| 21. |
- Mikkola, Kaija, et al.
(författare)
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Auditory event-related potentials and cognitive function of preterm children at five years of age
- 2007
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Ingår i: Clinical Neurophysiology. - : Elsevier BV. - 1872-8952 .- 1388-2457. ; 118:7, s. 1494-1502
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Tidskriftsartikel (refereegranskat)abstract
- Objective: In our previous study, auditory event-related potentials (AERPs) in preterm 1-year-old children had a positive deflection at 150-350 ms that correlated positively with their 2-year neurodevelopmental outcome. In a study of the same subjects at age 5, our aim was to assess AERPs and their relationship to neuropsychological test results. Methods: Preterm small (SGA, n = 13), appropriate for gestational age (AGA, n = 15), and control (n = 13) children were assessed with an Easy paradigm presenting a large frequency change accompanied with occasional novel sounds, and a Challenging paradigm presenting small frequency and duration changes with a rapid rate. The preterm children underwent neurocognitive tests. Results: Easy paradigm. The P1 response to frequency deviant was smaller and MMN larger in the preterm than in the control children. Challenging paradigm. The P1 response to standard, frequency, and duration deviants was smaller in the preterm than in the control children. The N2 response to frequency deviant was larger in the preterm than in the control children. AGA and SGA children had similar AERPs. The P1, N2, and MMN amplitudes correlated with verbal IQ and NEPSY language subtests. Conclusions: Small P1 response(s) appears to be typical for preterm children. Significance: Small P1 response in preterm children may suggest altered primary auditory processing. (c) 2007 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.
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| 22. |
- Mikkola, Kaija, et al.
(författare)
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Fetal growth restriction in preterm infants and cardiovascular function at five years of age
- 2007
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Ingår i: Journal of Pediatrics. - : Elsevier BV. - 1097-6833 .- 0022-3476. ; 151:5, s. 494-499
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Tidskriftsartikel (refereegranskat)abstract
- Objectives We have previously reported an increased cardiac workload in newborn preterm small (SGA) infants, but not in infants appropriate for gestational age (AGA). We hypothesized that these cardiovascular changes win persist at follow-tip at 5 years of age. Study design We assessed blood pressure, echocardiography, and shin perfusion with laser Doppler flowmetry in 22 SGA (S21 +/- 248 g. 28.5 +/- 2:5 gestational weeks) and in 25 AGA (1065 +/- 241 g, 27.6 +/- 0.8 weeks) preterm children at age 5 years. Laser Doppler flowmetry also was used in 13 control children (3982 +/- 425 g, 40.4 +/- 1.8 weeks). Results The preterm children in both the SGA and AGA groups had similar higher systolic blood pressures, increased interventricular septum thicknesses, and smaller left ventricular end-diastolic diameters compared with population reference values. Maximal endothelium-independent perfusion to sodium nitroprusside was higher and maximal endothelium-dependent perfusion to acetylcholine reached a plateau earlier in the AGA preterm group than in the control group. Conclusions Prematurity may, impair cardiovascular function independently of intrauterine growth restriction. Altered cardiac dimensions and differences in perfusion responses may reflect increased cardiac afterload.
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| 23. |
- Mikkola, K, et al.
