Placental pathology and neurological morbidity in preterm infants during the first two weeks after birth

Background

The placenta plays a crucial role during pregnancy and dysfunction causes long-term neurological problems. Identifying placenta-related risks for neurological problems shortly after birth may provide clues for early interventions aiming to improve neurological outcome.

Objective

To determine the association between placental pathology and neurological morbidity in preterm infants during the first two weeks after birth.

Study design

Placentas of 52 singleton, preterm infants (GA: 25–31 weeks, BW: 560–2250 grammes) were examined for histopathology. The infants' neurological condition shortly after birth was determined by assessing the quality of their general movements (GMs): normal, abnormal, or hypokinetic, on days 5, 8, and 15. A motor optimality score (MOS) was also assigned.

Results

Examination of the placentas revealed maternal vascular underperfusion (n = 29), ascending intrauterine infection (AIUI) (n = 19), villitis of unknown aetiology (n = 6), chronic deciduitis (n = 11), foetal thrombotic vasculopathy (FTV) (n = 9), and elevated nucleated red blood cells (NRBCs) as a marker for foetal hypoxia (n = 7). None of the placental lesions were significantly associated with the quality of GMs or MOS.

Conclusions

This study indicated that placental lesions were not associated with infants' neurological condition as measured by the quality of their general movements during the first two weeks after birth.     

Uniform treatment thresholds for hyperbilirubinemia in preterm infants: background and synopsis of a national guideline

Background

To prevent severe hyperbilirubinemia and bilirubin neurotoxicity, the American Academy of Pediatrics' management guideline for hyperbilirubinemia in near term infants is used worldwide. A leading guideline for jaundiced preterm infants is lacking whereas the risk on severe hyperbilirubinemia is high in these infants. Our aim was to define uniform treatment thresholds for jaundiced preterm infants. In this article we present the history and a synopsis of this novel national guideline.

Study Design

A survey on guidelines for hyperbilirubinemia in preterm infants was sent to all Dutch Neonatal Intensive Care Units (NICUs). After comparison with international guidelines, a new consensus-based guideline was developed.

Results

Treatment thresholds of all 10 NICUs were based on Total Serum Bilirubin (TSB) and related to birth weight (n = 9) and gestational age (n = 1). NICUs used age-specific (n = 6) or fixed (n = 4) TSB-thresholds resulting in a large range of thresholds (maximal 170 μmol/L for phototherapy and 125 μmol/L for exchange transfusion). Acidosis, asphyxia, sepsis, active hemolysis and intraventricular hemorrhage were the most frequently used risk factors. Consensus was agreed upon TSB-based treatment thresholds, categorized in 5 birth weight groups and divided in high and low risk infants.

Conclusion

There was no standardized care for jaundiced preterm infants in the Netherlands. In addition to the internationally used guideline for (near) term infants, a novel “consensus based” guideline for preterm infants with a gestational age of less than 35 weeks has been developed and implemented in the Netherlands. This guideline is approved and recommended by the Dutch Society of Pediatrics.     

Functional impairments at school age of preterm born children with late-onset sepsis

Background

Late-onset sepsis is a relatively common complication particularly of preterm birth that affects approximately a quarter of very low birth weight infants.

Aim

We aimed to determine the motor, cognitive, and behavioural outcome at school age of preterm children with late-onset sepsis compared to matched controls.

Study design and subjects

A prospective case-control study that included preterm infants (gestational age < 32 weeks and/or birth weight < 1500 g) admitted to our Neonatal Intensive Care Unit in 2000-2001 with a culture-proven late-onset sepsis, and controls matched for gestational age.

Outcome measures

At school age we assessed motor skills, intelligence, visual perception, visuomotor integration, verbal memory, attention, executive functioning, and behaviour.

Results

At 6-9 years, 21 of 32 children with late-onset sepsis (68%) had borderline or abnormal motor outcome with most problems in fine motor skills. Their total IQ was 89 compared to 98 in controls. In addition, verbal memory and attention were affected compared to controls (0.61 standard deviations (SD), 95% confidence interval (CI) 0.04-1.17, p = 0.033 and 0.94 SD, 95% CI 0.32-1.62, p = 0.011, respectively). Multiple episodes of sepsis and gram-negative sepsis were risk factors for worse cognitive outcome.

