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1.
Background
More information is needed on ‘low-risk’ preterm infants' neurological outcome so that they can be included in follow-up programs at least until school age.Objective
To examine the neuropsychological outcome in a group of low-risk low birth weight (LBW) children without neurological impairment followed from birth to 5 years of age.Patients
26 intellectually normal children born preterm (30–34 weeks gestation) without major neurological disabilities and 23 control children born at term and matched for age, sex, and parental educational and occupational status.Methods
Subjects already evaluated at 3 years of age underwent assessment again at 5 years using as neuropsychological outcome measures a wide range of tests including perceptual and visual–motor function, language comprehension and expression, and attention skills.Results
When tested at 5 years, children born preterm still obtained significantly lower mean scores than controls on visual motor integration test (57 vs 64, p = 0.01), visual perception test (41 vs 43, p = 0.002) and a trend toward a lower score in the picture vocabulary test (81 vs 85.5, p = 0.07). The group of premature infants and controls improved their performance over time in the neuropsychological abilities investigated and, in some skills such as visual perception. Children born preterm took longer than those born at term to reach similar performance levels, 5 versus 3 years.Conclusion
Ex low-risk children born preterm achieve lower scores over time in visual–motor and perceptual ability scales and in some language tests than children born at term. Like high-risk premature infants even those at low risk deserve regular follow-up with long-term programs. 相似文献2.
Background
Preterm infants are at high risk of encountering oral feeding difficulties. Early sensorimotor interventions may improve oral feeding skills in preterm infants.Aim
To further explore the effects of an oral (O), tactile/kinesthetic (T/K), and combined (O + T/K) sensorimotor intervention on preterm infants' nutritive sucking, swallowing and their coordination with respiration.Study design
Seventy-five infants (29 [0.3, standard error of mean, SEM] weeks gestation, 49 males/26 females) were randomly assigned to an O group involving sensorimotor input to the oral structures; a T/K group involving sensorimotor input to the trunk and limbs; a combined (O + T/K) group; and a control group.Outcome measures
Stage of sucking, suction and expression amplitudes (mm Hg), suck–swallow ratio, stability of suck–swallow interval, and swallow–respiration patterns.Results
The O group had significantly more advanced sucking stages, and greater suction and expression amplitudes than controls [p ≤ 0.035, effect size (ES) > 0.6]. The suck–swallow ratio and stability of suck–swallow intervals did not significantly differ among groups (p ≥ 0.181, ES ≤ 0.3). The three interventions led to fewer swallows bracketed by prolonged respiratory pauses compared to controls (pause–swallow–pause, p ≤ 0.044, ES ≥ 0.7). The T/K and combined (O + T/K) groups had greater occurrence of swallows bracketed by expiration than the control and O groups (expiration–swallow–expiration, p ≤ 0.039, ES ≥ 0.3).Conclusion
The O intervention enhanced specific components of nutritive sucking. All three interventions resulted in improved swallow–respiration coordination. Sensorimotor interventions have distributed beneficial effects that go beyond the specific target of input. 相似文献3.
Aydemir O Aydemir C Sarikabadayi YU Altug N Erdeve O Uras N Oguz SS Dilmen U 《Early human development》2012,88(5):315-319
Background/Aim
Transient tachypnea of the newborn (TTN) is a consequence of inadequate neonatal lung fluid clearance. Natriuretic peptides play an important role in the regulation of extracellular fluid volume. The aim of the study was to investigate the relation between plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels and TTN, and to find out its role in predicting disease severity.Methods
A prospective controlled study involving 67 infants with TTN and 33 controls ≥ 34 weeks gestational age was conducted. Study and control groups were compared for plasma NT-proBNP levels measured on the 6th, 24th, 72nd and 120th hours of life. Cardiac systolic functions were evaluated by echocardiography.Results
NT-proBNP levels were significantly higher in neonates with TTN compared to controls at 6th, 24th, 72nd and 120th hours (p < 0.001). NT-proBNP levels at 24th and 72nd hours were significantly higher in infants with prolonged tachypnea (p = 0.007 and p = 0.03) and in those who required respiratory support (p = 0.006 and p < 0.001). Tachypnea duration was correlated with NT-proBNP levels at 24 h (r = 0.41, p = 0.001). At a cut-off value of 6575 pg/ml, NT-proBNP had a sensitivity of 85% and specificity of 64% to predict mechanical ventilation requirement. Cardiac systolic functions were normal in all TTN patients.Conclusion
Plasma NT-proBNP levels are increased in neonates with TTN. Measurement of plasma NT-proBNP can be useful for predicting infants who will have prolonged tachypnea and mechanical ventilation requirement. 相似文献4.
