Early human development最新文献_第3页

Extra-uterine placental transfusion and intact-cord stabilisation of moderately preterm to term infants in caesarean deliveries - A feasibility study with historical control (INTACT-2)

IF 2.2 3区医学 Q2 OBSTETRICS & GYNECOLOGY

Early human development

Pub Date : 2025-02-06 DOI: 10.1016/j.earlhumdev.2025.106208

Elisabeth Sæther , Ola Andersson , Tor Åge Myklebust , Solveig Bjellmo , Stine Bernitz , Solhild Stridsklev , Beate Horsberg Eriksen

Background: Although delayed umbilical cord clamping (DCC) is universally recommended, implementation has been difficult in caesarean deliveries. The study objective was to test if extra-uterine placental transfusion (delivering the placenta before cord clamping) to facilitate intact-cord stabilisation could be a feasible and safe alternative to DCC (≥ 1 min) for moderately preterm to term infants with caesarean delivery in regional anaesthesia and their mothers. Methods: This feasibility study included infants with GA 32⁰ to 42³ weeks with planned or emergency caesarean delivery. Primary outcome was intervention compliance. Safety outcomes were prevalence of blood loss ≥1000 ml or postoperative wound infection in mothers, and prevalence of early cord clamping (ECC), low 5-min Apgar scores and hypothermia in infants. Results: We included 123 mother-infant pairs in the intervention group and 158 in the historical control group. The intervention was successfully completed in 121 of 123 cases. There were no statistically significant differences in maternal outcomes. Significantly less infants in the intervention group had ECC before 60 s (OR 0.07, CI (0.01–0.51), P = 0.009) and 5-min Apgar scores <7 (P = 0.003) compared to historical controls. There was no significant difference in infant hypothermia. Conclusion: Extra-uterine placental transfusion may be a reasonable alternative to DCC for term and near term preterm infants with caesarean delivery in regional anaesthesia. The intervention may be especially useful in low-income birth settings with high prevalence of iron deficiency/anaemia and no mobile resuscitation equipment.

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引用次数: 0

Clinical validation of an abridged AIMS: Streamlining motor screening in the first-year infant

IF 2.2 3区医学 Q2 OBSTETRICS & GYNECOLOGY

Early human development

Pub Date : 2025-02-03 DOI: 10.1016/j.earlhumdev.2025.106207

Teresa Fair-Field , Bharath Modayur

This study validates an abridged version of the Alberta Infant Motor Scale (AIMS), termed the “salient set,” to streamline infant screening using video analysis and machine learning. Twenty-one retrospective infant videos were manually tagged by trained occupational therapists using only the 15-item salient set with support vector regressors (SVRs) trained on a larger sample (n = 102) predicting the true (full) AIMS score. The SVR demonstrated strong concurrent validity of the salient set with the full 58-item AIMS (Pearson correlation: 0.99). The abridged set showed high screening sensitivity (1.0) and specificity (0.895), while reducing evaluation time by 67 %. The salient set offers a useful contribution to machine learning by detecting an abridged set of items while still accurately and appropriately identifying infants for EI referral.

引用次数: 0

Does paced bottle-feeding improve the quality and outcome of bottle-feeding interactions? 有节奏的奶瓶喂养是否改善了奶瓶喂养互动的质量和结果？

IF 2.2 3区医学 Q2 OBSTETRICS & GYNECOLOGY

Early human development

Pub Date : 2025-02-01 DOI: 10.1016/j.earlhumdev.2024.106181

Alison K. Ventura , Vivian M. Drewelow , Taylor N. Richardson

Background

Responsive feeding is recommended and occurs when caregivers use infants' behavioral cues to guide the timing, pacing, and duration of feeding. Paced bottle-feeding is an approach designed to promote responsive bottle-feeding by mimicking the behavioral benefits of breastfeeding. This study evaluates the efficacy of paced bottle-feeding compared to typical bottle-feeding and breastfeeding for promoting responsive feeding and other markers of healthy feeding outcomes, such as slower feeding rates and lower likelihood of spitting up.

Methods

This within-subject, experimental study involved 29 mothers and their typically developing full-term infants. Participants were observed during three feeding conditions: Breastfeeding, Typical bottle-feeding, and Paced bottle-feeding. Each feeding session was video-recorded and coded using the Nursing Child Assessment Caregiver-Child Interaction Feeding Scale. Outcome measures included maternal sensitivity to infant cues, infant clarity of cues, infant milk intake, meal duration, and feeding rate. Mixed linear models were used for data analysis.

