| 1. |
- Aubert, Adrien M., et al.
(författare)
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Developmental motor problems and health-related quality of life in 5-year-old children born extremely preterm: A European cohort study
- 2023
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Ingår i: Developmental Medicine & Child Neurology. - : WILEY. - 0012-1622 .- 1469-8749. ; 65:12, s. 1617-1628
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Tidskriftsartikel (refereegranskat)abstract
- Aim To measure the association between cerebral palsy (CP) and non-CP-related movement difficulties and health-related quality of life (HRQoL) among 5-year-old children born extremely preterm (<28 weeks gestational age). Method We included 5-year-old children from a multi-country, population-based cohort of children born extremely preterm in 2011 to 2012 in 11 European countries (n = 1021). Children without CP were classified using the Movement Assessment Battery for Children, Second Edition as having significant movement difficulties (<= 5th centile of standardized norms) or being at risk of movement difficulties (6th-15th centile). Parents reported on a clinical CP diagnosis and HRQoL using the Pediatric Quality of Life Inventory. Associations were assessed using linear and quantile regressions. Results Compared to children without movement difficulties, children at risk of movement difficulties, with significant movement difficulties, and CP had lower adjusted HRQoL total scores (beta [95% confidence interval] = -5.0 [-7.7 to -2.3], -9.1 [-12.0 to -6.1], and - 26.1 [-31.0 to -21.2]). Quantile regression analyses showed similar decreases in HRQoL for all children with CP, whereas for children with non-CP-related movement difficulties, reductions in HRQoL were more pronounced at lower centiles. Interpretation CP and non-CP-related movement difficulties were associated with lower HRQoL, even for children with less severe difficulties. Heterogeneous associations for non-CP-related movement difficulties raise questions for research about mitigating and protective factors.
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| 2. |
- Aubert, Adrien, et al.
(författare)
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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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Ingår i: Pediatric Research. - : SPRINGERNATURE. - 0031-3998 .- 1530-0447. ; 94:2, s. 771-780
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Tidskriftsartikel (refereegranskat)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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| 3. |
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| 4. |
- Baraldi, Erika, 1982-, et al.
(författare)
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Clinical Protocol & Research Process of Stockholm Preterm Interaction-Based Intervention, SPIBI
- 2019
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Ingår i: Pediatric Research. - : Springer Science and Business Media LLC. - 0031-3998 .- 1530-0447. ; 86:Suppl., s. 54-55
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundExtremely preterm (EPT) born children are at increased risk of cognitive and neurodevelopmental impairment, neuropsychiatric disorders and academic difficulties. Parents of EPT born children are extra vulnerable for anxiety, posttraumatic stress disorder and depression and the parent-child interaction is negatively affected by prematurity. There is some evidence that early interventions have beneficial effects on neurocognitive and motor outcomes (Spittle A et al 2015). Based on a previous intervention (Verkerk G et al 2012) and adjusted to the Swedish context with 480 days paid parental leave, we created a post–discharge intervention, SPIBI, for families of EPT born children.MethodThe aim of (SPIBI) is to improve the quality of the parent-child interaction, child development and parental mental health in families with EPT born children. . SPIBI is a randomized controlled beginning at discharge and lasting until the child is 12 months corrected age. The trial design is a two arm randomized trial with four recruiting sites in Stockholm. Intervention group (target, n=65) receives 10 visits and two telephone calls from a trained interventionist and the control group (target n=65) receives treatment as usual plus an extended follow-up program. The SPIBI-team has recruited and trained 6 multi-professional and NICU-experienced interventionists. The training takes one year (0.2 of full time) and the content was both theoretical and practical, including pilot-cases. ResultSPIBI is an ongoing research project, beginning the 1st of September 2018 and planning to end recruitment the 31st of August 2020 and finishing the home-visits in August 2021. By the end of April 2019, 33 eligible infants had been identified within the four neonatal units in Stockholm; of which 26 children approved and 7 children declined participation. At this stage, three children have dropped out of the study, because of severe social challenges and child death. Identified challenges have been social and medical vulnerability of the EPT-families, finding the optimal multi-professional balance of motoric, psychological, pedagogical and medical kernels of the intervention, ethical considerations when to ask families for participation, lack of long-term discharge-planning of the neonatal units and large geographical spread of NICUs as well as families.ConclusionIn conclusion, the protocol seem to be feasible and appreciated by parents in the target group. With regard to the small recruitment base, trials of this kind needs a long inclusion time. Since EPT-children and their parents displays a wide scope of difficulties and challenges, multi-professional cooperation is preferable, placing high demands of sensitivity, professional respect and time for long collaborative processes.
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| 5. |
- Baraldi, Erika, 1982-, et al.
(författare)
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Early intervention program of extreme preterm born infants, status report three years into the project
- 2021
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Children born extremely preterm (e.g. before 28 gestational weeks, EPT) runs a greater risk of cognitive, motor and neurobehavioral impairment later in life, compared to children born at term. Moreover, being a parent of an EPT born child increases the probability of developing depression and posttraumatic stress disorder post-partum, as well as the premature birth may affect the parent-child interaction negatively. In an attempt to decrease the psychological and motoric negative impact of both the child and parents, our multi-professional team has developed an early intervention during the first year at home focusing om parent-child interaction of the EPT born children: Stockholm Preterm Interaction-Based Intervention, SPIBI (Baraldi et al., 2020a). The target of the RCT is 130 children and after 32 months 112 children has been included in the study, evenly distributed in the intervention group and control group. At children’s corrected age of one-year, parents from 14 of the first included families were interviewed about their experiences from the intervention program, resulting in a qualitative article. Three main themes of parental experiences of the first year at home emerged: child-related concerns (concerning child medical state, self-regulation and recovery), parental inner state (concerning loneliness, ambivalence and premature parental identity), and changed family dynamics (concerning the couple, siblings and intergenerational support). The parents from the intervention group reported that the intervention had given them security, a sense that the interventionist has been knowledgeable and in some cases that the program was important but not necessary to them (Baraldi et al., 2020b). With 85% of the targeted subjects included it is clear that an extensive early home-visit intervention program is feasible in the Swedish context, even though the pandemic has slowed down the recruitment pace and has forced adjustments to be made such as the use of telemedicine, exclusion of toys in the follow-up process and intensified hygienic procedures.
