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| 2. |
- Aaltonen, Minna, et al.
(författare)
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Inhaled nitric oxide treatment inhibits neuronal injury after meconium aspiration in piglets
- 2007
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Ingår i: Early Human Development. - : Elsevier BV. - 0378-3782 .- 1872-6232. ; 83:2, s. 77-85
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Tidskriftsartikel (refereegranskat)abstract
- Background: Meconium aspiration-induced hypertensive lung injury is frequently associated with neuronal damage. Inhaled nitric oxide (iNO) is widely used in the treatment of pulmonary hypertension, but its effects on the brain are poorly known. Aims: The aim of this study was to determine the effects of iNO treatment on the neuronal tissue after meconium aspiration. Study design: 71 anesthetized, catheterized and ventilated newborn piglets were studied for 6 h. Thirty-five piglets were instilled with a bolus of human meconium intratracheally and 36 piglets with saline instillation served as controls. Nineteen meconium piglets and 17 control piglets were continuously treated with 20 ppm of iNO, started at 30 min after the insult. The extent of neuronal injury was analysed histologically, and the levels of brain tissue lipid peroxidation products, reduced glutathione (GSH), myeloperoxidase activity and oxidized DNA were analysed as indicators of oxidative stress. Results: iNO treatment diminished the pulmonary hypertensive response caused by meconium aspiration, but did not change systemic or carotid hemodynamics. NO administration was associated with reduced neuronal injury and diminished amount of oxidized DNA in the hippocampus of the meconium piglets. Further, iNO treatment was associated with decreased level of GSH in the cortex, but no change in lipid peroxidation production or myeloperoxidase activity was detected in any of the studied brain areas. Conclusions: Our results suggest that iNO treatment may inhibit DNA oxidation and neuronal injury in the hippocampus, associated with newborn meconium aspiration.
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| 3. |
- Bystrova, K., et al.
(författare)
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The effect of Russian Maternity Home routines on breastfeeding and neonatal weight loss with special reference to swaddling
- 2007
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Ingår i: Early Human Development. - : Elsevier BV. - 0378-3782 .- 1872-6232. ; 83:1, s. 29-39
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Tidskriftsartikel (refereegranskat)abstract
- Background: Few investigations have considered evaluating the effects of certain combinations of ward routines like swaddling of the baby and separation of mother and baby on infant variables such as neonatal weight toss. Aims: To study the effect of different ward routines in respect to proximity to mother and type of infant apparel, on breastfeeding parameters (amount of ingested milk, volume of supplements, number of breastfeeds, total duration of breastfeeding time) day 4 after birth as well as recovery from neonatal weight loss and infant's weight on day 5. Study design and subjects: In a randomized trial with factorial design four treatment groups including 176 mother-infant dyads were studied 25-120 min after birth. Randomized treatments focused on care routines administered to the infants after delivery and later in the maternity ward as well as to the type of clothing the infants received. Group 1 infants were placed skin-to-skin with their mothers after delivery, and had rooming-in while in the maternity ward. Group 2 infants were dressed and placed in their mothers' arms after delivery, and roomed-in with mothers in the maternity ward. Group 3 infants were kept in the nursery both after birth and while their mothers were in the maternity ward. Group 4 infants were kept in the nursery after birth, but roomed-in with their mothers in the maternity ward. Equal numbers of infants were either swaddled or clothed in baby attire. Breastfeeding parameters were documented during day 4 after birth. Infant's weight was measured daily. Results: Babies who were kept in the nursery received significantly more formula and significantly less breast-milk, than did babies who roomed-in with their mothers. Swaddling did not influence the breastfeeding parameters measured. However, swaddled babies who had experienced a 2-h separation period after birth and then were reunited with their mothers tended to have a delayed recovery of weight loss compared to those infants who were exposed to the same treatment but dressed in clothes. Furthermore, swaddled babies who were kept in the nursery and received breast-milk supplements had a significantly delayed recovery of weight loss after birth when compared to those infants ingesting only breast-milk. On day 5, regression analyses of predicted weight gain in the exclusively breastfed infants indicated a significant increase per 100 ml breast-milk (59 g), compared to the predicted weight gain on day 5 per 100 ml supplements in the swaddled babies (14 g) (P=0.001). Conclusion: Supplements given to the infants in the nursery had a negative influence on the amount of milk ingested. In addition, supplement feeding or a short separation after birth when combined with swaddling was shown to have a negative consequence to infant weight gain.
