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Miyake H, Nakano R, Yamamoto S, Isayama T, Sasaki H. Mortality and neurodevelopmental outcomes in very low birth weight infants with esophageal atresia. Pediatr Surg Int 2023; 39:294. [PMID: 37975896 DOI: 10.1007/s00383-023-05579-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/22/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE Very low birth weight infants (VLBWIs) have been thought as risk of bad outcomes in the patients with esophageal atresia (EA). However, detailed outcomes of EA within VLBWIs were not fully understood. We aimed to reveal short- and long-term outcomes in VLBWIs with EA. METHODS Clinical data regarding VLBWIs with EA registered in Neonatal Research Network Japan, a multicenter research database in Japan, were collected. Patients with chromosomal abnormality were excluded. Short term outcome was survival discharge from NICU and long-term outcome was neurodevelopmental impairment (NDI) at 3 years. RESULTS A total of 103 patients were analyzed. the overall survival discharge rate from NICU was 68.0% (70/103). The risk of death was increased as the birth weight got reduced. The presence of associated anomaly increased the risk of death. Three-year neurodevelopmental information was available in 32.9% (23/70) of patients. Of the 23 included patients for 3-year follow-up, 34.8% had NDI. The risk of NDI was increased as the birth weight reduced. CONCLUSIONS In VLBWIs with EA, survival discharge from NICU was still not high. More immature patients and patients with an associated anomaly had worse outcomes. Among patients who survived, NDI was confirmed in a certain number of patients.
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Affiliation(s)
- Hiromu Miyake
- Department of Pediatric Surgery, Shizuoka Children's Hospital, 860 Urushiyama, Aoi-ku, Shizuoka, 4208660, Japan.
- Shizuoka Graduate University of Public Health, Shizuoka, Japan.
| | - Reiji Nakano
- Department of Neonatology, Shizuoka Children's Hospital, Shizuoka, Japan
| | | | - Tetsuya Isayama
- Division of Neonatology, Center of Maternal-Fetal Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Hatoko Sasaki
- Shizuoka Graduate University of Public Health, Shizuoka, Japan
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Camerota M, McGowan EC, Carter BS, Check J, Dansereau LM, DellaGrotta SA, Helderman JB, Hofheimer JA, Neal CR, O'Shea TM, Pastyrnak SL, Smith LM, Lester BM. Maternal Prenatal Risk Phenotypes and Neurobehavioral Outcomes among Infants Born Very Preterm. J Pediatr 2023; 260:113521. [PMID: 37244578 PMCID: PMC10527115 DOI: 10.1016/j.jpeds.2023.113521] [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: 11/01/2022] [Revised: 05/16/2023] [Accepted: 05/21/2023] [Indexed: 05/29/2023]
Abstract
OBJECTIVE To assess whether prenatal risk phenotypes are associated with neurobehavioral impairment for children born <30 weeks of gestation at discharge from the neonatal intensive care unit (NICU) and at 24-month follow-up. STUDY DESIGN We studied infants from the Neonatal Neurobehavior and Outcomes in Very Preterm Infants (NOVI) study, a multisite investigation of infants born <30 weeks of gestation. There were 704 newborns enrolled in the NOVI study; of these, 679 (96%) had neonatal neurobehavioral data and 556 (79%) had 24-month follow-up data. Maternal prenatal phenotypes (physical and psychological risk groups) were characterized from 24 physical and psychological health risk factors. Neurobehavior was assessed at NICU discharge using the NICU Network Neurobehavioral Scales and at 2-year follow-up using the Bayley Scales of Infant and Toddler Development and the Child Behavior Checklist. RESULTS Children born to mothers in the psychological risk group were at increased risk for dysregulated neonatal neurobehavior (OR, 2.04; 95% CI, 1.08-3.87) at NICU discharge, and for severe motor delay (OR, 3.80; 95% CI, 1.48-9.75), and clinically significant externalizing problems (OR, 2.54; 95% CI, 1.15-5.56) at age 24 months, compared with children born to mothers in the low-risk group. Children born to mothers in the physical risk group were more likely to have severe motor delay (OR, 2.70; 95% CI, 1.07-6.85) compared with the low-risk group. CONCLUSIONS High-risk maternal prenatal phenotypes were associated with neurobehavioral impairment for children born very preterm. This information could identify newborns at risk for adverse neurodevelopmental outcomes.
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Affiliation(s)
- Marie Camerota
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI; Department of Pediatrics, Women and Infants Hospital, Providence, RI.
| | - Elisabeth C McGowan
- Department of Pediatrics, Women and Infants Hospital, Providence, RI; Department of Pediatrics, Alpert Medical School of Brown University, Providence, RI
| | - Brian S Carter
- Department of Pediatrics-Neonatology, Children's Mercy Hospital, Kansas City, MO
| | - Jennifer Check
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC
| | - Lynne M Dansereau
- Department of Pediatrics, Women and Infants Hospital, Providence, RI
| | | | | | - Julie A Hofheimer
- Department of Pediatrics, University of North Carolina and Chapel Hill School of Medicine, Chapel Hill, NC
| | - Charles R Neal
- Department of Pediatrics, University of Hawaii John A. Burns School of Medicine, Honolulu, HI
| | - T Michael O'Shea
- Department of Pediatrics, University of North Carolina and Chapel Hill School of Medicine, Chapel Hill, NC
| | - Steven L Pastyrnak
- Department of Pediatrics, Spectrum Health-Helen DeVos Hospital, Grand Rapids, MI
| | - Lynne M Smith
- Department of Pediatrics, Harbor-UCLA Medical Center, Torrance, CA
| | - Barry M Lester
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI; Department of Pediatrics, Women and Infants Hospital, Providence, RI; Department of Pediatrics, Alpert Medical School of Brown University, Providence, RI
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Hofheimer JA, McGowan EC, Smith LM, Meltzer-Brody S, Carter BS, Dansereau LM, Pastyrnak S, Helderman JB, Neal CR, DellaGrotta SA, O'Shea TMD, Lester BM. Risk Factors for Postpartum Depression and Severe Distress among Mothers of Very Preterm Infants at NICU Discharge. Am J Perinatol 2023. [PMID: 37072014 DOI: 10.1055/s-0043-1768132] [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: 04/20/2023]
Abstract
OBJECTIVE To identify psychological, medical, and socioenvironmental risk factors for maternal postpartum depression (PPD) and severe psychological distress (SPD) at intensive care nursery discharge among mothers of very preterm infants. STUDY DESIGN We studied 562 self-identified mothers of 641 infants born <30 weeks who were enrolled in the Neonatal Neurobehavior and Outcomes in Very Preterm Infants Study (NOVI) conducted in nine university-affiliated intensive care nurseries. Enrollment interviews collected socioenvironmental data, depression, and anxiety diagnoses prior to and during the study pregnancy. Standardized medical record reviews ascertained prenatal substance use, maternal and neonatal medical complications. The Edinburgh Postnatal Depression Scale and Brief Symptom Inventory were administered at nursery discharge to screen for PPD and SPD symptoms, respectively. RESULTS Unadjusted analyses indicated mothers with positive screens for depression (n = 76, 13.5%) or severe distress (n = 102, 18.1%) had more prevalent prepregnancy/prenatal depression/anxiety, and their infants were born at younger gestational ages, with more prevalent bronchopulmonary dysplasia, and discharge after 40 weeks postmenstrual age. In multivariable analyses, prior depression or anxiety was associated with positive screens for PPD (risk ratio [RR]: 1.6, 95% confidence interval [CI]: 1.1-2.2) and severe distress (RR: 1.6, 95% CI: 1.1-2.2). Mothers of male infants had more prevalent depression risk (RR: 1.7, 95% CI: 1.1-2.4), and prenatal marijuana use was associated with severe distress risk (RR: 1.9, 95% CI: 1.1-2.9). Socioenvironmental and obstetric adversities were not significant after accounting for prior depression/anxiety, marijuana use, and infant medical complications. CONCLUSION Among mothers of very preterm newborns, these multicenter findings extend others' previous work by identifying additional indicators of risk for PPD and SPD associated with a history of depression, anxiety, prenatal marijuana use, and severe neonatal illness. Findings could inform designs for continuous screening and targeted interventions for PPD and distress risk indicators from the preconception period onward. KEY POINTS · Preconceptional and prenatal screening for postpartum depression and severe distress may inform care.. · Prior depression, anxiety, and neonatal complications predicted severe distress and depression symptoms at NICU discharge.. · Readily identifiable risk factors warrant continuous NICU screening and targeted interventions to improve outcomes..