Results

Maternal sensitivity to infant cues and infant clarity of cues were similar between paced bottle-feeding and typical bottle-feeding but lower than breastfeeding. Paced bottle-feeding led to significantly longer feeding durations and slower feeding rates than typical bottle-feeding, with no significant differences in milk intake. Infant clarity of cues moderated impacts of feeding condition on maternal sensitivity to infant cues; when infants exhibited lower clarity of cues, maternal sensitivity to infant cues was lowest during typical bottle-feeding compared to paced bottle-feeding and breastfeeding.

Conclusions

Paced bottle-feeding effectively slowed feeding rates and extended meal durations. Paced bottle-feeding was also associated with greater maternal sensitivity to infant cues compared to typical bottle-feeding when infants had lower clarity of cues. These findings provide preliminary evidence of the potential for paced bottle-feeding to promote responsive feeding.

背景：反应性喂养是推荐的，当照顾者使用婴儿的行为线索来指导喂养的时间、节奏和持续时间时，就会发生反应性喂养。节奏奶瓶喂养是一种旨在通过模仿母乳喂养的行为益处来促进反应性奶瓶喂养的方法。本研究评估了与典型的奶瓶喂养和母乳喂养相比，有节奏的奶瓶喂养在促进反应性喂养和其他健康喂养结果标志（如较慢的喂养速度和较低的吐痰可能性）方面的功效。方法：本课题内的实验研究涉及29位母亲及其典型发育的足月婴儿。参与者在三种喂养条件下观察：母乳喂养，典型的奶瓶喂养和有节奏的奶瓶喂养。每次喂养过程都被录像，并使用护理儿童评估护理者-儿童互动喂养量表进行编码。结果测量包括母亲对婴儿线索的敏感性，婴儿对线索的清晰度，婴儿牛奶摄入量，用餐时间和喂养率。采用混合线性模型进行数据分析。结果：母亲对婴儿线索的敏感性和婴儿对线索的清晰度在节奏奶瓶喂养和典型奶瓶喂养之间相似，但低于母乳喂养。与典型的奶瓶喂养相比，有节奏的奶瓶喂养导致喂养持续时间更长，喂养速度更慢，而牛奶摄入量没有显著差异。婴儿线索清晰度调节喂养条件对母亲对婴儿线索敏感性的影响；当婴儿表现出较低的线索清晰度时，与有节奏的奶瓶喂养和母乳喂养相比，在典型的奶瓶喂养期间，母亲对婴儿线索的敏感性最低。结论：有节奏的奶瓶喂养有效地减缓了喂养速度，延长了进餐时间。与典型的奶瓶喂养相比，当婴儿对线索的清晰度较低时，有节奏的奶瓶喂养也与母亲对婴儿线索的敏感度更高有关。这些发现为有节奏的奶瓶喂养可能促进反应性喂养提供了初步证据。

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引用次数: 0

Effect of sequential swallow training programme on feeding transition and suck-swallow-breath coordination in preterm infants 顺序吞咽训练方案对早产儿进食过渡和吸吮-吞咽-呼吸协调的影响。

IF 2.2 3区医学 Q2 OBSTETRICS & GYNECOLOGY

Early human development

Pub Date : 2025-02-01 DOI: 10.1016/j.earlhumdev.2025.106193

Guoqiang Ren , Lina Fan , Yanni Chen , Haihong Lei , Wenhua Wu , Ying Ma , Yanxia Huang

Aims

To retrospectively evaluate the effect of a sequential swallow training programme (SSTP) consisting of nonnutritive sucking (NNS), modified feeding posture, oral sensory-motor intervention and breath exercise on the independent oral feeding transition and coordination of suck-swallow-breath (SSB) functions in preterm infants.

Methods

Sixty preterm infants received SSTP intervention and sixty infants receiving NNS were set as control. The feeding performance and SSB coordination were assessed using POFRAS and NOMAS scales.

