Early human development最新文献_第3页

Exploring the burden of preterm infant care in Africa: A comprehensive review of current research 探索非洲早产儿护理负担：对当前研究的全面回顾。

IF 2 3区医学 Q2 OBSTETRICS & GYNECOLOGY

Early human development

Pub Date : 2025-12-20 DOI: 10.1016/j.earlhumdev.2025.106464

Mary Mayowa Adetoye , John Ehi Aboje , Mercy Chisom Agu , Praise Oluwatobi Ogunleke , Eno Abasi Sunday , Babalola David Olaoluwa , Alexander Idu Entonu , Tahav Joshua Kachina , Gbolahan Olatunji , Emmanuel Kokori , Nicholas Aderinto

Objective(s)

Preterm birth, delivery before 37 weeks of gestation, remains a major contributor to neonatal morbidity and mortality worldwide, with sub-Saharan Africa disproportionately affected. This review aimed to examine the multidimensional burden of caring for preterm infants in African contexts, focusing on economic, psychological, social, and health system challenges experienced by caregivers and healthcare providers.

Study design

A narrative review approach was adopted. A comprehensive literature search was conducted across PubMed, Scopus, Web of Science, Google Scholar, and African Journals Online (AJOL), as well as relevant grey literature. Thirty-three studies meeting predefined inclusion criteria were analyzed to identify recurring themes and intervention gaps related to preterm infant care across diverse African settings.

Results

The review revealed substantial financial strain on families due to high out-of-pocket expenditures, inadequate insurance coverage, and logistical challenges such as transportation barriers, especially in rural areas. Caregivers frequently experienced anxiety, depression, and social isolation, compounded by poor communication and limited emotional support within health facilities. Health systems were characterized by shortages of essential neonatal equipment, inadequate staffing, inconsistent clinical protocols, and limited training in evidence-based neonatal care. Promising interventions identified included kangaroo mother care, antenatal corticosteroid use, and automated oxygen titration systems.

Conclusion(s)

Caring for preterm infants in Africa involves intersecting economic, emotional, and systemic challenges. Strengthening policy and research frameworks, expanding caregiver support, and implementing culturally sensitive, evidence-based interventions are essential to reduce preterm mortality and alleviate caregiver burden across the region.

目标(s)：早产，即妊娠37周前分娩，仍然是全世界新生儿发病率和死亡率的主要原因，撒哈拉以南非洲受到的影响尤为严重。本综述旨在研究非洲环境下照顾早产儿的多维负担，重点关注照顾者和卫生保健提供者所面临的经济、心理、社会和卫生系统挑战。研究设计：采用叙述性回顾法。对PubMed、Scopus、Web of Science、b谷歌Scholar、African Journals Online （AJOL）以及相关的灰色文献进行了全面的文献检索。分析了33项符合预定义纳入标准的研究，以确定非洲不同环境中与早产儿护理相关的反复出现的主题和干预差距。结果：审查显示，由于自付费用高、保险覆盖面不足以及运输障碍等后勤挑战，特别是在农村地区，家庭面临着巨大的经济压力。护理人员经常感到焦虑、抑郁和社会孤立，再加上卫生设施内沟通不畅和情感支持有限。卫生系统的特点是基本新生儿设备短缺，人员配备不足，临床方案不一致，循证新生儿护理培训有限。确定的有希望的干预措施包括袋鼠妈妈护理，产前皮质类固醇使用和自动氧滴定系统。结论：在非洲，照顾早产儿涉及经济、情感和系统方面的交叉挑战。加强政策和研究框架，扩大对护理人员的支持，实施具有文化敏感性的循证干预措施，对于降低整个地区的早产死亡率和减轻护理人员负担至关重要。

{"title":"Exploring the burden of preterm infant care in Africa: A comprehensive review of current research","authors":"Mary Mayowa Adetoye , John Ehi Aboje , Mercy Chisom Agu , Praise Oluwatobi Ogunleke , Eno Abasi Sunday , Babalola David Olaoluwa , Alexander Idu Entonu , Tahav Joshua Kachina , Gbolahan Olatunji , Emmanuel Kokori , Nicholas Aderinto","doi":"10.1016/j.earlhumdev.2025.106464","DOIUrl":"10.1016/j.earlhumdev.2025.106464","url":null,"abstract":"<div><h3>Objective(s)</h3><div>Preterm birth, delivery before 37 weeks of gestation, remains a major contributor to neonatal morbidity and mortality worldwide, with sub-Saharan Africa disproportionately affected. This review aimed to examine the multidimensional burden of caring for preterm infants in African contexts, focusing on economic, psychological, social, and health system challenges experienced by caregivers and healthcare providers.</div></div><div><h3>Study design</h3><div>A narrative review approach was adopted. A comprehensive literature search was conducted across PubMed, Scopus, Web of Science, Google Scholar, and African Journals Online (AJOL), as well as relevant grey literature. Thirty-three studies meeting predefined inclusion criteria were analyzed to identify recurring themes and intervention gaps related to preterm infant care across diverse African settings.</div></div><div><h3>Results</h3><div>The review revealed substantial financial strain on families due to high out-of-pocket expenditures, inadequate insurance coverage, and logistical challenges such as transportation barriers, especially in rural areas. Caregivers frequently experienced anxiety, depression, and social isolation, compounded by poor communication and limited emotional support within health facilities. Health systems were characterized by shortages of essential neonatal equipment, inadequate staffing, inconsistent clinical protocols, and limited training in evidence-based neonatal care. Promising interventions identified included kangaroo mother care, antenatal corticosteroid use, and automated oxygen titration systems.</div></div><div><h3>Conclusion(s)</h3><div>Caring for preterm infants in Africa involves intersecting economic, emotional, and systemic challenges. Strengthening policy and research frameworks, expanding caregiver support, and implementing culturally sensitive, evidence-based interventions are essential to reduce preterm mortality and alleviate caregiver burden across the region.</div></div>","PeriodicalId":11435,"journal":{"name":"Early human development","volume":"214 ","pages":"Article 106464"},"PeriodicalIF":2.0,"publicationDate":"2025-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145827364","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

Outcomes in extremely preterm neonates after the introduction of early low-dose hydrocortisone treatment: A retrospective case-control study 引入早期低剂量氢化可的松治疗后极早产儿的结局：一项回顾性病例对照研究。

IF 2 3区医学 Q2 OBSTETRICS & GYNECOLOGY

Early human development

Pub Date : 2025-12-18 DOI: 10.1016/j.earlhumdev.2025.106463

Ellie Purcell , Pooja Sachdev , Dushyant Batra

Objective

Assess the association between use of early low-dose hydrocortisone (ELDH) in extremely preterm neonates, and bronchopulmonary dysplasia (BPD)-free survival at 36 weeks completed gestational age (CGA), as well as additional secondary outcomes.

