Early human development最新文献

Background

Our objective was to determine whether the use of two or more courses of low-dose systemic dexamethasone for extubation of ventilator-dependent preterm infants after the first week of life, as proposed in the DART study, is associated with greater neurodevelopmental harm at two years of corrected age, compared to a single course.

Methods

Retrospective review at seven level III neonatal intensive care units. Preterm infants who underwent only one course of systemic dexamethasone for extubation were grouped into DART-1; those who underwent two or more courses were grouped into DART-2. Data and outcomes of infants in DART-2 were compared with those in DART-1.

Results

150 preterm infants were studied: 104 in DART-1 and 46 in DART-2. Patients in DART-2 had a lower gestational age (25 vs. 26 weeks, p = 0.031) and greater morbidity. The average dexamethasone cumulative dose for patients in DART-1 was 0.819 mg/kg, vs. 1.697 mg/kg for patients in DART-2. A total of 14 patients died. The neuromotor and neurosensory assessments at two years of corrected age revealed in the DART-2 survivors, after the multivariate analysis, a higher prevalence of cerebral palsy with functional motor class 2 (OR = 6.837; 95%CI: 1.054–44.337; p = 0.044) and ophthalmological problems requiring the use of glasses (OR = 4.157; 95%CI: 1.026–16.837; p = 0.046).

Conclusions

In this cohort, the use of more than one course of systemic dexamethasone in low doses for extubation of ventilator-dependent premature infants after the first week of life was associated, at two years of corrected age, with a higher prevalence of cerebral palsy with functional motor class 2 and ophthalmological problems requiring the use of glasses.

Background

The survival of the smallest and most immature preterm infants, born at 23–24 weeks of gestation, has improved significantly. While there is a substantial amount of research on the neurocognitive and social outcomes of extremely premature birth, little is known about the survivors' subjective experience of being born preterm and its effect on later life.

Aims

The purpose was to study the subjective experiences of school-aged children born at 23–24 weeks of gestation, in order to understand their perspectives on how being born extremely early had affected their life.

Study design

Qualitative descriptive study.

Methods

18 school-aged children (12 girls and 6 boys, 7–15 years of age), born at 23 or 24 weeks of gestation, were interviewed. The semi-structured interview guide covered six topics about quality of life: somatic health, functioning, learning and memory, emotional health, social relations, experience of prematurity and its effect.

Results

Most children reported memories, which were told to them by parents, about their premature birth and early life. Using qualitative thematic analysis, the narratives of the children were classified into three groups: 1) the go-with-the-flow children, who identified little or no effect of prematurity, 2) the ponderers, who reflected on some effects such as minor physical challenges, and 3) the hesitants, who either did not connect their challenges with prematurity, or did not produce much reflection overall.

Conclusions

Children had been told about their early life by the parents and repeated these memories indicating that prematurity had become a significant part of the family story. Differences were found how the children reflected on the impact of prematurity in their personal life. It is essential to include preterm survivors' own perspectives already during childhood and adolescence into the research of extreme prematurity.

The left-cradling bias (i.e., the motor asymmetry for cradling infants on the left side) has often been associated to the right-hemispheric social-emotional specialization, and it has often been reported to be stronger in females than in males. In this study we explored the effects of sexual orientation and gender identity on this lateral bias by means of a web-based investigation in a sample of adults (485 biological females and 196 biological males) recruited through LGBTQIA+ networks and general university forums. We exploited a cradling imagery task to assess participants' cradling-side preference, and standardized questionnaires to assess participants' homosexuality (Klein Sexual Orientation Grid) and gender nonconformity (Gender Identity/Gender Dysphoria Questionnaire for Adults and Adolescents). Results confirmed the expected left-cradling bias across all sexual orientation groups except for heterosexual males. Importantly, higher homosexuality scores were associated with higher proportions of left cradling in males. These results suggest that sexual orientation can influence cradling preference in males, indicating a complex interaction between biological and psychological factors in the laterality of social-emotional processing. Finally, the left-cradling bias seems to confirm its role as a behavioral proxy of social-emotional functional lateralization in humans.

Objective

Understand how high-risk infants' development changes over time. Examine whether NICU Network Neurobehavioral Scale (NNNS) profiles are associated with decrements in developmental outcomes between ages 2 and 3 years in infants born very preterm.

Study design

The Neonatal Outcomes for Very preterm Infants (NOVI) cohort is a multisite prospective study of 704 preterm infants born <30 weeks' gestation across nine university and VON affiliated NICUs. Data included infant neurobehavior measured by NNNS profiles at NICU discharge and the Bayley Scales of Infant and Toddler Development (BSID-III) at ages 2 and 3 years. Generalized estimating equations tested associations between NNNS profiles and BSID-III composite score changes between ages 2 and 3 years.

Results

The final study sample included 433 infants with mean gestational age of 27 weeks at birth. Infants with dysregulated NNNS profiles were more likely to have decreases in BSID-III Cognitive (OR = 2.66) and Language scores (OR = 2.53) from age 2 to 3 years compared to infants with more well-regulated neurobehavioral NNNS profiles. Further, infants with more well-regulated NNNS profiles were more likely to have increases in BSID-III Cognitive scores (OR = 2.03), rather than no change, compared to infants with dysregulated NNNS profiles.

Conclusions and relevance

Prior to NICU discharge, NNNS neurobehavioral profiles identified infants at increased risk for developing later language and cognitive challenges. Findings suggests that neonatal neurobehavior provides a unique, clinically significant contribution to the evaluation of very preterm infants to inform treatment planning for the most vulnerable.

Background

The excess neonatal adiposity is considered a risk factor for the development of childhood obesity and the birth weight is a marker of health throughout life.