Results

The transition interval were 8.42 ± 4.49 and 10.27 ± 5.05 days for SSTP and NNS group, respectively (P = 0.022). SSTP group had substantially more weight gains and shorter in-hospital stay than NNS. Two groups had comparable POFRAS and NOMAS scores before interventions, which were significantly increased after treatments in the two groups (P < 0.05). SSTP groups exhibited higher POFRAS scores, and better NOMAS performance reflected by the movement and coordination of jaw and tongue, especially in the normal sucking domain than the NNS group (P < 0.05). Both interventions significantly reduced the episodes of desaturation, apnea, and bradycardia, while no priority was shown for SSTP comparing with NNS. Multivariate linear regression analysis revealed that SSTP intervention was independently associated with decreased full oral feeding transition days, more weight gain during intervention and higher POFRAS score after intervention.

Conclusion

SSTP intervention shorten the transition days to full oral feeding and efficiently improved oral movement and coordination of SSB pattern when feeding.

目的：回顾性评价由非营养性吸吮（NNS）、改良喂养姿势、口腔感觉运动干预和呼吸练习组成的顺序吞咽训练计划（SSTP）对早产儿独立口腔喂养过渡和吸吮-吞咽-呼吸（SSB）功能协调的影响。方法：60例接受SSTP干预的早产儿和60例接受NNS干预的早产儿作为对照。采用POFRAS和NOMAS量表评估摄食性能和SSB协调性。结果：SSTP组和NNS组的转换时间分别为8.42±4.49和10.27±5.05 d （P = 0.022）。与NNS组相比，SSTP组体重增加更多，住院时间更短。两组干预前POFRAS和NOMAS评分相当，治疗后两组POFRAS和NOMAS评分显著升高(P结论：SSTP干预缩短了向全口喂养过渡的时间，有效改善了喂养时口腔运动和SSB模式的协调性。

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引用次数: 0

Early postnatal transitional circulation in fetal growth restricted neonates 出生后早期过渡循环限制了新生儿的生长。

IF 2.2 3区医学 Q2 OBSTETRICS & GYNECOLOGY

Early human development

Pub Date : 2025-02-01 DOI: 10.1016/j.earlhumdev.2024.106170

Lisa Bjarkø , Drude Fugelseth , Guttorm Haugen , Eirik Nestaas

Background

Fetal growth restriction (FGR) may impact early postnatal transitional circulation.

Aim

Echocardiographic assessment of left ventricular cardiac output, superior vena cava (SVC) and ductus venosus (DV) blood flow in FGR neonates first three days after birth.

Study design

Prospective observational study.

Subjects

FGR and Non-FGR neonates.

Outcome measures

Left ventricular cardiac output, SVC and DV blood flow day one, two, and three.

Results

Adjusting for gestational age (GA), birth weight, sex, and twin/singleton, flow measurements were similar between Late-FGR (GA ≥ 32 weeks, n = 23) and Non-FGR (GA ≥ 32 weeks, n = 39). On day three, Late-FGR had significantly lower left ventricular stroke volume (Estimated Marginal Means (Standard Error) 0.99 (0.08) vs 1.22 (0.06) mL/kg, p = 0.027) and higher heart rate (134 (5) vs 119 (4) beats/min, p = 0.032). Left ventricular cardiac output and left ventricular stroke volume decreased significantly from day one to three in both groups; Late-FGR 170 (8) to 149 (8) mL/min/kg, p = 0.007, and 1.34 (0.07) to 1.17 (0.07) mL/kg, p = 0.015, and Non-FGR 161 (6) to 144 (6) mL/min/kg, p = 0.002, and 1.27 (0.06) to 1.16 (0.06) mL/kg, p = 0.021. SVC flow remained unchanged from day one to three in Late-FGR (92 (6) to 83 (6) mL/min/kg, p = 0.161) and decreased significantly in Non-FGR (83 (5) to 71 (5) mL/min/kg, p = 0.021). DV blood flow remained unchanged. No measurements differed between Early-FGR (GA 30⁺⁰–31⁺⁶ weeks) and Late-FGR.

Conclusions

Late-FGR had limited impact on left ventricular cardiac output, SVC and DV blood flow in early neonatal period. Most adaptive circulatory changes occurred early during transition.