Design

Retrospective, matched, case-control study.

Setting

Tertiary neonatal intensive care units in Nottingham University Hospitals NHS Trust (Queens Medical Centre and Nottingham City Hospital).

Patients

188 extremely preterm neonates. 94 historical controls born between 1 October 2017 and 30 September 2019. 94 cases born between 1 January 2020 and 31 December 2021.

Interventions

ELDH using the published PREMILOC study protocol (total dose of 8.5 mg/kg over 10 days) initiated within the first 24 h of life.

Primary outcome measure

Survival without BPD at 36 weeks CGA.

Results

There were no statistically significant associations between the sex, gestational age or birthweight of the groups. There was no significant association between the use of ELDH and increased survival without BPD at 36 weeks CGA (p = 0.153) or reduction in mortality (p = 0.814). Using ELDH was significantly associated with an increased incidence of culture positive late-onset sepsis (p = 0.006), higher non-invasive respiratory support days (p = 0.032) and a longer total length of stay (p = 0.004).

Conclusions

ELDH use was not associated with an improvement in BPD free survival in extremely preterm neonates. The cases had a higher incidence of culture positive late-onset sepsis and longer duration of respiratory support. Further research exploring stratification of preterm neonates that will benefit from ELDH is needed.

目的：评估极早产新生儿早期使用低剂量氢化可的松（ELDH）与36周全胎龄（CGA）无支气管肺发育不良（BPD）生存率之间的关系，以及其他次要结局。设计：回顾性、配对、病例对照研究。环境：诺丁汉大学医院NHS信托（女王医疗中心和诺丁汉市医院）的三级新生儿重症监护室。患者：188例极早产儿。2017年10月1日至2019年9月30日期间出生的94个历史对照。2020年1月1日至2021年12月31日期间出生的94例。干预措施：使用已公布的PREMILOC研究方案（总剂量为8.5 mg/kg，超过10天）在生命的前24小时内开始ELDH。主要结局指标：36周无BPD生存期。结果：两组患者的性别、胎龄和出生体重无统计学意义。使用ELDH与36周CGA时无BPD的生存率增加（p = 0.153）或死亡率降低（p = 0.814）之间无显著相关性。使用ELDH与培养阳性晚发型脓毒症发生率增加（p = 0.006）、无创呼吸支持天数增加（p = 0.032）和总住院时间延长（p = 0.004）显著相关。结论：ELDH的使用与极早产儿无BPD生存的改善无关。培养阳性的晚发型脓毒症发生率较高，呼吸支持持续时间较长。需要进一步研究将受益于ELDH的早产儿分层。

{"title":"Outcomes in extremely preterm neonates after the introduction of early low-dose hydrocortisone treatment: A retrospective case-control study","authors":"Ellie Purcell , Pooja Sachdev , Dushyant Batra","doi":"10.1016/j.earlhumdev.2025.106463","DOIUrl":"10.1016/j.earlhumdev.2025.106463","url":null,"abstract":"<div><h3>Objective</h3><div>Assess the association between use of early low-dose hydrocortisone (ELDH) in extremely preterm neonates, and bronchopulmonary dysplasia (BPD)-free survival at 36 weeks completed gestational age (CGA), as well as additional secondary outcomes.</div></div><div><h3>Design</h3><div>Retrospective, matched, case-control study.</div></div><div><h3>Setting</h3><div>Tertiary neonatal intensive care units in Nottingham University Hospitals NHS Trust (Queens Medical Centre and Nottingham City Hospital).</div></div><div><h3>Patients</h3><div>188 extremely preterm neonates. 94 historical controls born between 1 October 2017 and 30 September 2019. 94 cases born between 1 January 2020 and 31 December 2021.</div></div><div><h3>Interventions</h3><div>ELDH using the published PREMILOC study protocol (total dose of 8.5 mg/kg over 10 days) initiated within the first 24 h of life.</div></div><div><h3>Primary outcome measure</h3><div>Survival without BPD at 36 weeks CGA.</div></div><div><h3>Results</h3><div>There were no statistically significant associations between the sex, gestational age or birthweight of the groups. There was no significant association between the use of ELDH and increased survival without BPD at 36 weeks CGA (<em>p</em> = 0.153) or reduction in mortality (<em>p</em> = 0.814). Using ELDH was significantly associated with an increased incidence of culture positive late-onset sepsis (<em>p</em> = 0.006), higher non-invasive respiratory support days (<em>p</em> = 0.032) and a longer total length of stay (<em>p</em> = 0.004).</div></div><div><h3>Conclusions</h3><div>ELDH use was not associated with an improvement in BPD free survival in extremely preterm neonates. The cases had a higher incidence of culture positive late-onset sepsis and longer duration of respiratory support. Further research exploring stratification of preterm neonates that will benefit from ELDH is needed.</div></div>","PeriodicalId":11435,"journal":{"name":"Early human development","volume":"214 ","pages":"Article 106463"},"PeriodicalIF":2.0,"publicationDate":"2025-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145827294","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

Recent short-term and long-term outcomes of massive pulmonary hemorrhage in extremely low birth weight infants: A nationwide cohort study 极低出生体重儿大量肺出血的近期和长期结果：一项全国性队列研究

IF 2 3区医学 Q2 OBSTETRICS & GYNECOLOGY

Early human development

Pub Date : 2025-12-16 DOI: 10.1016/j.earlhumdev.2025.106460

Yu Seon Kim , Eun Yeob Kim , Hye Jin Cho , Hye Won Cho , Eun Hee Lee , Byung Min Choi

Introduction

To evaluate the short- and long-term outcomes, particularly neurodevelopment, of extremely low birth weight (ELBW) infants with massive pulmonary hemorrhage, in the context of recent improvements in perinatal and neonatal intensive care.

Study design

Data from the prospective registry of the Korean Neonatal Network of ELBW infants born in 69 hospitals across South Korea between 2014 and 2022 were retrospectively analyzed.

Results

Seven hundred and eight (11.2 %) of 6344 ELBW infants were diagnosed with MPH and divided into survivors at discharge (n = 253, 35.7 %) and in-hospital deaths (n = 455, 64.3 %). The annual incidence of MPH significantly declined from 13.9 % in 2014 to 7.7 % in 2022, and was accompanied by a similar decrease in in-hospital mortality.

Surviving infants who experienced MPH had higher rates of in-hospital morbidities. They also showed more adverse neurodevelopmental outcomes than those without MPH. After multivariable adjustment, the risks of cerebral palsy (OR 2.136; 95 % CI 1.253–3.638) and moderate developmental delay on BSID-II/III (OR 2.088; 95 % CI 1.279–3.409) remained significantly higher in MPH survivors.