(författare)
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Neurodevelopmental outcome at 5 years of age of a national cohort of extremely low birth weight infants who were born in 1996-1997
- 2005
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Ingår i: Pediatrics. - : American Academy of Pediatrics (AAP). - 1098-4275 .- 0031-4005. ; 116:6, s. 1391-1400
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Tidskriftsartikel (refereegranskat)abstract
- Objective. Increasing survival of extremely low birth weight (ELBW; birth weight < 1000 g) infants raises a concern regarding the risks of adverse long-term outcome such as cognitive dysfunction. Few studies have reported long-term follow-up of representative regional cohorts. The objective of this study was to assess the 5-year outcome of a prospectively followed national ELBW infant cohort. Methods. Of all live-born ELBW infants (n = 351) who were delivered in the 2-year period 1996 - 1997 in Finland, 206 (59%) survived until the age of 5 years. Of these, 103 were born at < 27 gestational weeks (GW). A total of 172 children were assessed with neurocognitive tests ( Wechsler Preschool and Primary Scale of Intelligence - Revised and a Developmental Neuropsychological Assessment [NEPSY]). Nine children with cognitive impairment and inability to cooperate in testing were not assessed. Motor development was assessed with a modified Touwen test. Results. The rate of cognitive impairment in the ELBW survivors was 9%. The rate of cerebral palsy was 14% (19% of ELBW infants who were born at < 27 GW). The mean full-scale IQ of the assessed children was 96 +/- 19 and in children of GW < 27 was 94 +/- 19. Attention, language, sensorimotor, visuospatial, and verbal memory values of NEPSY assessment were significantly poorer compared with normal population means. Four percent needed a hearing aid, and 30% had ophthalmic findings. Of 21 children who had been treated with laser/cryo for retinopathy of prematurity, 17 (81%) had abnormal ophthalmic findings. Of the whole cohort, 41 (20%) exhibited major disabilities, 38 (19%) exhibited minor disabilities, and 124 (61%) showed development with no functional abnormalities but subtle departures from the norm. Only 53 (26%) of the total ELBW infant cohort were classified to have normal outcome excluding any abnormal ophthalmic, auditory, neurologic, or developmental findings. Being small for gestational age at birth was associated with suboptimal growth at least until age 5. Conclusions. Only one fourth of the ELBW infants were classified as normally developed at age 5. The high rate of cognitive dysfunction suggests an increased risk for learning difficulties that needs to be evaluated at a later age. Extended follow-up should be the rule in outcome studies of ELBW infant cohorts to elucidate the impact of immaturity on school achievement and social behavior later in life.
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| 24. |
- Noponen, Tommi, et al.
(författare)
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Circulatory Effects of Inhaled Iloprost in the Newborn Preterm Lamb.
- 2009
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Ingår i: Pediatric Research. - 1530-0447. ; 66, s. 416-422
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Tidskriftsartikel (refereegranskat)abstract
- Inhaled nitric oxide (iNO) has an established role in the treatment of pulmonary hypertension in the newborn. However, costs and potential toxicity associated with iNO have generated interest in alternative inhaled selective pulmonary vasodilators such as iloprost. In a preterm lamb model of respiratory distress syndrome, we studied effects of increasing doses of iloprost followed by iNO on right ventricular pressure (RVP) and circulation including cerebral oxygenation. Fetal sheep were randomized to three doses (0.2 - 4 mg/kg) of iloprost (n=9) or saline (n=10), administered as 15 min inhalations with 15 min intervals after a 60-min postnatal stabilisation. No differences were found in RVP, arterial pO2, or cardiac index according to treatment. The cerebral oxygenation, measured with near-infrared spectroscopy, deteriorated in control lambs, but not in iloprost lambs. Iloprost treatment followed by iNO resulted in a larger decrease (p=0.007) in RVP than saline treatment followed by iNO. In conclusion, iloprost stabilised cerebral oxygenation and when followed by iNO had a larger effect on RVP than iNO alone. Although species differences may be relevant, these results suggest that iloprost should be studied in newborn infants for the treatment of pulmonary hypertension.
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| 25. |
- Norman, Elisabeth, et al.
(författare)
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Electroencephalographic response to procedural pain in healthy term newborn infants
- 2008
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Ingår i: Pediatric Research. - 0031-3998 .- 1530-0447. ; 64:4, s. 429-34
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Tidskriftsartikel (refereegranskat)abstract
- The current study aimed to characterize changes in EEG-related measures after noxious stimuli in neonates, and to assess their potential utility as measures of pain and/or discomfort during neonatal intensive care.Seventy-two healthy term infants were investigated: Twenty-eight had a non skin-breaking pin-prick on the heel, randomized to receive either oral glucose (n=16) or water (n=12) before the stimulus. 21 infants were studied during a venous blood sample from the dorsum of the hand, 23 infants during a capillary heel stick. Behavioral pain responses were assessed with the Premature Infant Pain Profile (PIPP) scale. The stimulus evoked a significant increase in higher frequency components (10-30Hz) which also correlated to behavioral measures. The frontotemporal localization of the increased activity with frequency bands similar to electromuscular artifacts and the relation to behavioral measures confirmed that this activity corresponds to an increase in muscle tone. There was no change in frontal EEG asymmetry in any of the groups. The present results indicate that responses in cortical activity recorded by EEG are not useful for clinical assessment of infants' responses to noxious stimuli.
