Early human development最新文献

Aim

To identify relationships between early medical factors and preterm infant feeding behaviors at term-equivalent age.

Methods

Forty-three very preterm infants born ≤32 weeks gestation had standardized feeding assessments using the Neonatal Eating Outcome Assessment at term-equivalent age (36–42 weeks postmenstrual age). Medical factors were collected and analyses were run to determine if associations between different medical factors and feeding performance exist.

Results

Lower Neonatal Eating Outcome Assessment scores at term-equivalent age were associated with lower estimated gestational age (p < .01), lower birthweight (p < .01), older postmenstrual age at discharge (p < .01), longer length of stay in the neonatal intensive care unit (p < .01), chronic lung disease (p = .03), as well as more days on total parenteral nutrition (p = .03), endotracheal intubation (p < .01), and noninvasive mechanical ventilation (p < .01).

Conclusion

More feeding problems are observed in infants born earlier, with longer hospital stays, and with complex medical courses. Knowledge of the association between these medical factors and feeding difficulties allows for identification of infants who may benefit from early, targeted interventions to optimize the feeding process.

Background

This study addresses a critical knowledge gap by exploring the intricate relationship between low birth weight (LBW) and the heightened risk of suboptimal academic achievement during adolescence through a comprehensive retrospective cohort design.

Methods

In this registry-based cohort study, meticulously linked health and curriculum-based test data for individuals born in New South Wales (NSW), Australia, between 2003 and 2005 were employed. Birth weight data were carefully sourced from the NSW perinatal data collection (PDC). The educational performance of offspring was thoroughly evaluated using the National Assessment Program for Literacy and Numeracy (NAPLAN) during grade 9, approximately at 14 years of age.

Results

After rigorous adjustments for potential confounders, findings revealed a compelling narrative: LBW adolescents demonstrated an elevated susceptibility to not meeting national minimum standards across all domains, encompassing spelling [OR, 1.59 (95%CI 1.48–1.69)], writing [OR, 1.51 (95%CI 1.41–1.61)], reading [OR, 1.38 (95%CI 1.29–1.48)], and numeracy [OR, 1.52 (95%CI 1.40–1.63)]. Notably, LBW boys exhibited a more pronounced inclination towards diminished academic performance compared to their female counterparts.

Conclusions

This comprehensive retrospective cohort study, based on linked data, unequivocally establishes LBW as significantly associated with an increased vulnerability to substandard educational achievement during adolescence. Particularly robust effects were observed in females across all outcomes. Aimed at investigating whether LBW serves as a predictive factor for later academic difficulties, this study underscores the imperative for the adoption and fortification of preventative and early intervention strategies to curtail the prevalence of LBW-associated academic underachievement in later adolescence.

Background

To evaluate the relationship of the second to fourth digit ratio (2D:4D), a biomarker of prenatal sex hormone exposure, with wrist ratio (WR), wrist-palm ratio (WPR), body mass index (BMI), waist-hip ratio (WHR), and handgrip strength (HGS) in different carpal tunnel syndrome (CTS) severity.

Method

This study involved 90 female participants (aged 18 to 83) with CTS. According to CTS severity, the participants were divided into four groups: normal, mild, moderate, and severe. All parameters of hand anthropometry and body fat distribution were measured, and the mean 2D:4D, WR, WPR, HGS, BMI, and WHR values were compared based on CTS severity. Data were collected with a visual analog scale (VAS) for pain and a Likert (LS) scale for numbness severity.

Results

The mean age, 2D:4D, WD, WW, WR, WPR, BMI, and HGS values showed a significant differences between CTS severity groups. We found that lower 2D:4D and higher WPR and BMI were associated with increased risk of CTS (AUC = 0.728) after removing the effect of age. Bilateral hands were affected in 38.9 % (70/180) of participants. Regression analysis showed that lower HGS can be used as independent variable for predicting the females having bilateral affected hands. The LS score was considerably higher in the severe and moderate groups. Also, the VAS score was significantly higher in the severe group.

Conclusion

The findings of the study demonstrated an association between 2D:4D, WPR, and BMI among women, emphasizing the effect of intrauterine sex hormone exposure on late life CTS severity.

Background

Infants with prematurity, low birthweight, and medical comorbidities are at high risk for developmental delays and neurodevelopmental disabilities and require close monitoring. Due to the COVID-19 pandemic, high-risk infant follow-up (HRIF) programs have adapted to perform developmental assessments via telehealth.

Objectives

Describe the referral rates to initiate, continue, or increase/add early intervention (EI) therapies based on in-person use of the Bayley Scales of Infant and Toddler Development, 4th Edition (BSID-IV) or telehealth use of the Developmental Assessment in Young Children, 2nd Edition (DAYC-2).