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Affiliation(s)
- Julie A Hofheimer
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Elisabeth C McGowan
- Department of Pediatrics, Women and Infant's Hospital/Brown University, Providence, Rhode Island
| | - Lynne M Smith
- Department of Pediatrics, Harbor-UCLA Medical Center, Los Angeles, California
| | - Samantha Meltzer-Brody
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Brian S Carter
- Department of Pediatrics, Department of Medical Humanities and Bioethics, University of Missouri-Kansas City, School of Medicine, Kansas City, Missouri
| | - Lynne M Dansereau
- Brown Center for the Study of Children at Risk, Brown Alpert Medical School and Women and Infants Hospital, Providence, Rhode Island
| | - Steven Pastyrnak
- Department of Pediatrics, Spectrum Health Helen DeVos Children's Hospital/Michigan State University, Grand Rapids, Michigan
| | - Jennifer B Helderman
- Department of Pediatrics, Wake Forest University School of Medicine, Winston Salem, North Carolina
| | - Charles R Neal
- Division of Neonatology, Department of Pediatrics, Kapi'olani Medical Center for Women and Children and Hawaii Pacific Medical Group, University of Hawaii John A Burns School of Medicine, Honolulu, Hawaii
| | - Sheri A DellaGrotta
- Brown Center for the Study of Children at Risk, Brown Alpert Medical School and Women and Infants Hospital, Providence, Rhode Island
| | - Thomas Michael D O'Shea
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Barry M Lester
- Departments of Pediatrics, Brown Center for the Study of Children at Risk, Brown Alpert Medical School and Women and Infants Hospital, Providence, Rhode Island
- Department of Psychiatry and Human Behavior, Brown Center for the Study of Children at Risk, Brown Alpert Medical School and Women and Infants Hospital, Providence, Rhode Island
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4
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Martin M, Smith L, Hofheimer JA, McGowan EC, O'Shea TM, Pastyrnak S, Carter BS, Helderman J, Check J, Neal C, Roberts MB, Dansereau LM, Della Grotta SA, Lester BM. Bronchopulmonary dysplasia and neurobehavioural outcomes at birth and 2 years in infants born before 30 weeks. Arch Dis Child Fetal Neonatal Ed 2023; 108:142-148. [PMID: 35999044 PMCID: PMC9947192 DOI: 10.1136/archdischild-2021-323405] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 08/02/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To identify neurobehavioural risks in preterm infants with bronchopulmonary dysplasia (BPD) prior to hospital discharge. DESIGN AND PATIENTS Longitudinal study of 676 newborns born before 30 weeks of gestation. SETTING Nine university NICUs affiliated with six universities. All were Vermont Oxford Network (VON) participants. PATIENTS AND INTERVENTIONS Infants were enrolled in the Neonatal Neurobehavior and Outcomes in Very Preterm Infants Study from April 2014 to June 2016. Prospective medical record reviews, VON definitions and criteria, and maternal interviews were used to collect maternal and neonatal medical variables and socioenvironmental data. MAIN OUTCOME MEASURES NICU Network Neurobehavioral Scale (NNNS) at the time of hospital discharge; Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III) and Gross Motor Function Classification System at 2 years' corrected age. RESULTS Infants with moderate/severe BPD were less attentive (Wald χ2 9.68, p=0.008), more lethargic (Wald χ2 9.91, p=0.007), with increased non-optimal reflexes (Wald χ2 7.37, p=0.025). Infants with moderate/severe BPD were more likely to have Bayley-III language and motor scores <85 (adjusted OR (aOR) 1.74, 95% CI 1.06 to 2.85, and aOR 2.06, 95% CI 1.10 to 3.85). Infants with both moderate/severe and mild BPD were more likely to have a cerebral palsy diagnosis (aOR 2.96, 95% CI 1.34 to 6.54, and aOR 2.81, 95% CI 1.32 to 5.99). CONCLUSIONS BPD severity presents risks for poor neurodevelopment at NICU discharge and at age 2 years. Early identification of poorly regulated behaviour can provide critical information for early preventive and targeted interventions with potential to improve long-term outcomes.
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Affiliation(s)
- Monika Martin
- Department of Pediatrics, Harbor-UCLA Medical Center, Torrance, California, USA
| | - Lynne Smith
- Department of Pediatrics, Harbor-UCLA Medical Center, Torrance, California, USA
| | - Julie A Hofheimer
- Department of Pediatrics, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Elisabeth C McGowan
- Department of Pediatrics, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
- Department of Pediatrics, Women and Infants Hospital of Rhode Island, Providence, Rhode Island, USA
| | - T Michael O'Shea
- Department of Pediatrics, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Steve Pastyrnak
- Department of Pediatrics, Helen DeVos Children's Hospital, Grand Rapids, Michigan, USA
| | - Brian Scott Carter
- Department of Pediatrics-Neonatology, Children's Mercy Hospital, Kansas City, Missouri, USA
| | - Jennifer Helderman
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Jennifer Check
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Charles Neal
- Department of Pediatrics, University of Hawai'i at Mānoa John A Burns School of Medicine, Honolulu, Hawaii, USA
| | - Mary B Roberts
- Center for Primary Care and Prevention, Care New England Health System, Providence, Rhode Island, USA
| | - Lynne M Dansereau
- Department of Pediatrics, Women and Infants Hospital of Rhode Island, Providence, Rhode Island, USA
- Brown Center for the Study of Children at Risk, Providence, Rhode Island, USA
| | - Sheri A Della Grotta
- Department of Pediatrics, Women and Infants Hospital of Rhode Island, Providence, Rhode Island, USA
- Brown Center for the Study of Children at Risk, Providence, Rhode Island, USA
| | - Barry M Lester
- Department of Pediatrics, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
- Department of Pediatrics, Women and Infants Hospital of Rhode Island, Providence, Rhode Island, USA
- Brown Center for the Study of Children at Risk, Providence, Rhode Island, USA
- Department of Psychiatry and Human Behavior, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
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Resuscitation decisions in fetal myelomeningocele repair should center on parents' values: a counter analysis. J Perinatol 2022; 42:971-975. [PMID: 35393530 DOI: 10.1038/s41372-022-01385-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 03/14/2022] [Accepted: 03/25/2022] [Indexed: 11/08/2022]
Abstract
In our response to, "Parental request for non-resuscitation in fetal myelomeningocele repair: an analysis of the novel ethical tensions in fetal intervention" by Wolfe and co-authors, we argue that parental authority should guide resuscitation decision-making for a fetus at risk for preterm delivery as a complication of fetal myelomeningocele (fMMC) repair. Due to the elevated morbidity and mortality risks of combined myelomeningocele, extreme prematurity, and fetal hypoxia, parents' values regarding the acceptability of possible outcomes should be elicited and their preferences honored. Ethical decision-making in these situations must also consider the broader context of the fetal-maternal dyad. Innovations in fetoscopic approaches to fMMC repair may pose additional complexity to these resuscitation decisions.
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Associations between maternal pre-pregnancy body mass index and neonatal neurobehavior in infants born before 30 weeks gestation. J Perinatol 2022; 42:483-490. [PMID: 35132152 PMCID: PMC9007858 DOI: 10.1038/s41372-021-01308-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 11/16/2021] [Accepted: 12/23/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine the relationship between maternal pre-pregnancy body mass index (BMI) and neonatal neurobehavior in very premature infants. STUDY DESIGN Multi-center prospective observational study of 664 very preterm infants with 227 born to obese mothers. The NICU Network Neurobehavioral Scale (NNNS) assessed neurobehavior at NICU discharge. RESULTS Elevated BMI combined with infection increased the odds of having the most poorly regulated NNNS profile by 1.9 times per BMI SD. Infants born to mothers with elevated BMI in combination with: infection had poorer self-regulation, chorioamnionitis had increased asymmetrical reflexes, diabetes had poorer attention, and low SES required more handling. CONCLUSION Maternal pre-pregnancy BMI alone did not affect short-term neonatal neurobehavior in infants born before 30 weeks gestation. Infants born to mothers with elevated pre-pregnancy weight in addition to infections, diabetes, or socioeconomic adversity demonstrated increased risk of having the most poorly regulated NNNS profile and deficits in multiple domains.
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Helderman J, O’Shea TM, Dansereau L, Check J, Hofheimer JA, Smith LM, McGowan E, Neal CR, Carter BS, Pastyrnak SL, Betz B, Junewick J, Borders HL, DellaGrotta SA, Lester BM. Association of Abnormal Findings on Neonatal Cranial Ultrasound With Neurobehavior at Neonatal Intensive Care Unit Discharge in Infants Born Before 30 Weeks' Gestation. JAMA Netw Open 2022; 5:e226561. [PMID: 35394511 PMCID: PMC8994127 DOI: 10.1001/jamanetworkopen.2022.6561] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
IMPORTANCE Cranial ultrasound (CUS) findings are routinely used to identify preterm infants at risk for impaired neurodevelopment, and neurobehavioral examinations provide information about early brain function. The associations of abnormal findings on early and late CUS with neurobehavior at neonatal intensive care unit (NICU) discharge have not been reported. OBJECTIVE To examine the associations between early and late CUS findings and infant neurobehavior at NICU discharge. DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study included infants enrolled in the Neonatal Neurobehavior and Outcomes in Very Preterm Infants Study between April 2014 and June 2016. Infants born before 30 weeks' gestational age were included. Exclusion criteria were maternal age younger than 18 years, maternal cognitive impairment, maternal inability to read or speak English or Spanish, maternal death, and major congenital anomalies. Overall, 704 infants were enrolled. The study was conducted at 9 university-affiliated NICUs in Providence, Rhode Island; Grand Rapids, Michigan; Kansas City, Missouri; Honolulu, Hawaii; Winston-Salem, North Carolina; and Torrance and Long Beach, California. Data were analyzed from September 2019 to September 2021. EXPOSURES Early CUS was performed at 3 to 14 days after birth and late CUS at 36 weeks' postmenstrual age or NICU discharge. Abnormal findings were identified by consensus of standardized radiologists' readings. MAIN OUTCOMES AND MEASURES Neurobehavioral examination was performed using the NICU Network Neurobehavioral Scale (NNNS). RESULTS Among the 704 infants enrolled, 675 had both CUS and NNNS data (135 [20.0%] Black; 368 [54.5%] minority race or ethnicity; 339 [50.2%] White; 376 [55.7%] male; mean [SD] postmenstrual age, 27.0 [1.9] weeks). After covariate adjustment, lower attention (adjusted mean difference, -0.346; 95% CI, -0.609 to -0.083), hypotonicity (mean difference, 0.358; 95% CI, 0.055 to 0.662), and poorer quality of movement (mean difference, -0.344; 95% CI, -0.572 to -0.116) were observed in infants with white matter damage (WMD). Lower attention (mean difference, -0.233; 95% CI, -0.423 to -0.044) and hypotonicity (mean difference, 0.240; 95% CI, 0.014 to 0.465) were observed in infants with early CUS lesions. CONCLUSIONS AND RELEVANCE In this cohort study of preterm infants, certain early CUS lesions were associated with hypotonicity and lower attention around term-equivalent age. WMD was associated with poor attention, hypotonicity, and poor quality of movement. Infants with these CUS lesions might benefit from targeted interventions to improve neurobehavioral outcomes during their NICU hospitalization.
