | - Nana Rurua
- Pediatric Clinic Babymed, Tbilisi,
Georgia
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11
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Sentenac M, Chaimani A, Twilhaar S, Benhammou V, Johnson S, Morgan A, Zeitlin J. The challenges of heterogeneity in gestational age and birthweight inclusion criteria for research synthesis on very preterm birth and childhood cognition: An umbrella review and meta-regression analysis. Paediatr Perinat Epidemiol 2022; 36:717-725. [PMID: 34888904 DOI: 10.1111/ppe.12846] [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: 09/29/2021] [Revised: 10/27/2021] [Accepted: 11/07/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Meta-analyses of studies on very preterm (VPT) birth and childhood cognition select primary studies using gestational age inclusion criteria only, while others also include birthweight criteria. The consequences of this choice are unknown. OBJECTIVE The objective of this study was to describe the gestational age (GA) and birthweight (BW) criteria used in studies of VPT birth and cognition and to investigate whether meta-analysis results differ based on these criteria. DATA SOURCES Five systematic reviews on VPT birth and childhood IQ. STUDY SELECTION AND DATA EXTRACTION Country, birth years, GA-BW selection criteria and participant IQ were extracted from 156 studies representing 103 birth cohorts. SYNTHESIS Pooled standardised mean differences (SMD) in IQ between children born VPT and term-born controls were estimated by sub-group based on GA-BW criteria (GA, BW and GA-BW combined) and degree of preterm birth-low birthweight combinations: extremely preterm (EPT, <28 weeks) and extremely low BW (ELBW, <1000 g); VPT (<32 weeks) and very low BW (VLBW, <1500 g); and moderately MPT (<34 weeks) and moderately low BW (MLBW, <1800 g). RESULTS Cohorts used 27 distinct GA-BW inclusion criteria. Most common criteria were BW <1500 g (24 cohorts), BW <1000 g (12), GA <32 weeks (12) and GA <33 weeks (12); 23 studies used GA-BW combinations. BW-only criteria were more frequent in North America than Europe (63% versus 24%) and for cohorts before than after 1990 (67% vs 26%). Pooled SMD in IQ varied: SMDEPT/ELBW -0.94, 95% confidence interval [CI] -1.07, -0.82; SMDVPT/VLBW -0.78, 95% CI -0.85, -0.71; SMDMPT/MLBW -0.68, 95% CI -0.79, -0.57; however, there was no difference in SMD across cohorts using BW compared to GA criteria after adjustment on risk group. CONCLUSIONS These findings support the inclusion of studies using GA and/or BW criteria in meta-analyses on VPT birth and cognition to increase the geographical and temporal generalisability of the results and to allow investigation of the impact of the heterogeneous inclusion criteria in this literature on outcomes.
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Affiliation(s)
- Mariane Sentenac
- Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Paris, France
| | - Anna Chaimani
- Research Centre of Epidemiology and Statistics (CRESS-U1153), Université de Paris, INSERM, Paris, France
| | - Sabrina Twilhaar
- Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Paris, France
| | - Valérie Benhammou
- Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Paris, France
| | - Samantha Johnson
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Andrei Morgan
- Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Paris, France.,Department of Neonatal Medicine, Maternité Port-Royal, Paris, France
| | - Jennifer Zeitlin
- Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Paris, France
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12
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Biomarker und Neuromonitoring zur Entwicklungsprognose nach perinataler Hirnschädigung. Monatsschr Kinderheilkd 2022; 170:688-703. [PMID: 35909417 PMCID: PMC9309449 DOI: 10.1007/s00112-022-01542-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2022] [Indexed: 11/02/2022]
Abstract
Das sich entwickelnde Gehirn ist in der Perinatalperiode besonders empfindlich für eine Vielzahl von Insulten, wie z. B. Extremfrühgeburtlichkeit und perinatale Asphyxie. Ihre Komplikationen können zu lebenslangen neurokognitiven, sensorischen und psychosozialen Einschränkungen führen; deren Vorhersage bleibt eine Herausforderung. Eine Schlüsselfunktion kommt der möglichst exakten Identifikation von Hirnläsionen und funktionellen Störungen zu. Die Prädiktion stützt sich auf frühe diagnostische Verfahren und die klinische Erfassung der Meilensteine der Entwicklung. Zur klinischen Diagnostik und zum Neuromonitoring in der Neonatal- und frühen Säuglingsperiode stehen bildgebende Verfahren zur Verfügung. Hierzu zählen zerebrale Sonographie, MRT am errechneten Termin, amplitudenintegriertes (a)EEG und/oder klassisches EEG, Nah-Infrarot-Spektroskopie, General Movements Assessment und die frühe klinische Nachuntersuchung z. B. mithilfe der Hammersmith Neonatal/Infant Neurological Examination. Innovative Biomarker und -muster (Omics) sowie (epi)genetische Prädispositionen sind Gegenstand wissenschaftlicher Untersuchungen. Neben der Erfassung klinischer Risiken kommt psychosozialen Faktoren im Umfeld des Kindes eine entscheidende Rolle zu. Eine möglichst akkurate Prognose ist mit hohem Aufwand verbunden, jedoch zur gezielten Beratung der Familien und der Einleitung von frühen Interventionen, insbesondere vor dem Hintergrund der hohen Plastizität des sich entwickelnden Gehirns, von großer Bedeutung. Diese Übersichtsarbeit fokussiert die Charakterisierung der oben genannten Verfahren und ihrer Kombinationsmöglichkeiten. Zudem wird ein Ausblick gegeben, wie innovative Techniken in Zukunft die Prädiktion der Entwicklung und Nachsorge dieser Kinder vereinfachen können.