Conclusion

The incidence and in-hospital deaths of massive pulmonary hemorrhage in ELBW infants have decreased in recent years. However, improved survival may be accompanied by increased in-hospital morbidity and adverse neurodevelopmental outcomes, underscoring the need for ongoing monitoring and strategies to mitigate short- and long-term complications in this high-risk population.

简介：在最近围产期和新生儿重症监护改善的背景下，评估极低出生体重（ELBW）婴儿大量肺出血的短期和长期结局，特别是神经发育。研究设计：回顾性分析韩国新生儿网络2014年至2022年间在韩国69家医院出生的ELBW婴儿的前瞻性登记数据。结果：6344例ELBW婴儿中有778例（11.2%）被诊断为MPH，分为出院时存活（253例，35.7%）和住院死亡（4555例，64.3%）。MPH的年发病率从2014年的13.9%显著下降到2022年的7.7%，住院死亡率也出现了类似的下降。经历MPH的幸存婴儿的住院发病率更高。他们也比那些没有MPH的人表现出更多的不良神经发育结果。多变量调整后，脑瘫（OR 2.136; 95% CI 1.253-3.638）和BSID-II/III中度发育迟缓（OR 2.088; 95% CI 1.279-3.409）的风险在MPH幸存者中仍然显著较高。结论：新生儿肺大出血的发生率和院内死亡率近年来有所下降。然而，生存率的提高可能伴随着住院发病率的增加和不良的神经发育结果，强调需要持续监测和策略，以减轻这一高危人群的短期和长期并发症。

{"title":"Recent short-term and long-term outcomes of massive pulmonary hemorrhage in extremely low birth weight infants: A nationwide cohort study","authors":"Yu Seon Kim , Eun Yeob Kim , Hye Jin Cho , Hye Won Cho , Eun Hee Lee , Byung Min Choi","doi":"10.1016/j.earlhumdev.2025.106460","DOIUrl":"10.1016/j.earlhumdev.2025.106460","url":null,"abstract":"<div><h3>Introduction</h3><div>To evaluate the short- and long-term outcomes, particularly neurodevelopment, of extremely low birth weight (ELBW) infants with massive pulmonary hemorrhage, in the context of recent improvements in perinatal and neonatal intensive care.</div></div><div><h3>Study design</h3><div>Data from the prospective registry of the Korean Neonatal Network of ELBW infants born in 69 hospitals across South Korea between 2014 and 2022 were retrospectively analyzed.</div></div><div><h3>Results</h3><div>Seven hundred and eight (11.2 %) of 6344 ELBW infants were diagnosed with MPH and divided into survivors at discharge (<em>n</em> = 253, 35.7 %) and in-hospital deaths (<em>n</em> = 455, 64.3 %). The annual incidence of MPH significantly declined from 13.9 % in 2014 to 7.7 % in 2022, and was accompanied by a similar decrease in in-hospital mortality.</div><div>Surviving infants who experienced MPH had higher rates of in-hospital morbidities. They also showed more adverse neurodevelopmental outcomes than those without MPH. After multivariable adjustment, the risks of cerebral palsy (OR 2.136; 95 % CI 1.253–3.638) and moderate developmental delay on BSID-II/III (OR 2.088; 95 % CI 1.279–3.409) remained significantly higher in MPH survivors.</div></div><div><h3>Conclusion</h3><div>The incidence and in-hospital deaths of massive pulmonary hemorrhage in ELBW infants have decreased in recent years. However, improved survival may be accompanied by increased in-hospital morbidity and adverse neurodevelopmental outcomes, underscoring the need for ongoing monitoring and strategies to mitigate short- and long-term complications in this high-risk population.</div></div>","PeriodicalId":11435,"journal":{"name":"Early human development","volume":"214 ","pages":"Article 106460"},"PeriodicalIF":2.0,"publicationDate":"2025-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145793563","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

Parenthood after neonatal care -parenting sense of competence and coparenting three years after discharge 新生儿护理后父母的能力感与出院后三年父母的能力感

IF 2 3区医学 Q2 OBSTETRICS & GYNECOLOGY

Early human development

Pub Date : 2025-12-15 DOI: 10.1016/j.earlhumdev.2025.106462

Christine Persson , Jenny Ericson , Mats Eriksson , Raziye Salari , Renée Flacking

Many parents of infants in neonatal intensive care units (NICUs) experience trauma and a loss of their parental role, which may affect their parenting following discharge. This study aimed to compare parenting competence and coparenting between parents of NICU and non-NICU infants three years postpartum. We also examined factors influencing parenting among NICU parents.

We used a comparative cohort design to collect data from 561 parents who completed a set of questionnaires, including measures of parenting sense of competence, coparenting, dyadic relationship quality, social support, and depressive symptoms.

Three years postpartum, no differences were found in parenting sense of competence or coparenting between NICU parents and non-NICU parents. For both NICU mothers and fathers, a higher parenting sense of competence in satisfaction and efficacy was associated with a higher quality in the couple relationship. Mothers reported higher parenting satisfaction if they had not experienced a traumatic birth. Fathers reported higher parenting satisfaction if they had no depressive symptoms, and higher parenting efficacy if they had a longer couple relationship, received greater social support, had a shorter infant hospital stay, or were rooming-in with their partner and infant during hospitalization. Factors associated with more coparenting problems among NICU parents included lower couple relationship quality, a 7–14-day hospitalization for mothers, and lower social support for fathers.

This study highlights that early possibilities for parents to initiate parenthood together and receive adequate mental and social support during and after NICU hospitalization should be a priority for enhancing parents' sense of competence and coparenting.

许多新生儿重症监护病房（NICUs）婴儿的父母经历创伤和父母角色的丧失，这可能影响他们出院后的养育。本研究旨在比较产后3年新生儿重症监护病房和非新生儿重症监护病房婴儿父母的育儿能力和亲子关系。我们还研究了影响新生儿重症监护病房父母育儿的因素。我们采用比较队列设计收集了561名父母的数据，他们完成了一套问卷调查，包括父母能力感、父母养育、二元关系质量、社会支持和抑郁症状的测量。产后3年，NICU父母与非NICU父母在育儿能力意识和育儿能力方面均无差异。对于新生儿重症监护室的母亲和父亲来说，更高的育儿满意度和效能感与更高的夫妻关系质量相关。母亲们报告说，如果她们没有经历过创伤性分娩，她们的育儿满意度会更高。如果父亲没有抑郁症状，他们的育儿满意度会更高；如果他们的夫妻关系较长，得到更多的社会支持，婴儿住院时间较短，或者在住院期间与伴侣和婴儿同住一室，他们的育儿效果会更高。在新生儿重症监护室父母中，与育儿问题相关的因素包括夫妻关系质量较低，母亲住院7 - 14天，父亲社会支持较低。本研究强调，父母在新生儿重症监护室住院期间和住院后尽早开始为人父母，并获得足够的精神和社会支持，应该是提高父母能力和父母意识的优先事项。