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Affiliation(s)
- Jennifer Helderman
- Department of Pediatrics, Wake Forest School of Medicine, Winston Salem, North Carolina
| | - T. Michael O’Shea
- Department of Pediatrics/Neonatal-Perinatal Medicine, University of North Carolina School of Medicine, Chapel Hill
| | - Lynne Dansereau
- Brown Center for Children at Risk, Women and Infants Hospital of Rhode Island, Providence
| | - Jennifer Check
- Department of Pediatrics, Wake Forest School of Medicine, Winston Salem, North Carolina
| | - Julie A. Hofheimer
- Department of Pediatrics/Neonatal-Perinatal Medicine, University of North Carolina School of Medicine, Chapel Hill
| | - Lynne M. Smith
- Department of Pediatrics, Lundquist Institute at Harbor-UCLA, Torrance, California
| | - Elisabeth McGowan
- Department of Pediatrics, Brown Alpert Medical School and Women and Infants Hospital, Providence, Rhode Island
| | - Charles R. Neal
- Department of Pediatrics, University of Hawaii John A Burns School of Medicine, Honolulu
| | - Brian S. Carter
- Department of Pediatrics–Neonatology, Children’s Mercy Hospital, Kansas City, Missouri
| | - Steven L. Pastyrnak
- Department of Pediatrics, Spectrum Health–Helen DeVos Hospital, Grand Rapids, Michigan
| | - Bradford Betz
- Department of Pediatric Radiology, Spectrum Health–Helen DeVos Hospital, Grand Rapids, Michigan
| | - Joseph Junewick
- Department of Diagnostic Radiology, Spectrum Health–Helen DeVos Hospital, Grand Rapids, Michigan
| | | | - Sheri A. DellaGrotta
- Brown Center for Children at Risk, Women and Infants Hospital of Rhode Island, Providence
| | - Barry M. Lester
- Brown Center for Children at Risk, Women and Infants Hospital of Rhode Island, Providence
- Department of Psychiatry, Brown Alpert Medical School, Providence, Rhode Island
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8
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Camerota M, Graw S, Everson TM, McGowan EC, Hofheimer JA, O'Shea TM, Carter BS, Helderman JB, Check J, Neal CR, Pastyrnak SL, Smith LM, Dansereau LM, DellaGrotta SA, Marsit CJ, Lester BM. Prenatal risk factors and neonatal DNA methylation in very preterm infants. Clin Epigenetics 2021; 13:171. [PMID: 34507616 PMCID: PMC8434712 DOI: 10.1186/s13148-021-01164-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 09/02/2021] [Indexed: 11/28/2022] Open
Abstract
Background Prenatal risk factors are related to poor health and developmental outcomes for infants, potentially via epigenetic mechanisms. We tested associations between person-centered prenatal risk profiles, cumulative prenatal risk models, and epigenome-wide DNA methylation (DNAm) in very preterm neonates. Methods We studied 542 infants from a multi-center study of infants born < 30 weeks postmenstrual age. We assessed 24 prenatal risk factors via maternal report and medical record review. Latent class analysis was used to define prenatal risk profiles. DNAm was quantified from neonatal buccal cells using the Illumina MethylationEPIC Beadarray. Results We identified three latent profiles of women: a group with few risk factors (61%) and groups with elevated physical (26%) and psychological (13%) risk factors. Neonates born to women in higher risk subgroups had differential DNAm at 2 CpG sites. Higher cumulative prenatal risk was associated with methylation at 15 CpG sites, 12 of which were located in genes previously linked to physical and mental health and neurodevelopment. Conclusion We observed associations between prenatal risk factors and DNAm in very preterm infants using both person-centered and cumulative risk approaches. Epigenetics offers a potential biological indicator of prenatal risk exposure. Supplementary Information The online version contains supplementary material available at 10.1186/s13148-021-01164-9.
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Affiliation(s)
- Marie Camerota
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA. .,Department of Pediatrics, Women and Infants Hospital of Rhode Island, 101 Dudley Street, Providence, RI, 02905, USA.
| | - Stefan Graw
- Gangarosa Department of Environmental Health, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Todd M Everson
- Gangarosa Department of Environmental Health, Emory University Rollins School of Public Health, Atlanta, GA, USA.,Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Elisabeth C McGowan
- Department of Pediatrics, Alpert Medical School of Brown University, Providence, RI, USA
| | - Julie A Hofheimer
- Department of Pediatrics, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - T Michael O'Shea
- Department of Pediatrics, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Brian S Carter
- Department of Pediatrics-Neonatology, Children's Mercy Hospital, Kansas City, MO, USA
| | - Jennifer B Helderman
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Jennifer Check
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Charles R Neal
- Department of Pediatrics, University of Hawaii John A. Burns School of Medicine, Honolulu, HI, USA
| | - Steven L Pastyrnak
- Department of Pediatrics, Spectrum Health-Helen DeVos Hospital, Grand Rapids, MI, USA
| | - Lynne M Smith
- Department of Pediatrics, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Lynne M Dansereau
- Department of Pediatrics, Women and Infants Hospital of Rhode Island, 101 Dudley Street, Providence, RI, 02905, USA
| | - Sheri A DellaGrotta
- Department of Pediatrics, Women and Infants Hospital of Rhode Island, 101 Dudley Street, Providence, RI, 02905, USA
| | - Carmen J Marsit
- Gangarosa Department of Environmental Health, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Barry M Lester
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA.,Department of Pediatrics, Women and Infants Hospital of Rhode Island, 101 Dudley Street, Providence, RI, 02905, USA.,Department of Pediatrics, Alpert Medical School of Brown University, Providence, RI, USA
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9
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Aghagoli G, Sheinkopf SJ, Everson TM, Marsit CJ, Lee H, Burt AA, Carter BS, Helderman JB, Hofheimer JA, McGowan EC, Neal CR, O’Shea TM, Pastyrnak SL, Smith LM, Soliman A, Dansereau LM, DellaGrotta SA, Padbury JF, Lester BM. Epigenome-wide analysis identifies genes and pathways linked to acoustic cry variation in preterm infants. Pediatr Res 2021; 89:1848-1854. [PMID: 32967004 PMCID: PMC7985041 DOI: 10.1038/s41390-020-01172-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 07/23/2020] [Accepted: 09/01/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Preterm birth places infants at higher risk of adverse long-term behavioral and cognitive outcomes. Combining biobehavioral measures and molecular biomarkers may improve tools to predict the risk of long-term developmental delays. METHODS The Neonatal Neurobehavior and Outcomes in Very Preterm Infants study was conducted at nine neonatal intensive care units between April 2014 and June 2016. Cries were recorded and buccal swabs collected during the neurobehavioral exam. Cry episodes were extracted and analyzed using a computer system and the data were summarized using factor analysis. Genomic DNA was extracted from buccal swabs, quantified using the Qubit Fluorometer, and aliquoted into standardized concentrations. DNA methylation was measured with the Illumina MethylationEPIC BeadArray, and an epigenome-wide association study was performed using cry factors (n = 335). RESULTS Eighteen CpGs were associated with the cry factors at genome-wide significance (α = 7.08E - 09). Two CpG sites, one intergenic and one linked to gene TCF3 (important for B and T lymphocyte development), were associated with acoustic measures of cry energy. Increased methylation of TCF3 was associated with a lower energy-related cry factor. We also found that pitch (F0) and hyperpitch (F0 > 1 kHz) were associated with DNA methylation variability at 16 CpG sites. CONCLUSIONS Acoustic cry characteristics are related to variation in DNA methylation in preterm infants. IMPACT Preterm birth is a major public health problem and its long-term impact on health is not well understood. Cry acoustics, related to prematurity, has been linked to a variety of medical conditions. Biobehavioral measures and molecular biomarkers can improve prediction tools for long-term developmental risks of preterm birth. Variation in epigenetic modulation in preterm infants provides a potential link between preterm birth and unfavorable developmental outcomes.
