Early human development最新文献

High altitude exposure and the birth prevalence of congenital anomalies in newborns with Down syndrome 高海拔暴露与唐氏综合征新生儿先天性异常的出生患病率

IF 2.2 3区医学 Q2 OBSTETRICS & GYNECOLOGY

Early human development

Pub Date : 2025-04-23 DOI: 10.1016/j.earlhumdev.2025.106270

Daniel Linares , Beatriz Luna , Edson Loayza , Angela del Callejo , Maria Garcia-Sejas , Carlos Erostegui , Gonzalo Taboada

Background

Individuals with Down syndrome are inherently predisposed to congenital anomalies due to a susceptible genotype that may interact with environmental factors. High-altitude exposure, in particular, has been linked to an increased risk of congenital heart disease. However, few studies have explored environmental risk factors for congenital anomalies in this population, and the specific impact of high altitude remains under-investigated. This study aimed to evaluate maternal and environmental risk factors, including high-altitude residence, on the prevalence of congenital anomalies in newborns with Down syndrome.

Methods

We conducted a cross-sectional study at two specialized genetic centers in Bolivia, including patients referred from various regions of the country. Data on clinical history and habitual residence were extracted from medical records to identify potential risk factors. The primary outcome was the presence of major congenital anomalies. Univariate and multivariate logistic regression analyses were performed to assess the association between risk factors and congenital anomalies.

Results

A total of 301 Down syndrome cases were included, of which 182 (60.5 %) presented with major congenital anomalies, with congenital heart disease and gastrointestinal anomalies being the most prevalent. Maternal age, high-altitude exposure, preeclampsia, and consanguinity were significantly associated with an increased risk of congenital anomalies (all p < 0.05). Furthermore, stratified analysis revealed that high altitude was a significant risk factor for specific anomalies: patent ductus arteriosus (OR: 5.82, 95 % CI: [1.68–36.65], p = 0.02) and anorectal anomalies (OR: 5.29, 95 % CI: [1.52–33.45], p = 0.03).

Conclusion

Our findings indicate that both maternal and environmental factors, particularly high-altitude exposure, play a crucial role in the development of congenital anomalies in newborns with Down syndrome. These results underscore the need for enhanced surveillance and tailored clinical management in high-risk populations, as well as further research into preventive strategies to mitigate these risks.

背景唐氏综合征患者由于其易感基因型可能与环境因素相互作用，先天性畸形的风险与生俱来。特别是高海拔暴露与先天性心脏病风险增加有关。然而，很少有研究探讨这一人群先天性畸形的环境风险因素，而高海拔的具体影响仍未得到充分调查。本研究旨在评估包括高海拔居住地在内的母体和环境风险因素对唐氏综合征新生儿先天性异常患病率的影响。我们从医疗记录中提取了临床病史和常住地数据，以确定潜在的风险因素。主要结果是出现重大先天性畸形。结果共纳入了 301 例唐氏综合征病例，其中 182 例（60.5%）伴有重大先天性畸形，先天性心脏病和胃肠道畸形最为常见。产妇年龄、高海拔暴露、先兆子痫和近亲结婚与先天性畸形风险增加有显著相关性（所有 p 均为 0.05）。此外，分层分析显示，高海拔是特定畸形的重要风险因素：动脉导管未闭（OR：5.82，95 % CI：[1.68-36.65]，p = 0.02）和肛门直肠畸形（OR：5.29，95 % CI：[1.结论我们的研究结果表明，母体和环境因素，尤其是高海拔暴露，在唐氏综合征新生儿先天性畸形的发展中起着至关重要的作用。这些结果表明，有必要加强对高危人群的监测和有针对性的临床管理，并进一步研究降低这些风险的预防策略。

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引用次数: 0

The effect of heart rate on systolic and diastolic time intervals and cardiac function in stable and sick preterm infants 心率对稳定和患病早产儿收缩期和舒张期时间间隔及心功能的影响

IF 2.2 3区医学 Q2 OBSTETRICS & GYNECOLOGY

Early human development

Pub Date : 2025-04-16 DOI: 10.1016/j.earlhumdev.2025.106268

Koert de Waal, Enrico Petoello, Edward Crendal, Nilkant Phad

Background

Diastolic function includes relaxation and filling of the heart and is dependent on heart rate (HR) and time spent in either systole (St) or diastole (Dt). The St/Dt ratio increases as HR increased and is a marker of overall cardiac function in children with heart failure. The aim of this study is to describe cardiac cycle events in preterm infants.

