Early human development最新文献_第7页

Gut microbiota as a risk and protective factor in neonatal necrotizing enterocolitis: An integrative review 肠道菌群作为新生儿坏死性小肠结肠炎的风险和保护因素：一项综合综述

IF 2 3区医学 Q2 OBSTETRICS & GYNECOLOGY

Early human development

Pub Date : 2025-12-01 Epub Date: 2025-09-22 DOI: 10.1016/j.earlhumdev.2025.106401

Maria Júlia Onofre , Cesar Augusto Cirino Silva , Isadora Caixeta da Silveira Ferreira , Denise Von Dolinger de Brito Röder

Necrotizing enterocolitis (NEC) is characterized by inflammation of the gastrointestinal tract and intestinal necrosis, primarily affecting premature neonates. It is one of the leading causes of morbidity and mortality in this population. This article aims to analyze, based on recent scientific literature, the relationship between intestinal microbiota and the development of NEC in premature neonates, highlighting the main pathophysiological mechanisms and prevention strategies. We conducted an integrative literature review, with search in the Virtual Health Library (VHL) and Pubmed databases, applying the Patient, Intervention, Comparison and Outcomes (PICO) strategy. A total of 178 articles were initially identified, with the application of validated tools to assess the methodological quality of the studies. The final sample included 13 international articles. The main findings show intestinal dysbiosis, activation of immune pathways and metabolic alterations as key elements in the pathogenesis of NEC. On the other hand, the use of probiotics and enrichment of breast milk were associated with beneficial effects. In conclusion, NEC is a multifactorial disease associated with intestinal dysbiosis, with an increase in pathogenic bacteria and a reduction in beneficial bacteria such as Bifidobacterium spp. The activation of pro-inflammatory TLR4 receptors by bacterial LPS favors intestinal damage. Factors such as prematurity, use of antimicrobials, and changes in the composition of breast milk favor microbiota imbalance. Probiotics and breastfeeding are promising strategies for preventing this situation. Therefore, this article gathers pertinent information that can help in understanding the factors involved in NEC.

坏死性小肠结肠炎（NEC）以胃肠道炎症和肠道坏死为特征，主要影响早产儿。它是这一人群发病和死亡的主要原因之一。本文旨在结合近年来的科学文献，分析肠道菌群与早产儿NEC发病的关系，重点阐述其主要病理生理机制和预防策略。我们采用患者、干预、比较和结果（PICO）策略，在虚拟健康图书馆（VHL）和Pubmed数据库中进行了综合文献综述。最初共确定了178篇文章，并应用了经过验证的工具来评估研究的方法学质量。最后的样本包括13篇国际文章。主要研究结果表明，肠道生态失调、免疫途径激活和代谢改变是NEC发病的关键因素。另一方面，益生菌的使用和母乳的富集与有益效果有关。综上所述，NEC是一种与肠道生态失调相关的多因子疾病，致病菌增加，有益菌如双歧杆菌减少，细菌LPS激活促炎TLR4受体有利于肠道损伤。早产、抗菌剂的使用和母乳成分的变化等因素都有利于微生物群失衡。益生菌和母乳喂养是预防这种情况的有希望的策略。因此，本文收集了相关信息，可以帮助理解NEC所涉及的因素。

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引用次数: 0

The impact of early intervention on early spontaneous movements of infants: a systematic review 早期干预对婴儿早期自发运动的影响：一项系统综述。

IF 2 3区医学 Q2 OBSTETRICS & GYNECOLOGY

Early human development

Pub Date : 2025-12-01 Epub Date: 2025-09-24 DOI: 10.1016/j.earlhumdev.2025.106403

Dilara Bozgan-Baş , Bilge Nur Yardımcı-Lokmanoğlu , Akmer Mutlu

Background

Early intervention in infants can impact the process of neural differentiation during the period when the brain is highly plastic. However, it is unclear whether early intervention can similarly affect early spontaneous movements of infants.

Aim

To determine the effects of early intervention approaches on early spontaneous movements in infants.

Methods

Studies were eligible if they enrolled infants in any early intervention program and assessed early spontaneous movements using a general movements assessment pre- and post-intervention. Five databases were searched and the PRISMA guideline was followed. The Cochrane Risk of Bias Tool-2 and the Risk of Bias in Non-randomized Studies of Interventions were used to identify risk of bias. GRADE approach was used to assess the certainty of the evidence.