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Affiliation(s)
- Ghazal Aghagoli
- Brown Center for the Study of Children at Risk, Providence, RI,Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, RI,Department of Pediatrics, Women and Infants Hospital of Rhode Island, Providence, RI
| | - Stephen J. Sheinkopf
- Brown Center for the Study of Children at Risk, Providence, RI,Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, RI,Department of Pediatrics, Women and Infants Hospital of Rhode Island, Providence, RI,Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI
| | - Todd M. Everson
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Carmen J. Marsit
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Hannah Lee
- Brown Center for the Study of Children at Risk, Providence, RI,Department of Pediatrics, Women and Infants Hospital of Rhode Island, Providence, RI
| | - Amber A. Burt
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Brian S. Carter
- Department of Pediatrics-Neonatology, Children’s Mercy Hospital, Kansas City, MO
| | | | - Julie A. Hofheimer
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Elisabeth C. McGowan
- Brown Center for the Study of Children at Risk, Providence, RI,Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, RI,Department of Pediatrics, Women and Infants Hospital of Rhode Island, Providence, RI
| | - Charles R. Neal
- Department of Pediatrics, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI
| | - T. Michael O’Shea
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Steve L. Pastyrnak
- Department of Pediatrics, Spectrum Health-Helen DeVos Hospital, Grand Rapids, MI
| | - Lynne M Smith
- Department of Pediatrics, Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA
| | - Antoine Soliman
- Department of Pediatrics, Miller Children’s and Women’s Hospital Long Beach, Long Beach, CA
| | - Lynne M. Dansereau
- Brown Center for the Study of Children at Risk, Providence, RI,Department of Pediatrics, Women and Infants Hospital of Rhode Island, Providence, RI
| | - Sheri A DellaGrotta
- Brown Center for the Study of Children at Risk, Providence, RI,Department of Pediatrics, Women and Infants Hospital of Rhode Island, Providence, RI
| | - James F. Padbury
- Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, RI,Department of Pediatrics, Women and Infants Hospital of Rhode Island, Providence, RI
| | - Barry M. Lester
- Brown Center for the Study of Children at Risk, Providence, RI,Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, RI,Department of Pediatrics, Women and Infants Hospital of Rhode Island, Providence, RI,Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI
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10
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Everson TM, O'Shea TM, Burt A, Hermetz K, Carter BS, Helderman J, Hofheimer JA, McGowan EC, Neal CR, Pastyrnak SL, Smith LM, Soliman A, DellaGrotta SA, Dansereau LM, Padbury JF, Lester BM, Marsit CJ. Serious neonatal morbidities are associated with differences in DNA methylation among very preterm infants. Clin Epigenetics 2020; 12:151. [PMID: 33076993 PMCID: PMC7574188 DOI: 10.1186/s13148-020-00942-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 09/28/2020] [Indexed: 12/22/2022] Open
Abstract
Background Infants born very preterm are more likely to experience neonatal morbidities compared to their term peers. Variations in DNA methylation (DNAm) associated with these morbidities may yield novel information about the processes impacted by these morbidities. Methods This study included 532 infants born < 30 weeks gestation, participating in the Neonatal Neurobehavior and Outcomes in Very Preterm Infants study. We used a neonatal morbidity risk score, which was an additive index of the number of morbidities experienced during the NICU stay, including bronchopulmonary dysplasia (BPD), severe brain injury, serious neonatal infections, and severe retinopathy of prematurity. DNA was collected from buccal cells at discharge from the NICU, and DNAm was measured using the Illumina MethylationEPIC. We tested for differential methylation in association with the neonatal morbidity risk score then tested for differentially methylated regions (DMRs) and overrepresentation of biological pathways. Results We identified ten differentially methylated CpGs (α Bonferroni-adjusted for 706,278 tests) that were associated with increasing neonatal morbidity risk scores at three intergenic regions and at HPS4, SRRD, FGFR1OP, TNS3, TMEM266, LRRC3B, ZNF780A, and TENM2. These mostly followed dose–response patterns, for 8 CpGs increasing DNAm associated with increased numbers of morbidities, while for 2 CpGs the risk score was associated with decreasing DNAm. BPD was the most substantial contributor to differential methylation. We also identified seven potential DMRs and over-representation of genes involved in Wnt signaling; however, these results were not significant after Bonferroni adjustment for multiple testing. Conclusions Neonatal DNAm, within genes involved in fibroblast growth factor activities, cellular invasion and migration, and neuronal signaling and development, are sensitive to the neonatal health complications of prematurity. We hypothesize that these epigenetic features may be representative of an integrated marker of neonatal health and development and are promising candidates to integrate with clinical information for studying developmental impairments in childhood.
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Affiliation(s)
- Todd M Everson
- Gangarosa Department of Environmental Health, Emory University Rollins School of Public Health, Atlanta, GA, USA.
| | - T Michael O'Shea
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Amber Burt
- Gangarosa Department of Environmental Health, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Karen Hermetz
- Gangarosa Department of Environmental Health, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Brian S Carter
- Department of Pediatrics-Neonatology, Children's Mercy Hospital, Kansas City, MO, USA
| | - Jennifer Helderman
- Department of Pediatrics, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - Julie A Hofheimer
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Elisabeth C McGowan
- Department of Pediatrics, Brown Alpert Medical School and Women and Infants Hospital, Providence, RI, USA
| | - Charles R Neal
- Department of Pediatrics, University of Hawaii John A. Burns School of Medicine, Honolulu, HI, USA
| | - Steven L Pastyrnak
- Department of Pediatrics, Spectrum Health-Helen Devos Hospital, Grand Rapids, MI, USA
| | - Lynne M Smith
- Department of Pediatrics, Lundquist Institute At Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Antoine Soliman
- Department of Pediatrics, Miller Children's and Women's Hospital Long Beach, Long Beach, CA, USA
| | - Sheri A DellaGrotta
- Brown Center for the Study of Children at Risk, Brown Alpert Medical School and Women and Infants Hospital, Providence, RI, USA
| | - Lynne M Dansereau
- Brown Center for the Study of Children at Risk, Brown Alpert Medical School and Women and Infants Hospital, Providence, RI, USA
| | - James F Padbury
- Department of Pediatrics, Brown Alpert Medical School and Women and Infants Hospital, Providence, RI, USA
| | - Barry M Lester
- Department of Pediatrics, Brown Alpert Medical School and Women and Infants Hospital, Providence, RI, USA.,Brown Center for the Study of Children at Risk, Brown Alpert Medical School and Women and Infants Hospital, Providence, RI, USA.,Department of Psychiatry and Human Behavior, Brown Alpert Medical School, Providence, RI, USA
| | - Carmen J Marsit
- Gangarosa Department of Environmental Health, Emory University Rollins School of Public Health, Atlanta, GA, USA
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11
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Sociodemographic and medical influences on neurobehavioral patterns in preterm infants: A multi-center study. Early Hum Dev 2020; 142:104954. [PMID: 32007912 PMCID: PMC7115752 DOI: 10.1016/j.earlhumdev.2020.104954] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 12/06/2019] [Accepted: 01/13/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Among preterm infants, neurodevelopmental outcomes are influenced by both medical and sociodemographic factors. Less is known about the impact on these factors on neonatal neurobehavioral patterns. OBJECTIVE To determine associations between demographic, psychosocial and medical risk factors and neonatal neurobehavior. METHODS Multi-center observational study of infants born <30 weeks enrolled in the Neonatal Neurobehavior and Outcomes in Very Preterm Infants (NOVI) Study between April 2014-May 2016. Maternal medical, demographic, and psychological variables and infant medical variables were prospectively collected. Demographic, substance, psychological and medical risk indices were developed. Neurobehavioral assessment was performed using the NICU Network Neurobehavioral Scale (NNNS) at NICU discharge. RESULTS 709 infants were enrolled in the NOVI study, and for 679 infants with neurobehavioral assessments, 6 NNNS behavioral profiles were calculated using latent profile analysis. Profile 6 infants (n = 47/679, 7%) were atypical, having poor attention, self-regulation and movement quality, hypertonia and increased stress signs. After adjustment for site, profile 6 infants had significantly smaller head circumferences at birth (β -0.87; -1.59, -0.14), and higher rates of late sepsis (OR 3.38; CI 1.66, 6.92) compared to Profiles 1-5 infants. There were no significant differences in other neonatal morbidities between the two groups. Profile 6 infants had a higher prenatal demographic risk score (1.46 vs 1.07;β 0.34; CI 0.06, 0.61) compared to Profiles 1-5 infants. CONCLUSION NNNS behavioral profiles identify an atypical behavioral pattern that is associated with early influences of demographic and medical variables. Such behavioral patterns may be seen as early as NICU discharge.