Methods

Cardiac ultrasounds of preterm infants <32 weeks were retrospectively reviewed for cardiac cycle events from Tissue Doppler images and grouped by clinical indication of the scan as stable or as clinical deterioration with significant illness.

Results

412 scans in 201 preterm infants were analyzed. St/Dt ratio increased with increasing HR. St increased from 50 to 54 % of the cardiac cycle length with shortened diastolic duration. Isovolumetric contraction and relaxation remained unchanged at 9 and 12 % of the cardiac cycle respectively. Mean St, Dt and St/Dt ratio in stable infants were 195(19) msec, Dt 175(24) msec and 1.13 (0.16) respectively. Sick infants without cardiovascular medications showed a significantly shorter St and lower St/Dt ratio. Cardiovascular medications increased isovolumetric times, Dt, and early diastolic duration.

Conclusion

Reference values for cardiac cycle durations and St/Dt ratio are presented. Preterm hearts adapt to higher HR by shifting towards systole and shortened early diastole by optimising its force frequency relationship and enhanced relaxation. The St/Dt ratio was altered in preterm infants with significant illness. This simple ultrasound marker could be tested in further studies that investigate cardiovascular medications in preterm infants

舒张功能包括心脏的舒张和充盈，取决于心率（HR）和收缩期（St）或舒张期（Dt）的时间。St/Dt比值随着HR的增加而增加，是心力衰竭患儿整体心功能的标志。本研究的目的是描述早产儿的心脏周期事件。方法回顾性分析32周早产儿的心脏超声心动图，从组织多普勒图像中寻找心脏周期事件，并根据扫描的临床指征分为稳定或临床恶化伴重大疾病。结果分析了201例早产儿的412次扫描结果。St/Dt比值随HR的增加而增加。St从心脏周期长度的50%增加到54%，舒张期缩短。在心脏周期的9%和12%时，等容量收缩和舒张保持不变。平均St、Dt和St/Dt比值分别为195(19)msec、175(24)msec和1.13 (0.16)msec。未服用心血管药物的患儿St明显缩短，St/Dt比值明显降低。心血管药物增加等容时间、Dt和早期舒张持续时间。结论心脏周期持续时间和St/Dt比值有一定的参考值。早产儿心脏通过优化其力频率关系和增强舒张，向收缩期转移和缩短早期舒张期，以适应更高的心率。St/Dt比值在有重大疾病的早产儿中发生改变。这种简单的超声标记可以在进一步研究早产儿心血管药物的研究中进行测试

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引用次数: 0

Iron deficiency in pregnancy and its association with blood lead and manganese levels in offspring in Benin, Sub-Saharan Africa 撒哈拉以南非洲贝宁孕妇缺铁及其与后代血铅和锰水平的关系

IF 2.2 3区医学 Q2 OBSTETRICS & GYNECOLOGY

Early human development

Pub Date : 2025-04-07 DOI: 10.1016/j.earlhumdev.2025.106255

Shukrullah Ahmadi , Raymond Van Huizen , Romeo Zoumenou , Barbara Le Bot , Pierre Ayotte , Pierre Dumas , Achille Massougbodji , Philippe Glorennec , Florence Bodeau-Livinec

Introduction

The impact of prenatal iron deficiency (ID) on offspring's blood lead level (BLL) and blood manganese level (BML) in infancy remains poorly understood. This study aimed to assess associations between prenatal ID and BLL/BML in offspring in Benin. We also investigated associations between infant ID and corresponding BLL and BML in infants.

Materials and methods

Data on hematological parameters, metal blood concentrations, and socioeconomic status were obtained from a prospective mother-child cohort study in Allada, Benin. Blood samples were collected during pregnancy (n = 501), at delivery (n = 501), and from 12-month-old infants (n = 501) to assess iron deficiency and haemoglobin concentration. Additionally, BML was analyzed for a subset of 12-month-old infants (n = 271), and BLL was determined for the full cohort of 12-month-old infants (n = 501). Associations between ID and metal concentrations were examined using logistic regressions.