Methods

A retrospective chart review was conducted on 203 patients seen in the HRIF program at an academic medical center in Southern California. Patients were divided into in-person (BSID-IV) and telehealth (DAYC-2) assessment groups. Statistical analyses were performed to describe demographic characteristics, medical information, and referral rates for EI therapies by the types of visits.

Results

The in-person and telehealth groups demonstrated similar demographic and clinical characteristics and comparable referral rates for initiating EI therapies. Telehealth patients already receiving therapies were recommended to increase/add EI therapies at a higher rate compared to in-person patients.

Conclusions

The BSID-IV is widely used to assess for developmental delays in the high-risk infant population, but in-person administration of this tool poses limitations on its accessibility. Telehealth administration of an alternative tool, such as the DAYC-2, can lead to similar EI referral rates as in-person administration of the BSID-IV. Increased use of telehealth developmental assessments can promote timely detection of developmental delays and minimize gaps in healthcare access.

Objectives

To determine the agreement between HNNE and TIMP at TCA for preterm infants born <32⁺⁰ weeks' gestation, and to evaluate their correlation to PDMS-2 at 12-month corrected age (CA).

Methods

Infants born between November 2013 to June 2022 who had both HNNE and TIMP performed at TCA of 37⁺⁰–41⁺⁶ weeks gestation, and motor outcome assessed using the PDMS-2 at 12-month old were enrolled. The HNNE and 12-month PDMS-2 findings were categorized as optimal vs sub-optimal. TIMP was categorized as typical vs atypical. Cohen's kappa was used to determine the agreement between HNNE and TIMP. Sensitivity analysis and Receiver Operating Characteristic (ROC) curves were used to evaluate the predictive values of HNNE and TIMP on motor outcome at CA of 12-months.

Results

HNNE and TIMP done on 125 infants at TCA do not show reliable agreement. HNNE demonstrated slight and fair agreement with the 12-month Total Motor Quotient (TMQ) and Fine Motor Quotient (FMQ) of the PDMS-2 respectively. TIMP at TCA demonstrated fair agreement with all sub-domains of motor function on PDMS-2 at 12-months. In comparison with TIMP, HNNE at TCA is more sensitive at predicting suboptimal total, gross and fine motor outcomes at 12-month CA with sensitivity of 68.4 %, 51.9 %, and 83.3 % vs 44.4 %, 31.8 % and 53.3 % respectively. Atypical TIMP at TCA is more specific for suboptimal total, gross and fine motor outcomes at 12-month CA with specificity of 90.3 %, 89 % and 90.5 % respectively.

Neurobehavioral assessments at TCA using HNNE and TIMP were predictive of suboptimal fine motor quotient at CA of 12-months with AUC of 0.760 (p = 0.011) and 0.718 (p = 0.032) respectively. The difference in AUC between the 2 instruments of 0.042 was not statistically significant (p = 0.741).

Conclusions

While the HNNE and TIMP done at TCA did not demonstrate significant agreement, suboptimal HNNE and atypical TIMP at TCA were predictive of suboptimal FMQ on PDMS-2 at 12-month CA.

High rates of academic underachievement at 9–10 years have been identified in children born at risk of neonatal hypoglycaemia. This study investigated the stability of behaviour from early to mid-childhood and how this relates to academic outcomes in children born with at least one risk factor of neonatal hypoglycaemia in Aotearoa, New Zealand. Behaviour data was collected using the Bayley Scales of Infant and Toddler Development, Child Behaviour Checklist 1.5–5, and the Strengths and Difficulties Questionnaire for 466 children (52 % male; 27 % Māori, 60 % New Zealand European, 2 % Pacific, 11 % Other) at multiple timepoints between ages 2 and 10 years. Academic data was collected at 9–10 years using the e-asTTle online learning and assessment tool. Findings revealed a link between early childhood behaviour and academic outcomes could be detected as early as age 2, suggesting that identifying and addressing early behavioural issues in children at risk of neonatal hypoglycaemia could aid in targeted interventions.

Background

Bilirubin neurotoxicity involves a spectrum of varying severity that could result in adverse long-term sequelae.

Aims

To compare the neurodevelopmental outcome of full-term neonates who underwent exchange transfusion with those who did not.

Study design

A retrospective cohort study.

Subjects

This study included a retrospective review of records of sixty neonates who were matched in admission ages and serum bilirubin levels and the comparison groups were those who received an exchange transfusion (n = 30) versus those where exchange transfusion was planned, but the bilirubin levels dropped sufficiently during the period where the exchange blood was being prepared (n = 30). History, clinical examination, and laboratory investigations were documented.