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| 4. |
- Cheema, Riffat, et al.
(författare)
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Signs of fetal brain sparing are not related to umbilical cord blood gases at birth.
- 2009
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Ingår i: Early Human Development. - : Elsevier BV. - 1872-6232 .- 0378-3782. ; 85, s. 467-470
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Fetal chronic hypoxia leads to centralization of circulation in order to spare the vital organs brain, adrenals and the heart. This can be documented by Doppler ultrasound. Increased blood velocity in the fetal middle cerebral artery (MCA) is an acknowledged sign of centralization of circulation in chronic hypoxia, and is called brain sparing. AIM: Our aim was to assess the relationship between signs of brain sparing in the MCA and umbilical cord blood gases at birth. STUDY DESIGN: A prospective study. SUBJECTS: Singleton 57 high-risk pregnancies (outcome was compared with 21 normal pregnancies). METHODS: MCA Doppler was performed within 24 h of elective caesarean section in high-risk pregnancies. Umbilical cord blood gases were analysed at birth. MAIN OUTCOME MEASURES: Cord blood gases were related to signs of centralization of fetal circulation in the MCA. RESULTS: No correlation between signs of brain sparing in the MCA and cord blood gases. Apgar score at 5'<7 was seen in three newborns, but only one of these had antenatal signs of brain sparing. Newborns with antenatal brain sparing were admitted more often (p<0.04) and had a longer duration of stay in NICU (p<0.03) compared to newborns without brain sparing. CONCLUSION: Decreased pulsatility index in MCA is an acknowledged sign of fetal centralization of circulation during chronic hypoxia. However, signs of brain sparing are not related to cord blood gases at birth, which might suggest that redistribution of fetal circulation can maintain normal blood gases for a long time during chronic hypoxia.
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| 5. |
- Fu, Jing, et al.
(författare)
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Intracerebral regional distribution of blood flow in response to uterine contractions in growth-restricted human fetuses.
- 2007
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Ingår i: Early Human Development. - : Elsevier BV. - 1872-6232 .- 0378-3782. ; 83:9, s. 607-612
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To explore middle cerebral artery (MCA) and anterior cerebral artery (ACA) blood flow responses to superimposed acute hypoxemia in growth -restricted fetuses with and without established brain-sparing flow during basal conditions. Material and methods: 47 term fetuses suspected of growth restriction were exposed to an oxytocin challenge test with simultaneous cardiotocography and Doppler velocimetry in the umbilical artery, MCA and ACA. The MCA-to-ACA pulsatility index (PI) ratio was calculated during basal conditions, contractions and relaxations. Basal brain-sparing flow was defined as an MCA-to-umbilical artery PI ratio of <1.08, de novo brain-sparing flow in the MCA as an MCA PI decrease with I standard deviation during uterine contractions or relaxations compared with basal measurements, and de novo brain-sparing flow in the ACA as an ACA PI decrease with l standard deviation. Non-parametric statistical tests were used with P<0.05 considered significant. Results: MCA and ACA PI were both significantly tower in the brain-sparing flow group (N=8) during basal conditions (P <= 0.01). During the oxytocin challenge test, MCA and ACA PI both decreased in the non-brain -sparing flow group (N=39) (P <= 0.02) but not in the brain -sparing flow group (P >= 0.4). The MCA-to-ACA PI ratio remained unchanged in both groups. de novo brain-sparing flow calculations revealed no preferential flow to any cerebral artery. Conclusion: Cerebral circulatory responses to acute hypoxemia are synchronized in the middle and anterior cerebral arteries without any preferential regional flow distribution.
