Preterm Infants on Early Solid Foods and Neurodevelopmental Outcome-A Secondary Outcome Analysis of a Randomized Controlled Trial

There are no evidence-based recommendations regarding the introduction of solid foods in preterm infants. The objective of this study was to investigate whether age at the introduction of solid foods affects neurodevelopmental outcomes. This study focuses on analyzing secondary outcomes from a prospective trial involving very low birth weight infants who were randomly assigned to either an early (10-12th week corrected age) or a late (16-18th week corrected age) complementary feeding group. The study evaluated neurodevelopmental outcomes at one and two years of corrected age, as well as at three years and four months of uncorrected age by utilizing Bayley scales. In total, 89 infants were assigned to the early and 88 infants to the late group, all with a mean gestational age of 27 + 1 weeks. A linear mixed-effects model was used to compare neurodevelopmental outcomes across the study groups, taking into account variables such as gestational age at birth, sex, nutrition at discharge, parents' highest education level, and high-grade intraventricular hemorrhage. The analysis did not reveal any significant differences between the groups. The timepoint of the introduction of solid foods had no impact on neurodevelopmental outcomes at one and two years of corrected age, and at three years and four months of uncorrected age.

Polyunsaturated Fatty Acid Intake during Complementary Feeding and Neurodevelopmental Outcome in Very Low Birth Weight Infants

Polyunsaturated fatty acids (PUFAs) are vital for brain development, yet limited knowledge exists regarding PUFA intake during complementary feeding (CF) and its impact on neurodevelopmental outcomes in very low birth weight (VLBW) infants. This secondary analysis of a randomized intervention trial, aimed to investigate the association between dietary intake of total PUFAs, arachidonic acid (AA), and docosahexaenoic acid (DHA) during CF and neurodevelopmental outcomes at 12 and 24 months of corrected age (CA). Dietary intakes were assessed using monthly 3 day dietary protocols from 3 to 12 months CA. Neurodevelopmental outcome was evaluated using the Bayley Scales of Infant Development-III. Among the 177 randomized patients, PUFA intake and neurodevelopmental outcomes were evaluated in 140 (79%) infants. Higher total PUFA and DHA intakes significantly correlated with improved cognitive and motor function at 12 months CA, while increased AA intake notably enhanced motor scores at 12 months CA. However, median dietary intakes of AA and DHA (AA: 53.50-84.25 mg/d; DHA: 51.47-76.23 mg/d) fell short of recommended levels (AA: 140 mg/d; DHA: 100 mg/d) at any of the investigated timepoints. These findings emphasize the need to enhance total PUFA, DHA and AA intakes during CF, ensuring adherence to guidelines and unlocking the potential to improve neurodevelopmental outcomes in VLBW infants.

Piloting an ICU follow-up clinic to improve health-related quality of life in ICU survivors after a prolonged intensive care stay (PINA): study protocol for a pilot randomised controlled trial

Background

Intensive care unit (ICU) survivors often suffer from cognitive, physical and mental impairments, known as post-intensive care syndrome (PICS). ICU follow-up clinics may improve aftercare of these patients. There is a lack of evidence whether or which concept of an ICU follow-up clinic is effective. Within the PINA study, a concept for an ICU follow-up clinic was developed and will be tested in a pilot randomised controlled trial (RCT), primarily to evaluate the feasibility and additionally the potential efficacy.

Methods/design

Design: Pilot RCT with intervention and control (usual care) arms plus mixed-methods process evaluation. Participants: 100 ICU patients (50 per arm) of three ICUs in a university hospital (Regensburg, Germany), ≥ 18 years with an ICU stay of > 5 days, a sequential organ failure assessment (SOFA) score > 5 during the ICU stay and a life expectancy of more than 6 months.

Intervention: The intervention will contain three components: information, consultation and networking. Information will be available in form of an intensive care guide for patients and next of kin at the ICU and phone support during follow-up. For consultation, patients will visit the ICU follow-up clinic at least once during the first 6 months after discharge from ICU. During these visits, patients will be screened for symptoms of PICS and, if required, referred to specialists for further treatment. The networking part (e.g. special referral letter from the ICU follow-up clinic) aims to provide a network of outpatient care providers for former ICU patients. Feasibility Outcomes: Qualitative and quantitative evaluation will be used to explore reasons for non-participation and the intervention´s acceptability to patients and caregivers. Efficacy Outcomes: Health-related quality of life (HRQOL) will be assessed as primary outcome by the physical component score (PCS) of the Short-Form 12 Questionnaire (SF-12). Secondary outcomes encompass further patient-reported outcomes. All outcomes are assessed at 6 months after discharge from ICU.

