Differential Outcomes Associated with Early Medical Complications in Premature Infants

This study evaluated the effects of several early medical complicationson the intellectual and motoric development of premature verylow birth weight (VLBW) infants. A large cohort of prematureinfants was grouped according to the following complicationsat birth: (a) intraventricular hemorrhage with respiratory distresssyndrome (IVH-RDS); (b) respiratory distress syndrome withoutintraventricular hemorrhage (RDS-no IVH); (c) bronchial-pulmonarydysplasia without IVH (BPD); (d) bronchial-pulmonary dysplasiawith IVH(BPD-IVH); and (e) hydrocephalus (HYD) secondary toIVH. These complications are frequently associated with prematurityand were hypothesized to have differential effects on laterdevelopmental outcome. Premature infants in the five diagnosticgroups received the Bayley Scales of Infant Development at 6,12, and 24 months of age. Results reveal that the IVH-RDS andRDS-no IVH infants perform similarly and show performance inthe average range for their chronological age by 24 months.In contrast, the infants in the BPD and HYD groups have generallylower scores, which remain in the delayed range throughout thefollow-up period. These results show that IVH is associatedwith poorer intellectual outcomes only when it is accompaniedby BPD or progressive hydrocephalus. In addition, longer periodsof hospitalization, which are associated with BPD, have a significantlynegative effect on later outcome. The implication of these resultsfor early intervention is discussed.     

Surfactant protein C gene variation in the Finnish population - association with perinatal respiratory disease

Surfactant protein C (SP-C) is a small hydrophobic protein component of alveolar surfactant, a lipid-protein complex lining the alveolar surface of the lung. Surfactant deficiency is the main cause of respiratory distress syndrome (RDS) in premature infants. RDS is a major risk factor of a chronic lung disease called bronchopulmonary dysplasia (BPD). The dominant mutations of the SP-C gene have recently been associated with interstitial lung diseases. However, the common genetic variation in the surfactant protein C gene has not been studied in detail. In the present study, the exonic variation of the SP-C gene in the Finnish population (n=472) was defined, and the association of the allelic variants with the susceptibility to RDS and BPD was examined. Conformation-sensitive gel electrophoresis (CSGE) was used to determine the extent of exonic variation in the SP-C gene. Methods of genotyping were generated for three biallelic polymorphisms of the SP-C gene's exons 1, 4 and 5, which encode proSP-C. The frequencies of these polymorphisms were evaluated in a study population consisting of 158 DNA samples from full-term infants. In addition, the linkage disequilibrium between the SP-C alleles was evaluated by haplotype analysis of parent-infant triplets. The role of SP-C gene variation in RDS and in BPD was evaluated in a high-risk population of 245 premature infants. According to the present results, the SP-C polymorphisms were associated with RDS and with very premature birth. The strength of allelic associations differed according to the gender of the premature infants.     

Is Severity of Respiratory Disease Associated With Differences in Neurodevelopmental Patterns in Preterm Infants?

Neurodevelopmental outcomes were assessed at 6, 12, and 24 months of age for preterm infants (PT; n = 169) and full-term infants (FT; n = 120) to determine if neurodevelopmental patterns were related to severity of respiratory diagnosis, especially for infants with chronic lung disease. PT infants' respiratory diagnoses were either acute (transient respiratory distress: n = 55; respiratory distress syndrome: n = 48) or chronic (chronic pulmonary insufficiency of the preterm [CPIP]: n = 30; bronchopulmonary dysplasia [BPD]: n = 36). BPD and CPIP infant groups showed no differences in neurodevelopmental patterns, and both groups displayed poorer development in cognitive, language, daily living, and motor skills and more persistent neurological abnormalities across 24 months than infants with less severe respiratory diagnoses and FT infants.     