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| 6. |
- Baraldi, Erika, 1982-, et al.
(författare)
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Home-visits during the first year of life : a strengths-based intervention for extremely premature infants and their parents, a randomized-control trial developed in Stockholm Region
- 2020
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- In Sweden 400 children yearly are born extremely preterm (EPT; more than three months early). These children have an increased risk of later academic difficulties, neuropsychiatric disorder, cognitive and mental health issues. Since the first 1000 days of the brain development are so crucial for later development, the interdisciplinary Stockholm Preterm Interaction-Based Intervention (SPIBI) aims at strengthening the parent-child interaction, child development and parental mental health. The research is based on pedagogical, motor-developmental, medical and psychological science. The program is based on Vygotski’s theory of the zone of proximal development, as well theoretical frameworks of early intervention (Guralnick; Shonkoff). Additionally, Als’ synactive theory of understanding premature infant communication and needs, Bowlby’s attachment theory, and Emde’s emotional availability theory have been applied. SPIBI is an ongoing research project funded by Stockholm-County-Stockholm-University joint-collaboration grant 20160881. It is an RCT targeting 130 EPT infants and their parents in Stockholm with a 3-year inclusion period starting September 2018. The intervention consists of ten home-visits during the first year by trained interventionists, supporting the next developmental step of the child through a scaffolding process, strengthening parental sensitivity to infant cues, and promoting infant’s self-regulation. SPIBI has recruited and trained six multi-professional-NICU-experienced interventionists. Control group participants receive TAU plus an extended follow-up program.The overall aim is to present the framework and theory of change of SPIBI, relating to research findings, welfare policies and recommendations for infant’s “chain of care”. So far, sixty eligible infants have been identified within four neonatal units; of which 48 approved participation. The primary outcome is emotional availability of the parent and child, where we hypothesize that the intervention will affect the parental sensitivity and structure of interaction with the child. Secondary outcomes concern child development, i.e. motor development, cognition and occurrence of neuropsychiatric symptoms, parental mental health, anxiety and self-efficacy, where we also hypothesize positive effects of the intervention. Since Nordic countries have neonatal intensive care of high quality, the amount of EPT survivors is high compared to other countries; therefore, the educational systems must follow achievements reached by health care system and develop new evidence-based interventions in early childhood education, which are appropriated for EPT born children and their parents, following recent European Standards of Care for Newborn Health (2018).Insights from neuro-cognition, early intervention and educational research has shown the importance of interdisciplinary interventions, and this should be spread around the Nordic countries.Nordic countries offer a unique social environment, with governmental funded parental-leave, enabling early-interventions delivered by parents.The EPT children in Nordic countries are less affected by socioeconomic factors, as is often the case where maternity welfare and obstetrics is not publically financed. Hence, Nordic countries have a unique opportunity to perform research targeting EPT students and their parents specifically, with less confounding factors.Some Nordic countries have adopted policies concerning home-visiting support and infants’ rights, as recommended by the World Association of Mental health’s policy statement from 2016, and Nordic knowledge exchange and collaboration on these policies is warranted.
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| 7. |
- Baraldi, Erika, 1982-, et al.
(författare)
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Innovative multiprofessional early intervention aiming at improving development of prematurely born children
- 2024
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Abstract: Extremely preterm born children and their parents is a vulnerable group with a high risk of developmental delays, academic challenges and parental mental health difficulties. Previously interventions have been medical focusing of increasing survival, but recently post-discharge interventions improving long-term development have been presented. This abstract concerns a novel multiprofroessional intervention, Stockholm Preterm Interaction-Based Intervention (SPIBI) aiming at consolidation of expertise from educational, behavioral and medical fields in benefit of the child development and family well-being. Rationale and purpose: SPIBIs purpose is to enhance the parent-child interaction, child cognitive and motor development, child preschool social participation and parental mental health in families with extreme preterm born infants.Description of methods, results, or modes of inquiry: In a novel RCT a strengths-based post-discharge intervention targeting extreme preterm born (EPT= born before 28 gestational weeks) infants and their parents is being tested. 130 EPT born children and their parents have been randomly allocated to an intervention group receiving 10 home visits during the first year at home, or a control group receiving treatment as usual with an extended follow-up program. The novel intervention is named Stockholm Preterm Interaction-Based Intervention (SPIBI).Innovation: The field of long-term development of extremely born infants is innovative in itself, since the field consist of a severely vulnerable population on the verge of viability, who did not survive twenty years ago. The innovation in SPIBI is its consolidation of practical knowledge as well as research concerning the challenges of extreme prematurity from a medical (brain developmental), special educational (preschool behavioral), physiotherapeutic (motor), psychological (parent-child-interactional and cognitive) perspective. Working together will benefit the child and family as a whole, since extreme prematurity is a nuanced field with implications for several aspects of development. Despite this, previous international research from the field is almost always unidisciplinary.Implications for policy or practice: The outcome will influence practice at a regional and possible national level, concerning how a low cost early intervention may improve several outcomes and reduce challenges for a group of children with a high risk of developmental delays.Relationship to principles of diversity, equity, and inclusion: The extreme preterm born population often has double challenges, both concerning developmental delays and socioeconomic hardships, both internationally and in a Swedish context. Giving this vulnerable population initial extra support is ultimately a question of equity, increasing the chance of participating in fully inclusive learning environments ahead.Methods used to encourage audience engagement When presenting the poster, these 3 questions will be continuously discussed with researchers passing by:1. What do parents to medically fragile infants who have been balancing on the verge of death, need when the family comes back home from the hospital?2. What are the key elements of multidisciplinary and multiprofessional co-operation between medicine, psychology and special education?3. What may be the different needs of different groups of families with extreme preterm born children, regarding socioeconomic background, severity of prematurity and migration statues?