Results

Prenatal ID and IDA at the first and third antenatal care visit (ANC) were positively associated with infant BLL above 50 μg/L. Infants of mothers with prenatal ID and IDA had higher BLL. Moreover, prenatal ID and IDA at first and second ANC visits were positively associated with higher infant BML. In infancy, infants with ID and IDA had significantly higher BLL as compared to those without ID and IDA. Infant ID and IDA were positively associated with elevated BLL.

Conclusion

Elevated BLL and BML in infants were positively associated with ID and/or IDA prenatally during at least one ANC visit, while in infancy, infant ID and IDA were positively associated with elevated BLL only. Infants with ID and IDA showed higher BLL but not BML. This suggests that ID prenatally and during infancy may contribute to high blood lead concentrations in infants, which can lead to neurotoxicity. Treating ID and IDA is critical to prevent toxicity caused by high BLL in infants.

产前缺铁（ID）对子代婴儿期血铅（BLL）和血锰（BML）水平的影响尚不清楚。本研究旨在评估贝宁产前ID与后代BLL/BML之间的关系。我们还研究了婴儿ID与相应的BLL和BML之间的关系。材料和方法从贝宁Allada的一项前瞻性母婴队列研究中获得血液学参数、血液金属浓度和社会经济地位的数据。在怀孕期间（n = 501）、分娩时（n = 501）和12个月大的婴儿（n = 501）采集血液样本，以评估铁缺乏和血红蛋白浓度。此外，还分析了12个月大婴儿的BML子集（n = 271），并确定了整个12个月大婴儿队列（n = 501）的BLL。使用逻辑回归检验了ID和金属浓度之间的关系。结果第一次和第三次产前检查（ANC）时的产前ID和IDA与50 μg/L以上的婴儿BLL呈正相关。产前ID和IDA母亲的婴儿有较高的BLL。此外，第一次和第二次ANC就诊时的产前ID和IDA与较高的婴儿BML呈正相关。在婴儿期，有ID和IDA的婴儿的BLL显著高于无ID和IDA的婴儿。婴儿ID和IDA与BLL升高呈正相关。结论在至少一次ANC就诊期间，婴儿BLL和BML升高与产前ID和/或IDA呈正相关，而婴儿ID和IDA仅与BLL升高呈正相关。ID和IDA患儿的BLL较高，但BML不高。这表明，产前和婴儿期的铅血症可能导致婴儿血铅浓度升高，从而导致神经毒性。治疗ID和IDA对于预防婴儿高BLL引起的毒性至关重要。

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引用次数: 0

A study of the infant's lived experience of neonatal intensive care 新生儿重症监护婴儿生活经验的研究

IF 2.2 3区医学 Q2 OBSTETRICS & GYNECOLOGY

Early human development

Pub Date : 2025-04-03 DOI: 10.1016/j.earlhumdev.2025.106254

Natalie Duffy , Leah Hickey , Karli Treyvaud , Clare Delany

Background

Neonatal care is essential for survival. However, advancements in medical care may come at a cost to the infant's experience of living. Research has traditionally focused on the effectiveness of the medical aspects of neonatal intensive care. Less attention has been paid to the subjective experience of infants hospitalised in NICU.

Aim

To provide an infant-centred, rich understanding and comprehensive analysis of the lived experience of infants hospitalised in NICU.

Methods

To explore the infant experience, we designed a novel approach, termed 360-degree phenomenology. We utilised observational fieldnotes, bedside diaries, Newborn Behavioural Observation recording forms and verbatim transcripts from individual interviews. Thematic analysis was used to analyse these data sources.

Results

This paper uses the whole data set (comprising a series of 7 case studies) to describe 4 overarching themes: (1) scary and safe; (2) all these hard things; (3) an emotional challenge; and (4) moments of meeting.

Conclusion

Hospitalisation in the newborn period poses a significant challenge to the developing infant by virtue of the complex and confronting early life experiences they endure, both physically and emotionally. This research illuminates these challenges but also shows moments of powerful meeting and connection, that serve to protect and nurture the developing infant. By listening to and valuing the infant's unique perspective and placing the infant as a person central to their own care, our research highlights strategies for immediate actionable change and future areas of research to better their early life experiences and improve long-term health outcomes.