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| 6. |
- Fu, Jing, et al.
(författare)
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Restrained cerebral hyperperfusion in response to superimposed acute hypoxemia in growth-restricted human fetuses with established brain-sparing blood flow.
- 2006
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Ingår i: Early Human Development. - : Elsevier BV. - 1872-6232 .- 0378-3782. ; 82:Dec 1, s. 211-216
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To investigate the cerebral circulatory response to superimposed acute hypoxemia in growth-restricted fetuses with established brain-sparing flow (BSF) during basal conditions. Material and methods: 76 term fetuses suspected of growth restriction were exposed to Doppler velocimetry in the umbitical artery (UA) and middle cerebral artery (MCA), and in 38-39 cases also in Galen's vein (GV), straight sinus (SS), and transverse sinus (TS), before and during an oxytocin challenge test (OCT), and simultaneous to electronic fetal heart rate monitoring. Nonparametric statistical analyses compared presence/absence of established BSF (MCA-to-UA pulsatility index [PI] ratio < 1.08) with a two-tailed P < 0.05 considered significant. Results: The OCT (positive/negative) was not different in the BSF group (BSFG, N = 16) and the normal flow group (NFG, N=60) (P=0.2). During uterine contractions, the MCA PI decreased in the NFG, but not in the BSFG. De novo GV pulsations and increase of GV maximum flow velocity occurred during contractions in the NFG, but not in the BSFG. Significant SS flow velocity waveform changes were found in neither group and TS flow changes in the BSFG only. Conclusions: Fetuses without established brain-sparing flow during basal conditions responded with both arterial and venous brain-sparing flow during acute hypoxemia, whereas in fetuses with established brain-sparing flow the cerebral circulatory responses were absent or equivocal. Fetuses with established brain-sparing flow may have a limited capacity of further cerebral hyperperfusion during superimposed acute hypoxic stress. (c) 2005 Elsevier Ireland Ltd. All rights reserved.
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| 7. |
- Gäddlin, Per-Olof, 1946-, et al.
(författare)
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A fifteen-year follow-up of neurological conditions in VLBW children without overt disability: Relation to gender, neonatal risk factors, and end stage MRI findings
- 2008
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Ingår i: Early Human Development. - : Elsevier. - 0378-3782 .- 1872-6232. ; 84:5, s. 343-349
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Tidskriftsartikel (refereegranskat)abstract
- Background: Very low birthweight (VLBW; birth weight ≤ 1500 g) children run a greater risk than controls of developing neurosensory disabilities, but also minor neurological disturbances. Aims: To assess neurological status from the neonatal period up to fifteen years of age in VLBW children without overt neurological disability in relation to gender, neonatal risk factors, and Magnetic Resonance Imaging (MRI) findings of the brain. Study design: A population based follow-up study of VLBW children and their controls. Subjects: Eighty VLBW children without overt disability, in a cohort of 86 surviving VLBW children, were enrolled in a follow-up study at 40 weeks gestational age and at 4, 9, and 15 years of age. 56 VLBW children were examined with cerebral MRI at 15 years of age. Outcome measures: Neurological test scores. MRI findings, principally white matter damage (WMD). Results: VLBW children were inferior in neurological assessments in comparison with controls at 40 weeks gestational age and 4 and 15 years of age. VLBW girls did not differ from their controls at 9 and 15 years. Fourteen of 56 (25%) VLBW children had abnormal MRI findings and 13 were evaluated as mild WMD. Children with WMD did not differ in neurological outcome from those without WMD at any examination. Mechanical ventilation and/or intraventricular haemorrhage (IVH) during the neonatal period were significantly related to less a favourable outcome at follow-up examinations. Conclusion: A cohort of VLBW children without overt neurological disability had a poorer neurological condition up to adolescence in comparison with controls. A quarter of the VLBW children had mild WMD but without relation to the neurological functions. Mechanical ventilation and IVH were related to poorer neurological outcome.