{"title":"Parenthood after neonatal care -parenting sense of competence and coparenting three years after discharge","authors":"Christine Persson , Jenny Ericson , Mats Eriksson , Raziye Salari , Renée Flacking","doi":"10.1016/j.earlhumdev.2025.106462","DOIUrl":"10.1016/j.earlhumdev.2025.106462","url":null,"abstract":"<div><div>Many parents of infants in neonatal intensive care units (NICUs) experience trauma and a loss of their parental role, which may affect their parenting following discharge. This study aimed to compare parenting competence and coparenting between parents of NICU and non-NICU infants three years postpartum. We also examined factors influencing parenting among NICU parents.</div><div>We used a comparative cohort design to collect data from 561 parents who completed a set of questionnaires, including measures of parenting sense of competence, coparenting, dyadic relationship quality, social support, and depressive symptoms.</div><div>Three years postpartum, no differences were found in parenting sense of competence or coparenting between NICU parents and non-NICU parents. For both NICU mothers and fathers, a higher parenting sense of competence in satisfaction and efficacy was associated with a higher quality in the couple relationship. Mothers reported higher parenting satisfaction if they had not experienced a traumatic birth. Fathers reported higher parenting satisfaction if they had no depressive symptoms, and higher parenting efficacy if they had a longer couple relationship, received greater social support, had a shorter infant hospital stay, or were rooming-in with their partner and infant during hospitalization. Factors associated with more coparenting problems among NICU parents included lower couple relationship quality, a 7–14-day hospitalization for mothers, and lower social support for fathers.</div><div>This study highlights that early possibilities for parents to initiate parenthood together and receive adequate mental and social support during and after NICU hospitalization should be a priority for enhancing parents' sense of competence and coparenting.</div></div>","PeriodicalId":11435,"journal":{"name":"Early human development","volume":"214 ","pages":"Article 106462"},"PeriodicalIF":2.0,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145788767","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

Associations between parental stress, parent-infant bonding, and infant neuromotor functioning 父母压力、亲子关系和婴儿神经运动功能之间的关系。

IF 2 3区医学 Q2 OBSTETRICS & GYNECOLOGY

Early human development

Pub Date : 2025-12-11 DOI: 10.1016/j.earlhumdev.2025.106459

L.C. Span , E.M. Rodenboog , N.H. van Dokkum , A.F. Bos , C.A. Hartman

Aim

The young developing brain is very sensitive to many environmental influences, both positive and negative. Parental stress and parent-infant bonding have been shown to be associated with neurodevelopmental delays in toddlers. However, it is not known at what age these associations become relevant which we aim to study as early as three-months of age, paving the way for new intervention strategies.

Methods

This study included 339 parent-infant dyads or triads from the Dutch TRAILS-NEXT cohort. Parental stress and parent-infant bonding were assessed at three months of age using the ‘Nijmeegse Ouderlijke Stress Index – Korte versie’ (NOSI-K) and Postpartum Bonding Questionnaire (PBQ), respectively. Infant neurodevelopment was assessed using the General Movement Assessment (GMA), including the Motor Optimality score – Revised (MOS-R). Perinatal risk factors with known associations with infant neurodevelopment were included as potential confounders.

Results

210 infant-mother dyads and 147 infant-partner dyads were included in the main analysis. Parental stress levels were elevated in 7 % of mothers and 18 % of partners, but no significant correlations were found between parental stress, bonding, and MOS-R scores. After adjustments for confounders, neither parental bonding nor stress showed significant relationships with general movement characteristics in regression analyses, suggesting that other factors may influence individual differences in early motor development.

Conclusion

Parental stress and parent-infant bonding were not associated with infant neurodevelopment at age of three months, suggesting a wider window of opportunity to intervene in case of parental stress or suboptimal parent-infant bonding.

目的：年轻发育中的大脑对许多环境影响非常敏感，无论是积极的还是消极的。父母的压力和亲子关系已被证明与幼儿的神经发育迟缓有关。然而，目前尚不清楚这些关联在什么年龄变得相关，我们的目标是研究早在三个月大的时候，为新的干预策略铺平道路。方法：本研究包括来自荷兰TRAILS-NEXT队列的339对父母-婴儿二联体或三联体。在3月龄时分别采用Nijmeegse Ouderlijke压力指数- Korte版本（NOSI-K）和产后关系问卷（PBQ）评估父母压力和亲子关系。使用一般运动评估（GMA）评估婴儿神经发育，包括运动最佳性评分-修订（MOS-R）。已知与婴儿神经发育相关的围产期危险因素被列入潜在的混杂因素。结果：210对婴儿母亲和147对婴儿伴侣被纳入主分析。在7%的母亲和18%的伴侣中，父母的压力水平升高，但在父母的压力、亲密关系和MOS-R评分之间没有发现显著的相关性。在对混杂因素进行调整后，在回归分析中，父母关系和压力都没有显示出与一般运动特征的显著关系，这表明其他因素可能影响早期运动发育的个体差异。结论：父母压力和亲子关系与3月龄婴儿神经发育无关，提示在父母压力或亲子关系不理想的情况下，有更大的干预机会窗口。

{"title":"Associations between parental stress, parent-infant bonding, and infant neuromotor functioning","authors":"L.C. Span , E.M. Rodenboog , N.H. van Dokkum , A.F. Bos , C.A. Hartman","doi":"10.1016/j.earlhumdev.2025.106459","DOIUrl":"10.1016/j.earlhumdev.2025.106459","url":null,"abstract":"<div><h3>Aim</h3><div>The young developing brain is very sensitive to many environmental influences, both positive and negative. Parental stress and parent-infant bonding have been shown to be associated with neurodevelopmental delays in toddlers. However, it is not known at what age these associations become relevant which we aim to study as early as three-months of age, paving the way for new intervention strategies.</div></div><div><h3>Methods</h3><div>This study included 339 parent-infant dyads or triads from the Dutch TRAILS-NEXT cohort. Parental stress and parent-infant bonding were assessed at three months of age using the ‘Nijmeegse Ouderlijke Stress Index – Korte versie’ (NOSI-K) and Postpartum Bonding Questionnaire (PBQ), respectively. Infant neurodevelopment was assessed using the General Movement Assessment (GMA), including the Motor Optimality score – Revised (MOS-R). Perinatal risk factors with known associations with infant neurodevelopment were included as potential confounders.</div></div><div><h3>Results</h3><div>210 infant-mother dyads and 147 infant-partner dyads were included in the main analysis. Parental stress levels were elevated in 7 % of mothers and 18 % of partners, but no significant correlations were found between parental stress, bonding, and MOS-R scores. After adjustments for confounders, neither parental bonding nor stress showed significant relationships with general movement characteristics in regression analyses, suggesting that other factors may influence individual differences in early motor development.</div></div><div><h3>Conclusion</h3><div>Parental stress and parent-infant bonding were not associated with infant neurodevelopment at age of three months, suggesting a wider window of opportunity to intervene in case of parental stress or suboptimal parent-infant bonding.</div></div>","PeriodicalId":11435,"journal":{"name":"Early human development","volume":"214 ","pages":"Article 106459"},"PeriodicalIF":2.0,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145899287","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

