Early human development最新文献

Background, Aims

Circadian rhythm maturation may be disturbed in premature infants undergoing neonatal intensive care. We used continuous heart rate recordings across the entire neonatal intensive care period to study circadian rhythm development in preterm infants and to evaluate the roles of postmenstrual (PMA) versus postnatal age (PNA).

Materials and methods

The circadian rhythm was calculated using a cosine fit of heart rate. The circadian rhythm amplitudes were averaged weekly and studied relative to PMA and PNA using the linear mixed effects models, adjusting for clinical variables that could affect the heart rate. The daily circadian rhythms were used to create grand averages for PMA groups: $\le$31, 32–35, and > 35 weeks, and for PNA groups: $\le$30, 31–60, and > 60 days.

Results

Sixty-six infants were evaluated as part of an ongoing prospective study with gestational ages between 23 and 36 weeks. The PMA (1.47 × 10⁻² beats per minute (bpm)/week, P = 2.07 × 10⁻⁸) and PNA (1.87 × 10⁻² bpm/day; P = 1.86 × 10⁻⁶) were significantly associated with the circadian rhythm amplitude independent of covariates. Infants $\le$31 weeks' PMA and $\le$30 days PNA, the phase of circadian rhythm amplitude grand averages showed a peak at night and a nadir during the day. Hereafter the circadian rhythm phase reversed to that established for mature individuals. The highest circadian rhythm amplitudes present >35 weeks' PMA and > 60 days PNA.

Conclusions

Our results indicate circadian rhythm matures with advancing gestation. The reversed circadian rhythm phase during the early postnatal period could be due to premature exposure to the ex-utero environment and warrant further study.

Maternal love and caregiving are pillars for optimal child development and may affect infant outcomes from pregnancy onwards. The present study aimed to examine whether maternal trait mindfulness during pregnancy and pre- and postnatal maternal-infant bonding were associated with maternal perceptions of infant temperament and social-emotional development. In total, 408 Dutch women (M_age = 31.33, SD = 3.59) participated in a prospective perinatal cohort study and completed questionnaires on trait mindfulness, prenatal bonding, postnatal bonding, infant temperament, and infant social-emotional development at 20 and 28 weeks of gestation, and 10 weeks, 6 and 12 months postpartum, respectively. Path analyses demonstrated that higher levels of the trait mindfulness facet non-judging (i.e., refraining from judgments about own feelings and thoughts) were associated with more pre- and postnatal maternal bonding and fewer social-emotional problems as perceived by the mother. Adopting an accepting and non-judgmental attitude may promote positive feelings of bonding and benefit the infant in terms of having fewer social-emotional problems in the first year of life. Mindfulness interventions may be offered to pregnant women in order to enhance maternal bonding and improve infant outcomes after birth.

Purpose

Congenital diaphragmatic hernia (CDH) affects 1 in 3000–5000 newborns. In survivors, long-term complications include gastroesophageal reflux (GER), feeding difficulties, and failure to thrive. Data from the parents' perspective remain scarce. This study aims to report the prevalence and impact of feeding difficulties on CDH families after discharge.

Methods

National web-based survey amongst families with CDH infants in 2021.

Results

Caregivers of 112 CDH survivors participated. The baseline characteristics were representative with 54 % male, 83 % left-sided CDH, prenatal diagnosis in 83 %, and 34 % requiring extracorporeal membrane oxygenation. Most infants (81 %) were discharged within three months, with 62 % feeding by mouth, and 30 % requiring a feeding tube. Persisting feeding difficulties were experienced by 73 %, GER being the most common (66 %), followed by insufficient weight gain (64 %). After discharge, 41 % received medical support for failure to thrive. The primary-care pediatrician was consulted most frequently for information (61 %) and treatment of feeding difficulties (74 %). Therapeutic success was reported in 64 %. A cessation of symptoms was achieved in 89 % within three years.

Conclusion

The majority of CDH infants had persistent feeding difficulties. This survey highlights the impact surrounding feeding problems on CDH families. Further studies and support systems are needed to raise the quality of life in CDH infants and their families.

Aim

Swedish guidelines for therapeutic hypothermia (TH) after perinatal asphyxia were established in 2007, following several randomised studies that demonstrated improved outcomes. We assessed the implementation of hypothermia treatment in a mid-Swedish region with a sizeable proportion of outborn infants.

Method

A population-based TH cohort from 2007 to 2015 was scrutinised for adherence to national guidelines, interhospital transport, including the use of a cooling mattress made of phase change material for thermal management, and outcomes.