Conclusions

At school age, a majority of preterm children with late-onset sepsis had motor problems. Their IQ was considerably lower than matched controls, and memory and attention were specifically impaired. Outcome at school age of preterm children with late-onset sepsis was worse than previously thought.     

High plasma cytokine levels, white matter injury and neurodevelopment of high risk preterm infants: assessment at two years

Background

Controversy exists regarding association of high levels of proinflammatory cytokines, neonatal morbidities and poor neurodevelopment outcome in very low birth weight infants.

Objective

To determine association between severity of early inflammatory response and neurodevelopment outcome in high risk very low birth weight infants.

Methods

Sixty-two very preterm infants with high risk for early-onset sepsis were followed up to 24 months corrected age. Blood sample was collected for IL-6, IL-8, IL-10, IL-1β, and TNF-α analysis. Neurodevelopment outcome by Bayley Scales of Infant Development II was assessed at 22 to 24 months. Magnetic Resonance Image was performed at least once during the first 12 months.

Results

In 24 (38.7%) MDI was < 85, and 16 (25.8%) had PDI < 85. Low birth weight was significantly associated with low MDI, and birth weight and periventricular leukomalacia were significantly associated with low PDI by multiple regression analysis. After controlling for birth weight and gestational age, none of the studied variables was associated with low MDI, and only periventricular leukomalacia with low PDI. Each additional 100 g in the birth weight reduced the probability of low MDI and PDI scores in 14%.

Conclusions

There was no association of high cytokines plasma levels with poor neurodevelopment outcome at 22 to 24 months' corrected age, suggesting that elevations of plasma proinflammatory cytokines early in life do not play an important role in pathophysiology of brain injury in high risk preterm infants.     

Perinatal cerebral insults alter auditory event-related potentials

Background

Auditory event-related potentials (AERPs) can be used as indices of neural information processing. Altered AERPs have been reported in children and young adults with frontal lobe infarction.

Aim

To test the hypothesis that perinatal brain injury affects cortical auditory processing.

Methods

We assessed AERPs at term, 6 and 12 months of age in preterm infants [n = 9, median gestational age (GA) 27.9, range 23.9-30.0 wk], term infants with perinatal intracerebral hemorrhage (ICH) [n = 5, GA 40.3, range 37.4-42.3 wk], and term infants with perinatal asphyxia [n = 4, GA 39.4, range 37.9-40.3 wk]. Healthy preterm (n = 16) and term infants (n = 22) served as controls. A harmonic tone of 500-Hz frequency was used as standard and of 750-Hz as deviant stimulus. Mean AERP amplitudes were calculated over 100 ms periods from 50 to 350 ms. The developmental outcome was followed until 2 years of age.

Results

The term ICH (p = 0.012) and asphyxia (p = 0.0016) group had smaller or more negative responses to the deviant, resulting in smaller or more negative MMR amplitudes than those of the controls. The preterm ICH group did not differ significantly from their preterm born controls. MMR varied in all patient groups and was not associated with adverse outcome.

Conclusion

AERP alterations suggest that perinatal cerebral insults affect cortical auditory processing.     

Cardiovascular and metabolic outcome in 6-8 year old offspring of women with type 1 diabetes with near-optimal glycaemic control during pregnancy

Background

High maternal glucose concentrations during diabetic pregnancy may lead to health problems in the offspring later in life. We showed in a previous nationwide study on pregnancy outcome in type 1 diabetic women that prepregnancy care was good and a near-optimal glycaemic control during pregnancy was achieved (mean HbA1c 6.2%).

Aims

We investigated to what extent current care and treatment of pregnant women with type 1 diabetes were related to cardiovascular and metabolic disturbances in the offspring at school age. Additionally, we studied the influence of level of maternal glycaemic control, preterm birth and neonatal macrosomia (birth weight > p90).

Study design

Observational cohort study.

Subjects

6-8 year old offspring of women with type 1 diabetes (ODM, n = 213) and a control group of children of non-diabetic women (n = 79).

Outcome measures

BMI, blood pressure, parameters of fasting glucose regulation and lipid metabolism, components of the metabolic syndrome (overweight, hypertension, impaired fasting glucose, dyslipidaemia).

Results

Parameters of fasting glucose regulation and lipid metabolism and the frequency of components of the metabolic syndrome did not significantly differ between ODM and controls. Systolic blood pressure was slightly higher in ODM. The influence of level of maternal glycaemic control, preterm birth and neonatal macrosomia on outcome in ODM was limited.

