Association of complex lipids containing gangliosides with cognitive development of 6-month-old infants

Background

Human breastmilk contains gangliosides which may play an important role in infant neurodevelopment.

Aim

A pilot study was conducted to assess the impact of infant formula supplemented with gangliosides from complex milk lipid on cognitive functions of normal healthy infants.

Study design

The study was a double-blind, randomized, controlled, parallel group clinical trial in which infants received the treatment or control product from 2 to 8 weeks of age until 24 weeks of age. The control group (n = 30) received standard infant formula and the treatment group (n = 29) received the same formula supplemented with complex milk lipid to increase the ganglioside content to approximately 11 to 12 μg/ml. A reference group (n = 32) consisted of normal healthy exclusively breast-fed infants.

Outcome measures

Cognitive development using the Griffith Scales and serum gangliosides was measured before (2–8 weeks of age) and after intervention (24 weeks of age).

Results

Ganglioside supplementation using complex milk lipids significantly increased ganglioside serum levels (control group vs treatment group, P = 0.002) and resulted in increased scores for Hand and Eye coordination IQ (P < 0.006), Performance IQ (P < 0.001) and General IQ (P = 0.041). Cognitive development scores and serum ganglioside levels for the treatment group did not differ from the reference group.

Conclusions

Supplementation of infant formula with complex milk lipid to enhance ganglioside content appears to have beneficial effects on cognitive development in healthy infants aged 0–6 months, which may be related to increased serum ganglioside levels.     

Development of serum IgA and IgM levels in breast-fed and formula-fed infants during the first week of life

Background

IgA and IgM antibodies play important roles to protect infants in early life

Aim

To study the effects of breast milk feeding versus formula feeding in early infancy on the development of serum IgA and IgM.

Methods

A group of 220 healthy infants born after uncomplicated pregnancies and deliveries were enrolled. The infants were divided into three groups according to feeding type: breast-fed (BF), formula-fed (FF), and mixed-fed (MF). Capillary blood was collected for serum IgA and IgM detection at the first week of life.

Results

The average concentrations of serum IgA and IgM in all infants were 1.171 ± 1.079 and 256.2 ± 165.8 μg/ml, respectively. There were significantly higher concentrations of serum IgA in the FF group than MF group at 3, 4 and 6 days of age and BF group at 5 and 6 days old. Paired serum IgA concentrations revealed that IgA significantly decreased in the BF group, but not in the FF and MF groups. Meanwhile, paired serum IgM concentrations revealed that IgM increased significantly during early infancy in all groups. However, the IgM levels had no difference among the 3 groups within 7 days of age.

Conclusions

Our study demonstrated the development of serum IgA and IgM in early life. Formula feeding induced higher serum IgA concentrations than breast‐feeding within 7 days of age. However, serum IgM concentration was significantly increased in early life in all groups but had no differences between the different feeding types. Breast‐feeding may protect antigen loading in early life.     

Feeding and growth of normal birth weight infants during the first year of life in Shanghai

Aim

This study aimed to explore the relationship between infant feeding practices and growth outcomes in the first 12 months of life.

Design

Investigators completed 262 questionnaires, which included infant feeding patterns, feeding environment, feeding beliefs/attitudes and caregivers' feeding behaviors through on-site face-to-face interviews with the main caregivers of infants at 12 months of age. The infant's weight and length at ages 6 and 12 months were measured.

Setting

The study was conducted in urban Shanghai, China.

Subjects

This study included 262 healthy normal birth weight full-term singleton 6-month-old infants and their main caregivers.

Results

Among 262 infants, 86 (32.82%) infants were overweight [BMI-for-age z scores (BAZ) > + 1] at 12 months. Compared with normal weight infants, the overweight infants had higher birth weights (P = 0.009). Furthermore, the overweight infants gained significantly more weight (P < 0.001) in the first year of life. In normal weight infants, caregivers worried more about infants being “underweight” and “eating less” (P < 0.001) whereas caregivers with overweight infants worried more about infants being “overweight” (P < 0.001). Consequently, the total score of caregivers' over-feeding behaviors was significantly higher in normal weight infants (P = 0.029). However, in overweight infants, the scores of “fed quickly within 10 min” (r = 0.223, P = 0.039) and “feeding was the best way to stop the infant's fussiness” (r = 0.285, P = 0.008) were positively correlated with BAZ.