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12
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Hofheimer JA, Smith LM, McGowan EC, O'Shea TM, Carter BS, Neal CR, Helderman JB, Pastyrnak SL, Soliman A, Dansereau LM, DellaGrotta SA, Lester BM. Psychosocial and medical adversity associated with neonatal neurobehavior in infants born before 30 weeks gestation. Pediatr Res 2020; 87:721-729. [PMID: 31600769 PMCID: PMC7082182 DOI: 10.1038/s41390-019-0607-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 09/19/2019] [Accepted: 09/25/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Psychosocial adversity escalates medical risk for poor outcomes in infants born <30 weeks gestation. Neonatal neurobehavior and maternal psychological and socioenvironmental assessments may identify the earliest specific intervention needs. We hypothesized that maternal prenatal anxiety, depression, and adverse medical and socioenvironmental conditions would be associated with less optimal neonatal neurobehavior at neonatal intensive care unit (NICU) discharge. METHODS We studied 665 infants at 9 university NICUs. Risk indices of socioenvironmental, maternal, and neonatal medical factors were obtained from standardized, structured maternal interviews and medical record reviews. Brain injuries were classified by consensus ultrasonogram readings. NICU Network Neurobehavioral Scale (NNNS) exams were conducted at NICU discharge. RESULTS On the NNNS, generalized estimating equations indicated infants of mothers with prenatal anxiety had less optimal attention, and those born to mothers with prenatal depression had increased lethargy. Maternal medical complications predicted suboptimal reflexes. Socioenvironmental risk predicted lower self-regulation and movement quality. Infants with more severe neonatal medical complications had lower attention, increased lethargy, and suboptimal reflexes. CONCLUSIONS Combined information from the observed associations among adverse prenatal maternal medical and psychosocial conditions, and neonatal complications may assist in the early identification of infants at elevated neurobehavioral risk.
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MESH Headings
- Adult
- Age Factors
- Anxiety/epidemiology
- Anxiety/psychology
- Child Development
- Depression/epidemiology
- Depression/psychology
- Female
- Gestational Age
- Humans
- Infant Behavior
- Infant, Newborn
- Infant, Newborn, Diseases/diagnosis
- Infant, Newborn, Diseases/epidemiology
- Infant, Newborn, Diseases/physiopathology
- Infant, Newborn, Diseases/psychology
- Infant, Premature/growth & development
- Infant, Premature/psychology
- Intensive Care Units, Neonatal
- Male
- Maternal Health
- Mental Health
- Mother-Child Relations
- Mothers/psychology
- Nervous System/growth & development
- Neurologic Examination
- Predictive Value of Tests
- Pregnancy
- Premature Birth
- Risk Assessment
- Risk Factors
- Social Determinants of Health
- Socioeconomic Factors
- United States/epidemiology
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Affiliation(s)
- Julie A Hofheimer
- Department of Pediatrics, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA.
| | - Lynne M Smith
- Department of Pediatrics, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Elisabeth C McGowan
- Department of Pediatrics, Brown Alpert Medical School and Women and Infants Hospital, Providence, RI, USA
| | - T Michael O'Shea
- Department of Pediatrics, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Brian S Carter
- Department of Pediatrics-Neonatology, Children's Mercy Hospital, Kansas City, MO, USA
| | - Charles R Neal
- Department of Pediatrics, University of Hawaii John A. Burns School of Medicine, Honolulu, HI, USA
| | - Jennifer B Helderman
- Department of Pediatrics, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - Steven L Pastyrnak
- Department of Pediatrics, Spectrum Health-Helen DeVos Hospital, Grand Rapids, MI, USA
| | - Antoine Soliman
- Department of Pediatrics, Miller Children's and Women's Hospital Long Beach, Long Beach, CA, USA
| | - Lynne M Dansereau
- Brown Center for the Study of Children at Risk, Brown Alpert Medical School and Women and Infants Hospital, Providence, RI, USA
| | - Sheri A DellaGrotta
- Brown Center for the Study of Children at Risk, Brown Alpert Medical School and Women and Infants Hospital, Providence, RI, USA
| | - Barry M Lester
- Department of Pediatrics, Brown Alpert Medical School and Women and Infants Hospital, Providence, RI, USA
- Brown Center for the Study of Children at Risk, Brown Alpert Medical School and Women and Infants Hospital, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Brown Alpert Medical School, Providence, RI, USA
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13
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Epigenome-wide Analysis Identifies Genes and Pathways Linked to Neurobehavioral Variation in Preterm Infants. Sci Rep 2019; 9:6322. [PMID: 31004082 PMCID: PMC6474865 DOI: 10.1038/s41598-019-42654-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 04/03/2019] [Indexed: 02/07/2023] Open
Abstract
Neonatal molecular biomarkers of neurobehavioral responses (measures of brain-behavior relationships), when combined with neurobehavioral performance measures, could lead to better predictions of long-term developmental outcomes. To this end, we examined whether variability in buccal cell DNA methylation (DNAm) associated with neurobehavioral profiles in a cohort of infants born less than 30 weeks postmenstrual age (PMA) and participating in the Neonatal Neurobehavior and Outcomes in Very Preterm Infants (NOVI) Study (N = 536). We tested whether epigenetic age, age acceleration, or DNAm levels at individual loci differed between infants based on their NICU Network Neurobehavioral Scale (NNNS) profile classifications. We adjusted for recruitment site, infant sex, PMA, and tissue heterogeneity. Infants with an optimally well-regulated NNNS profile had older epigenetic age compared to other NOVI infants (β1 = 0.201, p-value = 0.026), but no significant difference in age acceleration. In contrast, infants with an atypical NNNS profile had differential methylation at 29 CpG sites (FDR < 10%). Some of the genes annotated to these CpGs included PLA2G4E, TRIM9, GRIK3, and MACROD2, which have previously been associated with neurological structure and function, or with neurobehavioral disorders. These findings contribute to the existing evidence that neonatal epigenetic variations may be informative for infant neurobehavior.
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14
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Ameen SK, Alalaf SK, Shabila NP. Pattern of congenital anomalies at birth and their correlations with maternal characteristics in the maternity teaching hospital, Erbil city, Iraq. BMC Pregnancy Childbirth 2018; 18:501. [PMID: 30563491 PMCID: PMC6299654 DOI: 10.1186/s12884-018-2141-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Accepted: 12/11/2018] [Indexed: 12/03/2022] Open
Abstract
Background Congenital anomalies are a worldwide problem, causing perinatal and infant deaths and postnatal physical disabilities. This study aimed to determine the pattern and associated factors of the congenital anomalies in newborns delivered at the Maternity Teaching Hospital, Erbil city. Methods All the births occurring in the labor room of the Maternity Teaching Hospital in Erbil city, Kurdistan region, Iraq between 1st April 2015 and the end of March 2016 were recorded. All babies with congenital anomalies were identified. The rate and common types of congenital anomalies were estimated. A case-control study was conducted involving all women who had babies with congenital anomalies and the same number whose babies had no congenital anomalies. Data were collected using a structured questionnaire. Results Of the 35,803 recorded births in the Maternity Teaching Hospital, Erbil, 130 women delivered babies with at least one congenital anomaly, giving a rate of 3.63/1000 deliveries. The most common area for anomalies was the central nervous system (37.7%) followed by the musculoskeletal (23.1%) and gastrointestinal systems (20.8%). There was a statistically significant association between having a child with congenital anomalies and a maternal history of previous congenital anomalies (odds ratio [OR] 59.0, 95% CI 5.74–607.0), parental consanguinity (OR 6.26, 95% CI 2.42–16.19), and history of medical disorders (OR 153.2, 95% CI 25.9–905.4). Maternal occupation and smoking did not have any influence to develop congenital anomalies (OR 0.69, 95% CI 0.12–3.97 and OR 1.22,95% CI 0.19–7.93). Conclusion Anomalies were most likely to be in the central nervous system. Maternal history of previous congenital anomalies, parental consanguinity, and history of medical disorders were the most important factors associated with congenital anomalies. This study provides baseline information for future prevention and better management of patients likely to have babies with congenital anomalies. More research is required to identify the factors responsible for the different types of congenital anomalies. Electronic supplementary material The online version of this article (10.1186/s12884-018-2141-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sozan K Ameen
- Maternity Teaching Hospital, Erbil, Kurdistan region, Iraq
| | - Shahla Kareem Alalaf
- Department of Obstetrics and Gynecology, College of Medicine, Hawler Medical University, Erbil, Kurdistan region, Iraq.
