| 1. |
- Dykes, Fiona, et al.
(author)
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Encouraging breastfeeding : A relational perspective
- 2010
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In: Early Human Development. - : Elsevier BV. - 0378-3782 .- 1872-6232. ; 86:11, s. 733-736
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Journal article (peer-reviewed)abstract
- Despite the WHO recommendations that babies should be breastfed exclusively for six months and thereafter for up to two years and beyond this pattern of feeding is far from the global norm. Although breastfeeding is triggered through biological mechanisms which have not changed with time, the perception of breastfeeding as a phenomenon is variable, as it not only reflects cultural values of motherhood but is also negotiable from the perspective of the individual. This paper argues that relationships are central to encouraging breastfeeding at an organisational, family and staff-parent level. This shifts our conceptualisations away from the primary focus of breastfeeding as nutrition which, in turn, removes the notion of breastfeeding as a productive process, prone to problems and failure.
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| 2. |
- Germa, Alice, et al.
(author)
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Neonatal factors associated with alteration of palatal morphology in very preterm children : The EPIPAGE cohort study
- 2012
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In: Early Human Development. - : Elsevier. - 0378-3782 .- 1872-6232. ; 88:6, s. 413-420
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Journal article (peer-reviewed)abstract
- Background: Altered palatal morphology has been observed among some preterm children, with possible consequences on chewing, speaking and esthetics, but determinants remain unknown. Aim: To explore the role of neonatal characteristics and neuromotor dysfunction in alteration of palatal morphology at 5 years of age in very preterm children. Study design: Prospective population-based cohort study. Subjects: 1711 children born between 22 and 32 weeks of gestation in 1997 or born between 22 and 26 weeks of gestation in 1998 were included in the study. They all had a medical examination at 5 years of age. Outcome measures: Alteration of palatal morphology. Results: The prevalence of altered palatal morphology was 3.7% in the overall sample, 5.1% among boys and 2.2% among girls (adj OR: 2.52; 95%CI: 1.44–4.42). The risk for altered palatal morphology was higher for lower gestational age (adj OR: 0.85; 95%CI: 0.74–0.97 per week), small-for-gestational age children (adj OR: 2.11; 95%CI: 1.20–3.72) or children intubated for more than 28 days (adj OR: 3.16; 95%CI: 1.11–8.98). Altered palatal morphology was more common in case of cerebral palsy or moderate neuromotor dysfunction assessed at 5 years. Results were basically the same when neuromotor dysfunction was taken into account, except for intubation. Conclusion: Male sex, low gestational age, small-for-gestational age and long intubation have been identified as probable neonatal risk factors for alteration of palatal morphology at 5 years of age in very preterm children. Further studies are needed to confirm these results.
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| 3. |
- Griffin, Ian J., et al.
(author)
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Zinc and copper requirements in preterm infants : An examination of the current literature
- 2013
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In: Early Human Development. - : Elsevier. - 0378-3782 .- 1872-6232. ; 89:Supplement 2, s. S29-S34
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Journal article (peer-reviewed)abstract
- Background: Zinc and copper are essential for preterm infants, but recommended requirements from different groups vary widely. Recommended zinc intakes have steadily increased over the years. Although this would be expected to impair copper absorption, recommended copper intakes have not risen in parallel.Objectives: To systematically review the literature on zinc and copper retention in preterm infants; to examine the effect on zinc intake on copper retention; and to estimate the zinc and copper intakes required to meet the levels of zinc and copper retention required for normal growth.Design: Studies reporting zinc and/or copper retention in preterm infants (<36 weeks of gestation) during the first 120 days of life were identified using PubMed. Only studies reporting net retention were included.Results: Fourteen studies on zinc retention reporting data on 45 different groups were identified. Eleven studies (32 groups) were identified reporting copper retention. Zinc retention was significantly higher at higher zinc intakes, and higher in formula-based diets than in human milk based diets. Zinc intakes of between 1.8-2.4 mg/kg/d (from formula based diets) and 23-2.4 mg/kg/d (from human-milk based diets) were required to achieve adequate zinc retention. Copper retention was significantly positively correlated with copper intake and significantly negatively correlated with zinc intake. At the zinc intakes suggested previously (1.8-2.4, 2.3-2.4 mg/kg/d), copper intakes of between 200 and 250 mcg/kg/d are required to ensure adequate copper retention.Conclusions: Our results support the higher zinc intakes recommended in recent guidelines. However, they suggest that recommended copper intakes have not kept pace with increasing zinc intakes, and that preterm infants may need higher copper intakes than currently recommended.