Evaluating the effects of maternal diabetes on early infant neurodevelopment with a novel combination of four neurodevelopmental tools 评估母亲糖尿病对早期婴儿神经发育的影响与四种神经发育工具的新组合。

IF 2 3区医学 Q2 OBSTETRICS & GYNECOLOGY

Early human development

Pub Date : 2025-12-11 DOI: 10.1016/j.earlhumdev.2025.106461

Alexa Escapita , Alexandra Glatter , Eric Siegel , Tara Johnson , Hari Eswaran , Diana Escalona-Vargas

There are associations between maternal diabetes and neurodevelopmental disorders, such as autism spectrum disorders, attention-deficit/hyperactivity disorder, and intellectual disabilities. Using this knowledge, our objective is to characterize the effects of type 1 (T1DM) and type 2 diabetes mellitus (T2DM) on the neurodevelopment of infants.

We performed a prospective study on 54 infants of mothers with T1DM (n = 10), T2DM (n = 24), and non-diabetic controls (n = 20). To evaluate their neurodevelopment in multiple developmental domains, we used four assessments on 1–2-month-old infants: The Hammersmith Neonatal Neurological Examination (HNNE), The Dubowitz exam, The Capute Scales, and The General Movement Assessment (GMA).

Differences in neurodevelopmental outcomes did not reach statistical significance in any of the four assessments, individually or combined. However, we note the following trends: 20 infants had suboptimal neuromotor development (HNNE score < 30.5). T1DM group infants had lower mean language scores (83.7 vs 105.85) when compared to the control group. Using GMA, T2DM group infants had more abnormal writhing movements when compared to the other groups.

Our overall findings suggest that the T1DM group had lower language scores and the T2DM group had lower visual-motor (cognitive) scores which may indicate developmental delays. Further research is needed to confirm these findings. We suggest that these infant's parents consider developmental therapy, to promote early identification and treatment of potential developmental delays. To our knowledge this study would be the first to use the combination of these assessments to evaluate 1-month-olds in this patient population. Given the small sample size, these findings should be interpreted with caution.

产妇糖尿病与神经发育障碍，如自闭症谱系障碍、注意力缺陷/多动障碍和智力残疾之间存在关联。利用这些知识，我们的目标是表征1型（T1DM）和2型糖尿病（T2DM）对婴儿神经发育的影响。我们对54名母亲患有1型糖尿病（n = 10）、2型糖尿病（n = 24）和非糖尿病对照（n = 20）的婴儿进行了前瞻性研究。为了评估他们在多个发育领域的神经发育，我们对1-2个月大的婴儿进行了四种评估：Hammersmith新生儿神经系统检查（HNNE）、Dubowitz检查、Capute量表和一般运动评估（GMA）。在四种评估中，无论是单独评估还是联合评估，神经发育结果的差异都没有达到统计学意义。然而，我们注意到以下趋势：20名婴儿的神经运动发育（HNNE评分）不理想

{"title":"Evaluating the effects of maternal diabetes on early infant neurodevelopment with a novel combination of four neurodevelopmental tools","authors":"Alexa Escapita , Alexandra Glatter , Eric Siegel , Tara Johnson , Hari Eswaran , Diana Escalona-Vargas","doi":"10.1016/j.earlhumdev.2025.106461","DOIUrl":"10.1016/j.earlhumdev.2025.106461","url":null,"abstract":"<div><div>There are associations between maternal diabetes and neurodevelopmental disorders, such as autism spectrum disorders, attention-deficit/hyperactivity disorder, and intellectual disabilities. Using this knowledge, our objective is to characterize the effects of type 1 (T1DM) and type 2 diabetes mellitus (T2DM) on the neurodevelopment of infants.</div><div>We performed a prospective study on 54 infants of mothers with T1DM (<em>n</em> = 10), T2DM (<em>n</em> = 24), and non-diabetic controls (<em>n</em> = 20). To evaluate their neurodevelopment in multiple developmental domains, we used four assessments on 1–2-month-old infants: The Hammersmith Neonatal Neurological Examination (HNNE), The Dubowitz exam, The Capute Scales, and The General Movement Assessment (GMA).</div><div>Differences in neurodevelopmental outcomes did not reach statistical significance in any of the four assessments, individually or combined. However, we note the following trends: 20 infants had suboptimal neuromotor development (HNNE score < 30.5). T1DM group infants had lower mean language scores (83.7 vs 105.85) when compared to the control group. Using GMA, T2DM group infants had more abnormal writhing movements when compared to the other groups.</div><div>Our overall findings suggest that the T1DM group had lower language scores and the T2DM group had lower visual-motor (cognitive) scores which may indicate developmental delays. Further research is needed to confirm these findings. We suggest that these infant's parents consider developmental therapy, to promote early identification and treatment of potential developmental delays. To our knowledge this study would be the first to use the combination of these assessments to evaluate 1-month-olds in this patient population. Given the small sample size, these findings should be interpreted with caution.</div></div>","PeriodicalId":11435,"journal":{"name":"Early human development","volume":"214 ","pages":"Article 106461"},"PeriodicalIF":2.0,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145780545","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

Glucose-to-lactate ratio in infants with hypoxic-ischemic encephalopathy treated with hypothermia 低体温治疗婴儿缺氧缺血性脑病的血糖与乳酸比值

IF 2 3区医学 Q2 OBSTETRICS & GYNECOLOGY

Early human development

Pub Date : 2025-12-09 DOI: 10.1016/j.earlhumdev.2025.106458

Carlo Dani , Giulia Remaschi , Elia Benelli , Alessandra Cecchi , Clara Lunardi , Camilla Fazi , Andrea Bianchi , Elisa Scola , Enrico Fainardi , Vittorio Miele , Caterina Coviello

Background

Glucose-to-lactate ratio and abnormal values of glucose and lactate blood values, as well as neuroimaging, have been reported to predict neurodevelopmental outcome in infants with hypoxic–ischemic encephalopathy (HIE) treated with therapeutic hypothermia (TH). Our aim was to confirm or confute these correlations.

Methods

We retrospectively studied 48 late preterm and term infants, 31 with favourable and 17 with unfavourable outcome. Glucose-to-lactate ratio, glucose and lactate values were recorded before and during TH. They were studied with aEEG, cerebral magnetic resonance imaging (MRI), and the Bayley-III scales for assessing psychomotor development at 24 ± 2 months corrected age.