背景新生儿护理对婴儿的生存至关重要。然而，医疗护理的进步可能会以婴儿的生存体验为代价。传统的研究主要集中在新生儿重症监护的医疗效果方面。为了探索婴儿的经历，我们设计了一种新颖的方法，称为 360 度现象学。我们使用了现场观察笔记、床边日记、新生儿行为观察记录表和个别访谈的逐字记录稿。结果本文利用整个数据集（包括一系列 7 个案例研究）描述了 4 个总体主题：(1) 可怕而安全；(2) 所有这些困难的事情；(3) 情感挑战；以及 (4) 相遇的时刻。结论新生儿期的住院治疗对发育中的婴儿构成了巨大的挑战，因为他们在身体和情感上都要承受复杂而严峻的早期生活经历。这项研究揭示了这些挑战，但同时也展示了有力的会面和联系时刻，这些时刻有助于保护和培育发育中的婴儿。通过倾听和重视婴儿的独特视角，并将婴儿作为其自身护理的核心人物，我们的研究强调了可立即付诸行动的变革策略和未来研究领域，以改善他们的早期生活经历并提高长期健康结果。

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引用次数: 0

Sleep and emotional functioning in premature children: A systematic literature review 早产儿的睡眠和情绪功能：系统的文献综述

IF 2.2 3区医学 Q2 OBSTETRICS & GYNECOLOGY

Early human development

Pub Date : 2025-04-02 DOI: 10.1016/j.earlhumdev.2025.106251

Annemarie Kim Kozole Smid , Vita Štukovnik , Karin Bakracevic

Sleep, as the predominant behavioral state in newborns, especially in preterm infants, represents a key component for development. It is suggested that preterm children exhibit greater sleep difficulties compared to full-term children, as well as a disproportionately higher prevalence of emotional deficits. Due to the limited research on sleep and emotional functioning in the population of preterm children, particularly their interconnections, the primary aim of this systematic literature review was to explore existing scientific research on sleep and emotional functioning in preterm children, with particular focus on emotional regulation. Additionally, we aimed to examine potential links between these two constructs in this population. As a secondary objective, the review also considered studies addressing any interventions related to sleep or emotional functioning in preterm children. The results of the systematic literature review did not allow for definite conclusions regarding sleep in preterm compared to full-term children from a qualitative perspective. On the other hand, an increased presence of emotional and behavioral difficulties in this population was clearly identified. An effective intervention for regulating emotions and sleep was found to be the kangaroo care, as well when combined with music intervention. Breastfeeding also demonstrated positive effects on behavioral and emotional functioning. There appears to be a tendency for sleep problems to manifest more noticeably in late compared to early childhood. This finding highlighted the importance of long-term monitoring of this population through later childhood, adolescence, and even adulthood to better understand the long-term consequences of preterm birth on sleep and emotional functioning. Further research is essential for developing interventions that could mitigate or prevent long-term negative effects on sleep and emotional well-being associated with preterm birth.

睡眠作为新生儿，尤其是早产儿的主要行为状态，是发育的关键组成部分。研究表明，与足月儿童相比，早产儿表现出更大的睡眠困难，以及不成比例的更高的情绪缺陷患病率。由于对早产儿睡眠和情绪功能的研究有限，特别是它们之间的相互关系，因此本系统文献综述的主要目的是探索早产儿睡眠和情绪功能的现有科学研究，特别关注情绪调节。此外，我们的目的是在该人群中检查这两种结构之间的潜在联系。作为次要目标，该综述还考虑了针对早产儿睡眠或情绪功能相关干预措施的研究。系统文献综述的结果并不能从定性的角度得出关于早产儿和足月儿童睡眠的明确结论。另一方面，在这一人群中，情绪和行为上的困难明显增加。研究发现，袋鼠式护理是调节情绪和睡眠的有效干预措施，与音乐干预相结合也是如此。母乳喂养对行为和情感功能也有积极影响。与儿童早期相比，睡眠问题似乎在儿童晚期更为明显。这一发现强调了在儿童后期、青春期甚至成年期对这一人群进行长期监测的重要性，以便更好地了解早产对睡眠和情绪功能的长期影响。进一步的研究对于制定干预措施，减轻或预防与早产有关的睡眠和情绪健康的长期负面影响至关重要。

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引用次数: 0

Breech presentation at birth has short-term but no long-term effect on neurodevelopmental outcome in moderate and late preterm infants 出生时臀位对中度和晚期早产儿的神经发育结局有短期影响，但没有长期影响

IF 2.2 3区医学 Q2 OBSTETRICS & GYNECOLOGY

Early human development

Pub Date : 2025-04-01 DOI: 10.1016/j.earlhumdev.2025.106253

Anna Scheuchenegger , Christa Einspieler , Peter B. Marschik , Jasmin Pansy , Constanze Sommer , Bernhard Resch

Aim

To investigate the effects of fetal presentation at birth on spontaneous postnatal movements, postures and neurodevelopmental outcome in moderate and late preterm (MLPT) infants.