Conclusions

Current care and treatment of pregnant women with type 1 diabetes result in cardiovascular and metabolic outcome in the offspring at 6-8 years of age that is comparable to that in children of non-diabetic women. Further follow-up should substantiate these results at later age.     

Circulating adipocyte fatty acid binding protein levels in healthy preterm infants: Positive correlation with weight gain and total-cholesterol levels

Background

Adipocyte fatty acid binding protein (a-FABP) has been suggested to play an important role in the pathogenesis of metabolic syndrome. Preterm infants are at risk for the later development of insulin resistance, and, possibly, other components of metabolic syndrome.

Aim

To determine circulating levels of a-FABP in preterm infants and examine possible associations of a-FABP with metabolic indices (serum lipids, glucose, and insulin levels, and homeostasis model assessment index of insulin resistance [HOMA-IR]), levels of leptin and adiponectin, anthropometric parameters and weight gain.

Study design

Prospective cohort study.

Subjects

55 healthy preterm (mean [SD] gestational age 32.8 [1.8] weeks) and 23 fullterm infants (reference group).

Outcome measures

Serum a-FABP, lipids, glucose, insulin, leptin and adiponectin levels at 31.9 [10.4] days of life.

Results

Serum a-FABP levels did not differ significantly between preterm and fullterm infants. A-FABP levels correlated positively with total-cholesterol [total-C] in both preterm and fullterm infants (β = 0.33; p = 0.01 and β = 0.33; p = 0.04, respectively). In addition to total-C, weight gain correlated independently with a-FABP levels in preterm infants (β = 0.36, p = 0.01).

Conclusions

An association between a-FABP levels and indices of insulin resistance was not present in infants studied. As the development of insulin resistance in children born prematurely is possibly associated with weight gain in early postnatal life, follow-up of our study population is necessary to demonstrate whether a-FABP levels, shown to correlate with weight gain in preterm infants, are a predictive marker for the later development of insulin resistance in these infants.     

Cerebral measurements made using cranial ultrasound in term Ugandan newborns

Background

Few cUS studies of cerebral measurements are available for normal term infants. Normative data is important for evaluating cerebral structure size in symptomatic term infants and assessing preterm brain growth by term age.

Objectives

To (i) make linear measurements using cranial ultrasound (cUS) for major cerebral structures and intracranial spaces in normal newborn term infants, (ii) correlate these measurements with gestational age (GA), birth weight (BW), head circumference (HC), gender and within one infant (iii) examine inter/intra-observer variation, and (iv) compare these data with those currently available.

Design, setting and patients

Linear cUS measurements of major cerebral structures were made in well term-born Ugandan infants at Mulago University Hospital, Kampala. Correlations between the measurements and gender, HC, BW and GA were calculated. Intra- and inter-observer agreements were assessed.

Results

Data from 106 infants (mean GA 39.20 ± 1.4SD weeks) were analysed. Intra/inter-observer agreement was substantial/excellent. Significant correlations were found between HC and pons anterior-posterior diameter (p < 0.01), corpus callosal (CC) length (p = 0.02) and transverse cerebellar diameter (TCD, p < 0.01) and between BW and CC length (p = 0.02), vermis height (< 0.01) and thalamo-occipital distance (p = 0.03); no significant correlation was found with GA. Within infants CC length and TCD correlated significantly (p = 0.019). Males had larger left ventricular indices than females (p = 0.04). The data was similar to those from other populations.

Conclusions

These data provide reliable reference values for linear measurements of many cerebral structures made using cUS. The data agree well with those from other populations suggesting that cerebral size is similar in different ethnic groups.     

Assessment of risk factors for survival of neonates born after second-trimester PPROM

Objective

Assess fetal risk factors which impact survival of infants delivered after second-trimester PPROM.

Study design

Clinical records of 87 patients, who all had second-trimester rupture of membranes between 14 + 0 and 24 + 6 weeks of gestation treated January 1998 to July 2005 were reviewed regarding perinatal outcome. This study is based on 25 surviving infants.

Results

13 of these 25 infants died in the hospital. Survivors had a higher birth weight (p = 0.008) and higher Apgar scores after 5 min (p = 0.005) than those infants dying. No differences in UA pH, the need of catecholamines and no association between histological verified chorioamnionitis and early onset sepsis were seen between survivors and nonsurvivors.