Alyamac Dizdar E Ozdemir R Nur Sari F Yurttutan S Gokmen T Erdeve O Emre Canpolat F Uras N Suna Oguz S Dilmen U 《Early human development》2012,88(10):813-816
Background/aim
To determine whether there is an association between platelet counts and patent ductus arteriosus (PDA) incidence and/or closure in preterm newborns.Study design and subjects
Premature infants with hemodynamically significant PDA (n = 154) and a control group without PDA (n = 207) who were hospitalized in the NICU were retrospectively evaluated. Platelet counts and other platelet indices including mean platelet volume (MPV) and platelet distribution width (PDW) of the infants in both groups during the first 3 days of life were recorded. Ibuprofen was started in infants with hemodynamically significant PDA and echocardiography was repeated 48 h thereafter to assess the closure of ductus.Results
Median gestational age and birth weight of the infants with PDA were 28 (range 26–29) weeks and 1060 (range 892–1250) g respectively. Platelet counts were significantly lower in the patient group than in the control group (p < 0.001). Multivariate analysis including gestational age, presence of RDS, presence of thrombocytopenia and PDW showed that hemodynamically significant PDA was independently associated with platelet count < 150,000 (OR = 2.13, 95% CI 1.26–3.61; p = 0.005), high PDW (> 17) (OR = 2.68, 95% CI 1.41–5.09; p = 0.003) and the presence of RDS (OR = 2.25, 95% CI 1.41–3.59; p = 0.001). Baseline platelet counts of the infants in whom ductus closed or persisted after ibuprofen treatment were similar.Conclusions
PDA was associated with low platelet count and high PDW but not with other platelet indices in preterm infants. We could not show an association between platelet counts and persistence or closure after medical treatment. 相似文献5.
Katrin Mehler Annika Mainusch Eva Hucklenbruch-Rother Moritz Hahn Christoph Hünseler Angela Kribs 《Early human development》2014
Background
Moderately and late preterm infants represent a considerable and increasing proportion of infants cared for in neonatal departments worldwide. Parents of preterm infants are at risk of postpartal depression (PPD) and posttraumatic stress disorder (PTSD), and preterm infants are at risk of developmental impairment.Aim
This study aimed to assess (1) the incidence of parental PPD and PTSD in moderate to late preterm infants in comparison to full-term infants and (2) the influence of infants' motor repertoire assessed by Prechtl's general movements and illness severity on parental PPD and PTSD.Subjects
We studied 60 mothers and 56 fathers of 69 preterm infants (born at 32 to 37 weeks of gestation) and 32 mothers and 29 fathers of 34 full-term infants.Outcome measures
We assessed the incidence of parental PPD, PTSD and perceived social support as well as infants' illness severity and motor repertoire at birth, term and 3 months corrected age.Results
Preterm mothers and fathers had significant higher depression scores after birth compared to full-term parents (p = 0.033 and 0.021). Preterm fathers also had higher traumatization scores compared to full-term fathers (p = 0.007). Probable or possible PPD/PTSD was not associated with infant's illness severity or quality of motor repertoire. No differences in motor development were found between preterm and full-term infants.Conclusion
Moderate to late preterm infants' parents are at increased risk for PPD irrespective of infants' motor repertoire or illness severity. 相似文献6.