Results

Logistic regression analysis demonstrated that glucose (OR 30.219, 95 % Cl 1.473–62.069, P = 0.027) and lactate (OR 1.923, 95 % Cl 1.027–3.601, P = 0.041) blood level at 24 h of TH and MRI score (OR 2.668 95 % Cl 1.060–6.713. P = 0.037) were positively correlated with unfavourable outcome.

Conclusions

Glucose-to-lactate ratio did not predict neurodevelopmental outcome in infants with HIE treated with TH. Further investigation is needed to explore the prognostic significance of this biomarker. Glycemia and lactate blood levels measured at 24 h of TH, as well as cerebral MRI, are positively correlated with an increasing risk of unfavourable outcome.

研究背景：已有报道称，葡萄糖与乳酸比值、葡萄糖与乳酸血值异常以及神经影像学可以预测接受治疗性低温治疗的婴儿缺氧缺血性脑病（HIE）的神经发育结局。我们的目的是证实或反驳这些相关性。方法回顾性分析48例晚期早产儿和足月儿，其中31例预后良好，17例预后不良。在TH前和TH中记录葡萄糖-乳酸比值、葡萄糖和乳酸值。采用aEEG、脑磁共振成像（MRI）和Bayley-III量表评估24±2个月矫正年龄时的精神运动发展。结果logistic回归分析显示，TH 24 h血葡萄糖（OR 30.219, 95% Cl 1.473-62.069, P = 0.027）、乳酸（OR 1.923, 95% Cl 1.027-3.601, P = 0.041）水平与MRI评分（OR 2.668, 95% Cl 1.060-6.713）差异有统计学意义。P = 0.037)与不良结局呈正相关。结论糖乳酸比不能预测经TH治疗的HIE患儿的神经发育结局。该生物标志物的预后意义有待进一步研究。在促甲状腺激素24小时测量的血糖和乳酸水平，以及大脑MRI，与不良结果的风险增加呈正相关。

{"title":"Glucose-to-lactate ratio in infants with hypoxic-ischemic encephalopathy treated with hypothermia","authors":"Carlo Dani , Giulia Remaschi , Elia Benelli , Alessandra Cecchi , Clara Lunardi , Camilla Fazi , Andrea Bianchi , Elisa Scola , Enrico Fainardi , Vittorio Miele , Caterina Coviello","doi":"10.1016/j.earlhumdev.2025.106458","DOIUrl":"10.1016/j.earlhumdev.2025.106458","url":null,"abstract":"<div><h3>Background</h3><div>Glucose-to-lactate ratio and abnormal values of glucose and lactate blood values, as well as neuroimaging, have been reported to predict neurodevelopmental outcome in infants with hypoxic–ischemic encephalopathy (HIE) treated with therapeutic hypothermia (TH). Our aim was to confirm or confute these correlations.</div></div><div><h3>Methods</h3><div>We retrospectively studied 48 late preterm and term infants, 31 with favourable and 17 with unfavourable outcome. Glucose-to-lactate ratio, glucose and lactate values were recorded before and during TH. They were studied with aEEG, cerebral magnetic resonance imaging (MRI), and the Bayley-III scales for assessing psychomotor development at 24 ± 2 months corrected age.</div></div><div><h3>Results</h3><div>Logistic regression analysis demonstrated that glucose (OR 30.219, 95 % Cl 1.473–62.069, <em>P</em> = 0.027) and lactate (OR 1.923, 95 % Cl 1.027–3.601, <em>P</em> = 0.041) blood level at 24 h of TH and MRI score (OR 2.668 95 % Cl 1.060–6.713. <em>P</em> = 0.037) were positively correlated with unfavourable outcome.</div></div><div><h3>Conclusions</h3><div>Glucose-to-lactate ratio did not predict neurodevelopmental outcome in infants with HIE treated with TH. Further investigation is needed to explore the prognostic significance of this biomarker. Glycemia and lactate blood levels measured at 24 h of TH, as well as cerebral MRI, are positively correlated with an increasing risk of unfavourable outcome.</div></div>","PeriodicalId":11435,"journal":{"name":"Early human development","volume":"214 ","pages":"Article 106458"},"PeriodicalIF":2.0,"publicationDate":"2025-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145735975","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

Self-reported mental health in adults born extremely preterm. A population based, cross-sectional study 极度早产成人自我报告的心理健康状况。一项以人群为基础的横断面研究

IF 2 3区医学 Q2 OBSTETRICS & GYNECOLOGY

Early human development

Pub Date : 2025-12-05 DOI: 10.1016/j.earlhumdev.2025.106457

Åse Margrethe Reed , Bente Johanne Vederhus , Geir Egil Eide , Merete Røineland Benestad

Aims

The study aims to examine whether self-reported mental health outcomes among adults born extremely preterm differ from those of adults born at term.

Methods

A population-based, cross-sectional study was conducted. The study included 48 eligible individuals born between 1982 and 1985 in western Norway with a gestational age ≤ 28 weeks or birth weight ≤ 1000 g, and 46 term-born controls. Mental health was assessed at age 34 years using the Adult Self-Report questionnaire. Data was analysed to compare outcomes between preterm and term-born controls.

Results

At age 34 years, 32 (67 %) extremely preterm born and 36 (78 %) term-born participated. The extremely preterm group reported significantly higher scores than the term-born group on the mental health scales for anxious/depressed, withdrawn, somatic complaints, aggressive behaviour, internalizing, and total problems. The extremely preterm group had lower levels of education and employment, and higher rates of disability or unemployment.

Conclusions

The findings suggest an association between being born extremely preterm or with extremely low birth weight and poorer self-reported mental health in adulthood compared with term-born controls. Future research should investigate potential underlying causes of this relationship to improve understanding and develop preventive strategies.

目的：该研究旨在研究极度早产的成年人自我报告的心理健康状况是否与足月出生的成年人不同。方法采用基于人群的横断面研究。该研究包括48名1982年至1985年间出生在挪威西部、胎龄≤28周或出生体重≤1000g的符合条件的个体，以及46名足月出生的对照组。在34岁时使用成人自我报告问卷评估心理健康状况。对数据进行分析，比较早产儿和足月出生对照组的结果。结果34岁，重度早产儿32例（67%），足月新生儿36例（78%）。极度早产组在焦虑/抑郁、孤僻、躯体抱怨、攻击行为、内化和整体问题的心理健康量表上的得分明显高于足月出生组。极度早产组的受教育程度和就业水平较低，残疾率或失业率较高。研究结果表明，与足月出生的对照组相比，极度早产或出生体重极低的人成年后自我报告的心理健康状况较差存在关联。未来的研究应该调查这种关系的潜在原因，以提高理解和制定预防策略。