Results

Ten studies (involving 633 participants) were included. Most of the studies had a high or serious risk of bias, and the certainty of the evidence was low to very low. The studies varied in their intervention approaches, intensity, and inclusion criteria. The most common early intervention methods were motor interventions, such as physiotherapy, or parental involvement. In four out of five studies which showed an improvement, this improvement occurred during the fidgety period.

Conclusions

Early intervention in infants could influence the spontaneous movements, particularly during the fidgety period. The generalizability and comparability of the results are limited due to the heterogeneity of the methods, the low certainty of evidence and the high risk of bias. Future research should investigate the impact of high-level evidence approaches on early spontaneous movements.

背景：在婴儿大脑可塑性很强的时期，早期干预可以影响神经分化的过程。然而，尚不清楚早期干预是否能同样影响婴儿的早期自发运动。目的：探讨早期干预方法对婴儿早期自主运动的影响。方法：如果将婴儿纳入任何早期干预计划，并使用干预前和干预后的一般运动评估来评估早期自发运动，则研究符合条件。检索了5个数据库，并遵循了PRISMA指南。采用Cochrane偏倚风险工具-2和非随机干预研究的偏倚风险来确定偏倚风险。GRADE方法用于评估证据的确定性。结果：纳入10项研究（633名受试者）。大多数研究有很高或严重的偏倚风险，证据的确定性很低或很低。这些研究的干预方法、强度和纳入标准各不相同。最常见的早期干预方法是运动干预，如物理治疗，或父母参与。在显示改善的五分之四的研究中，这种改善发生在烦躁期。结论：早期干预可以影响婴儿的自发运动，特别是在烦躁期。由于方法的异质性、证据的低确定性和高偏倚风险，结果的通用性和可比性受到限制。未来的研究应该调查高水平证据方法对早期自发运动的影响。

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引用次数: 0

Prenatal hormonal signature (2D:4D) and dental maturation in childhood: a prospective study 产前激素特征（2D:4D）和儿童牙齿成熟：一项前瞻性研究。

IF 2 3区医学 Q2 OBSTETRICS & GYNECOLOGY

Early human development

Pub Date : 2025-12-01 Epub Date: 2025-10-09 DOI: 10.1016/j.earlhumdev.2025.106410

Türkan Ünal , Fatma Nur Kızılay , Emine Gülşen

Background

The second-to-fourth digit ratio (2D:4D) is a stable anthropometric marker thought to reflect prenatal androgen–estrogen balance. Although 2D:4D has been linked to developmental timing, its association with dental maturation remains unclear. This study evaluated whether 2D:4D relates to dental development in children and assessed its potential as a complementary biomarker.

Methods

In this study, 300 healthy children (150 girls, 150 boys; 6–12 years) were enrolled. Bilateral 2D:4D was measured with digital calipers (0.01 mm accuracy). Dental age was determined from panoramic radiographs using Demirjian's method. Analyses included t-tests/ANOVA, Pearson correlations, and multiple linear regression with chronological age, sex, body mass index (BMI), and 2D:4D as covariates. Hand-specific and sex-stratified comparisons were pre-specified; multiple testing was controlled using the Benjamini–Hochberg false-discovery rate (FDR) procedure, with significance set at q < 0.05 (false discovery rate–adjusted p-value).

Results

Mean chronological age was 9.10 ± 1.99 years, dental age 9.09 ± 2.03 years, and BMI 16.51 ± 1.89 kg/m². 2D:4D showed clear sex differences (higher in girls, p < 0.001). Chronological and dental ages were strongly correlated (r = 0.976, p < 0.001). In the overall sample, dental age correlated weakly with 2D:4D (right: r = 0.155, p = 0.007; left: r = 0.135, p = 0.019). Sex-stratified analyses indicated a positive but non-significant trend in girls (right: r = 0.135, p = 0.099; left: r = 0.110, p = 0.181) and no association in boys (all p > 0.05). In multivariable models, chronological age was the strongest predictor (p < 0.001); 2D:4D contributed independently (β = 0.12–0.16, p < 0.001), while BMI was not significant.