Objective
Labetalol is often used in severe preeclampsia (PE). Hypotension, bradycardia and hypoglycemia are feared neonatal side effects, but may also occur in (preterm) infants regardless of labetalol exposure. We analyzed the possible association between intrauterine labetalol exposure and such side effects.Study design
From 1 January 2003 through 31 March 2008, all infants from mothers suffering severe PE admitted to one tertiary care center were included. Severe PE was defined according to the International Society for the Study of Hypertension in Pregnancy (ISSHP) criteria. Infants exposed to labetalol in utero (labetalol infants) were compared with infants, who were not exposed to labetalol (controls). Neonatal records were reviewed for hypotension (RR < mean gestational age in weeks), bradycardia (heartrate < 100/min) and hypoglycaemia (glucose < 2.7 mmol/L) in the first 48 postnatal hours.Results
Of 109 infants, 55 had been exposed to labetalol, whereas 54 were not (controls). Gestational age at delivery and birthweight were similar in both groups (31.8 vs. 32.8 weeks (p = 0.06) and 1510 vs. 1639 grams (p = 0.25), respectively for the labetalol vs. control group). Hypotension occurred significantly more in conjunction with labetalol exposure (16, (29.1%) vs. 4 (7.4%); p = 0.003), irrespective of the route of administration. Patent ductus arteriosus (PDA) was present in 9 (56%) of hypotensive labetalol infants compared to 1 (24%) infant in the hypotensive control group (NS). In a multivariate regression model, labetalol exposure, the need for intubation and PDA appeared independently associated with hypotension (P < 0.001). Hypoglycemia occurred in 26 (47.3%) of labetalol infants and in 23 (42.6%) of control infants (p = 0.62). Bradycardia occurred in 4 (7.3%) of labetalol infants and in 1 (1.9%) of control infants (p = 0.18). Hypoglycemia was more common in premature infants (n = 45 (48,9%) vs. n = 4 (23.5%), p = 0.05) in both labetalol and control infants.Conclusion
Hypotension is more common after maternal labetalol exposure, regardless of the dosage and route of administration. The need for intubation and the presence of a PDA also play a role. Hypoglycemia is a very common finding in this population and is merely related to prematurity and independent of labetalol exposure as was the incidental occurrence of bradycardia. These findings on the neonatal side effects of maternal labetalol treatment in preeclampsia underline the importance of frequent blood glucose and blood pressure measurements in the first days of life, especially in intubated preterm infants with a PDA. 相似文献7.
Ioannou HP Diamanti E Piretzi K Drossou-Agakidou V Augoustides-Savvopoulou P 《Early human development》2012,88(7):563-566
Background and aim
Citrulline is a non-protein amino acid synthesized in the small intestine. In children with short-bowel syndrome, citrulline has served as a reliable marker of the residual bowel length and parenteral nutrition (PN) independence. In the present study we aim to assess the value of citrulline measurement in preterm neonates developing necrotizing enterocolitis (NEC).Methods
Plasma citrulline levels were measured prospectively in 17 preterm neonates with NEC stage II during the entire course of the disease. Serial citrulline determinations in 24 healthy preterm neonates on 2, 7, 14, 21 and 28 days of life (DOL), served as reference values.Results
In healthy preterm neonates plasma citrulline levels showed a progressive increase in relation to age. In neonates presenting with NEC, mean citrulline levels were significantly lower as compared to controls' citrulline levels of the most approximate day of life (DOL 7: 16.85 ± 4.2 vs 20.5 ± 4.5 μmol/L, p < 0.05; DOL 14: 18 ± 4.2 vs 23.5 ± 4.3 μmol/L, p < 0.01; DOL 21: 17 ± 2.5 vs 30 ± 5.7 μmol/L, p < 0.01). The optimal citrulline cut-off distinguishing NEC patient from controls was 17.75 μmol/L (sensitivity 76%, specificity 87%). Plasma citrulline at presentation correlated inversely with the duration of parenteral nutrition (r = − 0.49, p < 0.05). Consecutive citrulline determinations revealed that plasma citrulline increased during reintroduction and gradual increase of enteral nutrition.Conclusions
Our findings provide preliminary evidence that citrulline levels that are reduced in preterm neonates with NEC in comparison to age-matched controls and serial citrulline determinations could help to monitor improvement of functional enterocyte mass during the course and resolution of NEC. 相似文献8.
Objective
Assisted Reproductive Technology (ART) and premature birth are stressful and difficult experiences for women. No research to date has examined the impact of ART on mother–child relationship in instances of preterm delivery. This study explored the psychological status of preterm infants' ART-mothers and the quality of mother–infant dyadic interaction, up to child age of three months (Corrected Age = CA).Method
Forty-one ART-dyads and 53 Spontaneous Pregnancy (SP) dyads were enrolled. Mother and child were assessed at 5 to 7 days after birth (T1), at child discharge from hospital (T2), at one month after discharge (T3); and at 3 months CA (T4). The following measures were administered to the mothers: the Gordon Personal Profile Inventory, the Beck Anxiety Inventory, the Beck Depression Inventory, and the Parenting Stress Index S–F. Mother–child interaction was coded by using the Nursing Child Assessment Feeding Scale.Results
At childbirth, the control group mothers showed a higher level of anxiety than the ART-mothers did, but at T2, T3, T4, both groups' parenting stress levels were below threshold. Conversely, ART mothers more frequently provided suitable stimulation for their child's socio-emotional and cognitive development than the control group did. No significant between-group differences were observed in the mothers' capacity to respond to their children's distress, nor in sensitivity to child cues. Both infant groups showed equal ability to send clear signals and to respond to parent-provided care.Conclusions
ART and SP mothers with premature infants showed no differences in degree of emotional burden experienced during the neonatal period. Yet, dyadic interaction was qualitatively better in ART dyads than in SP dyads. 相似文献9.