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| 8. |
- Baraldi, Erika, 1982-, et al.
(författare)
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Insights Gained from Stockholm Preterm Interaction-Based Intervention - A Critical View
- 2022
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Konferensbidrag (refereegranskat)abstract
- SPIBI is a strength-based early intervention targeting parent-child interaction amongst extremely preterm born infants, currently tested in an RCT in Sweden. Of 130 infants, 72% have reached 12 months of age. Based on interviews with 17 parents’ and 6 intervention providers we identified SPIBI strengths and shortcomings. SPIBI seems feasible, is possible to integrate it into home-visiting practice and is appreciated by parents. Identified challenges are geographical distance; recruitment obstacles including Covid-19, leading to longer-term implementation; service-provider fatigue; and social adversities amongst some eligible participants requiring ethical considerations. Future improvements include: reconsidering inclusion criteria, increasing use of e-health, and exploring the possibility of a tiered approach.
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| 9. |
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| 10. |
- Baraldi, Erika, 1982-, et al.
(författare)
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Parents’ Experiences of the First Year at Home with an Infant Born Extremely Preterm with and without Post-Discharge Intervention : Ambivalence, Loneliness, and Relationship Impact
- 2020
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Ingår i: International Journal of Environmental Research and Public Health. - : MDPI AG. - 1661-7827 .- 1660-4601. ; 17:24
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Tidskriftsartikel (refereegranskat)abstract
- With increasing survival rates of children born extremely preterm (EPT), before gestational week 28, the post-discharge life of these families has gained significant research interest. Quantitative studies of parental experiences post-discharge have previously reported elevated levels depressive symptoms, posttraumatic stress-disorder and anxiety among the parents. The current investigation aims to qualitatively explore the situation for parents of children born EPT in Sweden during the first year at home. Semi-structured interviews were performed with 17 parents of 14 children born EPT; eight parents were from an early intervention group and nine parents from a group that received treatment as usual, with extended follow-up procedures. Three main themes were identified using a thematic analytic approach: child-related concerns, the inner state of the parent, and changed family dynamics. Parents in the intervention group also expressed themes related to the intervention, as a sense of security and knowledgeable interventionists. The results are discussed in relation to different concepts of health, parent–child interaction and attachment, and models of the recovery processes. In conclusion, parents describe the first year at home as a time of prolonged parental worries for the child as well as concerns regarding the parent’s own emotional state.
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| 11. |
- Baraldi, Erika, 1982-, et al.
(författare)
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Stockholm Preterm Interaction-Based Intervention, SPIBI
- 2019
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Konferensbidrag (refereegranskat)abstract
- BakgrundI Sverige föds mellan 300 och 400 barn innan den 28 graviditetsveckan. Omkring 2/3 av de extremt prematurfödda barnen har ingen eller en mild funktionsnedsättning medan 1/3 har medelsvår till svår funktionsnedsättning vid skolstart (Serenius et al, 2016). De vanligaste svårigheterna efter extrem prematur födsel är intellektuell funktionsnedsättning (Jarjour, 2015), i synnerhet svårigheter med arbetsminnet och den exekutiva funktionsutvecklingen (Stålnacke et al., 2018; Mulder et al., 2009). Även neuropsykiatriska funktionsnedsättningar som ADHD (Burnett et al., 2014) och autism är överrepresenterade i gruppen prematurfödda barn, 8- 29% av de extremt prematurfödda barnen skattas positivs på screeningtest för AST (Johnson et al., 2010; Kim, 2016 & Padilla et al., 2015).Inte bara barnet påverkas av den extremt för tidiga födseln, även föräldrarna kastas snabbt in i ett stressigt föräldraskap till ett skört och ofta sjukt spädbarn som inte är som de föreställde sig under graviditeten. Dessa stressiga omständigheter bidrar till att föräldrarna löper en ökad risk för posttraumatisk stress och depressiva symtom än föräldrar till fullgångna barn (Holditch-Davis et al, 2003; Holditch-Davis et al, 2015; Kong et al., 2013 & Singer på al., 1999). Dessutom påverkas samspelet mellan föräldrar och barn och familjesituationen negativt (Forcada-Guex et al., 2006; Saigal et al., 2000 & Treyvaut et al., 2014). När en förälder är psykiskt labil påverkar detta barnet på ett socialt, beteendemässigt och funktionellt sätt, ända till det för tidigt föda barnet är i förskoleåldern (Huhtala et al., 2011 & Huhtala et al., 2014). Det ger därför dubbel utdelning att ta hand om föräldrarna till tidigt födda barn, både genom att påverka den vuxne direkt och barnet indirekt.Svenska Prematurförbundet (SPF) har under flera år pekat på de långsiktiga effekterna av för tidig födsel och därmed behovet av långsiktigt stöd till de drabbade familjerna (Prematurförbundet, 2019). Efter utskrivning från sjukhuset rapporterar många av föräldrarna att de känner sig ensamma, stressade och oroliga. Sådana stödprogram har inte införts eller utvärderats tidigare i Sverige.Sammanfattningsvis, utifrån risken för negativa långtidseffekter av extrem prematuritet samt Prematurförbundets önskan om ytterligare stöd, finns ett tydligt behov av interventioner riktade till barnen och deras föräldrar i syfte att stödja föräldra-barnsamspelet, barnets utveckling på sikt samt föräldrarnas psykiska hälsa. SPIBI är et interventionsprogram