背景：胎儿生长受限（FGR）可能影响产后早期过渡循环。目的：FGR新生儿出生后3天左室心输出量、上腔静脉（SVC）和静脉导管（DV）血流的超声心动图评价。研究设计：前瞻性观察性研究。研究对象：FGR和非FGR新生儿。结果指标：左心室心输出量、SVC和DV血流量第1、2和3天。结果：调整胎龄（GA）、出生体重、性别和双/单胎后，晚期fgr （GA≥32周，n = 23）和非fgr （GA≥32周，n = 39）之间的流量测量相似。在第三天，fgr晚期患者左室卒中容量显著降低(估计边际均值（标准误差）0.99 (0.08)vs 1.22 (0.06) mL/kg, p = 0.027)，心率升高(134 （5)vs 119(4)次/分钟，p = 0.032）。两组左心室心输出量和左心室卒中容积从第1天到第3天显著下降；晚期fgr为170 (8)~ 149 (8)mL/min/kg, p = 0.007, 1.34 (0.07) ~ 1.17 (0.07) mL/kg, p = 0.015，非fgr为161 (6)~ 144 (6)mL/min/kg, p = 0.002, 1.27 (0.06) ~ 1.16 (0.06) mL/kg, p = 0.021。晚期fgr的SVC流量从第1天到第3天保持不变(92(6)至83 (6)mL/min/kg, p = 0.161)，非fgr的SVC流量显著下降(83（5)至71 (5)mL/min/kg, p = 0.021）。DV血流量保持不变。早期fgr （GA 30+0-31+6周）和晚期fgr之间没有测量差异。结论：晚期fgr对新生儿早期左室心输出量、SVC和DV血流量影响有限。大多数适应性循环变化发生在过渡早期。

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引用次数: 0

Association between cerebrospinal fluid levels of neuro-specific enolase after hypothermia alone and in combination with neurodevelopmental outcomes at age six years 6岁儿童单独低温后脑脊液中神经特异性烯醇化酶水平与神经发育结局的关系

IF 2.2 3区医学 Q2 OBSTETRICS & GYNECOLOGY

Early human development

Pub Date : 2025-02-01 DOI: 10.1016/j.earlhumdev.2024.106186

Toshiyuki Imanishi, Masaki Shimizu, Wakako Sumiya, Chika Kanno, Masayuki Kanno, Masami Kanno, Ken Kawabata

Background

Hypoxic-ischemic encephalopathy (HIE) is still associated with death and sequelae including cerebral palsy and intellectual disability despite induced hypothermia. Biomarkers, as early predictive indicators of adverse outcomes, are lacking.

Aims

To investigate whether post-rewarming cerebrospinal fluid (CSF)-neuro-specific enolase (NSE) levels after hypothermia are associated with neurodevelopmental outcomes at age six years, alone or when combined with amplitude-integrated electroencephalography (aEEG) and brain magnetic resonance imaging (MRI), as neuroimaging and neurophysiological indicators, respectively.

Participants

We retrospectively enrolled 157 patients with HIE from 2011 to 2018 with available post-rewarming CSF-NSE levels and developmental tests at age six years. Of these, 148 met the inclusion criteria, and 87 were evaluated in the final analysis.

Outcome measures

Multivariate receiver operating characteristic analysis determined the predictive ability of post-rewarming CSF-NSE levels for adverse outcomes including death and cerebral palsy, intellectual disability, and borderline disability at age 6 years either singly or in combination with aEEG and MRI findings, using logistic regression analysis.

Results

The cut-off value for CSF-NSE at a median 5 days after birth was 233 ng/dL (area under the curve 0.97, 95 % confidence intervals of 0.93–1.00, sensitivity 1, specificity 0.94) for death. Regarding cerebral palsy and intellectual disability, the combination of abnormal aEEG at 72 h, moderate-severe MRI injury findings, and with or without CSF-NSE (cut-off value: 55 ng/mL), odds ratio (95 % confidence intervals) improving from 8.6 (2.7–27.8) to 12.4 (3.5–43.9) (p < 0.01).

Conclusions

In patients with HIE, post-rewarming CSF-NSE levels were associated not only with death independently but with cerebral palsy and intellectual disability in combination with EEG and MRI findings.