Conclusions

2D:4D shows a weak association with dental maturation at the population level. Within-sex analyses reveal a non-significant positive trend in girls and no association in boys. As a simple, non-invasive measure, 2D:4D may provide supportive information alongside radiographic methods; confirmation in larger, longitudinal, sex-specific cohorts is warranted.

背景：第二与第四指比值（2D:4D）是一种稳定的人体测量指标，被认为可以反映产前雄激素与雌激素的平衡。虽然2D:4D与发育时间有关，但其与牙齿成熟的关系尚不清楚。本研究评估了2D:4D是否与儿童牙齿发育有关，并评估了其作为补充生物标志物的潜力。方法：在本研究中，300名健康儿童（150名女孩，150名男孩，6-12岁）入组。用数字卡尺（精度0.01 mm）测量双侧2D:4D。采用Demirjian的方法从全景x线片确定牙龄。分析包括t检验/方差分析、Pearson相关性和以实足年龄、性别、体重指数（BMI）和2D:4D为协变量的多元线性回归。手特异性和性别分层的比较是预先指定的；采用Benjamini-Hochberg误发现率（FDR）程序控制多重检验，显著性设为q。结果：平均实足年龄为9.10±1.99岁，牙龄为9.09±2.03岁，BMI为16.51±1.89 kg/m2。2D:4D表现出明显的性别差异（女孩较高，p < 0.05）。在多变量模型中，实足年龄是最强的预测因子(p)。结论：在人群水平上，2D:4D显示出与牙齿成熟的弱关联。性别内分析显示，女孩有不显著的积极趋势，男孩没有关联。作为一种简单、无创的测量方法，2D:4D可以与x线摄影方法一起提供支持性信息；在更大的、纵向的、性别特定的队列中进行确认是有必要的。

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引用次数: 0

Predicting mid-term hearing and developmental outcome in clinically inapparent congenital cytomegalovirus infection with hearing loss at birth 预测临床不明显的先天性巨细胞病毒感染伴出生听力损失的中期听力和发育结局。

IF 2 3区医学 Q2 OBSTETRICS & GYNECOLOGY

Early human development

Pub Date : 2025-12-01 Epub Date: 2025-10-11 DOI: 10.1016/j.earlhumdev.2025.106412

Pui Khi Chung , Fleurtje A.J. Schornagel , J. Goeman , Ann C.T.M. Vossen

objective

To assess the predictive value of clinical factors in children with clinically inapparent congenital cytomegalovirus infection (cCMV) and sensorineural hearing loss, for hearing and neurodevelopmental outcome.

Study design

This was a post hoc analysis of data from a nonrandomized trial performed in 37 infants (25 treated with 6 weeks valganciclovir, 12 controls) with cCMV and hearing loss, diagnosed after failing Newborn Hearing Screening. Candidate predictors were head circumference, birth weight, gestational age, neuroimaging results, and baseline hearing loss laterality. The primary outcome was the absolute change in hearing in the best ear (dB) from baseline to follow-up at 18–22 months. Secondary outcomes included change in hearing per ear (‘total-ear’ analysis) and neurodevelopmental outcomes measured by the Bayley Scales of Infant Development (BSID-III) at 18–22 months. Per candidate factor, bivariate linear regression models adjusted for treatment were performed.

Results

No correlations were found between candidate predictors and the primary hearing outcome. Linear correlations were observed for neurodevelopmental outcomes: severity of neuroimaging abnormalities was associated with cognitive and motor BSID-III scores (both P < 0.001) and head circumference with motor score (P < 0.001). No severe motor delay was seen in children with a head circumference above −1 SD, and infants with mild or moderate neuroimaging abnormalities generally had normal development or mild delay. Severe cognitive and motor delays were observed only in those with severe neuroimaging findings.

Conclusions

In children with clinically inapparent cCMV and hearing loss, head circumference and neuroimaging severity may be useful for predicting cognitive and motor outcomes.