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13
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Räikkönen K, Gissler M, Tapiainen T, Kajantie E. Associations Between Maternal Antenatal Corticosteroid Treatment and Psychological Developmental and Neurosensory Disorders in Children. JAMA Netw Open 2022; 5:e2228518. [PMID: 36001315 PMCID: PMC9403777 DOI: 10.1001/jamanetworkopen.2022.28518] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Corticosteroids administered to women at risk of imminent preterm birth is one of the most effective ways to improve the prognosis of infants born preterm. Scant data about long-term neurodevelopmental and neurosensory outcomes among the treatment-exposed children are mixed, suggesting that not all domains of neurodevelopmental and neurosensory function may be equally affected. Moreover, the long-term outcomes may vary according to whether the treatment-exposed children are being born preterm (<37 weeks and 0 days) or term (≥37 weeks and 0 days). OBJECTIVES To study whether antenatal corticosteroid treatment is associated with psychological developmental and neurosensory disorders in children born term and preterm and whether the associations persist in a sibling-comparison design. DESIGN, SETTING, AND PARTICIPANTS This population-based retrospective register-linkage study comprised all singleton live births in Finland between January 1, 2006, and December 31, 2017, followed up until December 31, 2018, as well as a sibling comparison among term sibling pairs. Data were analyzed from March 21, 2021, to July 7, 2022. EXPOSURES Antenatal corticosteroid treatment. MAIN OUTCOMES AND MEASURES Cox proportional hazards regression models were used to estimate the associations between antenatal corticosteroid treatment and physician-diagnosed specific developmental disorders of speech and language, scholastic skills, and motor function; pervasive developmental disorder; other or unspecified psychological developmental disorder; disorders of vison and hearing; epilepsy; and cerebral palsy. RESULTS The study population comprised 670 097 singleton children (342 562 boys [51.1%]) followed up for a median of 5.8 years (IQR, 3.1-8.7 years). Of the 14 868 treatment-exposed children (2.2%; 53.9% boys), 6730 (45.3%) were born term, and 8138 (54.7%) were born preterm, and of the 655 229 nonexposed children (97.8%; 51.1% boys), 634 757 (96.9%) were born term, and 20 472 (3.1%) were born preterm. Of the 241 621 eligible maternal sibling pairs born term, 4128 (1.7%) were discordant for treatment exposure. Compared with nonexposure in the entire population, treatment exposure was significantly associated with higher adjusted hazard ratios (aHRs) for specific developmental disorders of speech and language (aHR, 1.38 [95% CI, 1.27-1.50]; P < .001), specific developmental disorders of scholastic skills (aHR, 1.32 [95% CI, 1.13-1.54]; P = .004), specific developmental disorder of motor function (aHR, 1.32 [95% CI, 1.18-1.49]; P < .001), pervasive developmental disorder (aHR, 1.35 [95% CI, 1.17-1.56]; P < .001), other or unspecified disorder of psychological development (aHR, 1.88 [95% CI, 1.58-2.25]; P < .001), and vision or hearing loss (aHR, 1.22 [95% CI, 1.04-1.43]; P = .02). Compared with nonexposure in the term-born group, treatment exposure was significantly associated with higher aHRs for specific developmental disorders of speech and language (aHR, 1.47 [95% CI, 1.31-1.66]; P < .001), specific developmental disorders of scholastic skills (aHR, 1.28 [95% CI, 1.01-1.63]; P = .04), specific developmental disorder of motor function (aHR, 1.38 [95% CI, 1.12-1.70]; P < .001), pervasive developmental disorder (aHR, 1.42 [95% CI, 1.16-1.75]; P < .001), other or unspecified disorder of psychological development (aHR, 1.92 [95% CI, 1.51-2.43]; P < .001), epilepsy (aHR, 1.57 [95% CI, 1.22-2.01]; P < .001), and cerebral palsy (aHR, 2.18 [95% CI, 1.47-3.23]; P < .001). The hazard for any psychological developmental and neurosensory disorder was significantly higher for the treatment-exposed sibling compared with the nonexposed cosibling (absolute difference, 1.2% [95% CI, 0.03%-2.4%]; P < .001; aHR, 1.22 [95% CI, 1.04-1.42]; P = .01). Antenatal corticosteroids were not associated with either significant benefit or risk in the preterm group. CONCLUSIONS AND RELEVANCE This study suggests that the possible long-term psychological developmental and neurosensory harms warrant careful consideration of risks and benefits when deciding on maternal antenatal corticosteroid treatment.