Methods

The study population comprised 154 infants (55 % male, 55 % singletons) of whom 33 (21 %) were born in breech presentation. During the neonatal period and at 3–4 months post-term age, categorical Prechtl general movements assessment (GMA) and detailed scoring of motor functions was performed by means of the General Movement Optimality Score (GMOS) neonatally and Motor Optimality Score-Revised (MOS-R) later. Neurodevelopment was assessed at one year using Bayley-III.

Results

Infants born in breech presentation more frequently exhibited pathological GMs (p = 0.05) with increased stiffness in the lower extremities (p < 0.01) at neonatal age. Detailed motor assessments at 3–4 months post-term age (MOS-R) showed lower scores in infants born in breech compared to those with cephalic presentation at birth. Fetal presentation at the time of delivery did not impact neurodevelopmental outcomes at 12 months.

Conclusion

Breech presentation at birth affected GMs and movement assessments in the early postnatal period but had no persistent impact on neurodevelopmental outcomes at one year, suggesting a transient effect on lower extremity movements. Given stiffness in the extremities in neonates is an alarm sign and might relate to cramped synchronized GMs indicating an increased risk for cerebral palsy, fetal presentation at birth should be taken into consideration in neonatal neuromotor assessments.

目的探讨中晚期早产儿（MLPT）出生时胎位对其产后自主运动、体位和神经发育结局的影响。方法研究人群包括154名婴儿（55%为男婴，55%为单胎），其中33名（21%）为臀位分娩。在新生儿期和足月后3-4个月，采用新生儿一般运动最优性评分（GMOS）和随后的运动最优性评分-修订（MOS-R）进行分类Prechtl一般运动评估（GMA）和运动功能详细评分。神经发育在一年后使用Bayley-III评估。结果臀位出生的婴儿更容易出现病理性GMs (p = 0.05)，下肢僵硬增加(p <；0.01)。足月后3-4个月的详细运动评估（MOS-R）显示，臀位出生的婴儿得分低于出生时头位出生的婴儿。分娩时的胎儿外观对12个月时的神经发育结果没有影响。结论出生时臀位会影响出生后早期的GMs和运动评估，但对一年后的神经发育结果无持续影响，提示对下肢运动有短暂影响。鉴于新生儿四肢僵硬是一个警报信号，可能与同步GMs局促有关，表明脑瘫的风险增加，在新生儿神经运动评估中应考虑胎儿出生时的表现。

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引用次数: 0

Factors affecting the incidence of congenital anomaly of the kidney and urinary tract: A systematic review and meta-analysis 影响肾脏和泌尿道先天性异常发生率的因素：系统回顾和荟萃分析

IF 2.2 3区医学 Q2 OBSTETRICS & GYNECOLOGY

Early human development

Pub Date : 2025-04-01 DOI: 10.1016/j.earlhumdev.2025.106252

Gusti Ngurah P. Pradnya Wisnu , Gerhard Reinaldi Situmorang , Irfan Wahyudi , Arry Rodjani , Reza Fahlevi , Putu Angga Risky Raharja

Introduction

Congenital anomaly of kidney and urinary tract (CAKUT) is one of the most common congenital anomalies, occurring in over 1 % of live births and accounting for 40–50 % of chronic kidney failure cases in children. The prevalence of CAKUT was multifaceted and varies widely. This study aimed to report the latest evidence of incidence, trends, and risk factors associated with the incidence of CAKUT.

Evidence acquisition

We conducted a systematic search of PubMed, ScienceDirect, Scopus, and Proquest databases. The included studies were then assessed using Newcastle-Ottawa (NOS) risk of bias tools. Meta-analysis was performed using Review Manager version 5.4.1 software and presented as pooled incidence and Odds Ratio (OR) with a 95 % confidence interval.