Outcome measures

Neurodevelopmental outcome, at 6 months of age, using Bayley scales of infant development was assessed.

Results

The exchange group had statistically significant lower cognitive scores (p-value 0.005). The higher the rate of bilirubin decline, the better the language and motor scores in the phototherapy group (p-values 0.020 and 0.024 respectively). Infants with longer duration to exchange transfusion had lower cognitive, language, and motor scores (p-values 0.01, 0.001, and 0.003 respectively).

Conclusions

Slower rates of bilirubin decline and longer duration before intervention increase the chances of adverse neurodevelopmental outcomes.

Background

Preterm birth is associated with a high risk of long-term neuromotor disabilities such as coordination of movements, deficient antigravity limb movement, less adaptive postural control strategies, head deformities…

Aims

The aim of the present study was to examine the potential positive impact of a Supported Diagonal Flexion (SDF) skin-to-skin contact (SSC) positioning on the neuromotor development and movement quality of very preterm infants at term age.

Study design

Monocentric prospective matched-pair case-control study.

Subjects

Thirty very preterm infants and their mother were proposed either SDF SSC positioning (n = 15) or Vertical SSC positioning (n = 15).

Outcome measures

Amiel-Tison Neurological Assessment at Term (ATNAT) and observation of the spontaneous motor activity were assessed at term corrected age.

Results

Infants in the SDF group had less dolichocephaly (adj. p = .014) and arms in candlestick position (adj. p = .048). Only 3 in the SDF group against 11 in the vertical group showed nonoptimal spontaneous motor activity. Infants in the SDF group had more positive signs such as foot-to-foot contact (adj. p = .047) or arms movements toward midline (adj. p = .046 and 0.011).

Conclusions

The present study shows that nonoptimal spontaneous motor activity was increased and dolichocephaly was more common in the vertical group. Consistently with current guidelines, it is critical to consider preterm infants' postures during SSC or while in incubators or cradles.

Objective

To report pregnancy outcomes for women with kidney transplantation and investigate whether different intervals after transplantation have different effects on pregnancy outcomes.

Methods

A single-center retrospective study was performed. Based on intervals after transplantation, pregnant women with kidney transplantation are divided into two groups: intervals <5 years and ≧5 years. The maternal and neonatal outcomes were compared between the two groups.

Results

No maternal and neonatal deaths occurred. The average age of mothers during pregnancy was 32.3 ± 4.1 years and they had a functioning transplant for 4 (interquartile ranges, 3, 6) years. Preeclampsia occurs in sixteen (16.5 %) pregnancies and gestational diabetes (GDM) occurs in twenty (20.6 %). Eighty-eight newborns (90.7 %) had a gestational age of <37 weeks. The average gestational age for live births was 33.8 ± 2.2 weeks and the average birth weight was 2285.6 ± 581.8 g. Neonatal respiratory distress syndrome (NRDS) occurs in fifty-one babies (52.6 %), intraventricular hemorrhage (ICH) occurs in twenty-nine (29.8 %), atrial septal defects (ASD) occurs in thirty-two (32.9 %) and bronchopulmonary dysplasia (BPD) occurs in seven (7.2 %). Further analysis, pregnancy results, including pre-eclampsia, hypertension or GDM, did not differentiate between the two groups (intervals <5 years vs. ≧5 years). Neonatal outcomes, including premature delivery, low birth weight, mode of birth, small for gestational age (SGA), RDS, ICH, ASD, BPD were not distinguishable between the two groups (intervals <5 years vs. ≧5 years). The level of neonatal blood creatinine after birth was linearly related to high maternal creatinine, and can drop to normal levels within a week.

Conclusions

The incidence of maternal and neonatal complications in pregnancies following kidney transplantation is still high, despite the success of most pregnancies. Various posttransplant intervals had no significant impact on pregnancy outcomes.

This paper describes the development and justification of a qualitative methodology aimed at exploring the infant's personal experience of hospitalisation in the neonatal intensive care unit (NICU). We begin by briefly reviewing existing methods for documenting and recording infant experiences. These methods focus on the clinical needs of the infant predominantly through quantifiable medical outcome data. Research understanding their experience of receiving clinical care is lacking. By exploring newborn infant behaviour, cues, and communication strategies we assert the infant as a capable participant in neonatal research. We then describe the methodology and methods which we have named 360-degree phenomenology that draws directly from the capabilities and knowledge of the infants themselves. We propose this methodology will address the gap in the literature by enabling a rich and comprehensive overview of the early life experiences of infants hospitalised in NICU.