Conclusions

Overweight in early life is associated with carelessness about excessive appetite and some particular infant feeding behaviors of caregivers in Shanghai.     

The Stockholm Neonatal Family-Centered Care Study: effects on salivary cortisol in infants and their mothers

Background

Parental involvement in the care of preterm infants in neonatal intensive care units (NICUs) is common, but little is known about the effect on stress responses in mothers and infants.

Aims

The aim of this study is to evaluate the effect of family-centered care on salivary cortisol reactivity in mothers and preterm infants and the correlation between the mothers' and the preterm infants' salivary cortisol levels.

Methods

This study is part of a randomized controlled trial conducted at two level-II NICUs, including Family Care (FC), where parents were able to stay 24 h/day from admission to discharge, and Standard Care (SC). To investigate the cortisol response, saliva was collected from 289 preterm infants and their mothers before and after a diaper change at the time of discharge.

Results

No significant differences were found between the two groups in salivary cortisol reactivity, either in mothers or in infants. The results revealed a correlation between preterm infants' and their mothers' baseline and response cortisol in the FC group: r = 0.31 (p = 0.001) and r = 0.24 (p = 0.01), respectively. Such correlation was not observed in the SC group: r = 0.14 (p = 0.14) and r = 0.18 (p = 0.07), respectively.

Conclusions

Family-centered care had no effect on salivary cortisol reactivity during diaper change. However, sharing the same environment may increase the concordance between preterm infants' and their mothers' salivary cortisol levels.     

Altered placental development in pregnancies resulting in sudden infant death syndrome (SIDS)

Background

Sudden infant death syndrome (SIDS) is postulated to be a developmental disorder originating during fetal life in utero. Knowledge regarding the intrauterine environment in which SIDS infants develop is, however, inadequate and how the placenta develops prior to a SIDS event has not been studied.

Aim

To investigate the morphological development of the placenta obtained from full-term infants who subsequently succumbed to SIDS.

Study design

To estimate the percentage and total volumes of the chorionic villi and villous trophoblast membrane using stereological techniques.

Subjects

Placentas were obtained retrospectively from normal birthweight (SIDS-NBW n = 18) and small-for-gestational age (SIDS-SGA, n = 14) infants who had succumbed to SIDS, and compared to either control (n = 8) or SGA placentas (n = 7), respectively.

Results

SIDS-NBW placentas displayed evidence of augmented villous growth shown by significantly greater volumes of placental chorionic villi (gas-exchanging (GE) villi) in comparison to controls; this was not observed for SIDS-SGA placentas. However, both SIDS-NBW and SIDS-SGA placentas displayed significantly greater volumes of the cytotrophoblast (CT) (SIDS-NBW only), syncytiotrophoblast (SIDS-SGA only) and syncytial knots (SCT-K) and those displaying apoptotic syncytial nuclei (AP SCT-K). In contrast, SGA placentas displayed significantly reduced volumes of chorionic villi, GE villi and the villous trophoblast indicating a SIDS-specific effect associated with augmented placental growth.

Conclusions

Our findings provide initial evidence that placental abnormality, although not necessarily causative, may precede a subset of SIDS cases supporting the hypothesis that the origins of SIDS begin during fetal life in utero.     

Cerebral and mesenteric tissue oxygenation by positional changes in very low birth weight premature infants

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.     

Prevalence and predictors of idiopathic asymmetry in infants born preterm

Background

An idiopathic asymmetry in posture of the head is recognized as a risk factor to develop a deformational plagiocephaly (DP). In our neonatal follow-up clinic, an IA is often observed in infants born preterm at term-equivalent age (TEA).