Conclusion

Higher gestational age at birth, higher birth weight, the absence of histologically verified chorioamnionitis and 5 min Apgar scores of ≥ than 6 have positive prognostic value for survival of neonates delivered preterm after second-trimester PPROM.     

Serum chemokine levels and developmental outcome in preterm infants

Background

Cytokines and chemokines during perinatal period may involve the neurological development of newborns.

Aims

We investigated the association of circulating chemokines during neonatal period with the outcome of premature infants.

Study design

The prospective study enrolled 29 very low birth weight (< 1500 g) and appropriate-for-date infants having no underlying diseases. Serum concentrations of chemokines (CXCL8, CXCL9, CXCL10 and CCL2) and cytokines at birth and 4 weeks postnatal age were measured. Developmental quotients (DQ) at 3 years of age by the Kyoto Scale of Psychological Development were studied for the association with chemokine/cytokine levels and clinical variables including chorioamnionitis, Apgar scores, ventilator treatment and supplemental oxygen.

Results

CXCL8 levels at birth and days of ventilator treatment were negatively, CCL2 levels at 4 weeks after birth and 5-minute Apgar scores were positively correlated with the DQ of postural-motor [P-M] area at 3 years of age, respectively (CXCL8: correlation coefficient [CC] = − 0.394, p = 0.037, ventilation: CC = − 0.518, p = 0.006, CCL2: CC = 0.528, p = 0.013, and Apgar score: CC = 0.521, p = 0.005). Infants showing both ≥ 50 pg/ml of CXCL8 at birth and < 250 pg/ml of CCL2 4 weeks after birth had lower DQ of P-M than those who did not (p < 0.001). Multivariate analyses indicated that CCL2 levels at 4 weeks of age were higher in infants who attained normal DQ of P-M (≥ 85) (adjusted mean, 338.4 [95% confidence interval, 225.5-507.8]) than in those who did not (< 85) (159.0, [108.2-233.7]) (p = 0.019).

Conclusion

Circulating patterns of CXCL8 (IL-8) and CCL2 (MCP-1) during the neonatal period might affect the neurological development of preterm infants.     

Clinical determinants and utility of early postnatal maximum weight loss in fluid management of extremely low birth weight infants

Background

The early postnatal physiological body weight loss process is poorly understood in preterm infants. It is complicated by clinical conditions which adversely affect the body fluid balance during 1st two weeks of life. A lack of physiological weight loss potentially could result in significant morbidities. Body weight is utilized in determining daily fluid volume intakes. Extremely low birth weight infants (birth weight < 1000 g, ELBW) have the highest morbidity and mortality among all neonates.

Aim/objective

The objective was to evaluate the early postnatal weight changes and its clinical determinants in ELBW infants. We examined the maximum weight loss from birth weight (MWL) in ELBW infants and tested its association with clinical variables which could potentially implicate the body fluid balance during the first two weeks of life.

Study design

Prospectively entered data in the computerized radiology, biochemical and hematological records, and daily case notes were retrospectively extracted during a 3-year study period. The infants' and maternal demographic, clinical course and outcome variables relevant to body fluid balance during the first two weeks of life were correlated with MWL. Pearson's correlation coefficient and Pearson's partial correlation tests were utilized for data analysis.

Results

Data are presented as mean ± SD. MWL in the entire cohort (n = 102) was 14.2 ± 5.4%. Day of life of MWL was 5.5 ± 2.1 and that of birth weight regained 14.5 ± 4.2 days. MWL correlated negatively with gestational age, antenatal steroid receipt (ANS) and pregnancy associated hypertension and positively with total days on oxygen, fluid intake, urinary output and the day of life when birth weight was regained. All these correlations were lost after controlling for GA except for the day of life when birth weight was regained. MWL did not correlate with RDS or its severity, hypotension, PIE, IVH, PDA and length of stay. Over 91% infants had MWL within 3.1-25%. Male, Caucasian and ELBW infants unexposed to ANS tended to have weight loss in excess of 25%.

Conclusion

MWL is governed by maturation and is not affected by concurrent clinical factors including fluid intakes during the 1st two weeks of life in ELBW infants. MWL within the estimated range of 14.5 + 4.2% of birth weight does not promote morbidities. Male, Caucasian and ELBW infants unexposed to ANS are susceptible to excessively high weight losses in early postnatal period.     