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| 4. |
- Kocylowski, Rafal, et al.
(author)
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Hepatic aminotransferases of normal and IUGR fetuses in cord blood at birth
- 2012
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In: Early Human Development. - : Elsevier BV. - 1872-6232 .- 0378-3782. ; 88:7, s. 461-465
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Journal article (peer-reviewed)abstract
- Background: The accepted standard for assessing the wellbeing of the newborn is the Apgar score and blood gas analysis. However, the prediction of neonatal morbidity or mortality is limited. In small-for-gestation (SGA) fetuses at 18-38 weeks of gestation, pO(2) is <5th centile both in the umbilical artery and vein in 30%. In a previous study in singleton term neonates cardiac specific enzymes (B-type natriuretic peptide, BNP and cardiac troponin T, cTnT) are increased in growth-restricted fetuses compared with normals. Aims: To test the hypothesis, that fetuses with intra uterine growth restriction (IUGR) have elevated AST (GOT) and ALT (GPT) aminotransferases as a result of hypoxic liver cell injury, and to establish references ranges. Study design: Prospective cohort study, serum of umbilical artery (n = 156) and vein (n = 180), 599 normal singletons at 37(+0)-42(+0) weeks, neonates with IUGR (n = 41). analysis for pH, birthweight and maternal weight, spontaneous vs cesarean section, vein vs artery and for the sex. Outcome measures: Aspartate aminotransferase (AST. GOT) and Alanine aminotransferase (ALT, GPT) were measured in normals and IUGR neonates. Results: Neonates with IUGR (n = 41) had AST values that were not different from the reference group, but had significantly lower ALT (-1.49, 95% CI - 1.98 to - 1.00 vs 0.14, 95% CI - 0.42-0.13), (p<0.001), (Fig. 3). Conclusions: In neonates with IUGR, hypoxic hepatic injury markers in cord blood were not elevated. Rather, a substantially reduced ALT suggests a down-regulated hepatic activity. (C) 2011 Elsevier Ireland Ltd. All rights reserved.
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| 5. |
- Leipala, Jaana A., et al.
(author)
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Perinatal cerebral insults alter auditory event-related potentials
- 2011
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In: Early Human Development. - : Elsevier BV. - 1872-6232 .- 0378-3782. ; 87:2, s. 89-95
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Journal article (peer-reviewed)abstract
- Background: Auditory event-related potentials (AERPs) can be used as indices of neural information processing. Altered AERPs have been reported in children and young adults with frontal lobe infarction. Aim: To test the hypothesis that perinatal brain injury affects cortical auditory processing. Methods: We assessed AERPs at term. 6 and 12 months of age in preterm infants [n = 9. median gestational age (GA) 27.9, range 23.9-30.0 wk], term infants with perinatal intracerebral hemorrhage (ICH) [n = 5, GA 40.3, range 37.4-42.3 wk], and term infants with perinatal asphyxia In [n = 4. GA 39.4. range 37.9-40.3 wk]. Healthy preterm (n = 16) and term infants (n = 22) served as controls. A harmonic tone of 500-Hz frequency was used as standard and of 750-Hz as deviant stimulus. Mean AERP amplitudes were calculated over 100 ms periods from 50 to 350 ms. The developmental outcome was followed until 2 years of age. Results: The term ICH (p = 0.012) and asphyxia (p = 0.0016) group had smaller or more negative responses to the deviant, resulting in smaller or more negative MMR amplitudes than those of the controls. The preterm ICH group did not differ significantly from their preterm born controls. MMR varied in all patient groups and was not associated with adverse outcome. Conclusion: AERP alterations suggest that perinatal cerebral insults affect cortical auditory processing. (C) 2010 Elsevier Ireland Ltd. All rights reserved.