Discussion

The PINA study will determine feasibility and potential efficacy of a complex intervention in a pilot RCT to enhance follow-up care of ICU survivors. The pilot study is an important step for further studies in the field of ICU aftercare and especially for the implementation of a pragmatic multi-centre RCT.

Trial registration

ClinicalTrials.gov, NCT04186468. Submitted 2 December 2019

Supplementary Information

The online version contains supplementary material available at 10.1186/s40814-021-00796-1.

Outcome assessment in dermatology clinical trials and cochrane reviews: call for a dermatology-specific outcome taxonomy

BACKGROUND

Standardized outcome reporting is crucial for trial evidence synthesis and translation of findings into clinical decision-making. The OMERACT 2.0 Filter and COMET outcome domain taxonomy propose frameworks for consistent reporting of outcomes. There is an absence of a uniform dermatology-specific reporting strategy that uses precise and consistent outcome definitions.

OBJECTIVES

Our aim was to map efficacy/effectiveness outcomes assessed in dermatological trials to the OMERACT 2.0 Filter as a starting point for developing an outcome taxonomy in dermatology.

METHODS

We critically appraised 10 Cochrane Skin Reviews randomly selected from all 69 Cochrane Skin Reviews published until 01/2015 and the 220 trials included covering a broad spectrum of dermatological conditions and interventions. Efficacy/effectiveness outcomes were mapped to core areas and domains according to the OMERACT 2.0 Filter. The extracted trial outcomes were used for critical appraisal of outcome reporting in dermatology trials and for the preliminary development of a dermatology-specific outcome taxonomy.

RESULTS

The allocation of 1086 extracted efficacy/effectiveness outcomes to the OMERACT 2.0 Filter resulted in a hierarchically structured dermatology-specific outcome classification. In 506 outcomes (47%), the outcome concept to be measured was insufficiently described, hindering meaningful evidence synthesis. Although the core areas assessed in different dermatology trials of the same condition overlap considerably, quantitative evidence synthesis usually failed due to imprecise outcome definitions, non-comparable outcome measurement instruments, metrics and reporting.

CONCLUSIONS

We present an efficacy/effectiveness outcome classification as a starting point for a dermatology-specific taxonomy to provide trialists and reviewers with the opportunity to better synthesize and compare evidence.

12-year changes in cardiovascular risk factors in people with major depressive or bipolar disorder: a prospective cohort analysis in Germany

BACKGROUND

Major depressive disorder (MDD) and bipolar disorder are associated with certain cardiovascular risk factors (CVRFs), but it is unclear whether they are associated with unfavourable changes of clinically manifest CVRFs over time.

METHODS

We used baseline and 12-year follow-up (n = 1887) data from the German Health Interview and Examination Survey 1998. Multivariable linear regression models assessed associations between lifetime CIDI-diagnosed mood disorders at baseline and continuous risk factor-related outcomes (blood pressure, HbA1c, LDL-C, HDL-C, triglycerides, BMI) at follow-up.

RESULTS

We did not find consistent deterioration of CVRFs in persons with compared to persons without MDD. Analyses pointed to severity of mood disorder as an important correlate of long-term changes of comorbid hypertension: while a history of mild MDD was not associated with changes in CVRFs, moderate MDD was associated with lower blood pressure [systolic: β = - 7.5 (CI - 13.2; - 1.9); diastolic: β = - 4.5 (CI - 7.8; - 1.3)] and a history of bipolar disorder was associated with higher systolic blood pressure at follow-up (β = 14.6; CI 4.9-24.4). Further, severe MDD was weakly associated with a higher BMI at follow-up [β = 1.2 (CI 0.0; 2.4)]. These outcomes were not mediated by use of psychotropic medication and remained statistically significant after adjusting for the use of antihypertensive medication.

CONCLUSION

Since most investigated parameters showed no associations, participants with a lifetime history of MDD in this cohort did not carry a specific risk for a worsening of pre-existing clinically manifest CVRFs. Our findings extend evidence of MDD severity and bipolar disorder as important correlates of long-term changes of arterial hypertension and obesity.

The Impact of Norms on the Outcome of Children Born Very-Preterm when Using the Bayley-III: Differences between US and German Norms

BACKGROUND

The Bayley Scales of Infant and Toddler Development, third edition (Bayley-III) are widely used to assess the development of children born preterm. However, it is still unclear whether US norms are adequate for use in other populations. In 2014, the German version of the Bayley-III with German norms was published.