Vohr BR Yatchmink YE Burke RT Stephens BE Cavanaugh EC Alksninis B Nye JH Bacani D McCourt MF Collins AM Tucker R 《Early human development》2012,88(7):455-460
Objective
To determine the effects of a transition-home education and support program, BPD, and health insurance type on VLBW infant rehospitalizations at 3 and 7 months corrected age. It was hypothesized that the transition-home program would be associated with decreased rehospitalizations between Phase 1 and 2, and public health insurance and BPD would be associated with increased rehospitalizations.Methods
274 infants with birth weight < 1500 g were enrolled in two successive years of a transition-home program (Phase 1—start-up) and (Phase 2—full implementation) and followed to 7 months CA.Results
The Phase 2 rehospitalization rates were lower but not statistically significant at both 3 months (20% and 15%; p = 0.246), and 7 months (24% and 17%; p = 0.171). Infants with public insurance had twice as many rehospitalizations by 3 months (28% versus 11%; p = 0.018) in Phase 1. In regression analyses the intervention effects did not achieve significance for the cohort at 3 months (OR = 0.63; CI = 0.33 to 1.20) or 7 months (OR = 0.61; CI = 0.33 to 1.13). BPD and public insurance did not reach significance in the models whereas siblings were significantly associated with increased odds of rehospitalization. In subgroup analyses for infants on pubic health insurance the intervention significantly decreased the odds of rehospitalization between Phase 1 and 2(OR = 0.43; CI = 0.19 to 0.96) at 3 months.Conclusions
Our findings suggest that a transition-home program may be beneficial to reduce the rehospitalization rate for VLBW infants, and infants on public insurance may derive greater benefit. 相似文献10.
H Yang C Einspieler W Shi PB Marschik Y Wang Y Cao H Li YG Liao XM Shao 《Early human development》2012,88(10):837-843
Background
A deviant motor behaviour at age 3 to 5 months is predictive of cerebral palsy (CP). Particular features of the early motor repertoire even proved predictive of the degree of functional limitations as classified on the Gross Motor Function Classification System (GMFCS) in children with CP, born preterm.Aims
We aimed to determine whether an association between the early motor repertoire and the GMFCS also holds true for children born at term.Study design
Longitudinal study.Subjects
79 infants (60 boys and 19 girls; 47 infants born at term; video recorded for the assessment of movements and posture at age 9 to 20 weeks postterm age) who developed CP.Outcome measures
The GMFCS was applied at age 2 to 5 years.Results
Motor optimality at age 3 to 5 months showed a significant correlation with functional mobility and activity limitation as classified on the GMFCS at age 2 to 5 years in both children born at term (Spearman rho = − 0.66, p < 0.001) and born preterm (rho = − 0.37, p < 0.05). Infants born preterm were more likely to show normal movement patterns than infants born at term. A normal posture and an abnormal, jerky (yet not monotonous) movement character resulted in better levels of function and mobility. With the exception of one, none of the infants showed fidgety movements. A cramped-synchronised movement character, repetitive opening and closing of the mouth, and abnormal finger postures characterised children who would show a poor self-mobility later.Conclusions
Assessing the quality of motor performance at 9 to 20 weeks postterm age (irrespective of the gestational age) improves our ability to predict later functional limitations in children with CP. 相似文献11.