| | - Nazar P Shabila
- Department of Community Medicine, College of Medicine, Hawler Medical University, Erbil, Kurdistan region, Iraq
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15
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AbouEl-Ella SS, Tawfik MA, Abo El-Fotoh WMM, Elbadawi MA. Study of congenital malformations in infants and children in Menoufia governorate, Egypt. EGYPTIAN JOURNAL OF MEDICAL HUMAN GENETICS 2018. [DOI: 10.1016/j.ejmhg.2018.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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16
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Hirvonen M, Ojala R, Korhonen P, Haataja P, Eriksson K, Gissler M, Luukkaala T, Tammela O. Visual and Hearing Impairments After Preterm Birth. Pediatrics 2018; 142:peds.2017-3888. [PMID: 30018154 DOI: 10.1542/peds.2017-3888] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/18/2018] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Our aim was to determine and compare the incidences of sensory impairments among very preterm (VP) (<32 + 0/7 weeks), moderately preterm (MP) (32 + 0/7-33 + 6/7 weeks), late preterm (LP) (34 + 0/7-36 + 6/7 weeks), and term infants (≥37 weeks) and to establish risk factors of neurosensory disabilities. METHODS This national register study included all live-born infants in Finland between 1991 and 2008. Infants who died before the age of 1 year, who had any major congenital anomaly, or had missing data were excluded (n = 21 007; 2.0%). A total of 1 018 256 infants were analyzed. Incidences of hearing loss, visual disturbances or blindness, other ophthalmologic disorders, and retinopathy of prematurity were determined for gestational age (GA) groups. Risk factors of hearing loss and visual disturbances or blindness were analyzed. RESULTS The incidences of sensory impairments decreased with advancing GA at birth (P < .001). The most prominent factors associated with increased risks of hearing loss and visual impairment were intracranial hemorrhage and convulsions. VP (odds ratio [OR] 2.34; 95% confidence interval [CI] 1.75-3.14) and LP (OR 1.26; 95% CI 1.04-1.52) births were associated with an increased risk of hearing loss, and VP (OR 1.94; 95% CI 1.55-2.44), MP (OR 1.42; 95% CI 1.11-1.80), and LP (OR 1.31; 95% CI 1.16-1.49) births predicted an increased risk of visual impairment. CONCLUSIONS Incidences of sensory impairment decreased with increasing GA at birth. The most prominent risk factors predictive of sensory disabilities were intracranial hemorrhage and convulsions. VP and LP births were associated with an increased risk of hearing loss, and VP, MP, and LP births were associated with an increased risk of visual impairment.
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Affiliation(s)
- Mikko Hirvonen
- Department of Pediatrics, Central Finland Health Care District, Jyväskylä, Finland; .,Tampere Center for Child Health Research and
| | - Riitta Ojala
- Tampere Center for Child Health Research and.,Departments of Pediatrics and
| | - Päivi Korhonen
- Tampere Center for Child Health Research and.,Departments of Pediatrics and
| | - Paula Haataja
- Tampere Center for Child Health Research and.,Departments of Pediatrics and
| | - Kai Eriksson
- Tampere Center for Child Health Research and.,Pediatric Neurology, and
| | - Mika Gissler
- National Institute for Health and Welfare, Helsinki, Finland.,Research Centre for Child Psychiatry, University of Turku, Turku, Finland; and.,Division of Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Tiina Luukkaala
- School of Health Sciences, Faculty of Social Sciences, University of Tampere, Tampere, Finland.,Research and Innovation Center, Tampere University Hospital, Tampere, Finland
| | - Outi Tammela
- Tampere Center for Child Health Research and.,Departments of Pediatrics and
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17
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van Minde MRC, Hulst SM, Raat H, Steegers EAP, de Kroon MLA. Postnatal screening and care for non-medical risk factors by preventive child healthcare in deprived and non-deprived neighbourhoods. BMC Health Serv Res 2018; 18:432. [PMID: 29884178 PMCID: PMC5994004 DOI: 10.1186/s12913-018-3243-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 05/28/2018] [Indexed: 11/10/2022] Open
Abstract
Background Children born in families with non-medical risk factors, such as deprivation, have higher odds of preterm birth (< 37 weeks of gestation) or being born small for gestational age (birth weight < 10th percentile). In addition, growing up they are at risk for growth and developmental problems. Preventive Child Healthcare (PCHC) monitors growth and development of babies and children. Early identification of children at risk could result in early interventions to prevent growth and developmental problems in later life. Therefore, we aimed to assess current practices in postnatal risk screening and care for non-medical risk factors and the collaboration with other healthcare professionals, in both deprived and non-deprived neighbourhoods in the Netherlands. Methods Eight out of ten invited PCHC organisations, from different areas in the Netherlands, consented to participate in this study. A questionnaire was designed and digitally distributed to professionals working at these organisations, where 370 physicians and nurses were employed. Data was collected between June and September 2016. Descriptive statistics, chi square tests and t-tests were applied. Results Eighty-nine questionnaires were eligible for analyses. Twenty percent of the respondents were working in a deprived neighbourhood and 70.8% of the respondents were employed as nurse. Most of them performed screening for non-medical risk factors in at least 50% of their consultations. PCHC professionals working in deprived neighbourhoods encountered significantly more often families with non-medical risk factors and experienced significantly more communication problems than their colleagues working in non-deprived neighbourhoods. 48.2% of the respondents were satisfied with the current form of postnatal risk screening in their organisation, whereas 41.2% felt a need for a structured postnatal risk assessment. Intensified collaboration is preferred with district-teams, general practitioners and midwifes, concerning clients with non-medical risk factors. Conclusion This study shows that postnatal screening for non-medical risk factors is part of current PCHC practice, regardless the neighbourhood status they are deployed. PCHC professionals consider screening for non-medical risk factors as their responsibility. Consequently, they felt a need for a structured postnatal risk assessment and for an intensified collaboration with other healthcare professionals. Electronic supplementary material The online version of this article (10.1186/s12913-018-3243-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- M R C van Minde
- Department of Obstetrics & Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands. .,Department of Public Health, Erasmus University Medical Centre, Rotterdam, The Netherlands.
| | - S M Hulst
- Department of Obstetrics & Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - H Raat
- Department of Public Health, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - E A P Steegers
- Department of Obstetrics & Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - M L A de Kroon
- Department of Obstetrics & Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands.,Department of Public Health, Erasmus University Medical Centre, Rotterdam, The Netherlands.,Department of Health Sciences, University Medical Centre Groningen, Groningen, The Netherlands
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18
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Asami M, Kamei A, Nakakarumai M, Shirasawa S, Akasaka M, Araya N, Tanifuji S, Chida S. Intellectual outcomes of extremely preterm infants at school age. Pediatr Int 2017; 59:570-577. [PMID: 27935152 DOI: 10.1111/ped.13215] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Revised: 11/14/2016] [Accepted: 11/22/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND The survival rate of extremely preterm (EP) infants (<28 weeks of gestation) has improved dramatically, and there is great interest in the long-term prognosis. The aim of this study was to elucidate the influence of prenatal and postnatal care on long-term intellectual outcome in EP infants. METHODS Subjects were EP infants admitted to the neonatal intensive care unit from 1982 to 2005. The survival rate and neurodevelopmental outcomes at 6 years of age were analyzed for the periods 1982-1991 (period 1) and 1992-2005 (period 2). Logistic regression analysis was performed to examine risk factors for intellectual impairment. RESULTS Survival rate improved significantly from 84.5% (period 1) to 92.4% (period 2; P = 0.007). Follow-up data were obtained from 92 children in period 1 (69.7% of survivors) and from 245 in period 2 (72.3% of survivors). The incidence of intellectual impairment increased from 16.3% (period 1) to 31.0% (period 2). Significant factors associated with intellectual impairment were period 2 (OR, 3.53; P = 0.007), supplemental oxygen at 36 weeks' corrected age (OR, 2.22; P = 0.012), number of days in the hospital (OR, 1.01; P = 0.012), intraventricular hemorrhage (IVH; OR, 3.05; P = 0.024), and later tube-feeding commencement date (OR, 1.10; P = 0.032). CONCLUSIONS Despite an increase in survival rate, the rate of intellectual impairment increased in period 2. According to risk factor analysis, reducing the incidence of chronic lung disease and/or apnea, IVH, and nutritional deprivation is a key factor in improving the intellectual outcomes of EP infants.
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Affiliation(s)
- Maya Asami
- Department of Pediatrics, School of Medicine, Iwate Medical University, Morioka, Iwate, Japan
| | - Atsushi Kamei
- Department of Pediatrics, School of Medicine, Iwate Medical University, Morioka, Iwate, Japan
| | - Misato Nakakarumai
- Department of Pediatrics, School of Medicine, Iwate Medical University, Morioka, Iwate, Japan
| | - Satoko Shirasawa
- Department of Pediatrics, School of Medicine, Iwate Medical University, Morioka, Iwate, Japan
| | - Manami Akasaka
- Department of Pediatrics, School of Medicine, Iwate Medical University, Morioka, Iwate, Japan
| | - Nami Araya
- Department of Pediatrics, School of Medicine, Iwate Medical University, Morioka, Iwate, Japan
| | - Sachiko Tanifuji
- Department of Pediatrics, School of Medicine, Iwate Medical University, Morioka, Iwate, Japan
| | - Shoichi Chida
- Department of Pediatrics, School of Medicine, Iwate Medical University, Morioka, Iwate, Japan
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Myers P, Laventhal N, Andrews B, Lagatta J, Meadow W. Population-Based Outcomes Data for Counseling at the Margin of Gestational Viability. J Pediatr 2017; 181:208-212.e4. [PMID: 27814911 DOI: 10.1016/j.jpeds.2016.10.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Revised: 09/01/2016] [Accepted: 10/05/2016] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To survey neonatologists as to how many use population-based outcomes data to counsel families before and after the birth of 22- to 25-week preterm infants. STUDY DESIGN An anonymous online survey was distributed to 1022 neonatologists in the US. Questions addressed the use of population-based outcome data in prenatal and postnatal counseling. RESULTS Ninety-one percent of neonatologists reported using population-based outcomes data for counseling. The National Institute of Child Health and Human Development Neonatal Research Network Outcomes Data is most commonly used (65%) with institutional databases (14.5%) the second choice. Most participants (89%) reported that these data influence their counseling, but it was less clear whether specific estimates of mortality and morbidity influenced families; 36% of neonatologist felt that these data have little or no impact on families. Seventy-one percent reported that outcomes data estimates confirmed their own predictions, but among those who reported having their assumptions challenged, most had previously been overly pessimistic. Participants place a high value on gestational age and family preference in counseling; however, among neonatologists in high-volume centers, the presence of fetal complications was also reported to be an important factor. A large portion of respondents reported using prenatal population-based outcomes data in the neonatal intensive care unit. CONCLUSION Despite uncertainty about their value and impact, neonatologists use population-based outcomes data and provide specific estimates of survival and morbidity in consultation before and after extremely preterm birth. How best to integrate these data into comprehensive, family-centered counseling of infants at the margin of viability is an important area of further study.