Evidence synthesis

Eight studies in total were included from 2004 to 2022 (12.838 infants of all ages). NOS risk of bias tools indicated all studies had low risk of bias. The overall pooled incidence of CAKUT was 13,6 per 1000 births (95 % CI: 4 to 45,7 per 1000 births) in all infants and 4,9 per 1000 births (95 % CI: 1,1 to 21,3 per 1000 births) in term infants without congenital anomalies, with an increasing trend over the years. Factors, such as sex (boys) (OR = 1,53; 95 % CI 1,26-1,86), prematurity (OR = 1,46; 95 % CI 1,27-1,67), low birth weight (OR = 1,28; 95 % CI 1,10-1,48), maternal diabetes (OR = 1,81; 95 % CI 1,43-2,28), maternal obesity (OR = 1,45; 95 % CI 1,23-1,70), and maternal age (>40 years) were also found to be risk factors of CAKUT incidence. Furthermore, one study reported race (black people [OR = 0,89; 95 % CI 0,87-0,91] and Hispanics [OR = 1,22; 95 % CI 1,18-1,25]) to be a risk factor of CAKUT.

Conclusions

The incidence of CAKUT was high and showed an increasing trend over the years. Several risk factors, such as sex, prematurity, low birth weight, maternal diabetes, maternal obesity, maternal age and race were also found to be associated with CAKUT incidence. These findings should increase awareness regarding CAKUT incidence in at-risk populations.

摘要先天性肾尿路异常（先天性肾尿路异常）是最常见的先天性异常之一，发生率超过1 %的活产婴儿，占儿童慢性肾衰竭病例的40 - 50% %。CAKUT的流行是多方面的，差异很大。本研究旨在报告与CAKUT相关的发病率、趋势和危险因素的最新证据。我们对PubMed、ScienceDirect、Scopus和Proquest数据库进行了系统的检索。然后使用纽卡斯尔-渥太华（NOS）偏倚风险工具对纳入的研究进行评估。meta分析使用Review Manager 5.4.1版软件进行，并以合并发生率和优势比（OR）表示，置信区间为95% %。2004年至2022年共纳入8项研究（12.838名所有年龄段的婴儿）。NOS偏倚风险工具提示所有研究均为低偏倚风险。在所有婴儿中，CAKUT的总总发病率为13.6 / 1000例（95% % CI: 4 ~ 45.7 / 1000例），在无先天性异常的足月婴儿中为4.9 / 1000例（95% % CI: 1.1 ~ 21.3 / 1000例），多年来呈上升趋势。因素，如性别（男生）(OR = 1,53；95 % CI 1,26-1,86)，早产(OR = 1,46；95 % CI 1,27-1,67)，低出生体重(OR = 1,28；95 % CI 1,10-1,48)，产妇糖尿病(OR = 1,81；95 % CI 1,43-2,28)，产妇肥胖(OR = 1,45；95 % CI 1,23-1,70)和产妇年龄（>；40 岁）也是发生CAKUT的危险因素。此外，一项研究报告了种族(黑人[OR = 0,89；95 % CI 0,87-0,91]和西班牙裔[OR = 1,22；95 % CI 1,18-1,25])是ckut的危险因素。结论CAKUT发病率较高，且呈逐年上升趋势。一些危险因素，如性别、早产、低出生体重、母亲糖尿病、母亲肥胖、母亲年龄和种族也被发现与CAKUT发病率有关。这些发现应该提高人们对高危人群中CAKUT发病率的认识。

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引用次数: 0

Timing of initiation of therapeutic hypothermia in neonates with hypoxic ischemic encephalopathy born at a high-volume urban safety net hospital 在高容量的城市安全网医院出生的新生儿缺氧缺血性脑病的治疗性低温的开始时间

IF 2.2 3区医学 Q2 OBSTETRICS & GYNECOLOGY

Early human development

Pub Date : 2025-03-25 DOI: 10.1016/j.earlhumdev.2025.106249

Christine C. Pazandak , Maria Grajeda Martinez , Megan E. Whiting , Srinivas Kota , L. Steven Brown , Lina F. Chalak , Rachel L. Leon

Background

Ethnic and racial disparities in neonatal outcomes have been well-documented, including higher risk of hypoxic-ischemic encephalopathy (HIE). Therapeutic hypothermia (TH) is the only approved treatment for infants with moderate to severe HIE and previous studies have shown mixed results regarding the impact of timing of initiation of TH on outcomes. These studies often include both inborn and outborn neonates and few minority patients.