som ämnar fylla det behovet.MetodSPIBI består av en tvärprofessionell forskargrupp med neonatologer, psykologer, fysioterapeut och specialpedagog. Forskargruppen har designat en RCT i syfte att utvärdera effekten av ett samspelsbaserat interventionsprogram för extremt prematurfödda spädbarn och deras föräldrar, med sin början i utskrivningsprocessen som pågår under förta året hemma. Studien består av två armar, en interventionsgrupp och en kontrollgrupp, och barnen rekryteras från Stockholms fyra neonatalavdelningar under två års tid (sept 2018-sept 2020). Målet är att rekrytera 130 familjer på två år. Interventionsgruppen (IG) får 10 hembesök och två telefonsamtal från en specialutbildad behandlare. Interventionens fokus är styrkebaserat stöd av föräldra-barnsamspelet, öka förälderns lyhördhet för barnets signaler, stödja föräldern i att ge optimalt utvecklingsstöd till barnet samt öka barnets självreglerande förmåga. I det nationella uppföljningsprogrammet får alla extremt prematurfödda barn uppföljning vid 3 månader, 12 månader, 24 månader KÅ. Kontrollgruppens (KG) barn får utöver detta ett utökat uppföljningsprogram. Studiens sex behandlare arbetar inom neontalvården till vardags och har utöver detta fått en ettårig utbildning i SPIBI en dag per vecka, med både teoretisk grund och praktisk träning i interventionen, inklusive sex pilotfallshembesök. Pilotfallen videofilmades och diskuterades i grupp under handledning. Handledningen gavs direkt av de två holländska forskarna Karen Koldewijn och Marie-Jeanne Wolf från Amsterdam Academic Medical Centre som forskat på den snarlika TOP-interventionen i över 20 år och kunnat påvisa effekt på motoriken (Koldewijn et al., 2009; Meijssen et al., 2011; Flierman et al., 2016 & Koldewijn et al., 2010). Grunden till SPIBI interventionen kom utöver TOP-programmet från Cochrane-rapporten från 2015 om post-discharge interventions (Spittle et al., 2015).ResultatSPIBI är ett pågående forskningsprojekt som hittills rekryterat 44 barn, medan ytterligare 12 familjer tackat nej till deltagande i studien. I nuläget har två barn uteslutits ur studien av svåra psykosociala skäl och ytterligare två barn har avlidit under första året hemma. Identifierade utmaningar har varit den sociala och medicinska skörhet som de här familjerna behöver hantera, att hitta den optimala tvärprofessionella balansen mellan fysioterapeutiska, psykologiska, pedagogiska och medicinska inslag i interventionen, otillräcklig utskrivningsplanering från de olika sjukhusen, stor geografisk spridning på sjukhusenheterna samt den etiska frågan när i barnets liv det optimala tillfället för frågan om studiedeltagande är. Eftersom rekryteringsprocessen idag kommit halvvägs tidsmässigt kan inga resultat presenteras än, men med ett 80 % deltagande i studien och mycket positiv återkoppling från familjerna kan man dra slutsatsen att denna forskning är efterfrågad och ett viktigt nästa steg i utvecklingen av vården för våra allra mest sköra patienter.SlutsatserSlutsatsen är att SPIBI-protokollet är både genomförbart i klinisk praxis och samtidigt uppskattat av föräldrarna i målgruppen. Med hänsyn taget till den smala rekryteringsbasen kan denna typ av studie kräva en lång inkluderingstid alternativt inkludering på nationell nivå. Eftersom extremt prematurfödda barn och deras föräldrar uppvisar en rad svårigheter och utmaningar, är tvärprofessionellt samarbete att föredra vilket ställer höga krav på lyhördhet, professionell respekt och got om tid för samarbete. På Perinataldagarna kan forskningsprocessen och interventionsprogrammet presenteras i syfte att öka förståelsen för uppföljningen och behovet av ett integrerat föräldrastöd.
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| 12. |
- Baraldi, Erika, 1982-, et al.
(författare)
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Stockholm Preterm Interaction-based Intervention (SPIBI) – Av RCT Assessing Parent-Infant Interaction at 12 Months Corrected Age in Extremely Preterm Born Infants and Their Parents
- 2023
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- BackgroundParental responsiveness is of great importance for positive effects of behavioral and cognitive development in preterm infants and the Emotional availability scales (EAS) is a clinically relevant assessment measure, for early neurodevelopment. The EAS is an observational measure which reflects the quality of parent–child relationship and the child’s socio-emotional development. It has 4 adult domains (sensitivity, structuring, non-intrusiveness, non-hostility) and 2 child domains (responsiveness, involvement) (Biringen 2014). In an ongoing RCT of an intervention for extremely preterm (EPT) born infants and their parents, the Stockholm Preterm Interaction-Based Intervention (SPIBI), the primary outcome measure is EAS used at 12 months corrected age (CA). The aim for this sub-study is to evaluate the inter-rater reliability of EAS in this cohort.MethodDuring the first year after discharge, ten home visits were carried out from specially educated interventionists of our multidisciplinary team. 130 EPT infants were recruited and 115 have been filmed and assessed at 12 months CA. The parent was instructed to play with the infant for 10 minutes. Dyads were filmed, videos assessed and scored by a trained EAS-accredited team member. 20% of the videos (23/115) were assessed by an additional EAS-accreditor to evaluate inter-rater-reliability. Interclass Correlation Coefficient (ICC) were used. To obtain authenticity with real-life, the videos were filmed in a home setting with opportunity to choose study parent. Interaction were encouraged to proceed in an ordinary pattern.ResultsICC values range 0,86 - 0,96 within all dimensions, all individual values, 95%CI (Table 1). This indicates high inter-rater reliability, although some of the subscales had lower ICC (0,73-0,98). ConclusionThe SPIBI study corresponds well with EAS scoring assessment method for reflection of parent-infant interaction at 12 months CA in EPT born infants.
