Multi-risk infants: predicting attachment security from sociodemographic, psychosocial, and health risk among African-American preterm infants

Background: Ecological and transactional theories link child outcomes to accumulated risk. This study hypothesized that cumulative risk was negatively related to attachment, and that maternal sensitivity mediated linkages between risk and attachment. Methods: One hundred and twelve high‐risk African‐American premature infant–mother dyads participated. Psychosocial (maternal depression, stress and self‐efficacy) and sociodemographic risk (poverty, maternal education, marital status) were maternal self‐report (0–4 months). Infant health risk was obtained from hospital charts. Infant–mother attachment (12 months) and maternal sensitivity (4 months) were assessed with Q‐sort measures. Findings: Psychosocial and sociodemographic risk, but not infant health risk, negatively related to attachment. Both were mediated by maternal sensitivity. Conclusions: The impact of risk domains on attachment security was mediated by maternal sensitivity. Results emphasize the need for early intervention programs targeting premature infants to identify and address environmental and personal factors that place parenting at risk.     

Exposure to furosemide as the strongest risk factor for nephrocalcinosis in preterm infants

Background:  The objective of this study was to determine which of the many risk factors for nephrocalcinosis (NC) in preterm infants are most relevant.
Methods:  In 55 neonates born before 32 completed weeks of gestation, parameters relevant to NC were analyzed. Median birthweight was 1010 g (range 500–2070 g). Fifteen (27%) asymptomatic children had ultrasonographic NC.
Results:  In multivariate analysis the strongest independent risk factor was furosemide therapy above 10 mg per kg bodyweight cumulative dose, with a 48-fold increased risk of NC (odds ratio confidence interval 4.0–585, P < 0.01). The risk of NC was 1.65-fold higher per 100 g lower weight (1.07–2.56, P = 0.02) and 4.5-fold higher per mmol/l of urinary calcium concentration (1.14–17.7, P = 0.03). Many other risk factors were only significant in univariate analysis (gestational age, mechanical ventilation, infection, broncho-pulmonary dysplasia, blood transfusions, intraventricular hemorrhage, surfactant therapy, vasopressors, phenobarbital or caffeine, duration of hospital stay), indicating an indirect effect only. Other parameters of calcium and phosphate homeostasis were not significant, possibly due to standardized supplementation.
Conclusion:  We suggest that in preterm infants, furosemide should be prescribed with caution and close monitoring of calcium excretions is advisable. Some guidelines for infant respiratory distress syndrome now favor calcium-sparing thiazides if diuretics are considered.     

Prenatal and postnatal maternal smoking as risk factors for preschool children's mental health

Aim: To identify maternal prenatal and postnatal smoking as risk factors for psychosocial behaviour problems in Swedish preschool children. Methods: This prospective, longitudinal population study compared mothers' self-reported smoking during pregnancy and when the child was 3 mo old with behaviour problems according to Achenbach's Child Behavior Checklist at 3 y (1428 children) and 5.5 y of age (677 of the children). Results: 16% of the mothers smoked during pregnancy and the same number after the birth of the child. Controlling for possible confounding variables, maternal smoking was significantly related to externalizing problems, aggressive behaviour, and destructive/delinquent behaviour both at 3 y and 5.5 y. The effect was as strong for girls as for boys. Length and weight were lower for children of smoking mothers than for children of non-smoking mothers.

Conclusion: Our study supports the importance of preventing maternal smoking during pregnancy and the infant years. Even a few cigarettes per day have negative consequences for the child. The goal must be total abstinence from smoking both pre- and postnatally.     