Quantitative electroencephalographic patterns in normal preterm infants over the first week after birth

Background

Currently available tools to assist clinicians with prediction of neurodevelopmental outcome of preterm infants are inadequate. Modified cotside electroencephalography (EEG) has the ability to produce quantitative electrophysiologic measures. These measures may be useful in future prediction of outcome.

Aim

To determine patterns of change in quantitative EEG measures in preterm infants during their first week after birth.

Design

Observational.

Subjects

Preterm infants born at less than 32 weeks completed gestation surviving to discharge with unremarkable serial ultrasound scans.

Outcome measures

Changes in continuity, amplitude and spectral edge frequency measures of EEGs obtained over the first week after birth.

Results

Results of EEGs performed using a novel EEG device on 63 infants are reported here. Their median (range) gestation was 29 (24-31) weeks and birthweight was 1235 (540-1980) g. Quantitative measures of EEG continuity increased over the first week after birth from 72 (25-99)% to 92 (54-100)% at the 25 μV threshold, and from 39 (10-87)% to 64 (34-75)% at the 50 μV threshold, both p < 0.0001. There was a related 32% increase in median amplitude from 5.8 (2.6-10.6) μV on day 1 to 7.6 (4.3-9.4) μV on day 4, p = 0.005. There was a trend for average spectral edge frequency to fall from 10.7 (9.3-12.9) Hz on day 1 to 9.9 (8.1-12.3) Hz on day 3, p = 0.06. Each gestational tertile showed similar patterns.

Conclusions

There are consistent changes in quantitative neurophysiologic measures over the first week after birth, and particularly measures of continuity over the first 4 days, in normal preterm infants.     

Postural control of pre-term infants at 6 and 12 months corrected age

Background

Pre-term infants are at high risk for motor disabilities. Postural control, the basis for motor development, develops rapidly during the first year of life. An early start to extra-uterine life with an immature motor system may influence a pre-term infant's postural control.

Aims

To identify important prognostic factors and determine the difference in postural control between full-term and pre-term infants.

Method

Medical records of 93 pre-term infants with birth weight of less than 1501 g (mean birth weight = 1136.03 ± 243.86 g; mean gestational age = 29.14 ± 2.78 weeks) were reviewed. Data was collected from the preemie clinical follow-up program at the National Cheng Kung University, Taiwan.

Results

Results demonstrated that pre-term infants had poorer postural control than full-term infants both at 6 and 12 months adjusted age, and that medical complication as measured by the Neonatal Medical Index was the best predictor of postural control in pre-term infants in the first year of life. In addition, our findings confirmed that the development of postural control at 6 months adjusted age predicts the development of postural control at 12 months adjusted age after controlling for prognostic factors.

Conclusions

Both biological and social environmental factors appeared to be associated with pre-term infants' postural control at 6 and 12 months adjusted age. The development of postural control at 6 months adjusted age predicted the development of postural control at 12 months adjusted age. This suggested the value of early follow-up examinations at 6 months adjusted age.     

Prevalence of abnormal general movements in three-month-old infants

Background

The quality of general movements (GMs) is a sensitive tool to measure neurodevelopmental condition in early infancy. No information is available on prevalence rates of abnormal GMs in the general population.

Objective

To assess the prevalence of abnormal GMs in the general population of three-month-old infants and to evaluate the association of abnormal GM quality with medical and social risk factors.

Method

We recruited 535 infants in six well baby clinics in The Netherlands. GMs were video-taped at the corrected age of 2 to 4 months. GM-quality was assessed by two persons unaware of the infant's history. GM-quality was classified as normal optimal (NO), normal suboptimal (SO), mildly abnormal (MA) and definitely abnormal (DA). Only the last category implies clinically relevant dysfunction. Social, perinatal and postnatal characteristics were collected and their association with DA and abnormal (DA + MA) GMs were evaluated by means of univariate and logistic regression analyses.

Results

GM-quality could be assessed reliably in 455 infants (85%). Seventeen infants (3.7%) showed DA GMs and 113 (25%) MA GMs. DA GMs were associated with preterm birth and smoking during pregnancy; abnormal (DA + MA) GMs with preterm birth, a relatively low level of paternal profession and urban living conditions. These factors explained between 3% and 7% of variance.