Aims

To explore (1) the prevalence of an idiopathic asymmetry in 192 infants (gestational age ≤ 32.0 weeks) at TEA and 6 months corrected age (CA), (2) whether demographical, perinatal, and medical factors were predictors of the asymmetry, and (3) differences in motor maturation between infants with and without asymmetry.

Methods

In a retrospective study, frequencies of idiopathic asymmetry and DP, putative predictors, and Alberta Infant Motor Scale scores at 6 months CA were abstracted and analyzed with Chi², Mann–Whitney, logistic regression and T-test.

Results

The prevalence rate of a positional preference of the head at TEA was 44.8% (n = 86), 10.4% (20/192) had a DP at TEA and 13% (25/192) at 6 months CA. Positional preference, multiple birth and male gender predicted the presence of DP (p < .05, odds ratio 3.0, 3.2, and 3.1 respectively). Gross motor maturity at 6 months CA was less developed in infants with a positional preference at TEA compared to preterm norms (p = 0.01).

Conclusions

The high prevalence of a positional preference in infants born preterm at term equivalent age requires extra alertness to prevent the development of a deformational plagiocephaly, especially in boys and twins. Although, considering the lower prevalence of plagiocephaly at 6 months CA, therapists should be aware of over treating these infants.     

The role of plasma N-terminal pro-B-type natriuretic peptide in predicting the severity of transient tachypnea of the newborn

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.     

Saliva as a valid alternative in monitoring melatonin concentrations in newborn infants

Background and aims

Pineal physiology is not completely elucidated in newborn infants. As melatonin in pharmacological doses has been reported to reduce oxidative stress in neonates with asphyxia, respiratory distress syndrome, or sepsis, there is the need to better understand the physiological role of melatonin in the neonatal period. The aim of this study was to evaluate a new saliva sampling method suitable for newborn infants and to assess whether salivary melatonin could be used as a reliable, non-invasive, pain-free alternative to serum melatonin to study the pineal physiology in newborn infants.

Subjects and methods

In 86 healthy term newborn infants, a serum sample was collected by venipuncture after 36 h of life during blood sampling for newborn screening, immediately after a saliva sample had been collected.

Results

Of the 86 saliva samples, 62 were ‘ideal’ samples for the analysis. The median serum and salivary melatonin levels of the 62 newborns were 14.4 pg/mL (11.5-20.5 pg/mL) and 10.8 pg/mL (7.5-16.1 pg/mL), respectively. There was no significant difference between serum and salivary melatonin levels. The results revealed a highly significant correlation between the serum and salivary melatonin levels (Pearson's correlation coefficient, r = 0.793; p < 0.001). Linear regression analysis showed that the equation for the relationship between serum (x) and saliva (y) was y = 1.12x − 5.58 pg/mL.

Conclusion

To study pineal function in newborn infants, saliva collection using cotton buds and measurement of melatonin in saliva offers a valid, non-invasive, pain-free and practical alternative to blood sampling and determination of serum melatonin.     

Change in cognitive abilities over time during preschool age in low risk preterm children

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.     

Cognitive outcome at 24 months is more predictive than at 18 months for IQ at 8-9 years in extremely low birth weight children

Background

It is unclear whether developmental assessment later or earlier in childhood is the better predictor of intelligence at 8 years of age. This is an important distinction as many clinical trials assess their final outcomes only in early childhood, assuming the results are valid for later childhood cognitive functioning.

Aims

To compare the ability of developmental assessment at 18 months with 24 months in predicting general intellectual functioning at 8–9 years of age in extremely low birth weight (ELBW, birthweight < 1000 g) children.

Study design

Cohort study.

Subjects

58 ELBW survivors born during 1997 at the Royal Women's Hospital, Melbourne, Australia.

Outcome measures

Cognitive assessments at each of 18 months, 24 months (Mental Developmental Index [MDI]) and 8–9 years (Full Scale IQ) of age, corrected for prematurity were compared by regression analysis and by the κ statistic (agreement beyond chance).