Aim
There has been no clear consensus of the appropriate positioning in preterm infants. We aimed to evaluate the changes of cerebral and mesenteric tissue oxygenation in three different positions, by near infrared spectroscopy (NIRS), in stable very low birth weight (VLBW) infants of postnatal > 30 days.Methods
NIRS monitoring of cerebral and mesenteric tissue oxygenation in three different positions was performed in 29 stable preterm newborns in neonatal intensive care unit (NICU). The patients were observed in three different positions consecutively, each lasting for 4 h. The demographic features, cerebral and mesenteric tissue oxygenation with positional changes and feeding periods were recorded.Results
Mean gestational age, mean birth weight and mean postnatal age of the patients were 27.6 ± 1.7 weeks, 1046 ± 308 g and 42.4 ± 15.7 days, respectively. There were no statistically significant differences in cerebral and mesenteric tissue regional SO2 values in each position (p = 0.954 and p = 0.151, respectively). The values of cerebral and mesenteric tissue regional SO2 before and after feeding did not show any statistically significant difference in each position.Conclusions
Clinically stable very low birth weight infants are able to maintain a stable cerebral and mesenteric tissue oxygenation in different positions, both before and after feeding. Positional changes seem to be safe in VLBW stable infants and this influence should be considered in care of these patients in the NICU.Clinical Trials Identification Number: NCT01255189. 相似文献12.
Lene Tandle Lyngstad Bente Silnes Tandberg Hanne Storm Birgitte Lenes Ekeberg Atle Moen 《Early human development》2014
Background
Skin-to-skin contact reduces pain response in preterm infants subjected to minor painful procedures, such as heel lance. Diaper change is a procedure performed several times daily in hospitalized preterm infants. Routine care giving tasks such as diaper change may be stressful for the infant.Aims
The purpose of this study was to investigate whether diaper change induces stress and if skin-to-skin contact could reduce such stress, measured by changes in skin conductance.Study design
This was a randomized crossover pilot study in 19 preterm infants with gestational age between 28 and 34 weeks. The diaper change procedure was done twice in each infant, once during skin-to-skin contact, and once in incubator or bed with the mother present.Outcome measures
During diaper change heart rate (HR), peripheral oxygen saturation (SpO2), and changes in skin conductance (SC) peaks per sec, using the Skin Conductance Algesimeter (SCA), were registered.Results
The mean SC peaks/sec increased/decreased significantly under/after change of diapers which thereby underpins that this is a stressful procedure for the preterm infant.Skin-to-skin contact (SSC) entails significantly lower stress levels (p < 0.05) compared to diaper changed in an incubator/bed measured by the SCA.Conclusions
Diaper change is a stressful procedure for preterm infants and may be ameliorated by skin-to-skin contact. 相似文献13.
Background
Experiencing pain at newborn age may have consequences on one's somatosensory perception later in life. Children's perception for cold and warm stimuli may be determined with the Thermal Sensory Analyzer (TSA) device by two different methods.Aim
This pilot study in 5-year-old children born preterm aimed at establishing whether the TSA method of limits, which is dependent of reaction time, and the method of levels, which is independent of reaction time, would yield different cold and warm detection thresholds. The second aim was to establish possible associations between intellectual ability and the detection thresholds obtained with either method.Study design
A convenience sample was drawn from the participants in an ongoing 5-year follow-up study of a randomized controlled trial on effects of morphine during mechanical ventilation.Methods
Thresholds were assessed using both methods and statistically compared. Possible associations between the child's intelligence quotient (IQ) and threshold levels were analyzed.Results
The method of levels yielded more sensitive thresholds than did the method of limits, i.e. mean (SD) cold detection thresholds: 30.3 (1.4) versus 28.4 (1.7) (Cohen's d = 1.2, P = 0.001) and warm detection thresholds; 33.9 (1.9) versus 35.6 (2.1) (Cohen's d = 0.8, P = 0.04). IQ was statistically significantly associated only with the detection thresholds obtained with the method of limits (cold: r = 0.64, warm: r = − 0.52).Discussion
The TSA method of levels, is to be preferred over the method of limits in 5-year-old preterm born children, as it establishes more sensitive detection thresholds and is independent of IQ. 相似文献14.