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| 8. |
- Hellström-Westas, Lena, et al.
(författare)
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Electroencephalography and brain damage in preterm infants.
- 2005
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Ingår i: Early Human Development. - : Elsevier BV. - 1872-6232 .- 0378-3782. ; 81:3, s. 255-261
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Tidskriftsartikel (refereegranskat)abstract
- Electroencephalography (EEG) is a sensitive method for detection of brain injury in preterm infants. Although the acute and chronic EEG changes are mainly non-specific regarding type of injury, they correlate with later neurological and cognitive function. In infants developing periventricular hemorrhagic or ischemic brain injury, acute EEG findings include depression of background activity and presence of epileptic seizure activity. The chronic EEG changes associated with white matter injury and abnormal neurological development include delayed maturation, and presence of abundant rolandic sharp waves. Suboptimal cognitive development in preterm infants has been associated with changes in various sleep measures in EEG’s recorded at full term. Continuous EEG-monitoring during neonatal intensive care shows that cerebral electrical activity during this vulnerable period can be affected by several extracerebral factors, e.g. cerebral blood flow, acidosis and some commonly used medications. For diagnosis of brain injury in preterm infants with neurophysiological methods, a combination of early continuous EEG monitoring during the initial intensive care period and full EEG, performed at later stages, is probably optimal.
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| 9. |
- Jonas, W., et al.
(författare)
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Newborn skin temperature two days postpartum during breastfeeding related to different labour ward practices
- 2007
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Ingår i: Early Human Development. - : Elsevier BV. - 0378-3782 .- 1872-6232. ; 83:1, s. 55-62
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To investigate (1) the skin temperature pattern in newborns two days after birth in connection to breastfeeding and to examine (2) if the administration of epidural analgesia (EDA) and oxytocin (OT) infusion during labour influences this parameter at this point of time. Method: Forty-seven mother-infant pairs were included in the study: nine mothers had received OT stimulation during labour (OT group), 20 mothers had received an EDA and OT during labour (EDA group), while 18 mothers had received neither EDA nor OT stimulation during labour (control group). A skin temperature electrode was attached between the newborn's shoulder blades. The newborn was placed skin-to-skin on the mother's chest and covered with a blanket. The temperature was recorded immediately after the newborn was put on the mother's chest and at 5, 10, 20 and 30 min. Results: The temperature measured when the newborns were put skin-to-skin on their mothers' chest was significantly higher in the infants of the EDA group (35.07 °C) when compared to the control group (34.19 °C, p = 0.025). Skin temperature increased significantly (p = 0.001) during the entire experimental period in the infants belonging to the control group. The same response was observed in infants whose mothers received OT intravenously during labour (p = 0.008). No such rise was observed in infants whose mothers were given an EDA during labour. Conclusion: The results show that the skin temperature in newborns rises when newborns are put skin-to-skin to breastfeed two days postpartum. This effect on temperature may be hampered by medical interventions during labour such as EDA. © 2006 Elsevier Ireland Ltd. All rights reserved.
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| 10. |
- Kleberg, Agneta, et al.
(författare)
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Mothers' perception of Newborn Individualized Developmental Care and Assessment Program (NIDCAP) as compared to conventional care.