外周血内皮祖细胞与极低出生体重早产儿并发症发生相关性

目的分析内皮祖细胞（EPCs）与极低出生体重早产儿发生支气管肺发育不良（BPD）、早产儿视网膜病（ROP）和脑室内出血（IVH）并发症的相关性。方法选取于复旦大学附属儿科医院NICU住院的胎龄〈32周、出生体重〈1500g的早产儿,分别于出生时、生后7、14、21和28d及纠正胎龄36周时收集外周血,流式细胞仪检测EPCs水平,酶联免疫法检测血管内皮生长因子（VEGF）、基质细胞衍生因子等水平。结果68例极低出生体重早产儿纳入分析,其中对照组30例,BPD组20例,ROP组10例,IVH组8例。BPD组与对照组出生时EPCs水平差异无统计学意义,生后7d时点EPCs水平较对照组明显降低,CD34＋KDR＋：（0．019±0．009）％伽（0．026±0．012）％,P〈0．05;KDR＋CDl33＋：（0．004±D．002）％傩（0．008±0．004）％,P〈0．01;CD34＋KDR＋CDl33＋：（0．005±0．002）％船（0．008±0．004）％,P〈0．05。从出生时至生后21d,BPD组血浆VEGF水平均明显低于对照组。ROP组出生时至生后28d的EPCs水平与对照组差异无统计学意义,纠正胎龄36周时KDR＋CDl33＋和CD34＋KDR＋CDl33＋EPCs与对照组相比略有升高趋势。与对照组相比,IVH组生后不同时点的EPCs水平差异均无统计学意义。结论生后早期的EPCs和VEGF水平降低可能参与了早产儿BPD的发生,但其具体机制仍需进一步研究。     

Prospective evaluation of perinatal risk factors for cerebral palsy and delayed development in high risk infants.

Prematurity, intrauterine infection and perinatal brain injury have been reported to be significant risk factors of cerebral palsy (CP). We examined the perinatal predictors of cerebral palsy and delayed development (DD) in 184 high risk infants. Thirty-five infants were diagnosed as cerebral palsy and delayed development at 12 months corrected age. Antenatal, intrapartum, and neonatal factors were prospectively evaluated in 2 groups of high risk infants compared with controls; Group A (n = 79), infants weighing less than 2,000 g; Group B (n = 43), infants weighing 2,000 g or more. In univariate analysis, there were no significant antenatal and intrapartum factors associated with cerebral palsy and delayed development in either group. We found that significant postnatal risk factors of CP in group A included sepsis (p = 0.008), BPD (bronchopulmonary dysplasia) (p = 0.028), IVH (intraventricular hemorrhage) (p = 0.042), ventriculomegaly (VM) (p = 0.001) and a longer duration of mechanical ventilation (p = 0.001); while in group B, sepsis (p = 0.047) and neonatal seizure (p = 0.027) were significant risk factors. In multivariate analysis, sepsis in group B was a moderate risk factor of CP (OR (odds ratio) 1.47; 95% CI (confidence interval) 1.02-2.13). In conclusion, neonatal sepsis may contribute to the development of cerebral palsy and delayed development. We suggest that high risk infants who have sepsis should be carefully followed for cerebral palsy and delayed development. The prevention of cerebral palsy may be feasible by decreasing neonatal risk factors such as sepsis during the neonatal period.     

足月新生儿呼吸窘迫综合征危险因素及肺表面活性物质疗效评估

目的 探讨足月新生儿呼吸窘迫综合征（RDS）的危险因素,观察肺表面活性物质（PS）的疗效,为足月儿RDS的防治提供依据.方法 选取2007年1月至2011年12月郑州大学第三附属医院NICU收治的足月儿RDS为RDS组,以同期入院的非RDS足月儿为对照组,对两组性别、胎龄、分娩方式、宫内窘迫、出生窒息、母亲妊高症、糖尿病、胎膜早破进行单因素方差分析和Logistic多因素回归分析;并以RDS组中是否给予PS治疗分为应用PS亚组和未应用PS亚组,评估PS的疗效.结果 RDS组和对照组各106例进入分析.①RDS组发病时间为生后5 min至18 h,平均（4.9±3.4）h,其中生后6 h内发病87例（82.1%）,～12 h 16例（15.1%）,〉12 h 3例（2.8%）;X线胸片分级Ⅰ级28例（26.4%）,Ⅱ级36例（34.0%）,Ⅲ级23例（21.7%）,Ⅳ级19例（17.9%）;②Logistic回归分析显示男性（OR=10.35,95%CI：1.94～15.26）、胎龄〈39周（OR=6.59,95%CI：2.33～36.51）、剖宫产（OR=7.26,95%CI：11.61～23.22）、择期剖宫产（OR=13.14,95%CI：3.55～21.84）和出生窒息（OR=4.33,95%CI：2.74～27.39）是足月儿RDS的危险因素;③应用PS亚组72例,未应用PS亚组34例.机械通气发生率、机械通气天数、氧疗时间、住院天数和呼吸机相关性肺炎发生率应用PS亚组均显著低于未应用PS亚组（P〈0.05）;两亚组气胸、肺出血、持续性肺动脉高压和动脉导管未闭发生率差异均无统计学意义（P〉0.05）.结论 男性、胎龄〈39周、剖宫产尤其是无医学指征的择期剖宫产、出生窒息是足月儿RDS的危险因素,PS治疗足月儿RDS疗效较好.     