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Affiliation(s)
- Katri Räikkönen
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Mika Gissler
- Department of Knowledge Brokers, Finnish Institute for Health and Welfare THL (Terveyden ja hyvinvoinnin laitos), Helsinki, Finland
- Research Centre for Child Psychiatry, University of Turku, Turku, Finland
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Academic Primary Health Care Centre, Region Stockholm, Stockholm, Sweden
| | - Terhi Tapiainen
- Department of Pediatrics and Adolescent Medicine, Oulu University Hospital, Oulu, Finland
- Unit of Clinical Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Eero Kajantie
- Unit of Clinical Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
- Department of Public Health Solutions, Finnish Institute for Health and Welfare THL (Terveyden ja hyvinvoinnin laitos), Helsinki and Oulu, Finland
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Children’s Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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14
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Nobile S, Di Sipio Morgia C, Vento G. Perinatal Origins of Adult Disease and Opportunities for Health Promotion: A Narrative Review. J Pers Med 2022; 12:jpm12020157. [PMID: 35207646 PMCID: PMC8877993 DOI: 10.3390/jpm12020157] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 01/21/2022] [Accepted: 01/22/2022] [Indexed: 01/27/2023] Open
Abstract
The “developmental origins of health and disease” (DOHaD) hypothesis refers to the influence of early developmental exposures and fetal growth on the risk of chronic diseases in later periods. During fetal and early postnatal life, cell differentiation and tissue formation are influenced by several factors. The interaction between genes and environment in prenatal and early postnatal periods appears to be critical for the onset of multiple diseases in adulthood. Important factors influencing this interaction include genetic predisposition, regulation of gene expression, and changes in microbiota. Premature birth and intrauterine growth restriction (IUGR) are other important factors considered by the DOHaD hypothesis. Preterm birth is associated with impaired or arrested structural or functional development of key organs/systems, making preterm infants vulnerable to cardiovascular, respiratory, and chronic renal diseases during adulthood. Growth restriction, defined as impaired fetal growth compared to expected biological potential in utero, is an additional negative factor increasing the risk of subsequent diseases. Environmental factors implicated in the developmental programming of diseases include exposure to pollution, stress, drugs, toxic agents, nutrition, and exercise. The DOHaD may explain numerous conditions, including cardiovascular, metabolic, respiratory, neuropsychiatric, and renal diseases. Potential antenatal and postnatal preventive measures, interventions, and future directions are discussed.
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15
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Affiliation(s)
- Andrei S Morgan
- Université de Paris, Epidemiology and Statistics Research Center/CRESS, INSERM U1153 EPOPé, INRA, Paris, France
- Elizabeth Garrett Anderson Institute for Women's Health London, University College London, London, UK
- Department of Neonatal Medicine, Maternité Port-Royal, Association Publique des Hôpitaux de Paris (APHP), Paris, France
| | - Marina Mendonça
- Department of Psychology, University of Warwick, Coventry, UK
- Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, UK
| | - Nicole Thiele
- European Foundation for Care of the Newborn Infant, Munich, Germany
| | - Anna L David
- Elizabeth Garrett Anderson Institute for Women's Health London, University College London, London, UK
- National Institute for Health Research, University College London Hospital Biomedical Research Centre, London, UK
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