OBJECTIVES

We aimed to compare the performance of very-preterm infants at one, two, and three years of age using the German versus US norms of the Bayley-III.

METHODS

All children born prior to 32 weeks of gestational age during 2012 and 2015 and taking part in the follow-up program of the Medical University of Vienna were assessed and scored according to both German and US norms by two expert clinical psychologists at the age of one, two, and three years of age.

RESULTS

In total, 843 tests were obtained from 450 children. When looking at scaled scores for cognitive, language, and motor outcomes, preterm children achieved significantly lower scores in nearly all subtests with the German as compared to the US norms. In addition, the proportion of impaired children scoring < 1 standard deviation (SD) and < 2 SD below the norm was significantly higher in nearly all subtests when using the German compared to the US norms (p < 0.05).

CONCLUSIONS

Applying German and US norms of the Bayley-III leads to different outcomes in very-preterm children, and these differences are statistically significant and clinically relevant. Thus, comparisons of outcomes of very-preterm children using culturally specific norms are problematic, and these findings have to be considered.

Administration of Fortifier by Finger Feeder During Breastfeeding in Preterm Infants

OBJECTIVE

To evaluate the acceptance, adherence, and feasibility of fortifier administration by finger feeder during breastfeeding and to determine weight, length, and head circumference gains after discharge for preterm infants.

DESIGN

Observational pilot study.

SETTING

A Level III NICU and its outpatient clinic in Vienna, Austria.

PARTICIPANTS

Infants born at younger than 34 weeks gestation were included.

METHODS

Mothers were screened in a tertiary NICU and trained by certified lactation consultants to administer fortifier with a finger feeder during breastfeeding. Data on finger feeder use at home were collected by self-reported feeding diaries and questionnaires.

RESULTS

In total, data from 24 mother-infant dyads were analyzed. The acceptance rate was 67%. In 41.7%, more than 50% of meals were fortified. Mothers did not report problems in preparation, but 33% of the infants stopped latching on or drooled milk during finger feeder use.

CONCLUSION

Use of a finger feeder to administer fortifier to preterm infants enabled mothers to exclusively breastfeed their infants and meet their nutritional needs. The development of further methods to augment preterm infant nutrition that do not interfere with breastfeeding is of great interest.

Differences in attentional functioning between preterm and full-term children underline the importance of new neuropsychological detection techniques

AIM

The aim of this study was to investigate specific attentional components in preterm born children who had not yet started school.

METHODS

Between January and December 2011, we assessed 52 preterm and 52 full-term children aged between five years five months and six years two months, of comparable age and gender, at the Medical University of Vienna. Different attentional components were evaluated through selected subtests of the Test of Attentional Performance and the German version of the Wechsler Intelligence Scale for Children. Each child's behaviour was also evaluated using parental ratings and descriptive item-based evaluation during neuropsychological assessment.

RESULTS

Children born preterm showed poor attentional performance in sustained attention, focused attention and distractibility, as well as reductions in processing speed in divided attention and flexibility tasks. Children born preterm also showed decreased volitional attention compared with automatic attention. No problems were detected in alertness or inhibition. In addition, a higher rate of aborted tests, decreased motivation and poorer parental ratings were detected among the preterm population compared with full-term born children.

CONCLUSION

Our results highlighted differences in attentional functioning between preterm and full-term children, indicating the importance of new neuropsychological techniques for the detection of specific attentional disorders.

[Patient-centredness in health services research]

This paper provides a sketch of key research areas within health services research focusing on patient-centredness. The evaluation of patient-reported outcomes (PROs) is increasingly required for evaluating interventions in clinical trials and in routine health care. Often, however, it is un-clear which PROs are best suited for a particular research question. One of the most commonly used PRO is the construct of quality of life (QoL), which has become an established outcome in clinical trials and is also named as a health goal in the German Social Code of Law. The concept of patient empowerment implies that autonomy and room for manoeuver of the individual patient should be strengthened. However, it is un-clear how the concept is best operationalised. One prerequisite for patient empowerment in routine health care is the development and implementation of evidence-based patient information. Another prominent research area focuses on the role of self-help and patient organisations in health services. Topics of interest are aims and activities of self-help organisations, potentials and challenges of integrating self-help into professional health services, effects of organised self-help support on patients and barriers of use.