Early postnatal growth of low birthweight infants in the WIC program

Patterns of early postnatal growth were analyzed among low birthweight infants enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Infants were divided into four groups according to their neonatal status: (1) term, normal birthweight (NBW); (2) term, low birthweight (LBW); (3) moderately preterm LBW; and (4) very preterm LBW. Comparison of mean weight and length z‐scores indicated that term NBW and very preterm LBW infants were at or near the national reference averages at 8, 12, and 18 months. Term LBW and moderately preterm infants were lighter and shorter than the other two study groups at each visit. Term LBW and moderately preterm infants displayed evidence of catch‐up growth during the study period. Catch‐up growth was defined as a decrease in the percentage of infants below the 10th percentile for weight. The effect of neonatal body proportions on postnatal growth was investigated in term LBW infants. The infants were divided into two groups based on their ponderal index (PI) at birth (low PI and proportionate PI). Comparison of weight and length z‐scores indicated that both groups of term LBW infants improved in z‐scores between birth and the first visit (approximately 8 months). However, infants with evidence of asymmetric intrauterine growth restriction (low PI) continued to improve in weight and length z‐scores, whereas those with symmetric growth restriction (proportionate PI) remained lighter and shorter. Am. J. Hum. Biol. 13:261–267, 2001. © 2001 Wiley‐Liss, Inc.     

Neonatal Morbidities Associated with Histologic Chorioamnionitis Defined Based on the Site and Extent of Inflammation in Very Low Birth Weight Infants

Conflicting results on the influences of histologic chorioamnionitis (HC) on neonatal morbidities might be partly originated from using different definition of HC. The aim of this study was to determine the relationship between HC and neonatal morbidities using definition of HC that reflects the site and extent of inflammation. This was a retrospective cohort study of 261 very low birth weight (VLBW) infants admitted at a tertiary academic center. Based on the site of inflammation, HC was categorized: any HC; amnionitis; funisitis; amnionitis+funisitis. The extent of inflammation in each site was reflected by sub-defining high grade (HG). The incidences of morbidities in infants with and without HC were compared. The bronchopulmonary dysplasia (BPD) rate was significantly higher in infants with amnionitis and the severe retinopathy of prematurity (ROP) rate was significantly higher in infants with any HC and funisitis. After adjustment for both gestational age and birth weight, the respiratory distress syndrome (RDS) rate was significantly lower in infants with all categories of HC except for HG amnionitis and HG funisitis, which are not associated with lower RDS rate. HG amnionitis was significantly associated with increased BPD rate but the association of HC with severe ROP disappeared. In conclusion, HC is significantly associated with decreased RDS and HG amnionitis with increased BPD while lacking association with other neonatal morbidities in VLBW infants. The association with HC and neonatal morbidities differs by the site and extent of chorioamnionitis.