Sleep problems in young infants and maternal mental and physical health

AIM: Sleep problems in the second 6 months of life are common and associated with maternal depression. This paper extends previous research to (i) establish the prevalence of sleep problems in younger infants from a broader socio-economic spectrum, (ii) examine the relationship between infant sleep problems and maternal physical, as well as mental, health, and (iii) explore mothers' sleep quality as a potential mediator of this relationship. METHODS: Design: Cross-sectional, community survey in Melbourne, Australia. Sample: Mothers of 3- to 6-month-old infants (mean 4.6 months) recruited from well-child clinics in six sociodemographically diverse metropolitan local government areas. Outcome measures: Maternal mental and physical health; standardised questionnaire on infant sleep patterns; maternal report of an infant sleep problem (yes/no). RESULTS: The survey was completed by 692 mothers; 237 (34%) reported an infant sleep problem, of whom 73 (31%) rated the problem as severe. Sleep patterns characterising a problem included the infant waking seven nights per week, nursing the infant to sleep at the beginning of the night, the infant sleeping in the parent's room, and parental disagreement regarding managing infant sleep. There was no relationship between sleep problems and socio-economic levels. Mothers reporting infant sleep problems had poorer mental and physical health compared with those not reporting sleep problems. CONCLUSION: Sleep problems are common in early infancy across metropolitan socio-economic levels and are associated with poorer maternal health and well-being. Preventive strategies for infant sleep problems need to begin early in primary care to improve mothers' health.     

早产儿颅内出血危险因素的meta分析

目的综合评价早产儿颅内出血的危险因素。方法检索Cochrane图书馆、PubMed、ScienceDirect、中国学术文献总库、万方数据库及学位论文数据库,并辅以文献追溯、手工检索等,收集2000年1月至2012年12月有关早产儿颅内出血危险因素的临床资料。对纳入的研究数据采用Cochrane协作网提供的Revman5.2进行统计分析,根据文献异质性检验结果选用固定效应模型或者随机效应模型进行meta分析。结果经过筛选,共纳入文献9篇,meta分析显示各危险因素的合并OR值及其95%CI分别为：胎龄≤32周（OR=3.29,95%CI=2.76~3.91)、出生体质量≤1500 g（OR=2.68,95%CI=2.24~3.20)、孕母有合并症（OR=1.59,95%CI=1.23~2.06）、有宫内窘迫或出生后窒息（OR=2.42,95%CI=2.06~2.84）、机械通气（OR=3.23,95%CI=2.55~4.09）、代谢性酸中毒（OR=2.88,95%CI=2.04~4.05）、使用高浓度氧（OR=2.98,95%CI=1.63~5.44）、产前使用地塞米松（OR=0.69,95%CI=0.55~0.86）、新生儿呼吸窘迫综合征（OR=1.57,95%CI=1.04~2.39）,差异均有统计学意义。剖宫产（OR=0.99,95%CI=0.84~1.17）、多胎（OR=1.05,95%CI=0.79~1.40）、性别（OR=1.25,95%CI=0.97~1.59）差异无统计学意义。结论早产儿颅内出血的主要危险因素为胎龄≤32周、出生体质量≤1500 g、孕母有合并症、有宫内窘迫或出生后窒息、机械通气、代谢性酸中毒、使用高浓度氧及新生儿呼吸窘迫综合征。产前使用地塞米松可降低早产儿颅内出血发生率。     

早产儿脑室内出血高危因素的探讨

目的 采用床旁头部B超研究早产儿脑室内出血(IVH)发病情况,并对相关实验室检查结果 进行分析,以探讨IVH的高危因素.方法 2003年2月至2004年3月我院儿科病房共收治114例早产儿,应用东软NAS-2000型三维彩超诊断仪对早产儿在生后3 d进行床边头部B超检查,探查IVH发病情况;在生后24 h内进行血气分析、血细胞分析、凝血三项测定.结果 114例早产儿中,IVH34例,占29.8%.胎龄28～34周早产儿IVH发病率(43.8%)高于35周以上早产儿(12.0%),1500 g以下早产儿IVH发病率(58.8%)高于1500 g以上早产儿(24.7%),差异均有非常显著性(P＜0.01).与非IVH患儿比较,IVH患儿血红蛋白、血细胞比容明显增高(P＜0.05);凝血酶原时间、部分凝血活酶时间延长(P＜0.01);低氧血症、高碳酸血症、酸中毒发病率增加(P＜0.05).结论 小胎龄、低体重、贫血、血细胞比容增高、血小板计数下降、凝血异常、低氧血症及酸中毒可能与IVH发生有关.     