Hoppenbrouwers T Oliveira F Sandarupa S Khoo M Neuman M Ramanathan R 《Early human development》2012,88(7):555-561
Objective
To test the hypothesis that term-born Asian infants, at reduced risk to die of Sudden Infant Death Syndrome (SIDS) exhibit a circadian heart rate rhythm (CHR) at a later age than non-Asian term infants.Method
Repeated overnight heart rate (HR) traces obtained with a battery-operated Polar S810i heart-rate monitor at home in 17 Asian Torajan infants in Indonesia, were compared with those of 52 non-Asian infants monitored as part of the Collaborative Home Infant Monitoring Evaluation (CHIME). HR was determined using a moving window averaging technique. A comparison of median HR during quiet sleep (QS) episodes (identified by minimum HR variability), established the presence of CHR.Results
Seventy three percent of non-Asian CHIME infants ≤ 7 weeks exhibited CHR compared to 45% of Asian Torajan infants. Between 8 and 12 weeks, 94% of non-Asian CHIME infants exhibited CHR, compared to 33% of Asian Torajan infants (p < 0.001). Forty seven and 56% of Asian Torajan infants exhibited the CHR at the age intervals of 16–20 weeks and 21–25 weeks respectively. Active wakefulness percentages as a function of the entire recording and median QS HR were not significantly different in the two groups.Conclusion
Despite the fact that Asian Torajan infants were on average a week older than non-Asian CHIME babies, between two and three months of age only one in three exhibited the CHR, compared to virtually all non-Asian CHIME infants. We speculate that the cause of this difference rests in the infants' environment rather than their genetic origin. 相似文献15.
Dubnov-Raz G Hemilä H Vurembrand Y Kuint J Maayan-Metzger A 《Early human development》2012,88(3):191-194
Background
Selective serotonin reuptake inhibitors (SSRI) are commonly used to treat depression in pregnant women. Several adverse effects of prenatal SSRI exposure on the offspring have been described, including decreased growth. SSRI use by adults decreases bone mineral density, but this effect had not been examined in infants.Aim
To examine growth parameters and bone mineral density of infants born to mothers using SSRIs during pregnancy.Study design
Anthropometric variables and bone density were compared between 40 newborns exposed to SSRIs in utero, and 40 gestational-age matched control infants. Tibial bone speed of sound, a marker of bone density and strength, was measured using quantitative ultrasound. The difference in bone speed of sound between the two groups was compared using linear models, adjusting for relevant confounders.Results
Infants in the SSRI-exposed group were shorter, with a marginal statistical significance (49.3 ± 2.1 vs. 50.1 ± 1.3 cm, p = 0.07), while mean birth weight did not differ substantially between study groups. Head circumference was significantly smaller in the SSRI group (33.8 ± 1.2 vs 34.4 ± 1.1 cm, p = 0.005), remaining so even after adjustment for several confounders. No considerable difference was found in the bone speed of sound between SSRI-exposed infants and controls (3011 ± 116 vs. 3029 ± 129 m/s).Conclusions
We found no evidence that prenatal SSRI exposure hindered neonatal bone quality, yet a marginally shorter length and a smaller head circumference raise the possibility of an effect on bone growth. We conclude that the effect of SSRIs on fetal bone density seems minimal or absent. 相似文献16.
Cuttini M Ferrante P Mirante N Chiandotto V Fertz M Dall'Oglio AM Coletti MF Johnson S 《Early human development》2012,88(3):159-163
Background
Serial assessments of cognitive and language development are recommended for very preterm children, but standardized neuropsychological testing is time-consuming and expensive, as well as tiring for the child.Aims
To validate the Italian version of the PARCA-R parent questionnaire and test its clinical effectiveness in assessing cognitive development of very preterm children at 2 years of corrected age.Methods
120 consecutive Italian very preterm children (mean gestational age 28.8 weeks, standard deviation 2.1) were assessed in four hospitals through the Mental Development Index (MDI) of the Bayley Scales of Infant Development (BSID-II). Parents completed the PARCA-R questionnaire, designed to measure children's non-verbal and verbal (vocabulary and sentence complexity) cognitive level. The correlation between the MDI and the PARCA-R Parent Report Composite (PRC) was tested through the Pearson correlation coefficient, and the receiver operating characteristic (ROC) curve was used to identify optimal PRC cut-offs.Results
Significant correlation between the PRC score and MDI (r = 0.60, p < 0.001) indicated good concurrent validity. The area under the ROC curve was 0.83, and the cut-off of 46 lead to 72.7% sensitivity and 77.1% specificity in identifying children with moderate/severe cognitive delay (MDI < 70). Negative predictive value was 96.6 (90.3–99.3). Screening through PARCA-R would reduce the number of children with MDI ≥ 70 undergoing BSID-II or equivalent standardized tool from 109 to 25.Conclusions
The Italian version of PARCA-R retains good discriminative power for identifying cognitive delay in 2-year very preterm children. It is well accepted by parents, and represents a valid and efficient alternative for developmental screening and outcome measurement. 相似文献17.