Graphical Abstract

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Early intervention for low birth weight,preterm infants: the role of negative emotionality in the specification of effects

This study examined the relation of negative emotionality in infancy to child social and cognitive developmental outcomes among low birth weight (LBW) preterm infants participating in the Infant Health and Development Program (IHDP), a comprehensive compensatory education intervention beginning in infancy and lasting through age 3 years. In this analysis, intervention effects at age 36 months on maternal report of child behavior as assessed by the Child Behavior Checklist externalizing and internalizing scales and on intelligence as measured by the Stanford-Binet scale were largest among children characterized by higher levels of negative emotionality in infancy. Findings indicate that for LBW preterm infants characterized by negative emotionality at age 12 months the intervention was associated with a twofold decrease in the occurrence of clinically meaningful levels of behavior problems at age 3 years and a fourfold decrease in the occurrence of a high-risk profile in which both internalizing and externalizing scores are in the clinically meaningful range. The intervention was also associated with a fivefold decrease in the occurrence of IQ < or = 75 at age 3 years among children with higher levels of negative emotionality and heavier LBW (2001-2500 g). However, specific aspects of temperamental difficulty such as fearfulness and anger were related to internalizing and externalizing, respectively, in both the intervention and control groups. Findings are consistent with research linking negative emotionality in infancy with social and cognitive developmental outcomes in early childhood among normal birth weight infants. Results suggest the need for further attention to child temperament in early intervention research.     

系统评价胎龄小于32周早产儿预防性经鼻持续气道正压通气的作用

目的评价早产儿早期应用经鼻持续气道正压通气（NCPAP）预防呼吸窘迫综合征（RDS）,减少呼吸机应用、病死率和并发症的发生。方法以（prophylactic nasal CPAP OR early nasal CPAP）AND （preterm infants OR low birth weightinfants） ,经鼻持续气道正压通气AND（早产儿OR低出生体重儿）为英中文关键词,检索PubMed、EMBASE、Cochrane临床对照试验库、维普中文科技期刊数据库、中国知网和万方数据库,检索时间均从建库至2011年12月,并辅以手工检索。应用RevMan5．0软件进行Meta分析,根据异质性结果选择相应的效应模型分析;无法进行Meta分析时采用描述性分析。结果8篇RCT文献进入分析。Meta分析结果显示：NCPAP组未能显著降低早产儿气管插管呼吸机应用率（RR=-0．09,95％CI：-0．19～0．02,P=0．09）、RDS发生率（RR=0．81,95％CI：0．59—1．1,P=0．18）和病死率（RR=0．88,95％CI：0．72～1．09,P=0．25）;NCPAP组能显著减少早产儿肺表面活性物质应用率（RR=0．72,95％CI：0．64—0．80,P〈0．00001）。NCPAP组未能显著减少气管插管呼吸机通气时间（MD=-1．91d,95％CI：-6．47～4．45d,P=0．72）及氧气应用时间（MD=-0．46d,95％CI：-6．55—5．63d,P=0．88）。NCPAP组除增加气胸的发生率外,并未明显增加支气管肺发育不良、颅内出血、早产儿视网膜病、败血症、新生儿坏死性小肠结肠炎和动脉导管未闭等并发症的发生率。结论目前的证据表明早期应用NCPAP可减少肺表面活性物质应用,但增加了气胸的发生率;未能减少早产儿呼吸机应用、RDS发生率和病死率,未增加除气胸外的其他并发症发生率。     

早产,窒息和低出生体重对小儿智能发育影响的研究

采用ＤＤＳＴ、Ｇｅｓｃ１１ 两种智测方法对头位经产道分娩的１１６ 名０３ 岁小儿进行了回顾性研究。结果：（１）ＤＤＳＴ法的结果４ 组间具有差异（ Ｐ＜０－０５）；进一步检验发现早产组与对照组的智能发育差异无显著性（Ｐ＞０－０５），而窒息组、低体重组与对照组的差异有显著性（０－０１ ＜ Ｐ＜０－０５）；（２）Ｇｅｓｅｌｌ 测试４ 组内小儿的智能发育呈显著差异（Ｐ＜ ０－０５） ；而早产组、窒息组及低体重组与对照组进一步分析得Ｐ值依次小于０－０５、０－０１ 和０－０１；（３）各病例组内的统计学处理发现：早产、窒息和体重的程度不同，其对小儿的智能发育的影响亦不同（Ｐ值分别为０－０１ ＜ Ｐ＜ ０－０５ 和Ｐ＜０－０１）。结论：早产、窒息及低体重仅在一定条件下才能起消极作用。     

High birth weight is associated with human leukocyte antigen (HLA) DRB1*13 in full-term infants.