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Affiliation(s)
- Patrick Myers
- Feinberg School of Medicine, Northwestern University, Chicago, IL.
| | - Naomi Laventhal
- C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI
| | - Bree Andrews
- The University of Chicago Comer Children's Hospital, Chicago, IL
| | | | - William Meadow
- The University of Chicago Comer Children's Hospital, Chicago, IL
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A spectrum project: preterm birth and small-for-gestational age among infants with birth defects. J Perinatol 2015; 35:198-203. [PMID: 25275696 DOI: 10.1038/jp.2014.180] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 07/17/2014] [Accepted: 08/05/2014] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The aim of this study is to investigate the association between birth defects (BDs), prematurity and small-for-gestational age (SGA) in a population-based sample. STUDY DESIGN Participants were singleton live births enrolled in the National Birth Defects Prevention Study, including 18 737 case infants with one or more BD and 7999 controls. Logistic regression models to evaluate associations between BDs, prematurity and fetal growth were computed while adjusting for covariates. RESULT Cases were significantly more likely to be born prematurely than controls, particularly at 24 to 28 weeks of gestation. The highest odds ratios for preterm birth were found for intestinal atresia, anencephaly, gastroschisis and esophageal atresia. Infants with BDs were also significantly more likely to be SGA than controls (17.2 and 7.8%). CONCLUSION Infants with BDs are more likely than controls to be born prematurely and SGA. Findings from this study present additional evidence demonstrating a complex interaction between the development of BDs, prematurity and intrauterine growth.
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Survival rate of extremely low birth weight infants and its risk factors: case-control study in Japan. ISRN OBSTETRICS AND GYNECOLOGY 2013; 2013:873563. [PMID: 24371528 PMCID: PMC3858981 DOI: 10.1155/2013/873563] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Accepted: 10/09/2013] [Indexed: 11/18/2022]
Abstract
Aim. To clarify the effect of perinatal events on the survival of ELBW infants in Japan. Methods. 1,713 ELBW infants, from 92,630 live births in 2001 and 2002, born at 22–36 weeks of gestation were registered. Case was defined as death at discharge. The relevant variables were compared between the cases (n = 366) and the controls (n = 1,347). Results. The total survival rate was 78.6%. There was a significant difference between the survival rate in cesarean and vaginal delivery at 24–31 weeks of gestation. Cesarean delivery in infants with a birth weight >400 g was significantly advantageous to the survival rate of ELBW infants than vaginal delivery. The significant contributing factors were gestational age at delivery (OR: 0.97), Apgar score at 5 min (0.56), antenatal steroid (0.41), and birth weight (0.996). Nonvertex presentation (1.81), vaginal delivery (1.56), and placental abruption (2.50) were found to be significantly associated with neonatal death. Conclusions. Cesarean section might be advantageous for survival in ELBW infants over 24 gestational weeks or 400 grams of birth weight. Nonvertex presentation, vaginal delivery, and placental abruption could be significant risk factors for survival of ELBW infants.
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Uppal P, Holland AJA, Bajuk B, Abdel-Latif M, Jaffe A, Hilder L, Lui K, Oei JL. The association between maternal country of birth and neonatal intensive care unit outcomes. Early Hum Dev 2013; 89:607-14. [PMID: 23567194 DOI: 10.1016/j.earlhumdev.2013.03.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Revised: 03/06/2013] [Accepted: 03/12/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND Immigration is increasingly common worldwide and its impact on neonatal intensive care unit outcomes is uncertain. AIMS To determine the outcomes of children of immigrant mothers admitted to NICUs in New South Wales (NSW), Australia, between 2000 and 2006. STUDY DESIGN Record linkage study of routinely collected state-based health databases. SUBJECTS Infants of Australian-born (9813, 81.9%) and overseas born mothers (2166, 18.1%). OUTCOME MEASURES NICU and childhood outcomes to a maximum 5 years of age. RESULTS Immigrant mothers came from 122 countries, 897 (44%) from high income regions. Australian born mothers were more likely to be teenaged (Odds Ratio, 95% confidence interval: 3.07, 2.21-4.26), use drugs (3.55, 2.49-5.06) and suffer an antepartum hemorrhage (1.29, 1.14-1.48). They were less likely to have gestational diabetes (0.45, 0.38-0.54), fetal distress (0.75, 0.66-0.85) and intrauterine growth restriction (0.80, 0.67-0.93). Their infants were more likely to be admitted to the NICU for prematurity but less likely to have low 5 min Apgar scores (0.81, 0.69-0.93) or a congenital abnormality (0.79, 0.70-0.90). Infants of Middle-Eastern mothers had the lowest hospital survival rate (88.5%). Children of immigrant Asian mothers were least likely to be rehospitalized after NICU discharge (1.66, 1.27-2.17). CONCLUSIONS NICU outcomes are affected by maternal country of birth even within the same ethnic group. Further study regarding the impact of paternal race and immigration status and duration of residency will provide data for the changing cultural environment of global perinatal care.
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Affiliation(s)
- Preena Uppal
- Department of Newborn Care, Royal Hospital for Women, Randwick, NSW, Australia
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Abstract
Background—
There are well-established predisposing factors for the development of metabolic syndrome (MetS) in childhood or adolescence, but no specific risk profile has been identified as yet. The Prediction of Metabolic Syndrome in Adolescence (PREMA) study was conducted (1) to construct a classification score that could detect children at high risk for MetS in adolescence and (2) to test its predictive accuracy.
Methods and Results—
In the derivation cohort (1270 children), data from natal and parental profile and from initial laboratory assessment at 6 to 8 years of age were used to detect independent predictors of MetS at 13 to 15 years of age according to the International Diabetes Federation definition. In the validation cohort (1091 adolescents), the discriminatory capacity of the derived prediction score was tested on an independent adolescent population. MetS was diagnosed in 105 adolescents in the derivation phase (8%), whereas birth weight <10th percentile (odds ratio, 6.02; 95% confidence interval, 2.53–10.12,
P
<0.001), birth head circumference <10th percentile (odds ratio, 4.15; 95% confidence interval, 2.04–7.14,
P
<0.001), and parental overweight or obesity (in at least 1 parent; odds ratio, 3.22; 95% confidence interval, 1.30–5.29,
P
<0.01) were independently associated with diagnosis of MetS in adolescence. Among adolescents in the validation cohort (86 [8%] with MetS), the presence of all these 3 predictors predicted MetS with a sensitivity of 91% and a specificity of 98%.
Conclusions—
The coexistence of low birth weight, small head circumference, and parental history of overweight or obesity may be useful for detection of children at risk of developing MetS in adolescence.
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Balaji K, Sankar S, Nandagopal B. Low birth weight of newborns: magnitude of the problem seen in a 100 bed hospital of a rural area in vellore district, Tamil Nadu (India). Indian J Community Med 2011; 35:362-4. [PMID: 20922128 PMCID: PMC2940207 DOI: 10.4103/0970-0218.66861] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2009] [Accepted: 03/18/2010] [Indexed: 11/12/2022] Open
Affiliation(s)
- Kavitha Balaji
- Department of Obstetrics & Gynecology, Sri Narayani Hospital and Research Centre, Thirumalaikodi, Sripuram, Vellore-632 055, Tamin Nadu, India. E-mail:
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Shawky RM, Sadik DI. Congenital malformations prevalent among Egyptian children and associated risk factors. EGYPTIAN JOURNAL OF MEDICAL HUMAN GENETICS 2011. [DOI: 10.1016/j.ejmhg.2011.02.016] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Montes-Núñez S, Chávez-Corral DV, Reza-López S, Sanin LH, Acosta-Maldonado B, Levario-Carrillo M. Birth weight in children with birth defects. ACTA ACUST UNITED AC 2011; 91:102-7. [PMID: 21254364 DOI: 10.1002/bdra.20751] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2010] [Revised: 08/16/2010] [Accepted: 09/18/2010] [Indexed: 11/11/2022]
Abstract
BACKGROUND Birth defects (BDs) are a serious public health problem in Mexico. The objective of this paper was to identify the frequency of newborns (NBs) that are born small for gestational age with a birth defect. MATERIALS AND METHODS A cross-sectional study of NBs from hospitals part of the Mexican Institute of Social Security in Chihuahua, Mexico, was conducted. NBs were classified according to the presence or absence of a BD and according to their weight percentile using regional standards of birth weight. RESULTS NBs diagnosed with (n = 263) or without BDs (n = 64,626) were included in this study. A greater proportion of NBs small for gestational age were identified in cases involving BDs (20%), compared with NBs without BDs (9%). Moreover, the average decrease in birth weights of NBs with BDs associated with their digestive system was 210 grams (95% confidence interval [CI], -436/-12), with their genital organs 440 grams (95% CI, -730/-151), involving chromosomal abnormalities 230 grams (95% CI, -435/-26), or with their musculoskeletal system 289 grams (95% CI, -43/-147) according to the gestational age, sex, and condition of the NB (p < 0.05). CONCLUSIONS A greater proportion of NBs with BDs were associated with a low birth rate for their gestational age. In addition, some BDs were found to be associated with an impaired birth weight more often than others This suggests that clinical decisions regarding NBs with congenital defects and a lower birth weight for their gestational age should be diagnosed and treated for additional nutritional considerations as needed. Birth Defects Research (Part A), 2011. © 2011 Wiley-Liss, Inc.