Results

Both the 18-month and the 24-month MDI were significantly predictive of Full Scale IQ at 8–9 years, but more so for the 24-month MDI, with 38% of variance explained compared with 34% of variance explained by the 18-month MDI. The 24-month MDI, expressed as categories of severe, moderate, mild or no developmental delay, was more predictive of categories of severe, moderate, mild or no intellectual impairment at 8–9 years (weighted κ = 0.43, P < 0.001) than was the 18-month MDI (weighted κ = 0.35, P = 0.001).

Conclusions

Cognitive assessment at 24 months is superior to cognitive assessment at 18 months in predicting IQ and intellectual impairment at 8–9 years of age in ELBW children.     

Association between neonatal iron overload and early human brain development in premature infants

Background

Emerging evidence suggests that excess iron may be detrimental for brain development. However, little is known regarding the association between neonatal iron overload and subsequent neurodevelopment during infancy in vulnerable premature infants.

Aims

To evaluate the association between neonatal iron overload and neurodevelopment in premature infants.

Study design

Prospective cohort study.

Subjects

24–32 weeks gestational age infants who had serum ferritin (SF) measured at 34–35 weeks post-menstrual age (PMA) and did not meet exclusion criteria: SF < 76 ng/ml, toxoplasmosis, syphilis, rubella, cytomegalovirus, herpes infections, chromosomal disorders, or craniofacial anomalies were eligible. In addition, infants with sepsis or elevated C-reactive protein within 10 days before their SF measurement were excluded.

Outcome measures

Infants were evaluated for neurodevelopmental outcome at 8–12 months of age and were deemed to have neurodevelopmental impairment if they had one or more of the following: mental developmental index < 70, abnormal neurological examination, bilateral blindness, bilateral deafness, or required occupational, physical, or speech therapy.

Results

95 infants were studied. 70 had normal iron status (SF 76–400 ng/ml) while 25 were deemed to have iron overload (SF > 400 ng/ml) at 34–35 weeks PMA. There was a marginal increase in neurodevelopmental impairment among infants with iron overload compared to infants with normal iron status (64% vs. 41%, p = 0.05). However, after controlling for confounders, iron overload was not associated with neurodevelopmental impairment (Adjusted OR 0.71, 95% CI, 0.21–2.5).

Conclusion

Modest neonatal iron overload is not associated with neurodevelopmental impairment during infancy in premature infants.     

Longitudinal growth of head circumference in term symmetric and asymmetric small for gestational age infants

Aims

To study longitudinal growth pattern of head circumference of full-term symmetric and asymmetric small for gestational age (SGA) infants of the two sexes during first year of life.

Study Design

Mixed-longitudinal growth research design.

Subjects

Head circumference amongst full-term 100 symmetric, 100 asymmetric as well as 100 appropriate for gestational age (AGA) infants was measured at birth, 1, 3, 6, 9 and 12 months of age using standardized technique and instrument.

Results

The mean head circumference of male symmetric SGA infants measured significantly (p ≤ 0.001) smaller than asymmetric SGA infants while, in female symmetric SGA infants it measured shorter beyond 6 months. As compared to AGA infants, head circumference in symmetric and asymmetric SGA infants measured significantly smaller in size. Growth velocity for head circumference amongst symmetric and asymmetric SGA male infants did not show statistically significant differences. Rate of head circumference growth remained significantly higher amongst female asymmetric SGA infants than the symmetric ones between 3 and 6 months while, a reversal of trend was observed between 9 and 12 months.

Conclusion

The better growth attainments for head circumference of male and female asymmetric SGA infants than their symmetric SGA counterparts during first postnatal year of life may be attributed to the continuation of influence of “head sparing” experienced by asymmetric SGA babies during prenatal life.     

The effects of ibuprofen on sepsis parameters in preterm neonates

Aim

To examine the effects of ibuprofen used for patent ductus arteriosus (PDA) treatment on the production of the proinflammatory cytokines C-reactive protein (CRP) and interleukin 6 (IL-6) in preterm septic newborns.