In cord blood banking, substantial amounts of data on infants and cord blood are gathered at high cost, including birth weights and human leukocyte antigen (HLA) genotypes. As certain HLA alleles have been associated with protective host responses, it is possible that an HLA allele, or another factor linked to it, might even affect normal intrauterine growth. We explored cord blood bank data (n = 1381 infants) to elucidate whether there is an association between birth weight and HLA class II (DRB1) alleles. HLA DRB1 data were available from 1263 infants. We observed an association between birth weight and HLA DRB1*13, which was over-represented among full-term infants with the highest birth weights. The association remained when the birth weight was corrected for varying gestational age (relative birth weight) according to gender (P = 0.015). After correction of the P-value for multiple comparisons, the association was not statistically significant. However, when the birth weights of all infants were analysed for the effect of DRB1*13, infants positive for HLA DRB1*13 (n = 319) were found to have higher birth weights than infants negative for this allele (n = 944; median 3690 g vs. 3650 g, respectively; P = 0.044). Although the difference in median birth weight was only 40 g, it may be considered significant because it appeared after segregation of the infants into two groups according to the single HLA class II allele group earlier associated with protection against, for example, childhood type 1 diabetes and certain infectious diseases. The present finding may thus suggest identification of a new factor affecting normal intrauterine growth.     

Comparison of clinical efficacy of Newfactan versus Surfacten for the treatment of respiratory distress syndrome in the newborn infants

Newfactan is a domestically developed, bovine lung-derived, semi-synthetic surfactant. The aim of this study was to compare the clinical efficacy of Newfactan with that of Surfacten in the treatment of respiratory distress syndrome (RDS). Newfactan or Surfacten was randomly allocated to 492 newborn infants who were diagnosed as RDS and required surfactant instillation in four participating hospitals. The comparisons were made individually in two subsets of infants by birth weight (<1,500 g group [n=253] and > or =1,500 g group [n=239]). Short-term responses to surfactant and acute complications, such as the total doses of surfactant instilled, response type, extubation rate, ventilator settings, changes in respiratory parameters, air leak, patent ductus arteriosus, pulmonary hemorrhage, and intraventricular hemorrhage, and mortality during the 96 hr after surfactant instillation were measured. Long-term outcome and complications, such as total duration of intubation, bronchopulmonary dysplasia and periventricular leukomalacia, and ultimate mortality were measured. There were no significant differences in demographic and perinatal variables, shortterm responses to surfactant and acute complications, and long-term outcome and complications between Newfactan and Surfacten in both birth weight groups. We concluded that Newfactan was comparable to Surfacten in the clinical efficacy in the treatment of RDS in both birth weight groups.     

Metabolomic profiling in blood from umbilical cords of low birth weight newborns

ABSTRACT: BACKGROUND: Low birth weight has been linked to an increased risk to develop obesity, type 2 diabetes, and hypertension in adult life although the mechanisms underlying the association are not well understood. The objective was to determine whether the metabolomic profile of plasma from umbilical cord differs between low and normal birth weight newborns. METHODS: Fifty healthy pregnant women and their infants were selected. The eligibility criteria were being born at term and having a normal pregnancy and the pairs were grouped according to their birth weight: low birth weight (LBW, birth weight<10th percentile, n=20) and control (control, birth weight between the 75th-95th percentiles, n=30). Nuclear Magnetic Resonance (NMR) was used to generate metabolic fingerprints of umbilical cord plasma samples. Simultaneously, the metabolomic profiles of the mothers were analysed. The resulting data were subjected to chemometric, principal component and partial least squares discriminant analyses. RESULTS: Umbilical cord plasma from LBW and control newborns displayed a clearly differentiated metabolic profile. Seven metabolites were identified that discriminate the LBW from the control group. LBW newborns had lower levels of choline, proline, glutamine, alanine and glucose than the control newborns, while plasma levels of phenylalanine and citrulline were higher in LBW newborns (p<0.05). No significant differences were found between the two groups of mothers. CONCLUSIONS: Low birth weight newborns display a differential metabolomics profile as compared to those of normal birth weight, something not present in the mothers. The meaning and potential utility of the findings as biomarkers of risk need to be addressed in future studies.     