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| 13. |
- Baraldi, Erika, 1982-, et al.
(författare)
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Stockholm preterm interaction-based intervention (SPIBI) - study protocol for an RCT of a 12-month parallel-group post-discharge program for extremely preterm infants and their parents
- 2020
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Ingår i: BMC Pediatrics. - : Springer Science and Business Media LLC. - 1471-2431. ; 20:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Improved neonatal care has resulted in increased survival rates among infants born after only 22 gestational weeks, but extremely preterm children still have an increased risk of neurodevelopmental delays, learning disabilities and reduced cognitive capacity, particularly executive function deficits. Parent-child interaction and parental mental health are associated with infant development, regardless of preterm birth. There is a need for further early interventions directed towards extremely preterm (EPT) children as well as their parents. The purpose of this paper is to describe the Stockholm Preterm Interaction-Based Intervention (SPIBI), the arrangements of the SPIBI trial and the chosen outcome measurements.Methods: The SPIBI is a randomized clinical trial that includes EPT infants and their parents upon discharge from four neonatal units in Stockholm, Sweden. Inclusion criteria are EPT infants soon to be discharged from a neonatal intensive care unit (NICU), with parents speaking Swedish or English. Both groups receive three initial visits at the neonatal unit before discharge during the recruitment process, with a strengths-based and development-supportive approach. The intervention group receives ten home visits and two telephone calls during the first year from a trained interventionist from a multi-professional team. The SPIBI intervention is a strengths-based early intervention programme focusing on parental sensitivity to infant cues, enhancing positive parent-child interaction, improving self-regulating skills and supporting the infant’s next small developmental step through a scaffolding process and parent-infant co-regulation. The control group receives standard follow-up and care plus extended assessment. The outcomes of interest are parent-child interaction, child development, parental mental health and preschool teacher evaluation of child participation, with assessments at 3, 12, 24 and 36 months corrected age (CA). The primary outcome is emotional availability at 12 months CA.Discussion: If the SPIBI shows positive results, it could be considered for clinical implementation for child-support, ethical and health-economic purposes. Regardless of the outcome, the trial will provide valuable information about extremely preterm children and their parents during infancy and toddlerhood after regional hospital care in Sweden.Trial registration: The study was registered in ClinicalTrials.gov in October 2018 (NCT03714633).
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| 14. |
- Baraldi, Erika, 1982-, et al.
(författare)
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The development of a post-discharge intervention program in Sweden for extremely preterm infants and their caregivers, through home visits during their first year of life
- 2019
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Konferensbidrag (refereegranskat)abstract
- Sweden has a proactive neonatal intensive care, saving children born from gestation week 22, with a 90% survival rate in the extremely preterm (EPT) group. With increased survival rates, the long-term outcome of the EPT children has gained much research interest. Recent studies indicate that 1/3 of the EPT-children in Sweden show moderate to severe neurodevelopmental deficits when beginning school. An interdisciplinary research team has designed an intervention for EPT infants and their caregivers in their home-environment after hospital discharge and throughout the first year of life. The aim of the ongoing randomized controlled trial is to study intervention effects on the children’s cognitive, motor and psychosocial function, the parental mental health and the infant-parent interaction. This paper present the intervention’s theory of change, the validity considerations, and an overview of the syllabus of the training given to the interdisciplinary team of six clinicians who serve as interventionists.
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| 15. |
- Bolk, J., et al.
(författare)
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Perinatal risk factors for developmental coordination disorder in children born extremely preterm
- 2023
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Ingår i: Acta Paediatrica. - : Wiley. - 0803-5253 .- 1651-2227. ; 112:4, s. 675-685
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Tidskriftsartikel (refereegranskat)abstract
- AimChildren born extremely preterm frequently have developmental coordination disorder (DCD). We aimed to evaluate perinatal risk factors for DCD. MethodsSwedish national cohort study including 226 children born before 27 gestational weeks without major neurodevelopmental disabilities at 6.5 years. Outcome was DCD, defined as <= 5th percentile on the Movement Assessment Battery for Children-Second Edition. Perinatal risk factors were evaluated using multivariable logistic regression. ResultsDCD was present in 84/226 (37.2%) children. Of the risk factors known at 40 weeks gestation, independent and significant risk factors for DCD were: mother's age at delivery (odds ratio [OR] 1.73, 95% confidence interval [CI] 1.07-2.80); pre-eclampsia (2.79, 1.14-6.80); mother born in a non-Nordic country (2.23, 1.00-4.99); gestational age per week increase (0.70, 0.50-0.99) and retinopathy of prematurity (2.48, 1.26-4.87). Of factors known at discharge, postnatal steroids exposure (2.24, 1.13-4.46) and mechanical ventilation (1.76, 1.06-2.09) were independent risk factors when added to the model in separate analyses. ConclusionThe risk of DCD in children born extremely preterm was multifactorial and associated with gestational age largely mediated by ROP, maternal factors, pre-eclampsia, administration of postnatal steroids and mechanical ventilation. These risk factors are common among children born extremely preterm, contributing to their high risk of DCD.