背景：缺氧缺血性脑病（HIE）仍然与死亡和后遗症相关，包括脑瘫和智力残疾，尽管诱发了低温。缺乏作为不良后果早期预测指标的生物标志物。目的：研究低温后重新升温后脑脊液(CSF)-神经特异性烯醇化酶（NSE）水平是否与6岁时的神经发育结局相关，单独或联合波幅积分脑电图（aEEG）和脑磁共振成像（MRI），分别作为神经影像学和神经生理学指标。参与者：我们回顾性地纳入了2011年至2018年157例HIE患者，这些患者在复温后的CSF-NSE水平和6岁时的发育测试都是可用的。其中148例符合纳入标准，87例在最终分析中得到评价。结果测量：多变量受试者工作特征分析确定了复温后CSF-NSE水平对6岁时不良结局（包括死亡和脑瘫、智力残疾和边缘性残疾）的预测能力，无论是单独还是结合aEEG和MRI结果，采用logistic回归分析。结果：出生后5天CSF-NSE的死亡临界值为233ng /dL（曲线下面积0.97,95%可信区间0.93-1.00，敏感性1，特异性0.94）。对于脑瘫和智力残疾，72小时aEEG异常、中重度MRI损伤、伴或不伴CSF-NSE（临界值：55 ng/mL），比值比（95%置信区间）从8.6（2.7-27.8）提高到12.4 (3.5-43.9)(p)。结论：在HIE患者中，复温后CSF-NSE水平不仅单独与死亡相关，还与脑瘫和智力残疾相关（结合脑电图和MRI结果）。

{"title":"Association between cerebrospinal fluid levels of neuro-specific enolase after hypothermia alone and in combination with neurodevelopmental outcomes at age six years","authors":"Toshiyuki Imanishi, Masaki Shimizu, Wakako Sumiya, Chika Kanno, Masayuki Kanno, Masami Kanno, Ken Kawabata","doi":"10.1016/j.earlhumdev.2024.106186","DOIUrl":"10.1016/j.earlhumdev.2024.106186","url":null,"abstract":"<div><h3>Background</h3><div>Hypoxic-ischemic encephalopathy (HIE) is still associated with death and sequelae including cerebral palsy and intellectual disability despite induced hypothermia. Biomarkers, as early predictive indicators of adverse outcomes, are lacking.</div></div><div><h3>Aims</h3><div>To investigate whether post-rewarming cerebrospinal fluid (CSF)-neuro-specific enolase (NSE) levels after hypothermia are associated with neurodevelopmental outcomes at age six years, alone or when combined with amplitude-integrated electroencephalography (aEEG) and brain magnetic resonance imaging (MRI), as neuroimaging and neurophysiological indicators, respectively.</div></div><div><h3>Participants</h3><div>We retrospectively enrolled 157 patients with HIE from 2011 to 2018 with available post-rewarming CSF-NSE levels and developmental tests at age six years. Of these, 148 met the inclusion criteria, and 87 were evaluated in the final analysis.</div></div><div><h3>Outcome measures</h3><div>Multivariate receiver operating characteristic analysis determined the predictive ability of post-rewarming CSF-NSE levels for adverse outcomes including death and cerebral palsy, intellectual disability, and borderline disability at age 6 years either singly or in combination with aEEG and MRI findings, using logistic regression analysis.</div></div><div><h3>Results</h3><div>The cut-off value for CSF-NSE at a median 5 days after birth was 233 ng/dL (area under the curve 0.97, 95 % confidence intervals of 0.93–1.00, sensitivity 1, specificity 0.94) for death. Regarding cerebral palsy and intellectual disability, the combination of abnormal aEEG at 72 h, moderate-severe MRI injury findings, and with or without CSF-NSE (cut-off value: 55 ng/mL), odds ratio (95 % confidence intervals) improving from 8.6 (2.7–27.8) to 12.4 (3.5–43.9) (<em>p</em> < 0.01).</div></div><div><h3>Conclusions</h3><div>In patients with HIE, post-rewarming CSF-NSE levels were associated not only with death independently but with cerebral palsy and intellectual disability in combination with EEG and MRI findings.</div></div>","PeriodicalId":11435,"journal":{"name":"Early human development","volume":"201 ","pages":"Article 106186"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142964205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Neurodevelopmental impairment in children with Robin sequence: A systematic review and meta-analysis 罗宾序列儿童神经发育障碍：系统回顾和荟萃分析。

IF 2.2 3区医学 Q2 OBSTETRICS & GYNECOLOGY

Early human development

Pub Date : 2025-02-01 DOI: 10.1016/j.earlhumdev.2024.106185

Dimple Goel , Andrew Wilson , Gareth Baynam , Karen Waters , Jane Pillow , Shripada Rao

Objective

To estimate the global prevalence of neurodevelopmental impairment in children with Robin sequence (RS) at one year or more of age.