Conclusion

The study indicates that the prevalence of definitely abnormal GMs in the general population is 3.7% and that of mildly abnormal GMs 25%. The clinically relevant definitely abnormal GMs were associated with preterm birth and smoking during pregnancy.     

Pre-pregnancy iron reserves, iron supplementation during pregnancy, and birth weight

Background

Early iron supplementation in women with sufficient reserves could provoke iron excess resulting in haemoconcentration and low infant birth weight (IBW).

Aim

To clarify the influence of early iron supplementation on maternal iron status and the IBW, taking into account pre-pregnancy iron deposits.

Study design

Longitudinal, prospective study.

Subjects

Healthy women volunteers (n = 82) intending to become pregnant.

Outcome measures

Women were grouped as a function of their pre-pregnancy (low or present) iron stores (serum ferritin (SF) < or ≥ 20 μg/L) and time of commencement of iron supplementation during pregnancy; “early” (< 20 weeks) or “late” (≥ 20 weeks). Obstetric and clinical history, smoking habit, dietary intake and iron biochemical parameters were obtained at pre-pregnancy as well as at 1st, 2nd and 3rd trimesters. Haemoglobin, MCV, SF and transferrin saturation (TS) were measured.

Results

Overall, 36% of the women had low iron stores at pre-pregnancy. The mean early supplementation with iron was 140.7 mg/d and the mean of late supplementation was 99.01 mg/d. Early supplementation improves the biochemical status of the mother and does not provoke a significant increase in haemoconcentration relative to late supplementation independently of the pre-pregnancy iron levels.Supplemental iron had a positive effect on birth weight among women with pre-pregnancy low iron stores (β = 4.37; SE = 1.8; p = 0.038) and did not affect birth weight among women with present iron stores (β = − 0.008; SE = 3.03; p = 0.998).

Conclusion

Early iron supplementation with doses ~ 100 mg/d improves the biochemical status of the mother independently of her pre-pregnancy iron status. Supplementation with iron improves newborn birth weight in those women who start pregnancy with iron deficiency, and makes no significant difference to those women who are not iron deficient.     

Comparison of salivary cortisol, heart rate, and oxygen saturation between early skin-to-skin contact with different initiation and duration times in healthy, full-term infants

Background

There are few studies that compare the physiological and biological efficacies between different early skin-to-skin contacts (SSC) post birth.

Aim

To investigate physiologically and biochemically how early SSC with different initiation and duration time influence the stress post birth for full-term infants.

Study design

Non-experimental study.

Subjects

Study I; Thirty-two infants who began SSC 5 min or less [birth SSC, mean initiation time (standard deviation): 1.6 (1.1) min] after birth and 36 infants who did so more than 5 min [very early SSC, 26.3 (5.0) min] in heart rate (HR) and oxygen saturation (SpO₂) analysis. Study II; Eighteen infants who underwent SSC for 60 min or less [mean initiation time: 7.5 (12.2) min] and 61 infants who did so for more than 60 min [15.3 (12.5) min] in salivary cortisol analysis.

Outcome measures

HR and SpO₂ measured for 30 min post birth. Salivary cortisol concentration measured at 1 min, 60 min, and 120 min post birth.

Results

Birth SSC group reached HR stability of 120-160 bpm significantly faster than very early SSC group by Kaplan-Meier analysis (P = 0.001 by log-rank test). As for SpO₂ stability of 92% and 96%, no significantly between-group difference was found. Salivary cortisol levels were significantly lower between 60 and 120 min after birth in SSC group, continuing for more than 60 min compared with SSC group for 60 min or less after adjustment for salivary cortisol level at 1 min besides the infant stress factors (P = 0.046).

Conclusions

Earlier SSC beginning within 5 min post birth and longer SSC continuing for more than 60 min within 120 min post birth are beneficial for stability of cardiopulmonary dynamics and the reduction of infant stress during the early period post birth.     

Prevention of deformational plagiocephaly in neonates

Background

Since the early 90s a striking rise in deformational plagiocephaly (DP) has been reported, and a causal link between the “back to sleep” position recommended to reduce the risk of sudden infant death syndrome. Recent data suggested that supine position is a risk factor only when combined with other environmental factors

Objective

To evaluate the impact of early intervention in the newborn environment on the prevalence of DP at 4 months of life.