Methods

Patients with acute phase reactant elevation were divided into two groups according to receiving ibuprofen (Group I, n = 51) or not (Group II, n = 38). Course of sepsis was evaluated by CRP and IL-6 levels.

Results

CRP and IL-6 levels at the time of diagnosis were not different between two groups [16 ± 9.1 vs 16.4 ± 13.2 mg/dL (p = 0.43) for CRP and 124 ± 82 vs 119 ± 73 mg/dL (p = 0.517) for IL-6, respectively]. Similarly, they were statistically insignificant between the groups at the 2nd or 3rd days of ibuprofen treatment [14.3 ± 7.7 vs 13.7 ± 5.9 mg/dL (p = 0.21) for CRP and 83 ± 46 vs 86 ± 37 mg/dL (p = 0.29) for IL-6, respectively]. However, CRP and IL6 levels showed significant difference between groups in the following days; 6.03 ± 3.8 vs 9.1 ± 4.9 mg/dL (p = 0.025) for CRP and 42 ± 33.1 vs 58.9 ± 27.1 mg/dL (0.011) for IL-6 on 4th or 5th days of treatment and 2.3 ± 3.2 vs 4.1 ± 2.3 mg/dL (p = 0.032) for CRP and 16.1 ± 12.4 vs 21.3 ± 16.8 mg/dL (p = 0.016) for IL-6, on 7th to 10th days of treatment, respectively.

Conclusions

IL-6 and CRP may decrease in infants receiving ibuprofen treatment more than infants who do not receive it. This decrease should be considered at the time of caring a preterm infant with both sepsis and PDA after ibuprofen treatment.     

Allergic disease in the first year of life is associated with differences in subsequent neurodevelopment and behaviour

Background

Recent trials suggest a link between neuropsychological function, atopy and allergic disease particularly in early childhood; however the nature of this association remains unclear.

Aims

To investigate the relationship between early allergic disease and sensitisation at 12 months of age and neurodevelopmental outcomes at 18 months.

Study design

Linear or binary logistic regression analysis was used to determine whether allergic diseases or sensitization at 12 months of age was a significant predictor of neurodevelopmental test scores at the 18 months.

Subjects

Infants with a maternal history of allergic disease (n = 324).

Outcome measures

Allergic outcomes at 12 months of age included allergen sensitisation, eczema, IgE-mediated and food allergy, and neurodevelopmental outcomes at 18 included the Bayley Scales of Infant Toddler Development III Edition, the Achenbach Child Behaviour Checklist and the Macarthur Scales of Infant Toddler Development.

Results

Children with any diagnosed allergic disease at 12 months had evidence of reduced motor scores (p = .016), and this was most apparent for a diagnosis of eczema (p = .007). Non-IgE mediated food allergy was significantly positively associated with problem Internalising Behaviours (p = .010), along with a trend for effects on the Social–Emotional composite score for IgE-Mediated food allergies (p = .052). Allergic sensitisation was not independently associated with any effects on neurodevelopmental outcomes.

Conclusion

This study provides evidence that an allergic phenotype in infancy is associated with effects on neurodevelopment. Further research is required to investigate the nature of this relationship.     

The metabolic effects of two different lipid emulsions used in parenterally fed premature infants--a randomized comparative study

Objective

To compare the effects of two different lipid emulsions, based on soybean oil and olive oil respectively on plasma lipid concentrations and acylcarnitine profile of very low birth weight infants.

Design

Randomized comparative study.

Patients and methods

Forty very low birth weight infants, ≤ 32 weeks of gestational age and receiving at least 40% of the calorie taken by parenteral nutrition from lipid solution at 14th day of life were evaluated. Group I (n = 20) received soybean oil based lipid emulsion (Intralipid®) and Group II (n = 20) received olive oil based lipid emulsion (Clinoleic®).

Main outcome measures

Plasma lipid concentrations and acylcarnitine profile were assessed.