Cystic periventricular leukomalacia in preterm infants: an analysis of obstetric risk factors

Objective

To identify obstetric risk factors and to elucidate the effect of prolonged rupture of the membranes on the development of cystic periventricular leukomalacia (PVL) in preterm infants.

Methods

A retrospective case-control study of 95 preterm infants with the diagnosis of PVL and 245 healthy controls matched for gestational age. A total of 52 antenatal, intrapartum and neonatal characteristics were studied by univariate methods and logistic regression.

Results

Preterm premature rupture of membranes (PPROM) (odds ratio 2.1 [95% CI 1.3-3.4], P = .003), gestational age at PPROM (P = .025), prolonged rupture of membranes (P < .0001), administration of tocolytic agents (1.8 [1.1-3.0], P = .019) and antibiotics (1.9 [1.2-3.1], P = .008) were associated with PVL. The use of tocolytic agents > 24 h (P = .008), prolonged latency between the increase in maternal leukocyte count and birth (P = .034), spontaneous onset of labor (1.8 [1.0-2.9], P = .026), vaginal delivery (1.7 [1.1-2.8], P = .029) and male gender (1.5 [1.0-2.0], P = .04) were found more frequently in PVL cases. Preeclampsia (0.4 [0.1-0.9], P = .034), hypertension at booking (P = .009), sonographic IUGR (P = .020), abnormal blood flow of the umbilical artery (P = .032) and cesarean section without labor (0.5 [0.3-0.8], P = .006) were found less frequently. In logistic regression analysis, prolonged rupture of the membranes (P = .748), preeclampsia (P = .973), the use of antibiotics (P = .617) and beta-sympathomimetic tocolytic agents (P = .563) lost statistical significance, whereas birth weight (P = .036) became significant.

Conclusion

PPROM and prolonged rupture of the membranes may provoke adverse effects on the neurodevelopmental outcome of the preterm fetus. These findings may have implications on the obstetric management of PPROM beyond 30 weeks of gestation. Cesarean section without labor was less likely associated with the diagnosis of PVL.     

Adverse neurodevelopmental outcome in preterm infants: risk factor profiles for different gestational ages

Aim: Assessment of risk predictors for adverse neurodevelopmental outcome at 1 year of age in preterm infants with a gestational age <30 weeks (Group I) and 30–32 weeks (Group II).
Methods: Between January 2003 and December 2006, we prospectively enrolled 310 live-born infants between 23 and 32 weeks of gestation. The association between candidate risk factors and delayed motor or mental development (Bayley Scales of infant development II; psychomotor or mental developmental index <85) was analysed by means of logistic regression analysis.
Results: Two hundred and fifty infants were eligible for follow-up, and 205 (82.0%) completed the follow-up visit. Intracerebral haemorrhage, small for gestational age and late-onset sepsis were associated with an increased risk for delayed development in Group I (p < 0.05, each). Premature rupture of membranes was a risk condition relevant to Group II. Antenatal steroids were associated with a decreased risk of neurodevelopmental delay in both groups.
Conclusion: This study identified distinct risk factors for adverse outcome in preterm infants of lower (<30 weeks) and higher (30–32 weeks) gestational age. In the lower gestational age group, neonatal risk predictors are most important. Antenatal steroids appear to decrease the risk for adverse outcome in both age groups.     

Commentary: The multifaceted nature of maternal depression as a risk factor for child psychopathology – reflections on Sellers et al. (2014)

While much has been learned about depression in mothers as a risk for the development of psychopathology in offspring, many questions about how the risk is transmitted remain unanswered. Moreover, maternal depression is too often considered to be a unitary construct, ignoring the likely diversity among mothers with depression, which could play essential roles in understanding not only mechanisms of risk but also moderators of risk, i.e. for whom the association between maternal depression and adverse offspring outcomes may be stronger. Sellers et al. address both mechanisms and moderators, thereby contributing to the understanding of risk to offspring of depressed mothers in these two important ways. There is much to learn from this work, on many levels and for different audiences, including both researchers and practitioners. A key take‐home message of this study for all readers is that understanding the role of maternal depression in associations with child psychopathology requires a nuanced view of the nature of risk to children from depression in mothers. The often co‐occurring disorders and highly correlated additional aspects of the context in which depression occurs play important roles in the development of psychopathology in the offspring of depressed mothers.     