Study design

Electronic databases such as PubMed, Embase, CINAHL, APA PsycInfo, Emcare, MedNAR and Cochrane library were searched systematically from inception to 31st May 2024. Studies reporting on the neurodevelopmental (global, cognitive, or motor) outcomes in children with RS were included. Data was extracted using a standardized form by two independent reviewers. Overall and subgroup-specific prevalence (95% CI) of neurodevelopmental impairment was estimated with random-effects meta-analysis. Subgroup analyses were performed for three categories of RS: isolated (no other associated abnormalities), syndromic RS (associated with a genetic syndrome), and RS plus (associated with non-syndromic congenital abnormalities).

Results

A total of 2919 records were screened. Seventeen studies were included in the systematic review, of which data from 16 studies (n = 1008) were pooled for meta-analysis. The overall prevalence of neurodevelopmental impairment was 19 % (12–26 %). Neurodevelopmental impairment prevalence in isolated RS was 10 % (5 to16%), syndromic RS 19 % (02 to44%), and RS plus 63 % (39 to84%). The overall prevalence in non-isolated RS (syndromic and plus) was 35 % (22 to49%).

Conclusion

This is first systematic review and meta-analysis to report on the global prevalence of neurodevelopmental impairment in children with RS. Children with RS are at high risk of neurodevelopmental impairment and should be considered for long-term neurodevelopmental follow up. These findings will guide clinician counselling of parents, resource allocation, facilitate benchmarking, and enable the assessment of treatment impact in future studies.

研究目的研究设计：研究设计：对 PubMed、Embase、CINAHL、APA PsycInfo、Emcare、MedNAR 和 Cochrane 图书馆等电子数据库进行了系统检索，检索时间从开始至 2024 年 5 月 31 日。其中包括报告 RS 患儿神经发育（整体、认知或运动）结果的研究。由两名独立审稿人使用标准化表格提取数据。采用随机效应荟萃分析法估算神经发育障碍的总体患病率和亚组特异性患病率（95% CI）。对三类 RS 进行了亚组分析：孤立型 RS（无其他相关异常）、综合征型 RS（与遗传综合征相关）和 RS 加型 RS（与非综合征先天异常相关）：结果：共筛选出 2919 份记录。17项研究被纳入系统综述，其中16项研究（n = 1008）的数据被汇总进行荟萃分析。神经发育障碍的总患病率为 19%（12%-26%）。神经发育障碍在孤立型RS中的患病率为10%（5%至16%），综合型RS为19%（02%至44%），RS+型为63%（39%至84%）。非孤立型 RS（综合征和附加型）的总体患病率为 35%（22% 至 49%）：这是首次系统回顾和荟萃分析报告 RS 儿童神经发育障碍的全球患病率。RS患儿是神经发育障碍的高危人群，应考虑对其进行长期的神经发育随访。这些发现将为临床医生对家长的咨询、资源分配提供指导，有助于制定基准，并能在未来的研究中评估治疗效果。

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引用次数: 0

Primary respiratory support of extremely preterm neonates in the Netherlands: a national survey 荷兰极度早产新生儿的初级呼吸支持：一项全国性调查。

IF 2.2 3区医学 Q2 OBSTETRICS & GYNECOLOGY

Early human development

Pub Date : 2025-02-01 DOI: 10.1016/j.earlhumdev.2024.106182

Merel Boesveld , Marieke A.C. Hemels , Ronny Knol , Sandra A.M.J. Logtens-Abels , Matthias C. Hütten , Ruben S. Witlox , Christian V. Hulzebos , Hendrik J. Niemarkt , Daniel C. Vijlbrief

Introduction

Non-invasive respiratory support strategies have evolved to avoid bronchopulmonary dysplasia (BPD) in preterm infants. However, consensus on the best treatment strategy remains lacking. This study aims to investigate current practices and variations in primary respiratory support for extremely preterm neonates across neonatal intensive care units (NICUs) in the Netherlands.

Methods

A web-based questionnaire was distributed to neonatologists in the Netherlands. The survey covered aspects like the choice of respiratory support modalities, criteria for their application, and associated clinical practices.

Results

The response rate was 48.5 % (66/136). The majority used continuous positive airway pressure (CPAP) as primary respiratory support; 73.8 % for infants with gestational age (GA) ≤26 wks and 88.9 % for infants with GA 26–28 wks. The most used alternative was non-invasive positive pressure ventilation (NIPPV). Significant variation was particularly found in NIPPV settings. Respiratory support during less invasive surfactant administration (LISA) varied per NICU between CPAP and NIPPV, but overall CPAP was preferred.