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| 6. |
- Lundqvist, Cristina, et al.
(author)
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Early behaviour and development in breast-fed premature infants are influenced by omega-6 and omega-3 fatty acid status.
- 2010
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In: Early human development. - : Elsevier BV. - 1872-6232 .- 0378-3782. ; 86:7, s. 407-12
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Journal article (peer-reviewed)abstract
- Background: The requirement of essential fatty acids (EFA) for the development of the brain is well documented. Objective: To investigate the early neurological development at term and 44 weeks gestational age in preterm infants in relation to EFA concentrations in breast milk and in infants' and mothers' plasma phospholipids. Method: Fifty-one premature infants and their mothers were consecutively included in the study. The median gestational age was 34 weeks (range 24–36). The motor quality, motor and behavioural development were assessed by General Movements (GMs), the Brazelton Neonatal Behavioral Assessment Scale (BNBAS) and a Self Regulation Scale. Results: Mother's education and gestational age correlated to several outcome variables. Multiple regression with correction for background factors showed negative associations between early breast milk concentrations of Mead acid and GMs and between AA and the BNBAS clusters Orientation and Range of States, respectively. Between 40 and 44 weeks gestational age, no expected increased scores were observed for Regulation of States, Range of States and Self Regulation. During the corresponding time, increased concentration of linoleic acid in mothers' plasma was negatively associated with improvement in Orientation and increased concentration of EPA in the infants' plasma was positively associated with improvement in Autonomic Stability. Conclusions: The major omega-6 fatty acids and Mead acid were negatively associated with early development and omega-3 fatty acids positively associated. Mother's education and the gestational age influenced the outcome more strongly than mother's and infant's morbidities. Further follow-up will elucidate the significance of these early findings.
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| 7. |
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| 8. |
- Munsters, Josanne, 1986-, et al.
(author)
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Skin conductance measurements as pain assessment in newborn infants born at 22-27 weeks gestational age at different postnatal age
- 2012
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In: Early Human Development. - : Elsevier BV. - 0378-3782 .- 1872-6232. ; 88:1, s. 21-26
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Journal article (peer-reviewed)abstract
- BACKGROUND: To assess pain or stress in newborn infants submitted to intensive care is important but difficult, as different observational pain scales are not always reliable in premature infants. As an indicator of pain, skin conductance (SC) measurements have detected increased sweating in newborn infants >28 gestational age (GA) submitted to heel lancing. OBJECTIVE: To measure SC during heel lancing and routine care in newborn infants, born at 22 to 27 GA, with special relation to postnatal age (PNA). METHODS: In six infants <28+0 GA and 4 infants ≥28+0 GA spontaneous SC activity and behavioural state (Neonatal Pain Agitation and Sedation Scale (N-PASS)) was measured before, during and after each intervention. Measurements were repeated in each patient at different PNA. RESULTS: Baseline SC prior to intervention took longer time to stabilise and was higher in <28 than in ≥28+0 PNA. The combination of heel lancing and squeezing gave an increased SC in <28 PNA, whereas heel lancing alone gave the same SC response in ≥28+0 PNA. A possibly continued immature response in SC measurements was not observed. Oral glucose admission prior to heel lancing increased SC. Routine care did not give any changes in SC. Except during orogastric tube placement no signs of discomfort or pain could be detected by the neonatal pain, agitation and sedation scale (N-PASS) in <28 PNA. to the combination of heel lancing and squeezing. A maturational development of the SC was observed in infants born <28 GA. SC seems to be able to differentiate between pain and discomfort.
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| 9. |
- Mörelius, Evalotte, et al.