Novel energy resolving x-ray pinhole camera on Alcator C-Mod

A new energy resolving x-ray pinhole camera has been recently installed on Alcator C-Mod. This diagnostic is capable of 1D or 2D imaging with a spatial resolution of ≈1 cm, an energy resolution of ≈1 keV in the range of 3.5-15 keV and a maximum time resolution of 5 ms. A novel use of a Pilatus 2 hybrid-pixel x-ray detector [P. Kraft et al., J. Synchrotron Rad. 16, 368 (2009)] is employed in which the lower energy threshold of individual pixels is adjusted, allowing regions of a single detector to be sensitive to different x-ray energy ranges. Development of this new detector calibration technique was done as a collaboration between PPPL and Dectris Ltd. The calibration procedure is described, and the energy resolution of the detector is characterized. Initial data from this installation on Alcator C-Mod is presented. This diagnostic provides line-integrated measurements of impurity emission which can be used to determine impurity concentrations as well as the electron energy distribution.

Reference values and early determinants of intra-abdominal fat mass in primary school children

BACKGROUND

Intra-abdominal fat (IAF) is a valuable predictor of cardiovascular morbidity. However, neither reference values nor determinants are known in children.

METHODS

IAF was assessed as sonographically measured intra-abdominal depth in 1,046 children [median age 7.6 years, interquartile range (IQR) 7.2-7.9; 54% boys] of the URMEL-ICE study.

RESULTS

The intraclass correlation coefficient for intraobserver agreement was 0.93. The median IAF showed a significant gender difference (boys: 54.6 mm, IQR 50.1-59.3, vs. girls: 51.7 mm, IQR 46.3-56.4; p < 0.001). Age- and gender-specific centiles were generated. IAF showed a positive correlation to systolic blood pressure [regression coefficient (β) = 0.24 mm Hg/mm; p < 0.001] and a negative correlation to HDL cholesterol (β = -0.01 mmol/l/mm; p < 0.001). IAF showed a positive association with increased paternal and maternal BMI (β = 0.28 mm/kg/m(2) and 0.27 mm/kg/m(2); p < 0.001), increased weight gain in the first 2 years of life (β = 3.04 mm; p < 0.001), and maternal smoking during pregnancy (β = 2.4 mm; p = 0.001). Increased parental education was negatively associated with IAF (maternal: β = -0.65 mm/degree; p = 0.004, and paternal: β = -0.61 mm/degree; p = 0.002).

CONCLUSION

Sonography was a reliable tool to estimate IAF. Factors influencing IAF included rapid infant weight gain, smoking during pregnancy, and parental BMI and education. Since IAF showed an association with cardiovascular risk factors even in prepubertal children, it might become a valuable predictor of cardiovascular vulnerability.

Interplay of time-delayed feedback control and temporally correlated noise in excitable systems

The interplay of time-delayed feedback and temporally correlated coloured noise in a single and two coupled excitable systems is studied in the framework of the FitzHugh-Nagumo (FHN) model. By using coloured noise instead of white noise, the noise correlation time is introduced as an additional time scale. We show that in a single FHN system the major time scale of oscillations is strongly influenced by the noise correlation time, which in turn affects the maxima of coherence with respect to the delay time. In two coupled FHN systems, coloured noise input to one subsystem influences coherence resonance and stochastic synchronization of both subsystems. Application of delayed feedback control to the coloured noise-driven subsystem is shown to change coherence and time scales of noise-induced oscillations in both systems, and to enhance or suppress stochastic synchronization under certain conditions.

Outcome of very-low-birth-weight infants at 1 and 2 years of age. The importance of early identification of neurodevelopmental deficits

The developmental and neurologic outcome of very-low-birth-weight infants (n=76) at 1 and 2 years, corrected for postconceptional age, and variables predicting outcome were assessed. At 1 year 24% of tile children were neurologically normal and at 2 years 61%. Developmental status was evaluated by use of the Griffiths Developmental Scales. The rate of cognitively normal children remained constant (58% at 1 year and 59% at 2 years) indicating that developmental status at 1 year was predictive for the second year. This early period is important, therefore, for the identification of developmental deficits and for establishing early, adequate interventions.

Inhibition of secretin-stimulated exocrine pancreatic secretion by diazoxide in the rat

Diazoxide, a known insulin inhibitor, inhibits the pancreatic exocrine response to secretin in unanesthetized rats and does not modify the CCK-PZ-stimulated secretion. These results suggest that insulin may have a role on the stimulation of exocrine pancreas through secretin.