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- Aubert, Adrien, et al.
(author)
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Risk factors for cerebral palsy and movement difficulties in 5-year-old children born extremely preterm
- 2023
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In: Pediatric Research. - : SPRINGERNATURE. - 0031-3998 .- 1530-0447. ; 94:2, s. 771-780
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Journal article (peer-reviewed)abstract
- BackgroundMotor impairment is common after extremely preterm (EPT, <28 weeks gestational age (GA)) birth, with cerebral palsy (CP) affecting about 10% of children and non-CP movement difficulties (MD) up to 50%. This study investigated the sociodemographic, perinatal and neonatal risk factors for CP and non-CP MD.MethodsData come from a European population-based cohort of children born EPT in 2011-2012 in 11 countries. We used multinomial logistic regression to assess risk factors for CP and non-CP MD (Movement Assessment Battery for Children - 2nd edition <= 5th percentile) compared to no MD (>15th percentile) among 5-year-old children.ResultsCompared to children without MD (n = 366), young maternal age, male sex and bronchopulmonary dysplasia were similarly associated with CP (n = 100) and non-CP MD (n = 224) with relative risk ratios (RRR) ranging from 2.3 to 3.6. CP was strongly related to severe brain lesions (RRR >10), other neonatal morbidities, congenital anomalies and low Apgar score (RRR: 2.4-3.3), while non-CP MD was associated with primiparity, maternal education, small for GA (RRR: 1.6-2.6) and severe brain lesions, but at a much lower order of magnitude.ConclusionCP and non-CP MD have different risk factor profiles, with fewer clinical but more sociodemographic risk factors for non-CP MD.ImpactYoung maternal age, male sex and bronchopulmonary dysplasia similarly increased risks of both cerebral palsy and non-cerebral palsy movement difficulties.Cerebral palsy was strongly related to clinical risk factors including severe brain lesions and other neonatal morbidities, while non-cerebral palsy movement difficulties were more associated with sociodemographic risk factors.These results on the similarities and differences in risk profiles of children with cerebral palsy and non-cerebral palsy movement difficulties raise questions for etiological research and provide a basis for improving the identification of children who may benefit from follow-up and early intervention.
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| 2. |
- Raiskila, Simo, et al.
(author)
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Parent and nurse perceptions on the quality of family-centred care in 11 European NICUs
- 2016
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In: Australian Critical Care. - : Elsevier BV. - 1036-7314 .- 1878-1721. ; 29:4, s. 201-209
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Journal article (peer-reviewed)abstract
- BACKGROUND: Family-centred care (FCC) is a state-of-the-art practice in neonatal intensive care units (NICU) based on its shown benefits on the well-being of both infants and parents. However, there is no systematic knowledge about how FCC is implemented in different European contexts. OBJECTIVES: To describe parents' presence and the quality of FCC from the perspectives of mothers, fathers and nurses in 11 European NICUs. METHODS: A prospective survey was conducted in Finland, Sweden, Norway, Estonia, Spain and Italy. The perceived quality of FCC was measured using 8 text-message questions sent to the parents' mobile phones, one question each day, during the infant's hospital stay. Nurses answered corresponding questions through a Web questionnaire during a 3-month period. The responses were rated on a 7-point Likert scale. Parents who were not present in the unit during the day used a "0" response. RESULTS: A total of 262 families of preterm infants born before 35 gestational weeks participated in the study. Mothers gave 5045 responses, fathers gave 3971 responses and nurses gave 11,132 answers. The mothers were present during 92.7% and the fathers during 77.9% of the study days. The mothers rated the quality of FCC slightly higher than the fathers did (5.8 [95% CI 5.7-5.9] vs. 5.7 [95% CI 5.6-5.8], mean difference of 0.12 [95% CI 0.05-0.2], p<0.001). There was wide variation in the parents' presence and the quality of FCC between the units. The weakest aspects of FCC were emotional support, parents' participation in decision-making and fathers' participation in infant care. The perceived quality of FCC between the nurses and parents were comparable. CONCLUSIONS: This study showed a high perceived quality of FCC in 11 European units, as indicated by both parents and nurses. The innovative data-collection method and instrument successfully quantified each unit's FCC profile for further quality improvement and should be trialled in other NICUs and countries.
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| 3. |
- Takkis, Kalev, et al.