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Affiliation(s)
- Sonia Montes-Núñez
- Unidad de Investigación Médica en Epidemiología Clínica Chihuahua, Ave. Colón 1003, Colonia Obrera, Chihuahua, Mexico
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Navaei F, Aliabady B, Moghtaderi J, Moghtaderi M, Kelishadi R. Early outcome of preterm infants with birth weight of 1500 g or less and gestational age of 30 weeks or less in Isfahan city, Iran. World J Pediatr 2010; 6:228-32. [PMID: 20549417 DOI: 10.1007/s12519-010-0204-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2008] [Accepted: 05/29/2009] [Indexed: 11/27/2022]
Abstract
BACKGROUND The outcome of preterm neonates has been varied in different hospitals and regions in developing countries. This study aimed to determine the mortality, morbidity and survival of neonates weighing 1500 g or less and with gestational age of 30 weeks or less who were admitted to referral neonatal intensive care units (NICUs) of two hospitals in Isfahan city, Iran and to investigate the effect of birth weight, gestational age and Apgar score on infant mortality. METHODS We studied retrospectively the morbidity, mortality and survival of 194 newborns with a birth weight of </=1500 g and a gestational age of </=30 weeks who had been hospitalized during a 15-month period in NICUs of the two referral hospitals. The Kaplan-Meier method was used to estimate the survival of the neonates. The survival was defined as the discharge of live infant from the hospital within 75 days. RESULTS Overall, 125 (64.4%; 95%CI 58%-71%) of the 194 infants died during their hospital stay. The morbidity in this study was as follows: respiratory distress syndrome 76% (95%CI 70%-82%), septicemia 30.9% (95%CI 24%-37%), bronchopulmonary dysplasia 10.3% (95%CI 6%-15%), necrotizing enterocolitis 6.7% (95%CI 3%-10%), patent ductus arteriosus 12.4% (95%CI 8%-17%), intraventricular hemorrhage 7.2% (95%CI 4%-11%), and apnea 16.5% (95%CI 11%-22%). Packed cell transfusion was required in 43.3% (95%CI 36%-50%) of the neonates. The Kaplan Meier survival analysis revealed that 75% of the infants would live past 2 days, 50% after 14 days, and 25% after 69 days. CONCLUSIONS Even with modern perinatal technology and care, early deaths of very low birth weight infants are still common in our referral hospitals. The outcome of infants born at 24-28 weeks is unfavorable. The hospital level is an important factor affecting the mortality and morbidity of these infants.
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Affiliation(s)
- Fakhri Navaei
- Pediatrics & Neonatology Department, Isfahan University of Medical Sciences, Isfahan, Iran.
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Wang YA, Chapman M, Costello M, Sullivan EA. Better perinatal outcomes following transfer of fresh blastocysts and blastocysts cultured from thawed cleavage embryos: a population-based study. Hum Reprod 2010; 25:1536-42. [DOI: 10.1093/humrep/deq067] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Robertson CMT, Howarth TM, Bork DLR, Dinu IA. Permanent bilateral sensory and neural hearing loss of children after neonatal intensive care because of extreme prematurity: a thirty-year study. Pediatrics 2009; 123:e797-807. [PMID: 19403472 DOI: 10.1542/peds.2008-2531] [Citation(s) in RCA: 95] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE We present population-based, childhood prevalence rates of and neonatal risk factors for permanent hearing loss among extremely premature infants. METHODS By using an inception-cohort, longitudinal study design for 1974-2003, we studied permanent hearing loss among 1279 survivors with gestational age of < or =28 weeks and birth weight of <1250 g (mortality rate: 42.7%; lost to follow-up monitoring: 4.7%) Newborn hearing screening, performed by experienced pediatric audiologists, used click-evoked auditory brainstem response testing after 1975. Survivors underwent repeated behavioral audiologic testing and multidisciplinary follow-up monitoring. Permanent hearing loss was defined as mild/moderate (26-70 dB hearing level), severe/profound (71 to >90 dB hearing level), delayed-onset (diagnosed after previously normal hearing), or progressive (increase in loss of > or =15 dB hearing level). Permanent hearing loss rates were established at 3 years of age, with newborn, infant, and >5-year final hearing outcomes being recorded. Risk factors were compared for children with and without hearing loss, odds ratios were calculated, and prediction performance was determined through area under the curve analysis. RESULTS Forty (3.1%) of 1279 survivors 3 years of age had permanent hearing loss and 24 (1.9%) had severe/profound loss, with no changes over time. Bilateral delayed-onset loss occurred for 4 children (10%) and progressive loss for 11 children (28%). One child had auditory neuropathy, and 29 (73%) had multiple disabilities. Prolonged oxygen use, gastrointestinal surgery, patent ductus arteriosus ligation, and low socioeconomic index yielded good prediction of permanent hearing loss; oxygen use was the most significant predictor of severe/profound loss. CONCLUSIONS Permanent hearing loss remains an adverse outcome of extreme prematurity, complicated by significant delayed-onset and progressive loss. Prolonged supplemental oxygen use is a marker for predicting permanent hearing loss; this requires detailed analysis of the pathophysiologic features, to reduce the prevalence of permanent hearing loss.
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Affiliation(s)
- Charlene M T Robertson
- Section of Neurosciences, Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.
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Outcomes for the extremely premature infant: what is new? And where are we going? Pediatr Neurol 2009; 40:189-96. [PMID: 19218032 DOI: 10.1016/j.pediatrneurol.2008.09.017] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2008] [Revised: 08/07/2008] [Accepted: 08/07/2008] [Indexed: 02/07/2023]
Abstract
Two approaches were taken to determine what is new and where we are going in terms of outcomes for the extremely premature infant: publications from 2004 to 2007 were reviewed, and the 30-year outcome at the authors' institutions was assessed. Recent literature documents improving early childhood outcomes in the face of improved survival. Childhood cerebral palsy prevalence rates have been reported to be as low as 19 per 1000 live births for infants born at 20-27 weeks gestation. Vision and hearing loss have been reported in fewer than 1% of survivors. The rate of overall intellectual impairment has not improved, although impairment was reduced in a recent trial of caffeine therapy for apnea of prematurity, and this remains an important area for study. In sum, recent findings herald a more positive perspective on the outcome for extremely premature survivors. It can thus be expected that new intensive-care trials will attempt to reduce the proportion of survivors with adverse outcomes. Childhood assessments will have a greater focus on function and participation. Information on improved outcomes for preterm infants will inform guidelines of decision making used to help parents to determine what is best for their child. The audit component of follow-up studies will expand and more cohort and trial studies will become multicenter, national, and international.
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Low birth weight, prematurity, and paternal social status: impact on the basic competence test in Taiwanese adolescents. J Pediatr 2008; 153:333-8. [PMID: 18534212 DOI: 10.1016/j.jpeds.2008.04.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2007] [Revised: 03/13/2008] [Accepted: 04/03/2008] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To investigate whether birth weight and paternal education may have independent and interactive effects on the learning achievement of adolescents. STUDY DESIGN We linked birth weights, gestational ages (term or preterm) and paternal education of a 4-year birth cohort to the Basic Competence Test (BCT) scores in Mandarin, mathematics and science for junior high school students age 15 to 16 years. The study groups comprised infants with term low birth weight (TLBW; n = 33 507), preterm normal birth weight (PNBW; n =19 905), and preterm low birth weight (PLBW; n = 25 840), as well as randomly selected term infants with normal birth weight (TNBW; n = 83 756). Paternal education levels were categorized. RESULTS Compared with the TNBW adolescents, the TLBW adolescents consistently showed larger deficits in mean scores for Mandarin (beta = -2.36), mathematics (beta = -2.89), and science (beta = -2.11). The corresponding significant deficit scores for the PLBW adolescents were -1.93, -2.80, and -1.92. The deficit scores were very small for the PNBW adolescents. Paternal education was inversely associated with scores of all 3 groups. Lower paternal education level tended to worsen the negative impact of low birth weight on BCT scores. CONCLUSIONS Both lower birth weight and lower paternal education exert an independent and interactive effect on adolescent learning achievement.
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