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| 16. |
- Carlsson, Ylva, 1975, et al.
(författare)
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COVID-19 in Pregnancy and Early Childhood (COPE): study protocol for a prospective, multicentre biobank, survey and database cohort study.
- 2021
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Ingår i: BMJ open. - : BMJ. - 2044-6055. ; 11:9
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Tidskriftsartikel (refereegranskat)abstract
- There is limited knowledge on how the SARS-CoV-2 affects pregnancy outcomes. Studies investigating the impact of COVID-19 in early pregnancy are scarce and information on long-term follow-up is lacking.The purpose of this project is to study the impact of COVID-19 on pregnancy outcomes and long-term maternal and child health by: (1) establishing a database and biobank from pregnant women with COVID-19 and presumably non-infected women and their infants and (2) examining how women and their partners experience pregnancy, childbirth and early parenthood in the COVID-19 pandemic.This is a national, multicentre, prospective cohort study involving 27 Swedish maternity units accounting for over 86000 deliveries/year. Pregnant women are included when they: (1) test positive for SARS-CoV-2 (COVID-19 group) or (2) are non-infected and seek healthcare at one of their routine antenatal visits (screening group). Blood, as well as other biological samples, are collected at different time points during and after pregnancy. Child health up to 4years of age and parent experience of pregnancy, delivery, early parenthood, healthcare and society in general will be examined using web-based questionnaires based on validated instruments. Short- and long-term health outcomes will be collected from Swedish health registers and the parents' experiences will be studied by performing qualitative interviews.Confidentiality aspects such as data encryption and storage comply with the General Data Protection Regulation and with ethical committee requirements. This study has been granted national ethical approval by the Swedish Ethical Review Authority (dnr 2020-02189 and amendments 2020-02848, 2020-05016, 2020-06696 and 2021-00870) and national biobank approval by the Biobank Väst (dnr B2000526:970). Results from the project will be published in peer-reviewed journals.NCT04433364.
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| 17. |
- Challis, Pontus, et al.
(författare)
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Factors associated with the increased incidence of necrotising enterocolitis in extremely preterm infants in Sweden between two population-based national cohorts (2004-2007 vs 2014-2016)
- 2024
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Ingår i: Archives of Disease in Childhood-Fetal and Neonatal Edition. - : BMJ Publishing Group Ltd. - 1359-2998 .- 1468-2052. ; 109, s. 87-93
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Tidskriftsartikel (refereegranskat)abstract
- Objective To investigate potential risk factors behind the increased incidence of necrotising enterocolitis (NEC) in Swedish extremely preterm infants.Design Registry data from two population-based national cohorts were studied. NEC diagnoses (Bell stage >= II) were validated against hospital records.Patients All liveborn infants <27 weeks of gestation 2004-2007 (n=704) and 2014-2016 (n=895) in Sweden.Main outcome measures NEC incidence.Results The validation process resulted in a 28% reduction of NEC cases but still confirmed a higher NEC incidence in the later epoch compared with the earlier (73/895 (8.2%) vs 27/704 (3.8%), p=0.001), while the composite of NEC or death was lower (244/895 (27.3%) vs 229/704 (32.5%), p=0.022). In a multivariable Cox regression model, censored for mortality, there was no significant difference in early NEC (0-7 days of life) between epochs (HR=0.9 (95% CI 0.5 to 1.9), p=0.9), but being born in the later epoch remained an independent risk factor for late NEC (>7 days) (HR=2.7 (95% CI 1.5 to 5.0), p=0.001). In propensity score analysis, a significant epoch difference in NEC incidence (12% vs 2.8%, p<0.001) was observed only in the tertile of infants at highest risk of NEC, where the 28-day mortality was lower in the later epoch (35% vs 50%, p=0.001). More NEC cases were diagnosed with intramural gas in the later epoch (33/73 (45.2%) vs 6/26 (23.1%), p=0.047).Conclusions The increase in NEC incidence between epochs was limited to cases occurring after 7 days of life and was partly explained by increased survival in the most extremely preterm infants. Misclassification of NEC is common.
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| 18. |
- Challis, Pontus, et al.
(författare)
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Factors associated with the increased incidence of necrotising enterocolitis in extremely preterm infants in Sweden between two population-based national cohorts (2004-2007 vs 2014-2016)
- 2024
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Ingår i: Archives of Disease in Childhood. - : BMJ Publishing Group Ltd. - 1359-2998 .- 1468-2052. ; 109:1, s. 87-93
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Tidskriftsartikel (refereegranskat)abstract
- Objective To investigate potential risk factors behind the increased incidence of necrotising enterocolitis (NEC) in Swedish extremely preterm infants.Design Registry data from two population-based national cohorts were studied. NEC diagnoses (Bell stage >= II) were validated against hospital records.Patients All liveborn infants <27 weeks of gestation 2004-2007 (n=704) and 2014-2016 (n=895) in Sweden.Main outcome measures NEC incidence.Results The validation process resulted in a 28% reduction of NEC cases but still confirmed a higher NEC incidence in the later epoch compared with the earlier (73/895 (8.2%) vs 27/704 (3.8%), p=0.001), while the composite of NEC or death was lower (244/895 (27.3%) vs 229/704 (32.5%), p=0.022). In a multivariable Cox regression model, censored for mortality, there was no significant difference in early NEC (0-7 days of life) between epochs (HR=0.9 (95% CI 0.5 to 1.9), p=0.9), but being born in the later epoch remained an independent risk factor for late NEC (>7 days) (HR=2.7 (95% CI 1.5 to 5.0), p=0.001). In propensity score analysis, a significant epoch difference in NEC incidence (12% vs 2.8%, p<0.001) was observed only in the tertile of infants at highest risk of NEC, where the 28-day mortality was lower in the later epoch (35% vs 50%, p=0.001). More NEC cases were diagnosed with intramural gas in the later epoch (33/73 (45.2%) vs 6/26 (23.1%), p=0.047).Conclusions The increase in NEC incidence between epochs was limited to cases occurring after 7 days of life and was partly explained by increased survival in the most extremely preterm infants. Misclassification of NEC is common.