极低出生体质量儿视网膜病变筛查和高危因素分析

目的研究出生体质量≤1500g的早产儿视网膜病(ROP)发生率和临床高危因素,探讨预防小早产儿视网膜病的有效措施。方法回顾性分析2006年8月1日—2008年7月31日期间,在新生儿重症监护室住院的107例出生体质量≤1500g早产儿ROP筛查的结果,以发病组为观察组,非ROP为对照组,进行统计学分析。结果早产儿ROP的发生率为33.64%,Ⅰ期11例,Ⅱ期13例,Ⅲ期12例,检出时间为(245.36±12.85)d。妊娠并发症胎盘早剥和严重的早产儿并发症,增加了ROP的发病率;ROP的发生率与胎龄及出生体质量成反比,双胎及多胎妊娠不影响ROP的发生;对ROP的病因进行单因素分析发现,胎龄、出生体质量、抗生素使用时间、吸氧时间、血氧分压、肺表面活性物质的使用、支气管肺发育不良、机械通气、呼吸暂停与ROP有关(P<0.05);通过Logistic回归分析发现呼吸暂停、血氧分压和出生体质量是高危因素(P均<0.05)。结论呼吸暂停、血氧分压和出生体质量是ROP的高危因素,避免血氧波动有助于降低ROP的发生率。     

新生儿临床风险指数在早产低出生体重儿中的应用

新生儿临床风险指数（ clinical risk index for babies,CRIB ）是一种应用于早产低出生体重儿评估最初疾病严重程度,预测死亡风险率,评估各医疗机构的自身医疗质量,以及对各医疗机构之间进行客观医疗水平比较的评分系统,对我国日益发展的新生儿医学起着重要的作用。本文详细介绍了CRIB评分系统的来源及发展现状、具体评分细则以及CRIB的优点,对早产低出生体重儿死亡风险预测的准确性,并分析了其应用于预测早产低出生体重儿远期神经系统发育的价值。     

Hyperthermia in utero due to maternal influenza is an environmental risk factor for schizophrenia

A hypothesis is presented that the association between maternal influenza and other causes of fever during the second trimester of pregnancy and the subsequent development of schizophrenia in the child is due to the damage caused by hyperthermia to the developing amygdalohippocampal complex and associated structures in the fetal brain. Hyperthermia is a known cause of congenital defects of the central nervous system and other organs after sufficiently severe exposures during early organogenesis. The pathogenic mechanisms include death of actively dividing neuroblasts, disruption of cell migration and arborization and vascular damage. In experimental studies, hyperthermia during later stages of central nervous system development also caused damage to the developing brainstem that was associated with functional defects. This damage usually results in hypoplasia of the parts undergoing active development at the time of exposure. Recent studies have shown no evidence of direct invasion of the fetus by the influenza virus. Factors that might interact with hyperthermia include familial liability to schizophrenia, season of birth, maternal nutrition, severe stress and medications used to alleviate the symptoms of fevers. The time of the development of the fetal amygdalohippocampal complex and the changes found in its structure and associated areas of the brain are compatible with the known effects of hyperthermia.     

Population-based rates of severe respiratory syncytial virus infection in children with and without risk factors,and outcome in a tertiary care setting