Results

Of 136 admitted infants, 99 (73 %) were born outside the hospital. Ninety-eight percent fulfilled the criteria for postnatal depression/acidosis, and all patients had moderate-to-severe encephalopathy. Treatment was initiated within 6 h in 85 % of patients; amplitude-integrated electroencephalography/electroencephalography was recorded in 98 %, cranial ultrasound in 78 %, brain magnetic resonance imaging in 79 %, hearing tests in all, and follow-up was performed in 93 %. Although target body temperature was attained later (p < 0.01) in outborn than in inborn infants, at a mean (standard deviations) age of 6.2 (3.2) h vs 4.4 (2.6) h, 40 % of those transported using the cooling mattress were already within the therapeutic temperature range on arrival, and few were excessively cooled. The mortality rate was 23 %, and 38 % of the survivors had neurodevelopmental impairment at a median of 2.5 years.

Conclusion

The regionalisation of TH, including interhospital transport, was feasible and resulted in outcomes comparable to those of randomised controlled studies.

Background

The study aimed to investigate the association of second and fourth-digit (2D:4D) ratios with metabolic syndrome (MS) and cardiovascular disease risk (CVR).

Method

This case-control study was conducted between February and March 2024 with 200 participants (100 patients +100 controls). Biochemical parameters (glucose, total cholesterol, HDL, LDL, triglycerides, haemogram, HbA1C) were recorded. All participants were evaluated in terms of MS diagnostic criteria. CVR was calculated with the ESC CVD Risk Calculator. Second-digit and fourth-digit measurements were performed and the 2D:4D ratio of both hands and the difference between 2D:4D of both hands (Dr-l) were obtained. The relationship between 2D:4D and MS, CVR, and gender was evaluated. p < .05 was considered statistically significant.

Results

Forty-one percent of the study participants were male. The right-hand 2D:4D (R2D:4D) ratio was 1.009 ± 0.04 and the left-hand 2D:4D (L2D:4D) ratio was 0.991 ± 0.04 (p < .001). R2D:4D ratio was 1.010 ± 0.04 in women and 0.985 ± 0.03 in men (p = .019). R2D:4D (p < .001), Dr-l (p = .001), and CVR (p < .001) were significantly higher in men with MS (+) compared to MS (−).

Conclusion

In our study, the R2D:4D ratio was found to be associated with MS and CVR in men. Low intrauterine androgen exposure may affect the development of MS, but this effect is more prominent in males.

Background

This study aimed to evaluate the effect of ICC (cord clamping within the first 15 s), DCC (delayed cord clamping at 60 s), and cut-UCM (cut-umbilical cord milking, cord clamping within the first 15 s) groups on oxygen saturation (SpO2), heart rate (HR), and perfusion index (PI) up to 10 min after birth in newborn infants.

Methods

We conducted this randomized clinical trial in the delivery unit of a University Hospital with 189 infants born between 35 and 42 weeks of gestation. Participants were randomly assigned to one of three groups: ICC, DCC, and cut-UCM. The primary outcomes measured were SpO2, HR, and PI at the 1st, 3rd, 5th, and 10th minutes after birth. We utilized ANOVA and Bayesian calculations in this study.

Results

There was no difference between the ICC, DCC, and cut-UCM groups in SpO2, HR, and PI values at the 1st, 3rd, 5th, and 10th minutes of life, which did not significantly alter between the three groups in one-way ANOVA. Bayesian repeated-measure ANOVA calculations showed that SpO2 and heart rate results at the 1st, 3rd, 5th, and 10th minutes did not differ between ICC, DCC, and cut-UCM techniques with strong evidence. At the 3rd minute, PI was slightly higher in the DCC and cut-UCM groups compared to the ICC group, with anecdotal evidence. We found no difference between DCC and cut-UCM regarding the 3rd-minute PI, with moderate evidence.

Conclusion

Umbilical clamping procedures (ICC, DCC, and cut-UCM) did not affect SpO2 and HR in the first ten minutes of life, but 3rd-minute PI values were slightly higher in DCC and cut-UCM compared with ICC among late preterm and term neonates.

Background

This longitudinal study aimed to explore the impact of containers on gross motor percentile from 8 to 13 months corrected age during the walking development in moderate to late preterm infants.

Methods

Sixty preterm infants were enrolled in this study, and their monthly assessment the gross motor percentile using the Alberta Infant Motor Scale. Monthly parent interviews focused on collecting information about container characteristics.

Results

Infants exhibited fluctuating percentiles in gross motor development, averaging 37.81 (SD = 21.9; SEM = 1.4). The gross motor skills percentiles varied between 2 and 86 points across the six assessments. Factors significantly associated with gross motor development percentiles were a large container size (Coef. = 15.29; p < 0.001*) and a container with a soft floor surface (Coef. = 3.64; p = 0.042*).

Conclusion

Healthy preterm infants exhibited minimal instability in gross motor development and attained walking independently by 13 months. Placing preterm infants in a baby container during their first year should prioritize a wide space and a soft floor surface to enhance gross motor development.