- 2007
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Ingår i: Early Human Development. - : Elsevier BV. - 1872-6232 .- 0378-3782. ; 83:6, s. 403-411
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Tidskriftsartikel (refereegranskat)abstract
- Background: Family-centred care according to the Newborn Individualized Developmental Care and Assessment Program (NIDCAP) has been reported to positively influence family function. The aim was to examine if NIDCAP affects the views of prematurely born infants' mothers regarding maternal rote, perception of the infant and the neonatal care. Method: Preterm infants with gestational age < 32 weeks were randomly assigned to receive either care based on NIDCAP (n = 12) or conventional neonatal care (n = 13), forming two comparable groups with respect to gestational age, birth weight, female/male ratio, and initial illness severity. A questionnaire was designed to evaluate various aspects of the mothers' attitudes and apprehension of their maternal rote, perception of their infant and the neonatal care. The questionnaire was validated and given to the mothers when the infants reached 36 weeks postmenstrual age (PMA). Results: Ten mothers in each group replied to the questionnaire. The mothers in the NIDCAP-group perceived more closeness to their infants than did the control mothers (p = 0.022) and this feeling demonstrated no significant correlation to the infant's gestational age, weight at birth or severity of illness. Furthermore, the mothers in the NIDCAP-group tended to rate the staff's ability to support them in their role as a mother somewhat higher (p = 0.066), but at the same time they expressed more anxiety than did the control mothers (p = 0.033). Conclusion: Early intervention according to NIDCAP seems to facilitate a feeling of closeness between the mother and her premature infant regardless of the infant's birth weight or health status. The higher level of anxiety in the mothers in the NIDCAP-group, may mirror that the mothers in the NIDCAP-group had already bonded to their infants during the hospital stay.
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| 11. |
- Källén, Bengt
(författare)
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Reply to letter to the Editor
- 2005
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Ingår i: Early Human Development. - : Elsevier BV. - 1872-6232 .- 0378-3782. ; 81:5, s. 469-470
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 12. |
- Lagercrantz, H
(författare)
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The birth of consciousness
- 2009
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Ingår i: Early human development. - : Elsevier BV. - 1872-6232 .- 0378-3782. ; 85:1010 Suppl, s. S57-S58
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Tidskriftsartikel (refereegranskat)
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| 13. |
- Li, Hui, et al.
(författare)
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Acute centralization of blood flow in compromised human fetuses evoked by uterine contractions.
- 2006
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Ingår i: Early Human Development. - : Elsevier BV. - 1872-6232 .- 0378-3782. ; 82:11, s. 747-752
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Tidskriftsartikel (refereegranskat)abstract
- Background: During fetal hypoxia blood is redistributed to the brain ('brain-sparing'). Sequential changes of the cerebral and placental circulation in parallel in comparisons between basal conditions and acute hypoxic stress have not yet been thoroughly studied in human fetuses. Aim: To explore acute fetal middle cerebral artery (MCA) circulatory changes relative to umbilical artery (UA) blood flow in a clinical experimental model with hypoxic stress provoked by uterine contractions during an oxytocin challenge test (OCT). Study design: Prospective comparative between imminently compromised (OCT positive) and un-compromised (OCT negative) fetuses. Subjects and methods: 82 term pregnancies suspected of intrauterine growth restriction were exposed to simultaneous electronic fetal heart rate monitoring and Doppler recordings of pulsatility index (PI) in the UA and MCA during basal conditions and during uterine contractions and relaxations at an OCT. Outcome measures: Sequential changes of UA and MCA PI, OCT positive vs. negative cases. Nonparametric statistics with a P < 0.05 considered significant. Results: The UA PI was significantly higher in OCT positive cases (N=10) compared with OCT negative cases (N=72) during uterine contractions and relaxations, but not during basal measurements. During contractions and relaxations the MCA PI decreased significantly in both groups (brain-sparing), but significantly more in OCT positive cases. Conclusions: During acute hypoxic stress, changes towards a centralization of blood flow to the brain develop in imminently compromised (OCT positive) fetuses at an expense of the umbilicoplacental. blood flow, and the brain-sparing flow is more pronounced than in uncompromised (OCT negative) fetuses.
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| 14. |
- Mörelius, Evalotte, et al.
(författare)
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Is a nappy change stressful to neonates?