Associations of long‐chain polyunsaturated fatty acid concentrations with birth outcome in term Indian mothers and their neonates

The purpose of this study was to examine the maternal and cord long‐chain polyunsaturated fatty acid (LCPUFA) concentrations and their associations with birth outcome in term deliveries. Pregnant women (n = 253) delivering at term were divided into two groups based on their babies' birth weights (1) normal birth weight (NBW), that is, ≥2.5 kg (n = 190) and (2) low‐birth weight (LBW), that is, <2.5 kg (n = 63). Each group is further divided into two groups according to the baby's sex, that is, male NBW (M‐NBW), female NBW (F‐NBW), male LBW (M‐LBW), and female LBW (F‐LBW) groups. Maternal plasma docosahexaenoic acid and erythrocyte arachidonic acid (AA) levels were lower (P < 0.05 for both), while cord plasma docosahexaenoic acid and erythrocyte AA levels were higher (P < 0.05 for both) in LBW group when compared to the NBW group. Maternal erythrocyte AA levels were positively associated with birth weight (P = 0.001), while cord plasma docosahexaenoic acid levels were negatively (P = 0.05) associated with birth weight. Reduced maternal and increased cord LCPUFA levels exist in mothers delivering LBW babies, especially in mothers delivering female babies, indicative of sex‐specific effects. Am. J. Hum. Biol., 2011. © 2010 Wiley‐Liss, Inc.     

Interleukin-6-174-genotype, sepsis and cerebral injury in very low birth weight infants

We investigated the association between the interleukin 6 (IL-6)-174-genotype and unfavorable outcomes in preterm infants since it has been reported that the IL-6-174GG-genotype is associated with increased susceptibility to sepsis, and the IL-6-174CC-genotype is more common in preterm infants with severe intraventricular hemorrhage (IVH). We studied 1206 preterm infants with a birth weight below 1500 g. In contrast to previously published data, the frequency of IVH grade IV, periventricular leukomalacia, ventricular-peritoneal-shunting or death was not different between infants with different IL-6-genotypes: IL-6-174GG (n = 430) 8%, IL-6-174GC (n = 605) 9% and IL-6-174CC (n = 167) 12% (P = 0.2 for IL-6-174CC vs GG + GC). Furthermore, we were not able to confirm previously reported association between sepsis and the IL-6-174GG-genotype. Blood-culture-proven sepsis occurred in 19% of IL-6-174GG-carriers (n = 157), 26% of IL-6-174GC-carriers (n = 193) and 27% of infants carrying the IL-6-174CC-genotype (n = 67). We were not able to confirm previously reported associations between sepsis, cerebral injury and the IL-6-174-genotype in VLBW-infants.     

Cerebral oxygenation and cerebral oxygen extraction in the preterm infant: the impact of respiratory distress syndrome

Haemodynamic factors play an important role in the etiology of cerebral lesions in preterm infants. Respiratory distress syndrome (RDS), a common problem in preterms, is strongly related with low and fluctuating arterial blood pressure. This study investigated the relation between mean arterial blood pressure (MABP), fractional cerebral oxygen saturation (ScO₂) and fractional (cerebral) tissue oxygen extraction (FTOE), a measure of oxygen utilisation of the brain, during the first 72 h of life. Thirty-eight infants (gestational age < 32 week) were included, 18 with and 20 without RDS. Arterial oxygen saturation (SaO₂), MABP and near infrared spectroscopy-determined ScO₂ were continuously measured. FTOE was calculated as a ratio: (SaO₂–ScO₂)/SaO₂. Gestational age and birth weight did not differ between groups, but assisted ventilation and use of inotropic drugs were more common in RDS infants (P<0.01). MABP was lower in RDS patients (P<0.05 from 12 up to 36 h after birth), but increased in both groups over time. ScO₂ and FTOE were not different between groups over time, but in RDS infants ScO₂ and FTOE had substantial larger variance (P<0.05 at all time points except at 36–48 h for ScO₂ and P<0.05 at 12–18, 18–24, 36–48 and 48–60 h for FTOE). During the first 72 h of life, RDS infants showed more periods of positive correlation between MABP and ScO₂ (P<0.05 at 18–24, 24–36 36–48 48–60 h) and negative correlation between MABP and FTOE (P<0.05 at 18–24, 36–48 h). Although we found that the patterns of cerebral oxygenation and extraction in RDS infants were not different as compared to infants without RDS, we suggest that the frequent periods with possible lack of cerebral autoregulation in RDS infants may make these infants more vulnerable to cerebral damage.     