Methods

A multicentric, prospective, controlled study in healthy term neonates. Within 72 h of birth, all parents received the usual recommendations for positioning their infants to prevent sudden infant death syndrome. In the Intervention group, recommendations were also given to encourage spontaneous and unhindered physical movement. At 1, 2 and 4 months, we looked for plagiocephaly and collected information on the infants' environment.

Results

The environment of the Intervention group (n = 88) was significantly more favorable to unhindered movement than in the control group (n = 51) (lower immobility score, p < 0.01). The prevalence of DP was significantly lower in the Intervention group than in the control group (13% vs. 31%, p < 0.001). For each supplementary hour of immobility during the third and fourth months of life, the risk of DP at four months doubled (OR:2.1[1.4-3.2]).

Conclusion

Early postnatal intervention on the maternity ward reduces the prevalence of DP. The recent rise in the incidence of DP could be related to a lack of stimulation and encouragement to physical movement rather than to supine positioning proposed for prevention of sudden infant death syndrome.     

Increased rate of parental postpartum depression and traumatization in moderate and late preterm infants is independent of the infant's motor repertoire

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.     

Quantitative analysis of maturational changes in EEG background activity in very preterm infants with a normal neurodevelopment at 1 year of age

Background

The electroencephalographic (EEG) background pattern of preterm infants changes with postmenstrual age (PMA) from discontinuous activity to continuous activity. However, changes in discontinuity have been investigated by visual analysis only.

Aim

To investigate the maturational changes in EEG discontinuity in healthy preterm infants using an automated EEG detection algorithm.

Study design

Weekly 4 h EEG recordings were performed in preterm infants with a gestational age (GA) < 32 weeks and normal neurological follow-up at 1 year. The channel C3-C4 was analyzed using an algorithm which automatically detects periods of EEG inactivity (interburst intervals). The interburst-burst ratio (IBR, percentage of EEG inactivity during a moving time window of 600 s) and mean length of the interburst intervals were calculated. Using the IBR, discontinuous background activity (periods with high IBR) and continuous background activity (periods with low IBR) were automatically detected and their mean length during each recording was calculated. Data were analyzed with regression and multivariate analysis.

Results

79 recordings were performed in 18 infants. All recordings showed a cyclical pattern in EEG discontinuity. With advancing PMA, IBR (R² = 0.64; p < 0.001), interburst interval length (R² = 0.43; p < 0.001) and length of discontinuous activity (R² = 0.38; p < 0.001) decreased, while continuous activity increased (R² = 0.50; p < 0.001). Multivariate analysis showed that all EEG discontinuity parameters were equally influenced by GA and postnatal age.

Conclusion

Analyzing EEG background activity in preterm infants is feasible with an automated algorithm and shows maturational changes of several EEG derived parameters. The cyclical pattern in IBR suggests brain organisation in preterm infant.     

Amplitude integrated electroencephalographic activity in infants with congenital heart disease before surgery

Background

Infants with congenital heart disease (CHD) are at risk for brain injury. An accurate tool to monitor brain function is amplitude integrated EEG (aEEG). It records both background patterns and electrographic seizure activity (EA).

Aims

Our aim was to determine aEEG patterns in infants with CHD and to determine the differences between infants with a cyanotic or an acyanotic CHD.

Study design and subjects

Sixty-two full term newborns had either a cyanotic CHD (transposition of the great arteries (n = 24)) or an acyanotic CHD (hypoplastic left heart syndrome (n = 26), critical aortic valve stenosis (n = 1) or aortic coarctation (n = 11)). The background patterns, sleep-wake cycling (SWC), and EA were assessed. The first 72 h after starting prostaglandin E₁-therapy were used for analysis.

Results

The background patterns were mildly abnormal in 45% of the infants and severely abnormal at some point during the recording in 14% of the infants. We found no differences in background patterns between the two groups. EA was present in 12 (19%) infants. EA was more frequent in infants with acyanotic CHD (OR 9.4, 95% CI 1.1-78, p = 0.039). SWC was equally frequent in infants with cyanotic and infants with acyanotic CHD. A severely abnormal aEEG and EA were associated with more profound acidosis.

Conclusions

Before surgery the majority of infants with a CHD had an abnormal aEEG. aEEG helped to identify EA and it was a useful tool to evaluate brain function prior to surgery in CHD.