目的：探讨临床不明显先天性巨细胞病毒感染（cCMV）合并感音神经性听力损失患儿的临床因素对听力和神经发育预后的预测价值。研究设计：这是对一项非随机试验数据的事后分析，该试验在37名患有cCMV和听力损失的婴儿（25名接受6周缬更昔洛韦治疗，12名对照组）中进行，这些婴儿在新生儿听力筛查失败后被诊断为听力损失。候选预测因子包括头围、出生体重、胎龄、神经影像学结果和基线听力损失偏侧性。主要终点是18-22个月时最佳耳（dB）的听力从基线到随访的绝对变化。次要结果包括每只耳朵的听力变化（“全耳”分析）和18-22个月时Bayley婴儿发育量表（BSID-III）测量的神经发育结果。对每个候选因子进行双变量线性回归模型校正。结果：候选预测因子与主要听力结果无相关性。神经发育结局观察到线性相关：神经影像学异常的严重程度与认知和运动bdd - iii评分相关（均为P）。结论：在临床不明显的cCMV和听力损失的儿童中，头围和神经影像学严重程度可能有助于预测认知和运动结局。

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引用次数: 0

Development of children at age 7–8 years after intrauterine exposure to selective serotonin reuptake inhibitors (SSRIs) — Results from the Dutch prospective cohort SMOK study 7-8岁儿童在宫内暴露于选择性血清素再摄取抑制剂（SSRIs）后的发育——来自荷兰前瞻性队列SMOK研究的结果

IF 2 3区医学 Q2 OBSTETRICS & GYNECOLOGY

Early human development

Pub Date : 2025-12-01 Epub Date: 2025-09-26 DOI: 10.1016/j.earlhumdev.2025.106405

Christine N. van der Veere, Anne E. den Heijer, Arend F. Bos

Introduction

Selective serotonin reuptake inhibitors (SSRIs) are used by 2–6 % of pregnant women. Safety regarding the neurodevelopment of the child remains unknown.

Aim

To determine the effect of prenatal exposure to SSRIs on children's outcome at age 7–8 years, adjusted for maternal depression and anxiety.

Methods

This study is part of the Dutch SMOK study. Women (n = 107) were included during pregnancy. At age 7–8 years development of 79 children was examined using tests and questionnaires regarding intellectual ability, executive functioning, attention, social responsiveness, behavior and motor development. Maternal depression and anxiety was determined during pregnancy and at the children's assessment. Differences between SSRI-exposed and non-exposed children were tested using multiple linear regression analyses.

Results

All children had lower IQ scores after prenatal exposure to SSRIs but significance was lost after adjustment for maternal psychopathology. No differences in outcome were found on attention and motor development. Boys, not girls, scored significantly lower on Theory of Mind tests when they had been exposed to SSRIs (total norm score 7.9 ± 0.8 vs. 9.6 ± 0.5, p = 0.04; verbal norm score 8.6 ± 0.9 vs. 10.7 ± 0.6, p = 0.02). Scores on the Social Responsiveness Scale measuring social impairment were significantly higher in SSRI-exposed boys (50 ± 2 vs. 45 ± 2, p = 0.03). In girls, outcome on these domains was explained by maternal psychopathology, not by prenatal exposure to SSRIs.

Conclusions

Prenatal exposure to SSRIs is associated with increased risk of behavioral problems and social impairment associated with autism spectrum disorders only in boys.

选择性血清素再摄取抑制剂（SSRIs）被2- 6%的孕妇使用。关于儿童神经发育的安全性仍然未知。目的：确定产前暴露于SSRIs对7-8岁儿童结局的影响，调整母亲抑郁和焦虑。方法：本研究是荷兰吸烟研究的一部分。妇女（n = 107）包括在怀孕期间。对79名7-8岁儿童的智力、执行功能、注意力、社会反应、行为和运动发育进行了测试和问卷调查。母亲的抑郁和焦虑是在怀孕期间和孩子的评估中确定的。使用多元线性回归分析检测ssri暴露与非暴露儿童之间的差异。结果：所有儿童在产前暴露于ssri类药物后均有较低的智商得分，但在调整母亲精神病理后无显著意义。在注意力和运动发展方面，结果没有发现差异。当接触SSRIs时，男孩的心理理论测试得分明显低于女孩（总规范得分7.9±0.8比9.6±0.5,p = 0.04；言语规范得分8.6±0.9比10.7±0.6,p = 0.02）。ssri暴露男孩的社会反应量表（Social Responsiveness Scale）得分显著高于ssri暴露男孩（50±2比45±2，p = 0.03）。在女孩中，这些领域的结果可以用母亲的精神病理来解释，而不是产前暴露于SSRIs。结论：仅在男孩中，产前暴露于SSRIs与自闭症谱系障碍相关的行为问题和社交障碍的风险增加有关。