Background
Twin birth can be considered an additional risk factor for poor interactions between mothers and their very preterm (VP; < 32 weeks' gestation) infants.Aims
To explore if mothers of (VP) twins experience higher levels of stress than mothers of singletons and if mother–twin infant dyads experience poorer quality interactions.Method
Mothers of VP twin infants (N = 17) were closely matched to mothers of VP singleton infants (N = 17). Mother–infant interaction was assessed before discharge from hospital and during a home visit at three months corrected age using the Nursing Child Assessment Teaching Scale (NCATS). Mothers' responsiveness to their infants was assessed using the Responsivity subscale of the Home Observation for Measurement of the Environment (HOME) and mothers completed the Parenting Stress Index short form (PSI-SF).Results
Mothers of twins had significantly lower HOME responsiveness scores (median 9 vs. 10) at three months corrected age and were more likely to have total PSI-SF scores in the clinical range (> 90th percentile) compared to mothers of singletons (Fishers exact probability = 0.05). Twin infants had lower mean Total Child Domain NCATS scores than singletons both at discharge (9.07 vs. 11.33) and at three months corrected age (13.18 vs. 15.71) indicating they were less responsive communicators.Conclusions
VP twins present a greater challenge than singletons as their mothers experience high levels of parenting stress. Although mothers appear to compensate for twin infants' poorer clarity of cues in a structured, one to one task, mothers of twins were less responsive than mothers of singletons in an unstructured setting. 相似文献18.
Background
Children with congenital hearing loss (HL) are at increased risk of speech and language delays and require increased resource needs.Methods
Assessments of language, adaptive behavior, and resource needs at mean age of 60 ± 5 months. Effects of age of enrollment in Early Intervention (EI) and degree of HL were evaluated.Results
Children with HL had lower Reynell verbal comprehension scores (77.6 ± 18 versus 94.8 ± 15; p = 0.0001) and expressive language scores (85.9 ± 19 versus 97.4 ± 15; p = 0.0051) than hearing children. Children with HL enrolled in EI ≤ 3 months versus > 3 months had higher verbal comprehension (86.6 ± 21 versus 70.3 ± 12; p = 0.0143) and expressive language scores (92.1 ± 12 versus 80.5 ± 21; p = 0.0601), respectively. Children with bilateral moderate to profound HL and children with unilateral or bilateral mild HL were more likely to have low verbal comprehension scores versus children with hearing (75.8 ± 17 and 81.0 ± 22 versus 94.8 ± 15; p = 0.001), and receive more special educational services (100% and 100% versus 42%) respectively. After adjusting for degree of HL and Vineland adaptive scores < 70, entry to EI ≤ 3 months was associated with a 13.8 point higher verbal comprehension score (p = 0.047) for children with HL. The model accounted for 26% of variance.Conclusions
Persistent beneficial effects of early age of entry to EI on verbal comprehension scores are observed for children with congenital HL at preschool age. Children with HL continue to need comprehensive education services. 相似文献19.
Lund LK Vik T Skranes J Lydersen S Brubakk AM Indredavik MS 《Early human development》2012,88(8):623-629
Background
Being born with low birth weight is a risk factor for psychiatric morbidity.Few longitudinal studies have included diagnostic assessment and followed subjects into adulthood.Aim
To assess stability and change in psychiatric morbidity between adolescence and young adulthood in low birth weight subjects, and explore whether screening in adolescence can predict subsequent psychopathology in these groups.Study design
Prospective geographically based follow-up study of two low birth weight groups and a control group born between 1986 and 1988, assessed at 14 (T1) and 20 (T2) years of age.Subjects
Thirty eight subjects born preterm with very low birth weight (VLBW: ≤ 1500 g), 43 born at term but small for gestational age (SGA: < 10th percentile) and 64 controls with normal birth weight participated.Outcome measures
Mental health was assessed using diagnostic psychiatric interview at both study points supplemented with the Achenbach System of Empirically Based Assessment and Children's Global Assessment Scale at T1.Results
There was a trend towards increasing morbidity from T1 among VLBW (p = 0.086) and a significant increase among SGA (p = 0.003) participants. Supplementary assessment at T1 discriminated satisfactory between persons with and without psychiatric disorders at T2 (area under ROC curve: 0.66 to 0.89), but was most effective in the VLBW group.Conclusion
High psychiatric morbidity continued into young adulthood in the VLBW group and increased significantly in the SGA group. Screening in adolescence can be used to detect individuals at risk especially among those born at very low birth weight. 相似文献20.