Maternal postpartum behavior and the emergence of infant-mother and infant-father synchrony in preterm and full-term infants: the role of neonatal vagal tone

Relations between maternal postpartum behavior and the emergence of parent-infant relatedness as a function of infant autonomic maturity were examined in 56 premature infants (birthweight = 1000-1500 g) and 52 full-term infants. Maternal behavior, mother depressive symptoms, and infant cardiac vagal tone were assessed in the neonatal period. Infant-mother and infant-father synchrony, maternal and paternal affectionate touch, and the home environment were observed at 3 months. Premature birth was associated with higher maternal depression, less maternal behaviors, decreased infant alertness, and lower coordination of maternal behavior with infant alertness in the neonatal period. At 3 months, interactions between premature infants with their mothers and fathers were less synchronous. Interaction effects of premature birth and autonomic maturity indicated that preterm infants with low vagal tone received the lowest amounts of maternal behavior in the postpartum and the least maternal touch at 3 months. Infant-mother and infant-father synchrony were each predicted by cardiac vagal tone and maternal postpartum behavior in both the preterm and full-term groups. Among preterm infants, additional predictors of parent-infant synchrony were maternal depression (mother only) and the home environment (mother and father). Findings are consistent with evolutionary perspectives on the higher susceptibility of dysregulated infants to rearing contexts and underscore the compensatory mechanisms required for social-emotional growth under risk conditions for parent-infant bonding.     

Genetic variants of surfactant proteins A, B, C, and D in bronchopulmonary dysplasia

BPD_28D (O2 dependency at 28 days of life) and BPD_36W (O2 dependency at 36 wks post-menstrual age) are diseases of prematurely born infants exposed to mechanical ventilation and/or oxygen supplementation. In order to determine whether genetic variants of surfactant proteins (SPs-A, B, C, and D) and SP-B-linked microsatellite markers are risk factors in BPD, we performed a family based association study using a Greek study group of 71 neonates (<30 wks gestational age) from 60 families with, 52 BPD_28D and 19 BPD_36W, affected infants. Genotyping was performed using newly designed pyrosequencing assays and previously published methods. Associations between genetic variants of SPs and BPD subgroups were determined using Transmission Disequilibrium Test (TDT) and Family Based Association Test (FBAT). Significant associations (p相似文献   

Early Sodium and Fluid Intake and Severe Intraventricular Hemorrhage in Extremely Low Birth Weight Infants

Hypernatremic dehydration is an important cause of intracranial hemorrhage. A possible association of intraventricular hemorrhage (IVH) with hypernatremia and/or high sodium intake has been suggested in preterm infants. To investigate the associations of early fluid and sodium intake or serum sodium concentrations with severe intraventricular hemorrhage (IVH) in extremely low birth weight (ELBW) infants, we reviewed the medical records of 169 inborn ELBW infants. Daily fluid and sodium intake, urine output, weight loss and serum sodium concentration during the first 4 days of life were obtained. Patients were divided into the severe IVH (grade 3/4) and the control (no or grade 1/2 IVH) group. The maximum serum sodium concentration and the incidence of hypernatremia did not differ between the two groups. Related to the fluid balance and sodium intake, the risk for severe IVH was strongly associated with total fluid and sodium intake during the initial four days of life. With respect to the fluids other than transfusion, severe IVH can be discriminated only by sodium intake but not by fluid intake. Large randomized controlled trials are required to clarify the causal relationship between the early sodium intake and severe IVH in ELBW infants.

Graphical Abstract

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