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| 19. |
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| 20. |
- Erlandsson, Kerstin, 1961-, et al.
(författare)
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Development of a tool to analyse what resources are needed to implement a midwife-led care framework : the MIDWIZE conceptual framework
- 2022
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Ingår i: Sexual & Reproductive HealthCare. - : Elsevier BV. - 1877-5756 .- 1877-5764. ; 33
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: A midwife led care project targeting to decide what to do to achieve the SDG 2030 in maternal and child health, made a project team develop a tool to analyse what health care systems need, to adopt the MIDWIZE Conceptual Framework. The MIDWIZE Conceptual Framework wish to introduce the comprehensive midwifery-managed care provided women in Sweden to other countries, regions, and units where the framework is not fully applied.METHODS: In order to determine what resource needs would have to be met to improve midwife led care, a tool was developed using Delphi study technique.RESULTS: Using Delphi study technique together with on-site visits to two Sub-Saharan African countries, members of a project team went to Ethiopia and Uganda, where they visited governments, clinical or educational institutions and together with African leaders developed availability and efficiency of a tool to determine resource needs.CONCLUSION: If at some future time, a single country, region or unit, might want to use the tool for quality improvement purpose of midwife led care, then the tool might aid in taking the first step to determine what resources might be required and what changes might be recommended as concerns policy at the clinical or educational institution level that are part of already existing health care structures.
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| 21. |
- Farooqi, Aijaz, et al.
(författare)
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One-year survival and outcomes of infants born at 22 and 23 weeks of gestation in Sweden 2004-2007, 2014-2016 and 2017-2019
- 2024
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Ingår i: Archives of Disease in Childhood-Fetal and Neonatal Edition. - : BMJ Publishing Group Ltd. - 1359-2998 .- 1468-2052. ; 109:1, s. 10-17
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Tidskriftsartikel (refereegranskat)abstract
- ObjectiveTo explore associations between perinatal activity and survival in infants born at 22 and 23 weeks of gestation in Sweden. Design/SettingData on all births at 22 and 23 weeks' gestational age (GA) were prospectively collected in 2004-2007 (T1) or obtained from national registers in 2014-2016 (T2) and 2017-2019 (T3). Infants were assigned perinatal activity scores based on 3 key obstetric and 4 neonatal interventions. Main outcomeOne-year survival and survival without major neonatal morbidities (MNM): intraventricular haemorrhage grade 3-4, cystic periventricular leucomalacia, surgical necrotising enterocolitis, retinopathy of prematurity stage 3-5 or severe bronchopulmonary dysplasia. The association of GA-specific perinatal activity score and 1-year survival was also determined. Results977 infants (567 live births and 410 stillbirths) were included: 323 born in T1, 347 in T2 and 307 in T3. Among live-born infants, survival at 22 weeks was 5/49 (10%) in T1 and rose significantly to 29/74 (39%) in T2 and 31/80 (39%) in T3. Survival was not significantly different between epochs at 23 weeks (53%, 61% and 67%). Among survivors, the proportions without MNM in T1, T2 and T3 were 20%, 17% and 19% for 22 weeks and 17%, 25% and 25% for 23 weeks' infants (p>0.05 for all comparisons). Each 5-point increment in GA-specific perinatal activity score increased the odds for survival in first 12 hours of life (adjusted OR (aOR) 1.4; 95% CI 1.3 to 1.6) in addition to 1-year survival (aOR 1.2; 95% CI 1.1 to 1.3), and among live-born infants it was associated with increased survival without MNM (aOR 1.3; 95% CI 1.1 to 1.4). ConclusionIncreased perinatal activity was associated with reduced mortality and increased chances of survival without MNM in infants born at 22 and 23 weeks of GA.
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| 22. |
- Fernández de Gamarra-Oca, L., et al.
(författare)
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Hippocampal volumes and cognitive performance in children born extremely preterm with and without low-grade intraventricular haemorrhage
- 2023
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Ingår i: Brain Structure and Function. - : Springer. - 1863-2653 .- 1863-2661. ; 228:5, s. 1191-1200
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Tidskriftsartikel (refereegranskat)abstract
- Children born extremely preterm, especially those with intraventricular haemorrhage (IVH), are at increased risk of adverse cognitive outcomes during childhood. The present study aimed to explore the effects of IVH (grades I-II) on hippocampal volumes, and their correlates with cognitive performance. The sample consisted of 94 participants, including 54 children born extremely preterm (19 with IVH, grades I-II), and 40 children born at term. All participants underwent a magnetic resonance imaging study at the age of 10 (M-age = 10.20 years; SDage = 0.78), and 74 of them (45 extremely preterm and 29 full-term) carried out a cognitive assessment at 12 years old. Children born extremely preterm had lower scores in cognitive performance compared to their full-term peers. Significant positive partial correlations were observed between global bilateral hippocampus, left CA-field, and left subiculum volumes with processing speed in the full-term group, while no significant correlations were found in the extremely preterm group. Moderation analyses in the extremely preterm sample revealed that low-grade IVH moderated the relationship between right hippocampal volume and full-IQ (F((4,40) = )5.42, p = 0.001, R-2 = 0.35). Having greater right hippocampal volume had a protective effect on full-IQ in those children born extremely preterm with low-grade IVH.