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引用次数: 0

Identifying cognitive vulnerability in school-aged children born preterm: The role of neonatal and early-life factors 识别早产学龄儿童的认知脆弱性：新生儿和早期生活因素的作用

IF 2 3区医学 Q2 OBSTETRICS & GYNECOLOGY

Early human development

Pub Date : 2025-12-01 Epub Date: 2025-09-18 DOI: 10.1016/j.earlhumdev.2025.106396

Symeon Dimitrios Daskalou , Nikolaos Gerosideris , Georgia Tsakni , Pinelopi Vlotinou , Georgios Bablekos , Ioanna Giannoula Katsouri

Background

Children born preterm are at increased risk for cognitive difficulties. While gestational age is a known predictor, the combined influence of early-life variables such as breastfeeding, NICU stay, and birth weight on later cognitive outcomes remains less understood.

Objective

To compare cognitive performance between preterm and non preterm school-aged children and identify neonatal and postnatal predictors of verbal and non verbal intelligence.

Methods

A total of 140 children aged 6–12 years (70 preterm, 70 non preterm) were assessed using Raven's Coloured Progressive Matrices (CPM) and Crichton Vocabulary Scale (CVS). Mann–Whitney U tests and multiple linear regressions were used to examine group differences and predictors of cognitive scores. Predictors included gestational age, NICU stay, socioeconomic status (SES), breastfeeding, birth weight, age, and sex. VIF values were used to assess multicollinearity.

Results

Preterm children scored significantly lower than non preterm peers on both CPM (p < 0.001, r = − 0.27) and CVS (p < 0.001, r = − 0.43). Regression models showed that gestational age was a consistent predictor across both scales. Breastfeeding and higher SES were associated with higher CPM and CVS scores, while prolonged NICU stay negatively impacted CVS performance. No multicollinearity issues were detected (VIF < 2.6).

Conclusion

Preterm birth is linked to reduced cognitive performance during middle childhood, especially in verbal reasoning. Breastfeeding and shorter NICU stay may offer protective benefits. These findings highlight the importance of early-life factors and support targeted developmental surveillance and interventions for preterm populations.

早产儿童出现认知障碍的风险增加。虽然胎龄是一个已知的预测因素，但早期生活变量（如母乳喂养、新生儿重症监护室住院时间和出生体重）对后期认知结果的综合影响尚不清楚。目的比较早产儿和非早产儿学龄儿童的认知表现，探讨言语和非言语智力的新生儿和产后预测因素。方法采用Raven's彩色递进矩阵（CPM）和Crichton词汇量表（CVS）对140例6-12岁儿童（早产儿70例，非早产儿70例）进行评估。使用Mann-Whitney U检验和多元线性回归来检验组间差异和认知得分的预测因子。预测因素包括胎龄、新生儿重症监护室住院时间、社会经济地位（SES）、母乳喂养、出生体重、年龄和性别。VIF值用于评估多重共线性。结果早产儿的CPM （p < 0.001, r = - 0.27）和CVS （p < 0.001, r = - 0.43）得分均显著低于非早产儿。回归模型显示胎龄是两个尺度上一致的预测因子。母乳喂养和较高的SES与较高的CPM和CVS评分相关，而延长新生儿重症监护病房的时间会对CVS表现产生负面影响。未检测到多重共线性问题（VIF < 2.6）。结论早产与儿童中期认知能力下降有关，尤其是言语推理能力下降。母乳喂养和较短的新生儿重症监护病房可能提供保护作用。这些发现强调了早期生活因素的重要性，并支持对早产儿群体进行有针对性的发育监测和干预。

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引用次数: 0

Parental satisfaction on moving from open bay to single-family rooms neonatal intensive care unit 新生儿重症监护病房从开放式病房搬到单人家庭病房的家长满意度。

IF 2 3区医学 Q2 OBSTETRICS & GYNECOLOGY

Early human development

Pub Date : 2025-12-01 Epub Date: 2025-09-13 DOI: 10.1016/j.earlhumdev.2025.106394