{"title":"Self-reported mental health in adults born extremely preterm. A population based, cross-sectional study","authors":"Åse Margrethe Reed , Bente Johanne Vederhus , Geir Egil Eide , Merete Røineland Benestad","doi":"10.1016/j.earlhumdev.2025.106457","DOIUrl":"10.1016/j.earlhumdev.2025.106457","url":null,"abstract":"<div><h3>Aims</h3><div>The study aims to examine whether self-reported mental health outcomes among adults born extremely preterm differ from those of adults born at term.</div></div><div><h3>Methods</h3><div>A population-based, cross-sectional study was conducted. The study included 48 eligible individuals born between 1982 and 1985 in western Norway with a gestational age ≤ 28 weeks or birth weight ≤ 1000 g, and 46 term-born controls. Mental health was assessed at age 34 years using the Adult Self-Report questionnaire. Data was analysed to compare outcomes between preterm and term-born controls.</div></div><div><h3>Results</h3><div>At age 34 years, 32 (67 %) extremely preterm born and 36 (78 %) term-born participated. The extremely preterm group reported significantly higher scores than the term-born group on the mental health scales for anxious/depressed, withdrawn, somatic complaints, aggressive behaviour, internalizing, and total problems. The extremely preterm group had lower levels of education and employment, and higher rates of disability or unemployment.</div></div><div><h3>Conclusions</h3><div>The findings suggest an association between being born extremely preterm or with extremely low birth weight and poorer self-reported mental health in adulthood compared with term-born controls. Future research should investigate potential underlying causes of this relationship to improve understanding and develop preventive strategies.</div></div>","PeriodicalId":11435,"journal":{"name":"Early human development","volume":"214 ","pages":"Article 106457"},"PeriodicalIF":2.0,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145712093","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

Placental vascular abnormality is associated with worse neurodevelopmental outcomes for infants with congenital heart disease and genetic abnormality 胎盘血管异常与先天性心脏病和遗传异常婴儿较差的神经发育结局相关

IF 2 3区医学 Q2 OBSTETRICS & GYNECOLOGY

Early human development

Pub Date : 2025-11-25 DOI: 10.1016/j.earlhumdev.2025.106456

Kelly L. Meyer , Clare O'Hare , Mai He , Gillian Mayersohn , Avihu Z. Gazit , Anthony Odibo , Jinli Wang , Cynthia M. Ortinau

Objective

Determine the association of placental vascular abnormality with neurodevelopment (ND) in toddlers with congenital heart disease (CHD) requiring intervention with cardiopulmonary bypass (CPB) in the first year of life.

Study design

This single center retrospective cohort study included 69 singleton, term-born infants with prenatally diagnosed CHD requiring CPB in infancy who had placental pathology data and underwent ND follow-up assessment with the Bayley Scales of Infant and Toddler Development (Bayley). Infants with a clinically diagnosed genetic abnormality were included. Placental vascular abnormality was defined as maternal vascular malperfusion, fetal vascular malperfusion, or delayed villous maturation. Multivariable regression models were used to assess the association between placental vascular abnormality and Bayley scores.

Results

Placental vascular abnormality was present in 43 % (30/69) of the cohort and was associated with lower Bayley language and motor scores on univariate analysis. A significant interaction was identified between placental vascular abnormality and genetic abnormality, which occurred in 26 % (18/69) of the cohort. In multivariable models, compared to infants with genetic abnormality alone, infants with placental vascular abnormality and genetic abnormality had lower cognitive (group difference –18.4, 95 % CI –30.7, −6.1), language (group difference –27.5, 95 % CI –41.2, −13.9), and motor (group difference –27.6, 95 % CI –40.9, −14.2) composite scores. There was no association of placental vascular abnormality with ND scores for infants without genetic abnormality in multivariable models.

Conclusion

Placental vascular abnormalities are associated with worse ND outcomes in infants with CHD when a genetic abnormality is also present.

目的探讨1岁前需要体外循环干预的先天性心脏病患儿胎盘血管异常与神经发育（ND）的关系。研究设计：本单中心回顾性队列研究纳入69例单胎足月婴儿，产前诊断为CHD，需要婴儿期CPB，有胎盘病理资料，并采用Bayley婴幼儿发育量表（Bayley Scales of婴幼儿发育量表）进行ND随访评估。包括临床诊断为遗传异常的婴儿。胎盘血管异常被定义为母体血管灌注不良、胎儿血管灌注不良或绒毛成熟延迟。采用多变量回归模型评估胎盘血管异常与贝利评分之间的关系。结果43%（30/69）的队列患者存在胎盘血管异常，单因素分析显示胎盘血管异常与较低的Bayley语言和运动评分有关。胎盘血管异常和遗传异常之间存在显著的相互作用，26%（18/69）的队列发生了这种相互作用。在多变量模型中，与单纯遗传异常的婴儿相比，胎盘血管异常和遗传异常的婴儿的认知（组差-18.4,95% CI -30.7,−6.1）、语言（组差-27.5,95% CI -41.2,−13.9）和运动（组差-27.6,95% CI -40.9,−14.2）综合评分较低。在多变量模型中，没有遗传异常的婴儿胎盘血管异常与ND评分没有关联。结论胎盘血管异常与先天性先天性冠心病患儿较差的ND预后相关。

{"title":"Placental vascular abnormality is associated with worse neurodevelopmental outcomes for infants with congenital heart disease and genetic abnormality","authors":"Kelly L. Meyer , Clare O'Hare , Mai He , Gillian Mayersohn , Avihu Z. Gazit , Anthony Odibo , Jinli Wang , Cynthia M. Ortinau","doi":"10.1016/j.earlhumdev.2025.106456","DOIUrl":"10.1016/j.earlhumdev.2025.106456","url":null,"abstract":"<div><h3>Objective</h3><div>Determine the association of placental vascular abnormality with neurodevelopment (ND) in toddlers with congenital heart disease (CHD) requiring intervention with cardiopulmonary bypass (CPB) in the first year of life.</div></div><div><h3>Study design</h3><div>This single center retrospective cohort study included 69 singleton, term-born infants with prenatally diagnosed CHD requiring CPB in infancy who had placental pathology data and underwent ND follow-up assessment with the Bayley Scales of Infant and Toddler Development (Bayley). Infants with a clinically diagnosed genetic abnormality were included. Placental vascular abnormality was defined as maternal vascular malperfusion, fetal vascular malperfusion, or delayed villous maturation. Multivariable regression models were used to assess the association between placental vascular abnormality and Bayley scores.</div></div><div><h3>Results</h3><div>Placental vascular abnormality was present in 43 % (30/69) of the cohort and was associated with lower Bayley language and motor scores on univariate analysis. A significant interaction was identified between placental vascular abnormality and genetic abnormality, which occurred in 26 % (18/69) of the cohort. In multivariable models, compared to infants with genetic abnormality alone, infants with placental vascular abnormality and genetic abnormality had lower cognitive (group difference –18.4, 95 % CI –30.7, −6.1), language (group difference –27.5, 95 % CI –41.2, −13.9), and motor (group difference –27.6, 95 % CI –40.9, −14.2) composite scores. There was no association of placental vascular abnormality with ND scores for infants without genetic abnormality in multivariable models.</div></div><div><h3>Conclusion</h3><div>Placental vascular abnormalities are associated with worse ND outcomes in infants with CHD when a genetic abnormality is also present.</div></div>","PeriodicalId":11435,"journal":{"name":"Early human development","volume":"213 ","pages":"Article 106456"},"PeriodicalIF":2.0,"publicationDate":"2025-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145690754","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