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| 26. |
- Norman, Elisabeth, et al.
(författare)
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Thiopental pharmacokinetics in newborn infants: a case report of overdose.
- 2009
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Ingår i: Acta paediatrica. - : Wiley. - 1651-2227 .- 0803-5253. ; 98, s. 1680-1682
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Tidskriftsartikel (refereegranskat)abstract
- Abstract Thiopental may be used for sedation before intubation in newborn infants. A boy, born at 33 weeks of gestation (gw); birth weight 2435 g, was prescribed thiopental 3 mg/kg before intubation. He developed temporary hypotension and oxygen desaturation, and remained unconscious for longer than expected with a suppressed electroencephalography for 48 h. Serum thiopental concentration was 82, 59, 42 and 32 mumol/L after 20 min and 6, 24 and 68 h respectively. Serum concentrations from five newborn infants at the same time points after intubation with the same thiopental dose were used as reference values, and indicated a 10-fold overdose in the index case. The cause of the overdose could not be identified. The infant recovered; cerebral magnetic resonance imaging at the age of 42 gw and psychomotor development at 2 years were normal. These results show that thiopental concentrations are variable in neonates and there is a high risk of dosage error as no specific paediatric formulation is available. Conclusion: Well-designed procedures and continuous education are required to prevent errors and adverse events during drug delivery to newborn infants. To develop a safe method of administration for thiopental, an extended pharmacokinetic and pharmacodynamic study in neonates is warranted.
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| 27. |
- Novitski, Nikolai, et al.
(författare)
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Neonatal frequency discrimination in 250-4000-Hz range: Electrophysiological evidence
- 2007
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Ingår i: Clinical Neurophysiology. - : Elsevier BV. - 1872-8952 .- 1388-2457. ; 118:2, s. 412-419
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The precision of sound frequency discrimination in newborn infants in the 250-4000-Hz frequency range was determined using the neonatal electrophysiological mismatch response (MMR), the infant equivalent of adult mismatch negativity (MMN). Methods: The electroencephalogram (EEG) was recorded in I 1 full-term sleeping newborn infants mostly in active sleep (67 % of the time). Pure tones were presented through loudspeakers in an oddball paradigm with a 800-ms stimulus onset asynchrony (SOA). Each stimulus block contained a standard (p = 0.76) of 250, 1000, or 4000 Hz in frequency (in separate blocks) and deviants with a frequency change of either 5% or 20% of the standard (p = 0.12 of each). Results: A positive ERP deflection was found at 200-300 ms from stimulus onset in response to the 20% deviation from the 250, 1000, and 4000 Hz standard frequencies. The amplitude of the response in the 200-300 ms time window was significantly larger for the 20% than 5% deviation. Conclusions: We observed in newborn infants automatic frequency discrimination as reflected by a positive MMR. The newborns were able to discriminate frequency change of 20% in the 250-4000-Hz frequency range, whereas the discrimination of the 5% frequency change was not statistically confirmed. Significance: The present data hence suggest that the neonatal frequency discrimination has lower resolution than that in adult and older children data. (c) 2006 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.
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| 28. |
- Perez de Sá, Valéria, et al.
(författare)
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High brain tissue oxygen tension during ventilation with 100% oxygen after fetal asphyxia in newborn sheep
- 2009
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Ingår i: Pediatric Research. - 0031-3998 .- 1530-0447. ; 65:1, s. 57-61
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Tidskriftsartikel (refereegranskat)abstract
- The optimal inhaled oxygen fraction for newborn resuscitation is still not settled. We hypothesized that short-lasting oxygen ventilation after intrauterine asphyxia would not cause arterial or cerebral hyperoxia, and therefore be innocuous. The umbilical cord of fetal sheep was clamped and 10 min later, after delivery, ventilation with air (n = 7) or with 100% oxygen for 3 (n = 6) or 30 min (n = 5), followed by air, was started. Among the 11 lambs given 100% oxygen, oxygen tension (PO2) was 10.7 (1.8-56) kPa [median (range)] in arterial samples taken after 2.5 min of ventilation. In those ventilated with 100% oxygen for 30 min, brain tissue PO2 (PbtO2) increased from less than 0.1 kPa in each lamb to individual maxima of 56 (30-61) kPa, whereas in those given oxygen for just 3 min, PbtO2 peaked at 4.2 (2.9-46) kPa. The maximal PbtO2 in air-ventilated lambs was 2.9 (0.8-5.4) kPa. Heart rate and blood pressure increased equally fast in the three groups. Thus, prolonged ventilation with 100% oxygen caused an increase in PbtO2 of a magnitude previously only reported under hyperbaric conditions. Reducing the time of 100% oxygen ventilation to 3 min did not consistently avert systemic hyperoxia.