Wielenga Joke , Pascual April , Ruhe Kiki , de Ligt Chantal , van Kaam Anton

The purpose of the study was to assess the impact of moving from open bay units (OBU) to single-family rooms (SFR) on parental satisfaction in the Neonatal Intensive Care Unit (NICU) An observational longitudinal cohort study was conducted between February 2021 until January 2024, during which time the setting changed from OBU to SFR with a mixed transitional phase in between. All parents of infants admitted were eligible for inclusion. The Empathic-N was used to measure parental satisfaction. The Empathic-N was filled out by 110 mothers and 76 partners of 148 infants. The overall satisfaction when moving from an OBU and SFRs showed no statistical significant increase for both parents. Partners showed a statistically significant increase in the domains Communication and information (p = .012) and Organization (p = .012) after moving to SFRs. For mothers, only several statements within these domains showed a significant increase after transitioning to SFRs. In conclusion, parental satisfaction increased in specific domains after the transition from an OBU to SFR environment in a level III NICU. However, this improvement was modest and differed between mothers and partners. In case of pre-existing high parental satisfaction rates moving from OBU to SFR is not an important contributor to parental satisfaction.

本研究的目的是评估从开放式病房（OBU）转移到单户病房（SFR）对新生儿重症监护病房（NICU）父母满意度的影响。在2021年2月至2024年1月期间进行了一项观察性纵向队列研究，在此期间，设置从OBU转变为SFR，并在两者之间进行混合过渡阶段。所有入院婴儿的父母均符合入选条件。共情因子n用于衡量父母满意度。共情问卷由148名婴儿的110名母亲和76名伴侣填写。从OBU和SFRs转移后，父母双方的总体满意度没有统计学上的显著提高。合作伙伴在转移到SFRs后，在沟通和信息（p = 0.012）和组织（p = 0.012）领域显示统计学上显著增加。对于母亲来说，这些领域中只有几个陈述在过渡到srr后显着增加。综上所述，三级新生儿重症监护室从OBU环境过渡到SFR环境后，父母在特定领域的满意度有所提高。然而，这种改善是温和的，并且在母亲和伴侣之间存在差异。在已经存在的高父母满意度的情况下，从OBU转移到SFR并不是父母满意度的重要因素。

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引用次数: 0

The role of internalising trajectories in adult wealth and social relationships following very preterm birth/very low birth weight 内化轨迹在非常早产/非常低出生体重后的成人财富和社会关系中的作用。

IF 2 3区医学 Q2 OBSTETRICS & GYNECOLOGY

Early human development

Pub Date : 2025-12-01 Epub Date: 2025-09-16 DOI: 10.1016/j.earlhumdev.2025.106395

Yanlin Zhou , Elif Gonen , Peter Bartmann , Dieter Wolke

Background

Individuals born very preterm (VPT; <32 weeks) and/or with very low birth weight (VLBW; <1500 g) are at higher risk for internalising problems and adulthood difficulties. However, internalising symptoms fluctuate over time, and it remains unclear how these patterns of change relate to adult outcomes after VPT/VLBW birth.

Objective

To examine whether internalising trajectories from childhood to early adulthood mediate or moderate the association between VPT/VLBW birth and adult wealth and social relationship difficulties.

Methods

Data were drawn from the Bavarian Longitudinal Study (252 VPT/VLBW, 228 term-born), followed from birth to 34 years. Internalising symptoms were parent-reported at four waves (ages 6, 8, 13 and 26 years) and modelled into trajectories. Path analysis tested direct and indirect effects of VPT/VLBW status on outcomes at 34 years via these trajectories. Moderation was tested using analysis of variance. Covariates included sex, socioeconomic status (SES) at birth, and neurosensory impairments (NSI).

Results

Three internalising trajectories emerged: consistently low (70.4 %), decreasing (15 %), and increasing (14.6 %). The increasing trajectory mediated the association between VPT/VLBW birth and both lower wealth and greater social relationship difficulties. After adjusting for sex, SES, and NSI, only the mediation effect on wealth remained significant. Indirect effects accounted for approximately 15–18 % of the total effects. Interactions between birth group (VPT/VLBW vs. term-born) and internalising trajectory on adult outcomes were non-significant.