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| 23. |
- Hafström, Maria, 1962, et al.
(författare)
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Cerebral Palsy in Extremely Preterm Infants
- 2018
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Ingår i: Pediatrics. - : American Academy of Pediatrics (AAP). - 0031-4005 .- 1098-4275. ; 141:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND OBJECTIVES: The risk of cerebral palsy (CP) is high in preterm infants and is often accompanied by additional neurodevelopmental comorbidities. The present study describes lifetime prevalence of CP in a population-based prospective cohort of children born extremely preterm, including the type and severity of CP and other comorbidities (ie, developmental delay and/or cognitive impairment, neurobehavioral morbidity, epilepsy, vision and hearing impairments), and overall severity of disability. In this study, we also evaluate whether age at assessment, overall severity of disability, and available sources of information influence outcome results.METHODS: All Swedish children born before 27 weeks' gestation from 2004 to 2007 were included (the Extremely Preterm Infants in Sweden Study). The combination of neonatal information, information from clinical examinations and neuropsychological assessments at 2.5 and 6.5 years of age, original medical chart reviews, and extended chart reviews was used.RESULTS: The outcome was identified in 467 (94.5%) of eligible children alive at 1 year of age. Forty-nine (10.5%) children had a lifetime diagnosis of CP, and 37 (76%) were ambulatory. Fourteen (29%) had CP diagnosed after 2.5 years of age, 37 (76%) had at least 1 additional comorbidity, and 27 (55%) had severe disability. The probability for an incomplete evaluation was higher in children with CP compared with children without CP.CONCLUSIONS: Children born extremely preterm with CP have various comorbidities and often overall severe disability. The importance of long-term follow-up and of obtaining comprehensive outcome information from several sources in children with disabilities is shown.
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| 24. |
- Hellström, Sara, et al.
(författare)
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A follow up on the feasibility after national implementation of magnesium sulfate for neuroprotection prior to preterm birth.
- 2023
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Ingår i: Acta obstetricia et gynecologica Scandinavica. - : John Wiley & Sons. - 1600-0412 .- 0001-6349. ; 102:12, s. 1741-1748
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Tidskriftsartikel (refereegranskat)abstract
- The risk for brain injury manifested as cerebral palsy is higher in very preterm born children than in term. Prenatal administration of magnesium sulfate (MgSO4 ) has been shown to be neuroprotective and reduces the proportion of very preterm born children later diagnosed with cerebral palsy. A Swedish national clinical practice guideline was implemented in March 2020, stipulating the administration of a single intravenous dose of 6g MgSO4 1-24h prior to delivery before gestational age 32+0, aiming for 90% treatment coverage. The aim of this study was to evaluate the feasibility of this new clinical practice guideline in the first year of its implementation.Data on MgSO4 treatment were collected by reviewing the medical charts of women who gave birth to live born children in gestational age 22+0-31+6 during the period of March 1, 2020 to February 28, 2021, at five Swedish university hospitals. Women with pre-eclampsia, eclampsia, or high elevated liver enzymes low platelets (HELLP) were excluded.A total of 388 women were eligible and 79% received treatment with MgSO4 . Of the 21% not receiving treatment, 9% did not receive treatment due to lack of knowledge about the clinical practice guideline, 9% were not possible to treat and 3% had missing data. The proportion treated increased from 72% to 87% from the first to the last 3months. Of those treated, 81% received the drug within the stipulated timeframe (mean 8.7h, median 3.4h).There was a positive trend over time in the proportion of women receiving MgSO4 treatment, but the a priori target of 90% was not reached during the first year of implementation. Our findings indicate that this target could be reached with additional information to clinicians.
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| 25. |
- Kostilainen, Kaisamari, et al.
(författare)
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No impact of parental singing during the neonatal period on cognition in preterm-born children at 2–3 years
- 2023
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Ingår i: Acta Paediatrica, International Journal of Paediatrics. - : WILEY. - 0803-5253 .- 1651-2227. ; 112:7, s. 1471-1477
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Tidskriftsartikel (refereegranskat)abstract
- Aim: Studies examining the long-term effects of neonatal music interventions on the cognition of children born preterm are scarce. We investigated whether a parental singing intervention before term age improves cognitive and language skills in preterm-born children. Methods: In this longitudinal, two-country Singing Kangaroo, randomised controlled trial, 74 preterm infants were allocated to a singing intervention or control group. A certified music therapist supported parents of 48 infants in the intervention group to sing or hum during daily skin-to-skin care (Kangaroo care) from neonatal care until term age. Parents of 26 infants in the control group conducted standard Kangaroo care. At 2–3 years of corrected age, the cognitive and language skills were assessed with the Bayley Scales of Infant and Toddler Development, Third Edition. Results: There were no significant differences in cognitive and language skills between the intervention and control groups at the follow-up. No associations between the amount of singing and the cognitive and language scores were found. Conclusion: Parental singing intervention during the neonatal period, previously shown to have some beneficial short-term effects on auditory cortical response in preterm infants at term age, showed no significant long-term effects on cognition or language at 2–3 years of corrected age.
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