(author)
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The Stockholm Neonatal Family-Centered Care Study : Effects on salivary cortisol in infants and their mothers
- 2012
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In: Early Human Development. - : Elsevier. - 0378-3782 .- 1872-6232. ; 88:7, s. 575-581
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Journal article (peer-reviewed)abstract
- 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.
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| 10. |
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| 11. |
- Siira, Saila M., et al.
(author)
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Do spectral bands of fetal heart rate variability associate with concomitant fetal scalp pH?
- 2013
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In: Early Human Development. - : Elsevier Ireland Ltd. - 0378-3782 .- 1872-6232. ; 89:9, s. 739-742
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Journal article (peer-reviewed)abstract
- Background: Objective information on speci fi c fetal heart rate (FHR) parameters would be advantageous when assessing fetal responses to hypoxia. Small, visually undetectable changes in FHR variability can be quanti fi ed by power spectral analysis of FHR variability. Aims: To investigate the effect of intrapartum hypoxia and acidemia on spectral powers of FHR variability. Study design: This is a retrospective observational clinical study with data from an EU multicenter project. Subjects: We had 462 fetuses with a normal pH-value (pH > 7.20; controls) in fetal scalp blood sample (FBS) and 81 fetuses with a low scalp pH-value ( ≤ 7.20; low-FBS pH-fetuses). The low-FBS pH-fetuses were further divided into two subgroups according to the degree of acidemia: fetuses with FBS pH 7.11 – 7.20 (n = 58) and fetuses with FBS pH ≤ 7.10 (n = 23). Outcome measures: Spectral powers of FHR variability in relation to the concomitant FBS pH-value. Results: Fetuses with FBS pH ≤ 7.20 had increased spectral powers of FHR variability compared with controls (2.49 AU vs. 2.23 AU; p = 0.038). However, the subgroup of most affected fetuses (those with FBS pH ≤ 7.10) had signi fi cantly lower FHR variability spectral powers when compared to fetuses with FBS pH 7.11 – 7.20. Conclusions: This study shows that spectral powers of FHR variability change as a fetus becomes hypoxic, and that spectral powers decrease with deepening fetal acidemia.
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| 12. |
- Skiöld, Béatrice, et al.
(author)
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General movements and magnetic resonance imaging in the prediction of neuromotor outcome in children born extremely preterm
- 2013
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In: Early Human Development. - : Elsevier. - 0378-3782 .- 1872-6232. ; 89:7, s. 467-472
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Journal article (peer-reviewed)abstract
- BACKGROUND: Extremely preterm (EPT) birth is a major risk factor for brain injury and neurodevelopmental impairment. Reliable tools for early prediction of outcome are warranted.AIM: To investigate the predictive value of general movements (GMs) at "fidgety age" for neurological outcome at age 30 months in EPT infants, both in comparison and in combination with structural magnetic resonance imaging (MRI) at term equivalent age (TEA).STUDY DESIGN: Fifty-three infants born <27 weeks of gestation were included prospectively. MRI was performed at TEA and images were evaluated for white and grey matter abnormalities. GMs were assessed at age 3 months corrected ("fidgety age").OUTCOME MEASURES: Neuromotor outcome was assessed at age 30months corrected. Children were classified as having a normal neurological status, unspecific signs, or cerebral palsy (CP).RESULTS: Abnormal GMs were a common finding, seen in 32% (17/53) of infants. Of these, six infants (11%) had definitely abnormal GMs. Four infants (8%) had a diagnosis of CP at follow up. Definitely abnormal GMs were significantly associated to CP at 30 months (Fisher's Exact test p=0.03, sensitivity 50%, specificity 92%). Moderate-severe white matter abnormalities on MRI were more strongly associated with CP (Fisher's Exact test p<0.001, sensitivity 100%, specificity 98%) than GMs. Combining GMs with MRI-findings at TEA increased the predictive specificity to 100% (Fisher's Exact test, p=0.005), whereas sensitivity remained unchanged.CONCLUSIONS: The presence of definitely abnormal GMs was predictive of CP: prediction was significantly enhanced when the GMs assessment was combined with findings from MRI obtained at TEA.
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| 13. |
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