Conclusions

Increasing internalising symptoms partially mediate the impact of VPT/VLBW birth on adult wealth and social relationships. Findings highlight the value of continuing mental health support, particularly for those born VPT/VLBW.

背景：非常早产（VPT）个体；目的：研究从童年到成年早期的内化轨迹是否介导或调节了非常早产/VLBW出生与成年财富和社会关系困难之间的关联。方法：数据来自巴伐利亚纵向研究（252名VPT/VLBW， 228名足月出生），从出生到34岁。父母在四个阶段（6岁、8岁、13岁和26岁）报告了内化症状，并建立了轨迹模型。通径分析通过这些轨迹测试了VPT/VLBW状态对34岁时预后的直接和间接影响。使用方差分析检验适度性。协变量包括性别、出生时的社会经济地位（SES）和神经感觉障碍（NSI）。结果：出现了三种内化轨迹：持续低（70.4%）、下降（15%）和增加（14.6%）。增加的轨迹在VPT/VLBW出生与低财富和更大的社会关系困难之间起中介作用。在对性别、社会经济地位和自伤进行调整后，只有财富的中介效应仍然显著。间接效应约占总效应的15- 18%。出生组（VPT/VLBW vs足月出生）和内化轨迹对成年结局的相互作用不显著。结论：内化症状的增加部分介导了VPT/VLBW出生对成人财富和社会关系的影响。研究结果强调了持续心理健康支持的价值，特别是对那些出生时患有VPT/VLBW的人。

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引用次数: 0

The evidence for neonatal arginine supplementation — A narrative review 新生儿补充精氨酸的证据-叙述性回顾。

IF 2 3区医学 Q2 OBSTETRICS & GYNECOLOGY

Early human development

Pub Date : 2025-12-01 Epub Date: 2025-09-23 DOI: 10.1016/j.earlhumdev.2025.106402

F. Callaghan , C. Morgan

Arginine is proteomic conditionally essential amino acid in the neonatal period. As well as being necessary for protein synthesis and growth, it is a highly functional amino acid playing a key role in many metabolic pathways critical to neonatal health. These include the urea cycle and ammonia detoxification, spermidine synthesis, immune modulation and acting as the key substrate for nitric oxide synthesis. The arginine-nitric oxide (NO) pathway is an important mechanism by which hypoargininaemia may contribute to neonatal morbidity, particularly necrotising enterocolitis and potentially sepsis, pulmonary disease and post-operative recovery. The role of the inhibitory metabolite asymmetric dimethylarginine in the arginine-NO pathway has been recognised but the neonatal clinical implications have yet to be established.

Neonates dependent on parenteral nutrition are particularly vulnerable to hypoargininaemia. Both parenteral and enteral arginine supplementation has been shown in a small number of clinical trials to reduce the risk of necrotising enterocolitis. This evidence has been sufficient to result in recommendations for arginine supplementation in systematic reviews and international guidelines. The potential benefits from reducing the risk of other neonatal complications such as sepsis and prolonged postoperative recovery have not been studied. No arginine side effects have been reported but the studies are not large enough to provide complete assurance. The methods of parenteral and enteral arginine supplementation also require further research to establish optimal timing, dose and target plasma level. Nevertheless, arginine supplementation relatively easy to implement in clinical practice and remains a potentially cost effective method in reducing serious neonatal morbidities.

精氨酸是新生儿期蛋白质组学条件必需氨基酸。它不仅是蛋白质合成和生长所必需的，而且是一种功能强大的氨基酸，在许多对新生儿健康至关重要的代谢途径中起着关键作用。其中包括尿素循环和氨解毒、亚精胺合成、免疫调节和作为一氧化氮合成的关键底物。精氨酸-一氧化氮（NO）途径是低精氨酸血症可能导致新生儿发病率的重要机制，特别是坏死性小肠结肠炎和潜在的败血症、肺部疾病和术后恢复。抑制性代谢物不对称二甲基精氨酸在精氨酸-一氧化氮途径中的作用已被认识到，但新生儿临床意义尚未确定。依赖肠外营养的新生儿特别容易发生低精氨酸血症。在少数临床试验中，肠外和肠内补充精氨酸均显示可降低坏死性小肠结肠炎的风险。这一证据足以在系统评价和国际指南中推荐补充精氨酸。降低其他新生儿并发症（如败血症和术后恢复时间延长）的潜在益处尚未得到研究。没有精氨酸副作用的报道，但研究的规模还不足以提供完全的保证。肠外和肠内补充精氨酸的方法也需要进一步研究，以确定最佳的时间、剂量和目标血浆水平。然而，精氨酸补充在临床实践中相对容易实施，并且仍然是降低严重新生儿发病率的潜在成本有效的方法。