Aims

To evaluate the effect of a lifestyle intervention conducted among pregnant women with overweight on neonatal adiposity and birth weight.

Methods

A total of 350 pregnant women were recruited and randomly allocated into the control (CG) and intervention (IG) groups. Pregnant women in the IG were invited to participate in three nutritional counselling sessions based on encouraging the consumption of unprocessed and minimally processed foods, rather than ultra-processed foods, following the NOVA food classification system, which categorizes foods according to the extent and purpose of industrial processing, and the regular practice of physical activity. Neonatal adiposity was estimated using a previously validated anthropometric model. Adjusted linear regression models were used to measure the effect.

Results

Adopting the modified intention-to-treat principle, data from 256 neonates were analyzed for birth weight, and data from 163 for body composition estimation. The treatment had no effect on the proportion of fat mass [β 0.52 (95 % CI −1.03, 2.06); p = .51], fat-free mass [β −0.50 (95 % CI −2.45, 1.45); p = .61] or birth weight [β 53.23 (95 % CI −87.19, 193.64); p = .46].

Conclusions

In the present study, the lifestyle counselling used had no effect on neonatal adiposity or birth weight. Future studies should investigate the effect of more intensive interventions.

Background

Digit ratio (2D:4D) – the relative lengths of the index and ring finger – is sexually dimorphic (male < female), possibly because of the sex-differentiated impact of prenatal androgenization on fetal development in the 1st trimester. The sex difference remains stable with age and has been reported in children, adolescents, and adults from industrialized and non-industrialized societies. Handgrip strength (HGS) also is sexually dimorphic (males > females) and correlates negatively with 2D:4D.

Aims

To examine in a sample of young adult Tuvans from Siberia (Russian Federation): i) the association between 2D:4D measured directly from the palms with 2D:4D measured from radiographic images of the same individuals and ii) the associations between 2D:4D and HGS in Tuvan men and women.

Study design and subjects

The study was cross-sectional. Participants were Tuvans (n = 185; 80 men; mean age = 21.02 years). 2D:4D was measured with a caliper from the ventral surface of the palm (both hands) and from radiographic images (left hand). HGS of both hands was measured with a digital hand dynamometer. Body height and weight were measured with an anthropometer and a body composition scale.

Results

2D:4D ratios and anthropometric measures (including HGS) were sexually dimorphic. Men had lower 2D:4D and higher HGS than women. Direct measures of 2D:4D correlated positively with 2D:4D measured from radiographs. Body mass index (BMI) was a significant predictor of HGS for both sexes. Male right 2D:4D and female right and left 2D:4D correlated negatively with HGS after controlling for the influence of BMI. There were no associations with radiographic measurements of 2D:4D.

Conclusion

Our findings provide evidence of sexual dimorphism in 2D:4D among young adult Tuvans. Together with previous research on Tuvan children and adolescents, these findings provide clear evidence of 2D:4D sexual dimorphism in pre- and postpubertal Tuvans. The small negative association between 2D:4D and HGS corresponds to similar reports across populations, suggesting that 2D:4D is a weak correlate of muscular fitness.

Background

Inter-alpha inhibitor proteins (IAIPs) are structurally related proteins found in the systemic circulation with immunomodulatory anti-inflammatory properties. Reduced levels are found in inflammatory related conditions including sepsis and necrotizing enterocolitis, and in neonatal rodents after exposure to hypoxia ischemia. In the current study, cord blood IAIP levels were measured in neonates with and without exposure to hypoxic-ischemic encephalopathy (HIE).

Methods

This is a prospective cohort study including infants born ≥36 weeks over a one-year period. Term pregnancies were divided into two groups: a “reference control” (uncomplicated term deliveries), and “moderate to severe HIE” (qualifying for therapeutic hypothermia). IAIPs were quantified using a sensitive ELISA on the cord blood samples.

Results

The study included 57 newborns: Reference control group (n = 13) and moderate/severe HIE group (n = 44). Measurement of IAIP cord blood concentrations in moderate to severe HIE group [278.2 (138.0, 366.0) μg/ml] revealed significantly lower IAIP concentrations compared with the control group [418.6 (384.5, 445.0) μg/ml] (p = 0.002).

Conclusions

These findings suggest a potential role for IAIPs as indicators of neonates at risk for HIE. IAIP levels could have diagnostic implications in the management of HIE. Future research is required to explore the relationship between HIE and IAIPs as biomarkers for disease severity.

Category of study

Translational.

Objective

Identifying factors that can better predict the prognosis of neonates with hyperbilirubinemia is important. In this study, we aimed to evaluate the relationship between electroencephalography (EEG) findings and two-year prognosis in neonates with severe hyperbilirubinemia.

Methods & materials

In a cohort prospective study, we studied neonates with a total serum bilirubin level of higher than 18 mg/dL, who were admitted to the neonatal intensive care unit (NICU) of Ghaem hospital, Mashhad, Iran. EEG was recorded upon admission, for all neonates. Patients' data, including demographic characteristics, admission information, and pregnancy and birth data were gathered by obtaining history from parents and studying case files. Also, the relationship between initial EEG findings and final developmental status was assessed.

Results

Mean and standard deviation age of patients were 5.46 ± 3.13 days and average serum total bilirubin level was 23.97 ± 4.34 mg/dL at admission. Our findings revealed a significant correlation between the presence of trace alternant on EEG and developmental delay (P = .001). Presence of trace alternant waves on initial EEG at admission was significantly associated with developmental delay in the two year (P = .005).

Conclusion

These results indicate a relationship between developmental prognosis and the severity of hyper bilirubinemia in neonates. Also, our findings show that the presence of trace alternate waves on the initial EEG is significantly associated with developmental delay of the neonate in the future.