Five-year outcomes after cooling for hypoxic-ischemic encephalopathy and predictive value of aEEG 缺氧缺血性脑病降温后的5年预后及aEEG的预测价值

IF 2 3区医学 Q2 OBSTETRICS & GYNECOLOGY

Early human development

Pub Date : 2025-11-24 DOI: 10.1016/j.earlhumdev.2025.106455

Dorian Blommaert , Arend F. Bos , Anne E. den Heijer , Hendrik J. ter Horst

Background

Therapeutic hypothermia (TH) is standard practice for neonatal hypoxic-ischemic encephalopathy (HIE). Persistently abnormal amplitude-integrated electroencephalography (aEEG) background patterns are associated with adverse outcomes. We aimed to determine neurodevelopmental outcomes at age five and the predictive value of aEEG.

Study design

We studied infants with HIE treated with TH between 2013 and 2018. At age five, we assessed motor (neurological examination, movement-ABC) and cognitive outcomes. We classified children as developing typically (IQ ≥ 85 and M-ABC > p16), mildly abnormal (IQ 70–84 and/or cerebral palsy with GMFCS 1–2 and/or M-ABC ≤ p16), and severely abnormal (IQ < 70 and/or cerebral palsy GMFCS >2). During the first 96 h after birth, we assessed aEEG background patterns and presence of seizures.

Results

Out of 95 infants 14 (15 %) died and we lost 18 (22 %) survivors to follow-up. At age five, 33 (52 %) were developing typically, 21 (33 %) mildly abnormal, and 9 (14 %) severely abnormal. A severely abnormal aEEG at 48 h was the best predictor for death/severely abnormal outcome with a PPV of 88 %, and a PPV of 71 % for severe disability in survivors. Children with death/severely abnormal outcomes had electrographic seizures more frequently and a higher seizure burden than children developing typically/mildly abnormal (61 % vs 11 %, P < .001, median 40 vs 0 min, P < .001. Absence of electrographic seizures was highly predictive (NPV 92 %) of typical/mildly abnormal outcome in survivors.

Conclusion

Among survivors, five-year outcomes after TH were favorable. aEEG background patterns at 48 h and seizure burden were reliable predictors of five-year outcomes.

背景：低温治疗（TH）是新生儿缺氧缺血性脑病（HIE）的标准做法。持续异常的波幅综合脑电图（aEEG）背景模式与不良结果相关。我们的目的是确定5岁时的神经发育结局和aEEG的预测价值。研究设计我们研究了2013年至2018年间接受TH治疗的HIE婴儿。在5岁时，我们评估了运动（神经学检查，运动- abc）和认知结果。我们将儿童分为发育典型（IQ≥85,M-ABC > p16）、轻度异常（IQ 70 - 84和/或脑瘫，GMFCS 1-2和/或M-ABC≤p16）和严重异常（IQ <； 70和/或脑瘫GMFCS >；2）。在出生后的前96小时，我们评估了aEEG背景模式和癫痫发作的存在。结果95例患儿中14例（15%）死亡，18例（22%）死亡。在5岁时，33例（52%）发育典型，21例（33%）轻度异常，9例（14%）严重异常。48小时严重异常aEEG是死亡/严重异常结局的最佳预测指标，PPV为88%，幸存者严重残疾的PPV为71%。死亡/严重异常的儿童比典型/轻度异常的儿童更频繁地发生电图癫痫发作，癫痫发作负担更高（61% vs 11%, P < 0.001，中位数40 vs 0分钟，P < 0.001）。无电性癫痫发作是幸存者典型/轻度异常结局的高度预测（NPV为92%）。在幸存者中，TH后的5年预后良好。48小时aEEG背景模式和癫痫发作负担是5年预后的可靠预测因子。

{"title":"Five-year outcomes after cooling for hypoxic-ischemic encephalopathy and predictive value of aEEG","authors":"Dorian Blommaert , Arend F. Bos , Anne E. den Heijer , Hendrik J. ter Horst","doi":"10.1016/j.earlhumdev.2025.106455","DOIUrl":"10.1016/j.earlhumdev.2025.106455","url":null,"abstract":"<div><h3>Background</h3><div>Therapeutic hypothermia (TH) is standard practice for neonatal hypoxic-ischemic encephalopathy (HIE). Persistently abnormal amplitude-integrated electroencephalography (aEEG) background patterns are associated with adverse outcomes. We aimed to determine neurodevelopmental outcomes at age five and the predictive value of aEEG.</div></div><div><h3>Study design</h3><div>We studied infants with HIE treated with TH between 2013 and 2018. At age five, we assessed motor (neurological examination, movement-ABC) and cognitive outcomes. We classified children as developing typically (IQ ≥ 85 and M-ABC > p16), mildly abnormal (IQ 70–84 and/or cerebral palsy with GMFCS 1–2 and/or M-ABC ≤ p16), and severely abnormal (IQ < 70 and/or cerebral palsy GMFCS >2). During the first 96 h after birth, we assessed aEEG background patterns and presence of seizures.</div></div><div><h3>Results</h3><div>Out of 95 infants 14 (15 %) died and we lost 18 (22 %) survivors to follow-up. At age five, 33 (52 %) were developing typically, 21 (33 %) mildly abnormal, and 9 (14 %) severely abnormal. A severely abnormal aEEG at 48 h was the best predictor for death/severely abnormal outcome with a PPV of 88 %, and a PPV of 71 % for severe disability in survivors. Children with death/severely abnormal outcomes had electrographic seizures more frequently and a higher seizure burden than children developing typically/mildly abnormal (61 % vs 11 %, <em>P</em> < .001, median 40 vs 0 min, <em>P</em> < .001. Absence of electrographic seizures was highly predictive (NPV 92 %) of typical/mildly abnormal outcome in survivors.</div></div><div><h3>Conclusion</h3><div>Among survivors, five-year outcomes after TH were favorable. aEEG background patterns at 48 h and seizure burden were reliable predictors of five-year outcomes.</div></div>","PeriodicalId":11435,"journal":{"name":"Early human development","volume":"213 ","pages":"Article 106455"},"PeriodicalIF":2.0,"publicationDate":"2025-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145621592","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