The Effect of Intrauterine Growth Restriction on Long-Term Outcome in Very or Extremely Low Birth Weight Infants

The project consisted of two long-term follow-up studies of preterm children addressing the question whether intrauterine growth restriction affects the outcome. Assessment at 5 years of age of 203 children with a birth weight less than 1000 g born in Finland in 1996-1997 showed that 9% of the children had cognitive impairment, 14% cerebral palsy, and 4% needed a hearing aid. The intelligence quotient was lower (p<0.05) than the reference value. Thus, 20% exhibited major, 19% minor disabilities, and 61% had no functional abnormalities. Being small for gestational age (SGA) was associated with sub-optimal growth later. In children born before 27 gestational weeks, the SGA had more neuropsychological disabilities than those appropriate for gestational age (AGA). In another cohort with birth weight less than 1500 g assessed at 5 years of age, echocardiography showed a thickened interventricular septum and a decreased left ventricular end-diastolic diameter in both SGA and AGA born children. They also had a higher systolic blood pressure than the reference. Laser-Doppler flowmetry showed different endothelium-dependent and -independent vasodilation responses in the AGA children compared to those of the controls. SGA was not associated with cardio-vascular abnormalities. Auditory event-related potentials (AERPs) were recorded using an oddball paradigm with frequency deviants (standard tone 500 Hz and deviant 750-Hz with 10% probability). At term, the P350 was smaller in SGA and AGA infants than in controls. At 12 months, the automatic change detection peak (mismatch negativity, MMN) was observed in the controls. However, the pre-term infants had a difference positivity that correlated with their neurodevelopment scores. At 5 years of age, the P1-deflection, which reflects primary auditory processing, was smaller, and the MMN larger in the preterm than in the control children. Even with a challenging paradigm or a distraction paradigm, P1 was smaller in the preterm than in the control children. The SGA and AGA children showed similar AERP responses. Prematurity is a major risk factor for abnormal brain development. Preterm children showed signs of cardiovascular abnormality suggesting that prematurity per se may carry a risk for later morbidity. The small positive amplitudes in AERPs suggest persisting altered auditory processing in the preterm in-fants.Hyvin ennenaikainen syntymä ja sikiön kasvuhäiriö ovat riskitekijöitä lapsen kehitykselle. Tutkimuksessa selvitettiin viisivuotiaitten pienipainoisten keskosten neurologista suoriutumista, sydän-ja verenkiertoelimistön toimintaa sekä kuuloaivokuoren erottelukyvyn kehitystä. Suomessa 1996 1997 syntyneistä, alle 1000g painaneista keskosista 9 %:lla todettiin kehitysvammaisuus, 14 %:lla aivohalvaus, 4 %:lla oli kuulokoje. Vaikka keskosten älykkyys- ja neuropsykologisten testien tulosten keskiarvot asettuivat normaalialueelle, ne olivat merkittävästi viitearvoja pienempiä. Merkittävä toiminnallinen haitta todettiin 20 %:lla, lievä haitta 19 %:lla, ja 61 % lapsista oli toiminnallisesti normaaleja. Sikiökautinen kasvuhäiriö jatkui myöhemmin hitaana kasvuna. Toisessa, alle 1500 g painaneiden keskosten seurantatutkimuksessa sydämen ultraäänitutkimus 5 vuoden iässä osoitti kammioväliseinän paksuuntuneen, vasemman kammion diastolisen läpimitan pienentyneen ja systolisen verenpaineen nousseen verrattuna viitearvoihin. Ihon pintaverenkierron laser-Doppler tutkimuksessa raskauden kestoon nähden normaalipainoisina syntyneillä keskosilla todettiin erilainen vaste lääkeaineilla provosoituun endoteeliriippuvaiseen tai sileälihasriippuvaiseen verisuonten laajenemiseen kuin täysiaikaisina syntyneillä verrokeilla. Vastasyntyneisyyskaudella näillä keskosilla todettiin kuuloaivokuoren erottelukokeessa positiivinen jännitevaste 350 ms ärsykkeen alusta. Vuoden iässä äänisarjan poikkeama aiheutti keskosilla positiivisen erotusjännitevasteen, kun taas täysiaikaisina syntyneillä kontrollilapsilla vaste oli muuttunut odotetusti negatiiviseksi. Viiden vuoden iässä varhaiset positiiviset jännitevasteet, jotka kuvastavat primaarikuuloaivokuoren toimintaa, olivat vaimeammat kuin verrokeilla. Nämä varhaiset vasteet sekä äänisarjan poikkeaman erottaminen korreloivat kielelliseen suoriutumiseen. Kuuloerottelun aktiivista tarkkaavaisuutta vaativassa kokeessa tarkkaavuuden perusmekanismit olivat keskosilla samanlaisia kuin kontrolleilla, mutta kontrolleja vaimeammat jännitepotentiaalit voivat viitata kuuloärsykkeen poikkeavaan prosessointiin. Ennenaikaisuus on merkittävä riski keskushermoston kehitykselle. Ennenaikaisuus voi lisätä sydän- ja verenkiertoelimistön poikkeavaa toimintaa. Keskosten kuuloaivokuoren erottelukokeen poikkeavuudet voivat assosioitua poikkeavaan kielelliseen kehitykseen

Neural processing of changes in phonetic and emotional speech sounds and tones in preterm infants at term age