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引用次数: 0

Heart rate variability is associated with self-regulation and stress neurobehavior in preterm infants 早产儿心率变异性与自我调节和应激神经行为有关。

IF 2 3区医学 Q2 OBSTETRICS & GYNECOLOGY

Early human development

Pub Date : 2025-12-01 Epub Date: 2025-09-29 DOI: 10.1016/j.earlhumdev.2025.106406

E.L. Donnellan , R.B. Govindan , J. Ngwa , N. Andescavage , C. Limperopoulos , A.J. du Plessis

Background

The NICU (neonatal intensive care unit) Network Neurobehavioral Scale (NNNS) quantitatively assesses several distinct neurobehavioral domains. Neurobehavioral states interface with the autonomic nervous system. We sought to determine if autonomic tone, measured by heart rate variability (HRV), is associated with performance on NNNS neurobehavioral subscales.

Methods

Using continuous electrocardiogram recordings, we derived the following HRV measures: short (α1), and long-term (α2) fractal scaling exponents and short (RMS1) and long-term (RMS2) root mean square fluctuations. The NNNS was completed around term equivalent age (TEA). Linear mixed effects models tested associations between six NNNS subscales and HRV metrics. Secondary analyses explored the role of postmenstrual age (PMA) on associations between NNNS and HRV. These associations were further tested in the earliest and latest postnatal NICU weeks for each infant.

Results

We enrolled 39 premature infants (birth gestational age 23–36 weeks). Several HRV metrics were associated with Self-Regulation and Stress. After controlling for common NICU exposures (i.e. ventilation, steroids, caffeine and antibiotics), self-regulation was positively associated with alpha1 and RMS1 (standardized β = 0.262–0.284). Stress was associated negatively with alpha1 and RMS1 (standardized β = −0.283 to −0.286) and positively with alpha2 (standardized β = 0.245). Associations between Self-Regulation and Stress on RMS1 differed by PMA and NICU week, respectively. α1 and α2 at TEA predicted Stress (AUC = 0.730–0.775).

Conclusion

Of the six subscales examined, only Stress and Self-Regulation scores were associated with autonomic metrics in preterm infants. For short-term autonomic fluctuations, PMA and NICU week influenced this relationship. Furthermore, the fractal scaling exponents predict abnormal Stress scores.

背景：NICU（新生儿重症监护病房）网络神经行为量表（NNNS）定量评估几个不同的神经行为领域。神经行为状态与自主神经系统相连接。我们试图确定通过心率变异性（HRV）测量的自主神经张力是否与NNNS神经行为亚量表的表现有关。方法：利用连续心电图记录，推导出HRV指标：短期（α1）和长期（α2）分形标度指数以及短期（RMS1）和长期（RMS2）均方根波动。NNNS在学期等效年龄（TEA）左右完成。线性混合效应模型测试了6个神经网络神经网络分量表与HRV指标之间的关联。二次分析探讨了经后年龄（PMA）在NNNS和HRV之间的关联中的作用。这些关联在每个婴儿出生后最早和最晚的NICU周进一步测试。结果：我们招募了39例早产儿（出生胎龄23-36周）。几个HRV指标与自我调节和压力有关。在控制常见NICU暴露（即通气、类固醇、咖啡因和抗生素）后，自我调节与alpha1和RMS1呈正相关（标准化β = 0.262-0.284）。应激与α 1和RMS1呈负相关（标准化β = -0.283 ~ -0.286），与α 2呈正相关（标准化β = 0.245）。自我调节与应激在RMS1上的相关性分别因PMA和NICU周而异。TEA α1和α2预测应力（AUC = 0.730 ~ 0.775）。结论：在检查的六个亚量表中，只有压力和自我调节得分与早产儿的自主神经指标相关。对于短期自主波动，PMA和NICU周影响这一关系。此外，分形标度指数预测异常应力得分。

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引用次数: 0