The aim of this study was to make a population-based estimate of the risk of hospitalization and complications during virologically confirmed respiratory syncytial virus (RSV) infection in relation to established risk factors, and an estimation of additional risk factors and outcome as seen in a tertiary care referral centre. During a period of 12 y, all children with virologically confirmed RSV infection were included. Recorded complications were: admission to the intensive care unit, mechanical ventilation, death and later hospitalization for wheezing. In total, 1503 cases were identified, 1354 of which originated from the population defined by the catchment area. There was a biannual seasonal variation with late small outbreaks alternating with early large ones. The hospitalization rates for infants without risk factors were 0.8 and 1.4% during the 2 epidemic types. They were 1.6-3.2% for infants born preterm (<33 gestational wk), 2.9-7.0% for children under 2 y old with chronic lung disease of prematurity and 2.8-6.4% for infants with congenital heart disease. The presence of siblings in the family more than doubled the risk of hospitalization. Later hospitalization for wheezing occurred in 8.4 and 4.9% of children without risk factors over and under the age of 2 mo, respectively (p < 0.001). Conclusion: This study found lower population rates of hospitalization and complications than have previously been reported. The seasonal variation and the presence of siblings in the home influenced these rates by factors of 2.     

Alberta婴儿运动量表对新生儿重症监护室高危儿出院后筛查运动发育落后的准确性研究

目的 分析Alberta婴儿运动量表（AIMS）在NICU高危儿随访中筛查运动发育落后的应用价值，为更好解释患儿病情和尽早合理干预提供依据。方法 纳入经NICU治疗后并于2013年11月至2015年1月在上海健高儿科门诊部随访的高危儿，行AIMS和Peabody运动发育量表-第2版（PDMS-2）评估。将患儿的AIMS总分与PDMS-2的粗大运动发育商（GMQ）进行百分位数换算，分析两者的相关性。以6月龄后GMQ≥90作为运动发育正常的参考标准，绘制AIMS百分位数的ROC曲线，计算约登指数和预测界值。进而根据所得界值分析AIMS预测运动发育落后的价值。结果 70例高危儿进入分析，产生170个AIMS数据和70个6月龄PDMS-2 GMQ数据。0~3月龄的AIMS百分位数与PDMS-2的GMQ百分位数相关系数（r）为0.09（P=0.69）；≥4月龄两者的r为0.73（P＜0.001）。与参考标准比较，形成AIMS百分位数的ROC曲线，曲线下面积为0.929（95%CI:0.876~0.982），预测界值为P17.5。以AIMS百分位数＜17.5预测运动发育落后的敏感度为87.6%（95% CI:68.4％~95.4％），特异度为88.1%（95%CI:80.6％~93.1%），阳性预测值为65.0%（95%CI:48.3％~78.9％），阴性预测值为96.3%（95%CI:90.2％~98.8％）。结论 ＞3月龄的高危儿行AMIS评估对识别运动发育正常有很高的预测价值，为避免对高危儿过度诊断和干预提供依据。     

Cerebral palsy in preterm infants: a population-based case-control study of antenatal and intrapartal risk factors

Previous studies have indicated that foetomaternal infection increases the risk of spastic cerebral palsy (CP) in term infants, whereas this association appears to be less evident in preterm infants. The aim of this study was to analyse infection-related risk factors for spastic CP in preterm infants. A population-based series of preterm infants with spastic CP, 91 very preterm (<32 wk) and 57 moderately preterm (32-36 wk), born in 1983-90, were included and matched with a control group (n = 296). In total, 154 maternal, antenatal and intrapartal variables were retrieved from obstetric records. In the entire group, histological chorioamnionitis/pyelonephritis, long interval between rupture of membranes and birth, admission-delivery interval <4 h and Apgar scores of <7 at 1 min just significantly increased the risk of CP, and Apgar scores of <7 at 5 and 10 min were strongly associated with an increased risk. Abruptio placentae, Apgar scores <7 at 1 min and pathological non-stress test (reason for delivery) were significant risk factors of CP only in the moderately preterm and hemiplegic groups, whereas fever before delivery was a significant risk factor in the very preterm and spastic diplegic groups. Antibiotics during pregnancy was associated with CP only in the spastic diplegic CP group. Conclusion: Antenatal infections marginally increased the risk of CP. Low Apgar score and abruptio placentae were associated with CP, especially in moderately preterm infants with hemiplegic CP.     

A national study of risk factors associated with mortality in very low birthweight infants in the Malaysian neonatal intensive care units

To determine the risk factors associated with mortality in very low birthweight (VLBW) infants admitted to the neonatal intensive care units (NIUC) in Malaysia.