Objective: Auditory change-detection responses provide information on sound discrimination and memory skills in infants. We examined both the automatic change-detection process and the processing of emotional information content in speech in preterm infants in comparison to full-term infants at term age. Methods: Preterm (n = 21) and full-term infants' (n = 20) event-related potentials (ERP) were recorded at term age. A challenging multi-feature mismatch negativity (MMN) paradigm with phonetic deviants and rare emotional speech sounds (happy, sad, angry), and a simple one-deviant oddball paradigm with pure tones were used. Results: Positive mismatch responses (MMR) were found to the emotional sounds and some of the phonetic deviants in preterm and full-term infants in the multi-feature MMN paradigm. Additionally, late positive MMRs to the phonetic deviants were elicited in the preterm group. However, no group differences to speech-sound changes were discovered. In the oddball paradigm, preterm infants had positive MMRs to the deviant change in all latency windows. Responses to non-speech sounds were larger in preterm infants in the second latency window, as well as in the first latency window at the left hemisphere electrodes (F3, C3). Conclusions: No significant group-level differences were discovered in the neural processing of speech sounds between preterm and full-term infants at term age. Change-detection of non-speech sounds, however, may be enhanced in preterm infants at term age. Significance: Auditory processing of speech sounds in healthy preterm infants showed similarities to full-term infants at term age. Large individual variations within the groups may reflect some underlying differences that call for further studies.Peer reviewe

An extensive pattern of atypical neural speech-sound discrimination in newborns at risk of dyslexia

Objective: Identifying early signs of developmental dyslexia, associated with deficient speech-sound processing, is paramount to establish early interventions. We aimed to find early speech-sound processing deficiencies in dyslexia, expecting diminished and atypically lateralized event-related potentials (ERP) and mismatch responses (MMR) in newborns at dyslexia risk. Methods: ERPs were recorded to a pseudoword and its variants (vowel-duration, vowel-identity, and syllable-frequency changes) from 88 newborns at high or no familial risk. The response significance was tested, and group, laterality, and frontality effects were assessed with repeated-measures ANOVA. Results: An early positive and right-lateralized ERP component was elicited by standard pseudowords in both groups, the response amplitude not differing between groups. Early negative MMRs were absent in the at-risk group, and MMRs to duration changes diminished compared to controls. MMRs to vowel changes had significant laterality x group interactions resulting from right-lateralized MMRs in controls. Conclusions: The MMRs of high-risk infants were absent or diminished, and morphologically atypical, suggesting atypical neural speech-sound discrimination. Significance: This atypical neural basis for speech discrimination may contribute to impaired language development, potentially leading to future reading problems. (C) 2019 International Federation of Clinical Neurophysiology. Published by Elsevier B.V. All rights reserved.Peer reviewe

Latent class growth analysis identified different trajectories in cognitive development of extremely low birthweight children

Background Recent longitudinal studies suggest stable cognitive development in preterm children, although with great individual variation. This prospective neurocognitive follow-up study of extremely low birthweight (ELBW, 115) showed stable development (-3.2 points, p=0.250). Multiple linear regression showed that neonatal complications (intraventricular haemorrhage grade 3-4 and blood culture positive sepsis) and maternal education significantly predicted lower intelligence at the second assessment (F(3,106)=7.27, pPeer reviewe

Itselääkitys : Käypä hoito -suosituksen tiivistelmä

English summar

Vastasyntyneiden hätätilanteiden koulutusohjelma suomalaisiin synnytyssairaaloihin

Hätätilanteisiin varautuminen on keskeinen potilasturvallisuuden elementti. Suomen Perinatologisen Seuran neonatologijaos laati vastasyntyneiden hätätilanteiden koulutusohjelman parantamaan syntymän turvallisuutta

Effects of maternal singing during kangaroo care on maternal anxiety, wellbeing, and mother-infant relationship after preterm birth : a mixed methods study

Introduction Preterm birth may disturb the typical development of the mother-infant relationship, when physical separation and emotional distress in the neonatal intensive care unit may increase maternal anxiety and create challenges for early interaction. This cluster-randomized controlled trial examined the effects of maternal singing during kangaroo care on mothers' anxiety, wellbeing, and the early mother-infant relationship after preterm birth. Method In the singing intervention group, a certified music therapist guided the mothers (n = 24) to sing or hum during daily kangaroo care during 33-40 gestational weeks (GW). In the control group, the mothers (n = 12) conducted daily kangaroo care without specific encouragement to sing. Using a convergent mixed methods design, the quantitative outcomes included the State-Trait Anxiety Inventory (STAI) at 35 GW and 40 GW to assess the change in maternal-state anxiety levels and parent diaries to examine intervention length. Post-intervention, the singing intervention mothers completed a self-report questionnaire consisting of quantitative and qualitative questions about their singing experiences. Results The mothers in the singing intervention group showed a statistically significant decrease in STAI anxiety levels compared to the control group mothers. According to the self-report questionnaire results, maternal singing relaxed both mothers and infants and supported their relationship by promoting emotional closeness and creating early interaction moments. Discussion Maternal singing can be used during neonatal hospitalization to support maternal wellbeing and early mother-infant relationship after preterm birth. However, mothers may need information, support, and privacy for singing.Peer reviewe

Fetal growth restriction in preterm infants and cardiovascular function at five years of age

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