Study design

This retrospective cohort study of exclusively inborn neonates from a high-volume, urban, safety net hospital (SNH) serving primarily racial/ethnic minority patients assessed the impact of timing of initiation of TH on short-term outcomes.

Results

There were 268 infants diagnosed with moderate or severe HIE from 2009 to 2023. After excluding patients for late cooling (n = 32), participation in a clinical trial (n = 41), and major comorbidities (n = 8), there were 187 patients for analysis. Similar to our neonatal population, this study cohort consisted of 94 % racial/ethnic minority patients. The average time to initiate TH was 4.4 ± 1.1 h of life (HOL) and 88 % of qualifying neonates received TH by 6 HOL. Those initiating TH at <4 HOL compared to 4–6 HOL were more likely to have severe HIE (p = 0.01). The adjusted OR for the primary outcome of in-hospital death was not associated with timing of initiation of TH [aOR = 0.75 (95 % CI 0.40–1.33); p = 0.33], nor were secondary outcomes of abnormal brain MRI or length of stay.

Conclusion

In a vulnerable population from a high-volume SNH, timing of initiation of TH was not associated with short-term outcomes.

新生儿结局的种族差异已被充分证明，包括缺氧缺血性脑病（HIE）的高风险。治疗性低温（TH）是唯一被批准的治疗中至重度HIE婴儿的方法，先前的研究显示，关于开始治疗时间对结果的影响，结果好坏参半。这些研究通常包括出生和出生的新生儿和少数少数患者。研究设计：本回顾性队列研究对主要为少数种族/民族患者服务的大型城市安全网医院（SNH）的纯出生新生儿进行了研究，评估了起始时间对短期预后的影响。结果2009 - 2023年确诊为中重度HIE患儿268例。在排除了晚期冷却患者（n = 32）、参与临床试验患者（n = 41）和主要合并症患者（n = 8）后，共有187例患者进行分析。与我们的新生儿人群相似，该研究队列由94%的少数民族患者组成。启动TH的平均时间为4.4±1.1 h (HOL)， 88%符合条件的新生儿在6 h内接受了TH。与4 - 6 HOL相比，开始that <；4 HOL的患者更容易发生严重的HIE （p = 0.01）。调整后的院内死亡主要结局OR与开始使用TH的时间无关[aOR = 0.75 (95% CI 0.40-1.33)；p = 0.33]，脑MRI异常或住院时间的次要结局也不重要。结论：在高剂量SNH的易感人群中，启动TH的时间与短期预后无关。

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引用次数: 0

The role of prenatal testosterone-estrogen balance in the development of Os trigonum: A comparative matched-pair analysis 产前睾酮-雌激素平衡在三角肌发育中的作用：一项比较配对分析

IF 2.2 3区医学 Q2 OBSTETRICS & GYNECOLOGY

Early human development

Pub Date : 2025-03-25 DOI: 10.1016/j.earlhumdev.2025.106250

Mehmet Ali Tokgoz , Asim Ahmadov , Ethem Burak Oklaz , Haluk Yaka , Ramazan Duzgun , Cagatay Delice , Ulunay Kanatli

Background

The 2D:4D ratio, a marker of the prenatal testosterone-estrogen balance, is defined as the proportion of the second to fourth finger lengths, with lower values indicating greater testosterone exposure. Studies demonstrated that this exposure affects chondrocyte activity and function during secondary ossification. Considering that the os trigonum is an unfused secondary ossification center, investigating the relationship between hormonal balance and os trigonum could provide valuable insights as etiopathogenesis.

Aim

To investigate the relationship between the presence of os trigonum and the 2D:4D ratio.

Methods

A matched-pair cohort study was conducted to compare patients with and without an os trigonum among those undergoing ankle arthroscopy between 2019 and 2024. 34 patients in each group were matched 1:1 by age, sex, body mass index, and history of ankle overuse before age 14. Finger lengths were measured with a caliper and 2D:4D ratios were determined.

Results

The analysis revealed that patients with os trigonum had significantly lower 2D:4D ratios in the right hand (p < 0.001), left hand (p < 0.001), and average of both (p < 0.001) compared to those without. The average 2D:4D ratio had the highest predictive ability (AUC = 0.867), with a cut-off of 0.997 predicting the presence of os trigonum with 91.2 % sensitivity and 70.6 % specificity.