Caffeine was administered in the delivery room into infants with GA ≤26 weeks (30.2 %) and GA between 26 and 28 weeks (22.2 %). Doxapram was avoided in the first week of life in 81 % of the infants, independent of their GA.

Conclusion

The study highlights diverse practices in primary neonatal respiratory support in the Netherlands, with significant variation in NIPPV settings while there is uniformity in CPAP use, underscoring the need for cohesive guidelines and training to standardize care and improve outcomes for extremely preterm neonates.

无创呼吸支持策略已经发展到避免早产儿支气管肺发育不良（BPD）。然而，关于最佳治疗策略的共识仍然缺乏。本研究旨在调查荷兰新生儿重症监护病房（NICUs）中极早产儿初级呼吸支持的现状和变化。方法：向荷兰的新生儿科医生发放一份基于网络的问卷。调查涵盖了呼吸支持方式的选择、应用标准和相关的临床实践等方面。结果：有效率为48.5%（66/136）。大多数患者使用持续气道正压通气（CPAP）作为主要呼吸支持；胎龄≤26周的占73.8%，胎龄26 ~ 28周的占88.9%。最常用的替代方法是无创正压通气（NIPPV）。特别是在NIPPV环境中发现了显著的差异。在CPAP和NIPPV中，每个NICU在无创表面活性剂给药（LISA）期间的呼吸支持有所不同，但总体CPAP是首选。GA≤26周（30.2%）和GA在26 ~ 28周（22.2%）的婴儿在产房给予咖啡因。81%的婴儿在出生后的第一周避免使用多普唑仑，与GA无关。结论：该研究强调了荷兰初级新生儿呼吸支持的不同实践，NIPPV设置存在显著差异，而CPAP使用具有统一性，强调需要有凝聚力的指南和培训来标准化护理和改善极度早产儿的结果。

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引用次数: 0

Daughters of PCOS mothers and AMH plasma concentrations in pre-puberty and puberty: A meta-analysis PCOS母亲的女儿与青春期前和青春期AMH血浆浓度：荟萃分析。

IF 2.2 3区医学 Q2 OBSTETRICS & GYNECOLOGY

Early human development

Pub Date : 2025-02-01 DOI: 10.1016/j.earlhumdev.2025.106194

Polina Pavli, Theodoros Kalampokas, Makarios Eleftheriades, Irene Lambrinoudaki, Nikolaos F. Vlahos, George Valsamakis

Purpose

to compare the Anti-Müllerian hormone (AMH) plasma concentrations of pre-pubertal and pubertal daughters born to polycystic ovary syndrome (PCOS) mothers to daughters born to control mothers and to investigate their alterations during pre-puberty and all stages of puberty.

Methods

We critically investigated and meta-analyzed observational studies, which compared the plasma concentrations of AMH in pre-pubertal and pubertal daughters of PCOS pregnancies. A search of the literature was completed till the end of June of 2024 in the PubMed, Scopus, and Medline for the eligible studies. The meta-analysis followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). The primary outcome included AMH plasma concentrations.

Results

Our search yielded 961 potentially eligible studies, 5 of which were finally studied. Pre-pubertal female offsprings of PCOS mothers present higher plasma concentrations of AMH, with the pooled mean difference 10.08, while also pubertal daughters of PCOS mothers present higher plasma concentrations of AMH, with the pooled mean difference 15.79.

Conclusion

Pre-pubertal and pubertal female offsprings of PCOS mothers show higher AMH plasma concentrations, when compared to daughters of healthy mothers without PCOS. The main pathophysiological pathways of these findings seem to be hyperandrogenism, hyperinsulinemia, and also genetic, epigenetic and intrauterine factors.