(author)
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Signal Enhancement in the HPLC-ESI-MS/MS analysis of spironolactone and its metabolites using HFIP and NH4F as eluent additives
- 2017
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In: Analytical and Bioanalytical Chemistry. - : Springer. - 1618-2642 .- 1618-2650. ; 409:12, s. 3145-3151
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Journal article (peer-reviewed)abstract
- This paper describes an LC-MS/MS method to determine the concentration of spironolactone and its metabolites 7-alpha-methylthiospironolactone and canrenone in blood plasma samples. The resulting assay is simple (using protein precipitation for sample preparation) and sensitive (the lower limit of quantification is close to 0.5 ng/ml) while requiring only 50 mu l of plasma, making it especially suitable for analyzing samples obtained from pediatric and neonatal patients where sample sizes are limited. The sensitivity is achieved by using ammonium fluoride as an eluent additive, which in our case amplifies the signal from our analytes in the plasma solution on average about 70 times. The method is fully validated according to the European Medicines Agency's guideline and used for the measurement of pediatric patients' samples in clinical trials for evaluating oral spironolactone's and its metabolites' pharmacokinetics in children up to 2 years of age.
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| 4. |
- Varendi, Heili
(author)
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Human newborn behavior during exposure to maternal and other odors
- 2001
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Doctoral thesis (other academic/artistic)abstract
- Olfaction appears to play a pivotal role in immediate postnatal interactions between mammalian mothers and their offspring. The present study examined: (1) whether and how the newborn human infant and its mother communicate by means of olfaction; (2) the role of amniotic fluid (AF) and breast odors in such communication; (3) olfactory learning by neonates. An undisturbed communication may play an important role in the initiation and maintenance of breastfeeding. The newborns of studies I-V were uninfluenced by pharmacological pain relief given to the mother. Newborn babies seek and locate the mother's breast within the first hour after birth and prefer an unwashed breast to the washed alternative, indicating that olfaction is implicated in breast seeking behavior (I). Other senses (e.g. vision, touch, temperature sensitivity) may also help the baby to locate the nipple. To determine more precisely the role of olfaction, a cotton pad bearing the mother's breast odor was placed 17 cm in front of the baby who was laying prone on a warm bed. The breast odor elicited crawling movements towards the cotton pad and stereotyped prefeeding behaviors that are typically observed when babies are placed on their mother's chest. These findings indicate that smell, in the absence of other maternal cues, helps guide the baby to the nipple and evokes the behavioral preludes of breastfeeding (V). Amniotic fluid odor is attractive for mammalian neonates. The current study has shown that newborns prefer to suck from a breast treated with AF rather than a naturally smelling breast during the first postnatal hour, possibly reflecting prenatal learning (II). Within several days after birth, the AF preference was replaced by a preference for the natural breast odor, suggesting postnatal olfactory learning (III). Movement of the hand to the mouth and finger sucking are components of the prefeeding behavior displayed immediately after birth. This behavior is disturbed when AF was washed off the baby before it was given to the mother (II). Washing may therefore disrupt prefeeding behavior and proper attachment to the nipple, and related studies have shown that problems with nipple attachment are associated with early breastfeeding failure. Odors can influence behavior during stress. Newborns who were separated from their mother during the first postnatal hours were exposed to either AF odor or maternal breast odor presented on cotton pads. AF soothed newborns, whereas breast odor elicited increased crying relative to control trials (IV). The calming effect of AF might reflect prenatal exposure to that scent. Maternal breast odor may have signalled the presence of food, and the babies became frustrated/agitated when they could not reach the source. Immediate postnatal olfactory learning is shown in several mammals. The capability for early postnatal olfactory learning was studied in Caesarean section delivered babies, who during the first postnatal hour, were exposed for 30 min to an artificial odor (cherry or passion fruit) (VI). Caesarean section delivered babies demonstrated such olfactory learning at testing about three days later, but only if the mothers had experienced uterine contractions before the operation. The norepinephrine levels in the umbilical artery correlated positively to learning. This learning may depend upon locus coeruleus activation and/or the catecholamine surge, and is further evidence that uterine contractions contribute to neonatal adaptation. In summary, the newborn and its mother communicate by means of olfaction. Several common hospital care routines such as washing the baby immediately after birth and the mother's breasts before feeding interfere with this communication and should be avoided until we know more about its clinical significance.
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