Results

Triglyceride, cholesterol, high and low density lipoprotein levels, liver function tests were similar between two groups whereas very low density lipoprotein level was statistically lower in Group I (p < 0.05). Free carnitine levels were 15.73 ± 10.67 in Group I and 34.25 ± 22.18 μM in Group II (p = 0.012) and hexanoyl carnitine levels 2.18 ± 2.10 in Group I and 0.38 ± 0.12 μM in Group II, respectively (p = 0.005). Plasma medium chain acylcarnitine levels were significantly higher in Group I.

Conclusions

Low levels of very low density lipoprotein in Group I may be a way of hemostasis to keep the serum triglyceride within normal levels. Lower free carnitine levels in soybean oil-based group is the result of carnitine need during the mitochondrial transport of long chain fatty acids. In Group I, due to the inefficient transport of medium chain fatty acids into the mitochondria, medium chain acylcarnitines accumulate in plasma. This may be the reason of lower carnitine levels in Group I. We suggest that higher levels of hexanoyl carnitine, reflecting defective mitochondrial transport of hexanoyl which leads immunsupression, may be the cause of higher sepsis risk in Group I.     

Low platelet count is associated with ductus arteriosus patency in preterm newborns

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.     

Cerebral palsy in children: Movements and postures during early infancy, dependent on preterm vs. full term birth

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.     

Is newborn melatonin production influenced by magnetic fields produced by incubators?

Background

During permanence in most incubators, newborns are very close to the electric engine, which represents a source of electromagnetic fields (EMF). Previous studies demonstrated a decrease in melatonin production in adults and animals exposed to EMF.

Aims

To assess melatonin production in a group of newborns exposed to EMF, and to evaluate whether removing the babies from the source of MF can affect melatonin production.

Study design and subjects

We have recruited 28 babies (study group), who had spent at least 48 h in incubator where we had previously assessed the presence of significant EMF. We have measured their mean 6-hydroxy-melatonin-sulfate (6OHMS) urine excretion at the end of their permanence in the incubators, and compared it with their mean 6OHMS excretion after having been put in cribs, where EMF are below the detectable limit (< 0.1 mG). We have also measured urine 6OHMS twice, with an interval of 48 h, in a control group of 27 babies who were not exposed to EMF during both samples.

Results

Mean 6OHMS/cr values were respectively 5.34 ± 4.6 and 7.68 ± 5.1 ng/mg (p = 0.026) when babies were exposed to EMF in incubators, and after having been put in the crib. In the control group, mean 6OHMS/cr values in the first and in the second sample were respectively 5.91 ± 5.41 vs 6.17 ± 3.94 ng/mg (p = 0.679).

Conclusions

The transitory increase in melatonin production soon after removing newborns from incubators demonstrates a possible influence of EMF on melatonin production in newborns. Further studies are needed to confirm these data.     

Personality and stress appraisal in adults prenatally exposed to the Dutch famine

Background

Previous studies have shown that prenatal exposure to the Dutch famine is associated with an increased risk for several psychiatric disorders. Variation in personality characteristics and in stress appraisal may underlie mental disorders.

Aims

To investigate whether prenatal famine exposure is associated with personality characteristics and stress appraisal.

Study design

Cohort study.

Subjects

Participants included a total of 572 men and women, born as term singletons in a local hospital in Amsterdam around the time of the 1944–1945 Dutch famine.

Outcome measures

Scores on the Big Five Inventory and the Perceived Stress Scale (PSS).

Results

There were no statistically significant differences in the personality traits openness, conscientiousness, extraversion, agreeableness and neuroticism or in PSS scores between those unexposed and those exposed to famine during early, mid or late gestation. However, there were statistically significant (P = 0.01) and borderline significant interactions (P = 0.07) respectively between exposure to famine during early gestation and sex on conscientiousness and agreeableness. Subsequent analyses showed that men exposed to famine during early gestation had lower conscientiousness scores and women exposed during early gestation had higher agreeableness scores.

Conclusions

We conclude that conscientiousness and agreeableness may differ between men and women unexposed and exposed to famine during early gestation. As evidence was not very robust, future research should confirm the present findings.