目的：比较多囊卵巢综合征（PCOS）母亲所生青春期前和青春期女儿与对照组母亲所生女儿的抗缪勒氏管激素（AMH）血浆浓度，并研究其在青春期前和青春期各阶段的变化：我们对观察性研究进行了批判性调查和荟萃分析，这些研究比较了多囊卵巢综合征妊娠的青春期前女儿和青春期女儿的血浆AMH浓度。截至 2024 年 6 月底，我们在 PubMed、Scopus 和 Medline 上对符合条件的研究进行了文献检索。荟萃分析遵循了系统综述和荟萃分析的首选报告项目（PRISMA）。主要结果包括 AMH 血浆浓度：我们的搜索结果显示，有 961 项研究可能符合条件，其中 5 项最终得到了研究结果。多囊卵巢综合征母亲的青春期前女儿血浆中的AMH浓度较高，汇集平均差为10.08；多囊卵巢综合征母亲的青春期女儿血浆中的AMH浓度也较高，汇集平均差为15.79：多囊卵巢综合症母亲的青春期前和青春期女性后代与无多囊卵巢综合症的健康母亲的女儿相比，AMH血浆浓度更高。这些发现的主要病理生理途径似乎是高雄激素、高胰岛素血症，以及遗传、表观遗传和宫内因素。

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引用次数: 0

Parental occupational exposure to anticancer drugs and radiation: Risk of fetal loss and physical abnormalities in The Japan Environment and Children's Study 父母职业暴露于抗癌药物和辐射：日本环境与儿童研究中胎儿流产和身体异常的风险。

IF 2.2 3区医学 Q2 OBSTETRICS & GYNECOLOGY

Early human development

Pub Date : 2025-02-01 DOI: 10.1016/j.earlhumdev.2025.106195

Shunsuke Yamamoto , Masafumi Sanefuji , Hirosuke Inoue , Masataka Inoue , Yu Shimo , Shunichiro Toya , Maya Suzuki , Nozomi Abe , Norio Hamada , Utako Oba , Kentaro Nakashima , Masayuki Ochiai , Reiko Suga , Yuhki Koga , Mayumi Tsuji , Kiyoko Kato , Shouichi Ohga , Japan Environment and Children's Study (JECS) Group

Background

Many studies have indicated an association between maternal occupational exposure to hazardous agents, such as anticancer drugs and ionizing radiation, and an increased risk of adverse pregnancy outcomes, including stillbirths or miscarriages and physical abnormalities in offspring. However, the effects of recent advancements in protective measures to reduce these risks have not been clarified.

Aim

To investigate the current impact of parental occupational exposure to anticancer drugs and ionizing radiation on stillbirths or miscarriages as well as physical abnormalities under the circumstances of the developed safety protocols.

Methods

This cohort study utilized The Japan Environment and Children's Study dataset, which included 96,606 fetuses born between January 2011 and March 2014. This study focused on the association between occupational exposure to these agents during pregnancy and the incidence of stillbirths or miscarriages and physical abnormalities in offspring, employing Poisson regression models for adjusted relative risk.

Results

From the study population, 471 cases of stillbirths or miscarriages and 4493 infants with physical abnormalities were identified. Fisher's exact tests indicated no significant differences in fetal loss or physical abnormalities between the exposure groups. A multivariable analysis also found no significant association between maternal exposure to anticancer drugs and ionizing radiation and these adverse outcomes.

Conclusion

Under improved safety measures, maternal occupational exposure to anticancer drugs and ionizing radiation does not significantly affect the occurrence of stillbirths or miscarriages and physical abnormalities in offspring. These findings highlight the critical role of current safety practices and indicate lower reproductive risks with proper precautions.

背景：许多研究表明，母亲职业暴露于有害物质（如抗癌药物和电离辐射）与不良妊娠结局（包括死胎或流产和后代身体异常）风险增加之间存在关联。然而，最近在减少这些风险的保护措施方面取得的进展所产生的影响尚未得到澄清。目的探讨目前父母职业暴露于抗癌药物和电离辐射下对死产、流产及生理异常的影响。方法：本队列研究利用日本环境与儿童研究数据集，其中包括2011年1月至2014年3月出生的96,606名胎儿。本研究的重点是在怀孕期间职业暴露于这些物质与死产或流产的发生率和后代的身体异常之间的关系，采用泊松回归模型调整相对风险。结果：在研究人群中，有471例死产或流产，4493例婴儿有身体异常。Fisher的精确测试表明，在暴露组之间胎儿丢失或身体异常方面没有显著差异。一项多变量分析还发现，母亲接触抗癌药物和电离辐射与这些不良后果之间没有显著关联。结论：在安全措施改善的情况下，母亲职业暴露于抗癌药物和电离辐射对子代死产、流产和生理异常的发生无显著影响。这些发现突出了当前安全做法的关键作用，并表明采取适当的预防措施可以降低生殖风险。

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