- 2006
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Ingår i: Early Human Development. - : Elsevier BV. - 1872-6232 .- 0378-3782. ; 82:10, s. 669-676
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Infants in neonatal intensive care (NICU infants) are often cared for in a stressful environment that includes potentially painful or stressful interventions. The aim was to investigate whether NICU infants have different pattern of stress and pain responses than healthy newborns when challenged by a non-painful everyday care routine. Methods: NICU infants born at 23-38 weeks gestation (n=39) were compared to healthy fullterm newborns (n=30). Cortisol concentrations in saliva were determined before and 30 min after a standardised nappy change. The premature infant pain profile (PIPP) and the neonatal infant pain scale (NIPS) were evaluated before, during, directly after, 3 min after, and 30 min after the nappy change. The investigation was performed on two different occasions, first between postnatal days 2-7 and then between postnatal days 10-18. Results: NICU infants had higher median baseline salivary cortisol levels compared to full-term newborns on both occasions (17.1 nmol/L vs. 6.2 nmol/L p < 0.01 and 8.5 nmoL/L vs. 2.4 nmoL/L p < 0.01, respectively). Salivary cortisol decreased-in response to the second nappy change in NICU infants (p=0.01). NICU infants had higher PIPP scores during both nappy changes (p < 0.001 for both occasions) and more sustained increases in PIPP and NIPS up to 30 min after the nappy changes compared to full-term newborns. Conclusions: NICU infants have higher baseline salivary cortisol than healthy full-term newborns. There is a change in baseline cortisol. by age in both groups. Full.-term infants as well as NICU infants show an increased pain response to a standardised nappy change.
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| 15. |
- Wiberg, Nana, et al.
(författare)
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Physiological development of a mixed metabolic and respiratory umbilical cord blood acidemia with advancing gestational age.
- 2006
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Ingår i: Early Human Development. - : Elsevier BV. - 1872-6232 .- 0378-3782. ; 82:9, s. 583-589
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To investigate respiratory and metabolic components of gestational age-dependent umbilical cord blood gas changes. Study design: Cord blood gases were determined in 1336 vigorous singletons with uncomplicated cephatic vaginal delivery at 37-43 weeks. Linear regression analysis and non-parametric statistics were used with a P < 0.05 being significant. Results: Gestational age correlated negatively with arterial pH and HCO3- and positively with pCO(2) and base deficit. Venous blood showed corresponding changes except for pCO(2), which was independent of gestational age. Arterial pCO(2), but not venous, correlated positively with birthweight deviation from the mean. The fractional fetal CO2 production per birthweight unit and the fractional placental CO2 clearance per placental weight unit were not correlated with gestational age. Conclusions: A mixed respiratory and metabolic cord blood acidemia develops with advancing gestational age. The respiratory component depends on an increased 'CO2 load' fetus and not on deterioration of placental gas exchange. The etiology of the metabolic component is yet unknown. (c) 2006 Published by Elsevier Ireland Ltd.
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| 22. |
- Hagberg, Henrik, 1955, et al.
(författare)
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Brain injury in preterm infants--what can the obstetrician do?
- 2005
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Ingår i: Early human development. - : Elsevier BV. - 0378-3782. ; 81:3, s. 231-5
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Forskningsöversikt (refereegranskat)abstract
- Mothers at increased risk of preterm birth often receive glucocorticoids (GC), antibiotics and tocolytics by the obstetrician but the question is whether such interventions affect the risk of brain injury and neurological outcome. We suggest that one single course of antenatal GC is the most important treatment that can be offered to patients at risk of preterm birth at 24-34 weeks of gestation to prevent brain injury. Betamethasone seems advantageous to dexamethasone and repeated courses of GC should probably be avoided. Antibiotics given to patients with preterm premature rupture of membranes reduce neonatal morbidity and decrease the risk of sonographic cerebral abnormalities even though the effect on long-term neurological outcome is uncertain. From the perspective of the immature CNS, there is no evidence for treatment with tocolytics even though it allows transfer of the patient to a tertiary center and increases the likelihood of administration of a complete course of corticosteroids which may affect outcome.
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