The Emergence of Human Consciousness: From Fetal to Neonatal Life

A simple definition of consciousness is sensory awareness of the body, the self, and the world. The fetus may be aware of the body, for example by perceiving pain. It reacts to touch, smell, and sound, and shows facial expressions responding to exter- nal stimuli. However, these reactions are probably preprogrammed and have a subcortical nonconscious origin. Furthermore, the fetus is almost continuously asleep and unconscious partially due to endog- enous sedation. Conversely, the newborn infant can be awake, exhibit sensory awareness, and process memorized mental representations. It is also able to differentiate between self and nonself touch, express emotions, and show signs of shared feelings. Yet, it is unreflective, present oriented, and makes little reference to concept of him/herself. Newborn infants display features characteristic of what may be referred to as basic consciousness and they still have to undergo considerable maturation to reach the level of adult consciousness. The preterm infant, ex utero, may open its eyes and establish minimal eye contact with its mother. It also shows avoidance reactions to harmful stimuli. However, the thalamocortical connections are not yet fully established, which is why it can only reach a minimal level of consciousness

Fetal catecholamines and the Apgar score

Peer Reviewe

Preschool outcome in children born very prematurely and cared for according to the Newborn Individualized Developmental Care and Assessment Program (NIDCAP)

Aim: Care based on the Newborn Individualized Developmental Care and Assessment Program (NIDCAP) has been reported to exert a positive impact on the development of prematurely born infants. The aim of the present investigation was to determine the effect of such care on the development at preschool age of children born with a gestational age of less than 32 wk. Methods: All surviving infants in a randomised controlled trial with infants born at a postmenstrual age less than 32 wk (11 in the NIDCAP group and 15 in the control group) were examined at 66.3 (6.0) mo corrected for prematurity [mean (SD)]. In the assessment we employed the Wechsler Preschool and Primary Scale of Intelligence-Revised (WPPSI-R) for cognition, Movement Assessment Battery for Children (Movement ABC) for motor function, subtests of the NEPSY test battery for attention and distractibility, and the WHO definitions of impairment, disability and handicap. Exact binary logistic regression was employed. Results: There were no significant differences between the intervention group in Full-Scale IQ 93.4 (14.2) [mean (SD)] versus the control group 89.6 (27.2), Verbal IQ 93.6 (16.4) versus 93.7 (26.8) or Performance IQ 94.3 (14.7) versus 86.3 (24.8). In the NIDCAP group 8/13 (62%) survived without disability and for the children with conventional care this ratio was 7/19 (37%). The corresponding ratios for surviving without mental retardation were 10/13 (77%) and 11/19 (58%), and for surviving without attention deficits 10/13 (77%) and 10/19 (53%). Overall, the differences were not statistically significant, although the odds ratio for surviving with normal behaviour was statistical significant after correcting for group imbalances in gestational age, gender, growth retardation and educational level of the parents. Conclusion: Our trial suggests a positive impact by NIDCAP on behaviour at preschool age in a sample of infants born very prematurely. However, due to problems of recruitment less than half of the anticipated subjects were included in the study, which implies a low power and calls for caution in interpreting our findings. Larger trials in different cultural contexts are warranted

Indications of improved cognitive development at one year of age among infants born very prematurely who received care based on the Newborn Individualized Developmental Care and Assessment Program (NIDCAP)

Background and Objective: Care based on the Newborn Individualized Developmental Care and Assessment Program (NIDCAP) has been reported to exert a positive impact on the development of prematurely born infants. The aim of the present investigation was to determine the effect of such care on the 1-year development of infants born with a gestational age of less than 32 weeks. Methods: All surviving infants (11 in the NIDCAP group and 9 in the control group) were assessed employing the Bayley Scales of Infant Development at 1 year of corrected age. Results: The Mental Developmental Index (MDI) of children who had received care according to NIDCAP was higher [88 (72-114)] [median (range)] than the corresponding value for the control children [78 (50-82)] (p = 0.01). The odds ratio for being alive with an MDI > 80 was 14 (95% CI; 1.4-141.5) in favour of the intervention group. However, the Psychomotor Developmental Indices (PDI) were not significantly different [85 (61-108) and 69 (50-114), respectively] (p = 0.23). Conclusion: Our findings indicate that care based on the NIDCAP might have a positive impact on the cognitive development of infants born very prematurely. (C) 2002 Elsevier Science Ireland Ltd. All rights reserved

No indication of increased quite sleep in infants receiving care based on Newborn Individulized Developmental Care and Assessment Program (NIDCAP)

It has been proposed that the developmentally supportive care of very-low-birthweight (VLBW) infants provided by the Newborn Individualized Developmental Care and Assessment Program (NIDCAP) can improve the infants’ opportunities for rest and sleep. The aim of the present study was to determine whether quiet sleep (QS) in VLBW infants is affected by NIDCAP care. Twenty-two infants with a gestational age of <32 weeks at birth randomly received either NIDCAP (n = 11) or conventional care (n = 11). These two groups were comparable (mean (SD)) with respect to birthweight (1021 (240) vs. 913 (362) g, respectively) and gestational age (27.1 (1.7) vs. 26.4 (1.8) weeks). The infants in the NIDCAP group were cared for in a separate room by a group of specially trained nurses and subjected to weekly NIDCAP observations until they reached a postconceptional age (PCA) of 36 weeks. Quiet sleep (QS) was assessed from 24-h amplitude-integrated EEGs recorded at 32 and 36 weeks of PCA. The percentage of time [mean (SD)] spent in QS at 32 weeks of PCA was 33.5 (2.6) % for the NIDCAP group and 33.3 (6.9) % for the control infants (ns). At 36 wk, the corresponding values were 24.5 (3.2) % and 25.7 (4.7) %, respectively (ns). The number of QS periods/24 h decreased equally in both groups in association with maturation: from 24.6 (3.3) to 16.8 (1.8) and from 25.0 (5.8) to 17.5 (3.3), at 32 weeks, and 36 wk of PCA, respectively (NS). Conclusions: There were no indications of increased QS at 32 or 36 weeks of postconceptional age among VLBW infants who received care based on NIDCAP

Survival and neonatal morbidity among extremely preterm born infants in relation to gestational age based on the last menstrual period or ultrasonographic examination

Objectives: The aim of this study was to investigate the potential impact of gestational age (GA) estimation on the basis of the last menstrual period (LMP) in comparison with GA based on ultrasound examination on rates of survival and neonatal morbidity among extremely preterm infants. Methods: The Swedish national registry of infants born extremely preterm (Extremely Preterm Infants in Sweden Study), including infants born before 27 weeks of gestation, was used to identify 645 infants with available information. Incidences of stillbirth, survival, small for GA (SGA), and major neonatal morbidity were calculated in relationship to the GA estimated by each of the approaches. Results: Pregnancies, in general, appeared to be longer when GA was estimated by LMP than by ultrasound (17.2% of the pregnancies were longer than 27 weeks). The incidences of stillbirth, neonatal death, and major neonatal morbidity in relationship to GA were similar for both groups. The risks for SGA were elevated when GA according to ultrasound examination was at least 7 days shorter than GA based on the LMP. Conclusions: In our cohort of infants born extremely preterm, estimation of GA on the basis of LMP indicated a longer pregnancy than estimated by ultrasound but did not influence the incidences of neonatal survival and morbidity