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| 29. |
- Plunkett, Jevon, et al.
(författare)
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Mother's Genome or Maternally-Inherited Genes Acting in the Fetus Influence Gestational Age in Familial Preterm Birth
- 2009
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Ingår i: Human Heredity. - : S. Karger AG. - 1423-0062 .- 0001-5652. ; 68:3, s. 209-219
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Tidskriftsartikel (refereegranskat)abstract
- Objective: While multiple lines of evidence suggest the importance of genetic contributors to risk of preterm birth, the nature of the genetic component has not been identified. We perform segregation analyses to identify the best fitting genetic model for gestational age, a quantitative proxy for preterm birth. Methods: Because either mother or infant can be considered the proband from a preterm delivery and there is evidence to suggest that genetic factors in either one or both may influence the trait, we performed segregation analysis for gestational age either attributed to the infant (infant's gestational age), or the mother (by averaging the gestational ages at which her children were delivered), using 96 multiplex preterm families. Results: These data lend further support to a genetic component contributing to birth timing since sporadic (i.e. no familial resemblance) and nontransmission (i.e. environmental factors alone contribute to gestational age) models are strongly rejected. Analyses of gestational age attributed to the infant support a model in which mother's genome and/or maternally-inherited genes acting in the fetus are largely responsible for birth timing, with a smaller contribution from the paternally-inherited alleles in the fetal genome. Conclusion: Our findings suggest that genetic influences on birth timing are important and likely complex. Copyright (C) 2009 S. Karger AG, Basel
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| 30. |
- Pupp, Ingrid, et al.
(författare)
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Fresh-frozen plasma as a source of exogenous insulin-like growth factor-I in the extremely preterm infant
- 2009
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Ingår i: J Clin Endocrinol Metab. - : The Endocrine Society. - 1945-7197 .- 0021-972X. ; 94:2, s. 477-482
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Tidskriftsartikel (refereegranskat)abstract
- CONTEXT: Preterm birth is followed by a decrease in circulatory levels of IGF-I and IGF binding protein (IGFBP)-3, proteins with important neurogenic and angiogenic properties. OBJECTIVE: Our objective was to evaluate the effects of iv administration of fresh-frozen plasma (FFP) from adult donors on circulatory levels of IGF-I and IGFBP-3 in extremely preterm infants. DESIGN, SETTING, AND PATIENTS: A prospective cohort study was performed in 20 extremely preterm infants [mean (SD) gestational age 25.3 (1.3) wk] with clinical requirement of FFP during the first postnatal week. Sampling was performed before initiation of transfusion, directly after, and at 6, 12, 24, and 48 h after completed FFP transfusion. MAIN OUTCOME MEASURES: Concentrations of IGF-I and IGFBP-3 before and after transfusion of FFP were determined. RESULTS: FFP with a mean (SD) volume of 11 ml/kg (3.1) was administered at a median postnatal age of 2 d (range 1-7). Mean (SD) IGF-I and IGFBP-3 concentrations in administered FFP were 130 (39) and 2840 microg/liter (615), respectively. Immediately after FFP transfusion, mean (SD) concentrations of IGF-I increased by 133% from 11 (6.4) to 25 microg/liter (9.3) (P < 0.001) and IGFBP-3 by 61% from 815 (451) to 1311 microg/liter (508) (P < 0.001). Concentrations of IGF-I and IGFBP-3 remained higher at 6 (P < 0.001, P = 0.009) and 12 h (P = 0.017, P = 0.018), respectively, as compared with concentrations before FFP transfusion. Typical half-life of administrated IGF-I was 3.4 h for a 1-kg infant. CONCLUSION: Transfusion of FFP to extremely preterm infants during the first postnatal week elevates levels of IGF-I and IGFBP-3.
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