Method:

A prospective observational study of outcome of all VLBW infants born between 1 January 1993 and 30 June 1993 and admitted to the NICU.

Results:

Data of 868 VLBW neonates from 18 centres in Malaysia were collected. Their mean birthweight was 1223 g (95% confidence intervals: 1208–1238 g). Thirty-seven point four per cent (325/868) of these infants died before discharge. After exclusion of all infants with congenital anomalies ( n =66, and nine of them also had incomplete records) and incomplete records ( n =82), stepwise logistic regression analysis of the remaining 720 infants showed that the risk factors that were significantly associated with increased mortality before discharge were: delivery in district hospitals, Chinese race, lower birthweight, lower gestation age, persistent pulmonary hypertension of the newborn, pulmonary airleak, necrotizing enterocolitis of stage 2 or 3, confirmed sepsis, hypotension, hypothermia, acute renal failure, intermittent positive pressure ventilation, and umbilical arterial catheterization. Factors that were significantly associated with lower risk of mortality were: use of antenatal steroid, oxygen therapy, surfactant therapy and blood transfusion.

Conclusion:

The mortality of VLBW infants admitted to the Malaysian NICU was high and was also associated with a number of preventable risk factors.     

Patterns of breath intervals during non-nutritive sucking in full-term and ‘at risk’ preterm infants with normal neurological examinations

The interaction between respiration and non-nutritive sucking rhythms was investigated in 12 sleeping, normal, full-term, newborn infants and in 14 preterm infants who were examined repeatedly at 34, 40 and 46 wk of conceptional age. Full-term infants showed a shortening of breath intervals in the middle of sucking bursts and a lengthening of the breath interval spanning the end of sucking bursts. The differences were more marked in females than males.A rhythm interaction between sucking and respiration was also observed in preterm infants as young as 34 wk of conceptional age. Clinical neurological examinations did not discriminate between pretern infants above and below a median score for optimal obstetric conditions, but the interaction between breathing and sucking rhythms made such a discrimination, most clearly in females. Preterm infants with lower optimal obstetric scores showed less change of breath durations during sucking than preterms with higher scores. It was concluded that interaction of concurrent motor rhythms may be a sensitive index of central nervous system integrity in newborn infants, even when there are no clinical neurological signs of nervous system dysfunction.     

新生儿危重评分对出生第1 天近足月及足月新生儿呼吸疾病的预测价值

目的探讨危重新生儿急症监护的呼吸评分(ACoRN评分)及新生儿紧急生理学评分围产期补充-Ⅱ(SNAPPE-Ⅱ)评分对近足月及足月新生儿呼吸疾病严重程度的预测价值。方法回顾分析2017年6月至2018年6月出生24小时内的近足月及足月患儿的临床资料,计算ACoRN和SNAPPE-Ⅱ评分。将患儿分为呼吸异常组及非呼吸异常组,呼吸异常组再分为暂时性呼吸增快(TTN)组和其他呼吸异常组,采用logistic回归及受试者工作特征曲线(ROC)进行各组间比较。结果共纳入患儿259例,其中晚期早产儿116例(44.79%)、足月儿143例(55.21%),男146例(56.37%)、女113例(43.63%),出生胎龄(37.02±2.16)周,出生体质量(2.72±0.61)kg。TTN组89例,其他呼吸异常组33例,非呼吸异常组137例。三组间1分钟及5分钟Apgar评分、肺表面活性物质、抗生素应用、无创辅助通气、有创辅助通气、ACoRN评分和SNAPPE-Ⅱ评分的差异均有统计学意义(P0. 05)。Logistic回归分析显示,1分钟Apgar评分、住院天数、ACoRN评分及SNAPPE-Ⅱ评分与呼吸异常相关(P0.05);ROC分析显示,ACoRN联合SNAPPE-Ⅱ评分效能最高(0.991),其次为ACoRN评分(0.972),最低为SNAPPE-Ⅱ评分(0.550)。结论 ACoRN评分和SNAPPE-Ⅱ评分均为快速、简便的评估方法,两者联合对新生儿呼吸疾病严重程度具有一定的预测价值。