Modern medicine has revolutionized family planning. Remarkably, women¹ can carry to term embryos with whom they share no genetic connection, a feat made possible through egg donation and/or gestational surrogacy. Our reproductive systems evolved to accommodate embryos that are 50% related to the carrier, not 0% related. Here, we apply evolutionary theory to explain how and why pregnancy is riskier with an unrelated embryo. When a woman gestates an unrelated embryo, she is significantly more likely to develop preeclampsia and other diseases above and beyond the known risks associated with advanced maternal age, IVF, multiple gestation, and subfertility. Such “allogeneic pregnancies” are riskier even in fertile, healthy, commercial surrogates and when the egg is donated by a young, healthy donor. We propose that unrelated embryos present a special immune challenge to the gestational carrier, because they have fewer matching genes to the maternal body—therefore exacerbating symptoms of evolutionary maternal-fetal conflict. Indeed, maternal risks seem lower when the embryo is more related to the carrier, e.g., if a sister donates the egg. Finally, we discuss microchimerism in egg donation pregnancies, whereby wholly foreign cells pass from mother to embryo and vice-versa. We conclude with several medical proposals. First, egg donors and surrogates should be informed of the increased health risks they would face. In considerations of risk, these young, fertile women should not be compared to older, infertile women undergoing IVF; the proper comparison group is other young, fertile women. Second, contrary to some medical advice, perhaps genetically-related egg donors and surrogates should be preferred, all else equal. An immunological matching scheme, like what is used for organ transplants, could improve surrogate pregnancy outcomes. Third, more research is needed on microchimerism, sperm exposure, and the long-term impacts of allogeneic pregnancies on maternal and child health.

The ‘organizational-activational hypothesis’ posits that the fetal environment has a lasting impact on offspring physical, cognitive, and behavioral phenotype. An established biomarker for human prenatal testosterone exposure is the second-to-fourth digit ratio (2D:4D). While related facial characteristics and their social perceptions have been investigated in young adults, studies focusing on younger or older age groups are scarce. Standardized facial photographs of 17 Austrian boys aged 4 to 11 years were each rated by 162 adults in Austria (78 female, 84 male) for masculinity, dominance, physical strength, maturity, independence, cuteness, and prettiness. Following high interrater agreement (Cronbach's alphas >0.96), average ratings per face were subjected to a principal component analysis. The first principal component (52 % var. expl.) correlated positively with the boys' age (r = 0.685), whereas the second principal component (37 % var. expl.) reflected organizational effects of prenatal androgen exposure (i.e. androgenization), as shown by a negative correlation with the boys' 2D:4D (r = −0.487). Geometric morphometrics was employed to extract the facial shapes corresponding to these two principal components. Overall, adults consistently attributed masculinity in line with prenatal testosterone exposure, whereby masculinity was assessed as neither pretty nor cute. In contrast to findings within adults, boys' face ratings of dominance and physical strength did not correspond with their masculinity assessments, but rather with the social attributions reflecting age-related developmental progress (maturity and independence). This adds an ontogenetic layer of complexity. Prenatal testosterone exposure influences the development of boys' facial features, which in turn even shape social stereotypes in adults.

Background

Very preterm infants are at increased risk of neurodevelopmental impairments. The Neonatal Visual Assessment (NVA) assesses visual function and outcomes and has been used to assess early neurodevelopmental outcomes. This study aimed to compare NVA results of very preterm and term-born infants and to calculate the sensitivity and specificity of the NVA at term equivalent age (TEA) and three months corrected age (CA) to predict motor and cognitive outcomes at 12 months CA in very preterm infants.

Methods

This prospective observational cohort study recruited infants born before 31 weeks gestation and a healthy term-born control group. The NVA was assessed at TEA and three months CA, and neurodevelopmental outcomes (Bayley Scales of Infant and Toddler Development, Third Edition; Neurosensory Motor Developmental Assessment; Alberta Infant Motor Scale) were performed at 12 months CA. The sensitivity and specificity of the NVA to predict outcomes were calculated based on a previously published optimality score.

Results

248 preterm (54 % male) and 46 term-born infants (48 % male) were analysed. The mean NVA scores of preterm and term-born infants were significantly different at TEA (preterm 3.1$\pm$2.1; term-born 1.2$\pm$1.7, p < 0.001). The NVA had moderate sensitivity (59–78 %) and low specificity (25–27 %) at TEA, and low sensitivity (21–28 %) and high specificity (86–87 %) at three months CA for the prediction of preterm infants' outcomes at 12 months CA.

Conclusion

The NVA at TEA and three months CA was not a strong predictor of motor and cognitive impairments in this contemporary cohort of very preterm infants.