Conclusion

A low 2D:4D ratio, indicative of high intrauterine testosterone exposure, is associated with the presence of an os trigonum. Therefore, this research contributes to the growing evidence that prenatal testosterone exposure, may influence specific skeletal characteristics, such as the formation of accessory bones.

2D:4D比值是产前睾酮-雌激素平衡的标志，定义为第二指与第四指长度的比例，数值越低表明睾酮暴露程度越高。研究表明，在继发性骨化过程中，这种暴露会影响软骨细胞的活性和功能。考虑到三角肌是一个未融合的继发性骨化中心，研究激素平衡与三角肌的关系可以为其发病机制提供有价值的见解。目的探讨三角肌的存在与二维：四维比值的关系。方法采用配对队列研究，比较2019年至2024年接受踝关节镜检查的患者中有和没有三角肌的患者。每组34例患者按年龄、性别、体重指数、14岁前踝关节过度使用史按1:1匹配。用卡尺测量手指长度，并测定2D:4D比值。结果分析显示，三角区综合征患者右手2D:4D比值明显降低(p <；0.001)，左手(p <；0.001)，两者的平均值(p <；0.001)。平均2D:4D比值预测能力最高（AUC = 0.867），截止值为0.997，敏感性91.2%，特异性70.6%。结论低2D:4D比值与高宫内睾酮暴露有关，与三角肌的存在有关。因此，这项研究提供了越来越多的证据，证明产前睾酮暴露可能会影响特定的骨骼特征，如副骨的形成。

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引用次数: 0

Forever premature: Adults born preterm and their life challenges 永远早产：早产儿和他们的生活挑战

IF 2.2 3区医学 Q2 OBSTETRICS & GYNECOLOGY

Early human development

Pub Date : 2025-03-12 DOI: 10.1016/j.earlhumdev.2025.106248

Gaby Stegmann-Woessner , Peter Bartmann , Barbara Mitschdoerfer , Dieter Wolke

Background

Adults born preterm face greater social, cognitive, mental and physical challenges in adulthood than their full term born peers according to longitudinal studies. In contrast, little is known about the lived experiences of adults born preterm.

Objective

The study investigates the lived experiences of adults born preterm across the life course and their views on health care support.

Methods

A qualitative study of 21 participants completing semi structured interviews analyzed through content analysis.

Results

Over half of adults born preterm report trauma and feeling of otherness since early childhood, high sensitivity to the environment, higher introversion/shyness and social or performance related anxiety. Over half reported that their parents were traumatized by the preterm birth and tried to compensate by overprotective parenting that, however, stifled them becoming independent. Over half experienced bullying victimization and many have continuing mental health problems. Overload by demands in school or work is a consistent theme that makes it hard to have the energy to socialize. Many received physical therapy in childhood and most had psychotherapy in adulthood. Many feel that health professionals trivialize the long-term effects of prematurity and most find support from their parents or peer network.

Conclusions

Prematurity has significantly shaped the life of adults born preterm. Greater awareness and recognition of the unique needs of this group are essential to provide adequate support. Existing services fail to address these needs highlighting an urgent demand for enhanced social and psychological services for educational and workplace settings.

根据纵向研究，早产的成年人在成年后比足月出生的同龄人面临更大的社会、认知、精神和身体挑战。相比之下，人们对早产儿的生活经历知之甚少。目的了解早产儿成人全生命历程的生活经历及其对卫生保健支持的看法。方法通过内容分析，对21名完成半结构化访谈的参与者进行定性研究。结果超过一半的早产儿自童年早期就有创伤和异类感，对环境高度敏感，内向/害羞以及与社交或表现相关的焦虑。超过一半的人报告说，他们的父母因早产而受到创伤，并试图通过过度保护的父母来弥补，然而，这阻碍了他们变得独立。超过一半的人遭受过欺凌，许多人有持续的精神健康问题。学校或工作上的超负荷是一个一贯的主题，这使得人们很难有精力参加社交活动。许多人在童年时接受过物理治疗，大多数人在成年后接受过心理治疗。许多人认为，卫生专业人员轻视早产的长期影响，大多数人从父母或同龄人那里寻求支持。结论早产对早产儿的生命有显著影响。提高对这一群体独特需求的认识和认识对于提供充分的支持至关重要。现有的服务不能满足这些需要，突出了迫切需要加强教育和工作场所的社会和心理服务。

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引用次数: 0