Prediction of neurodevelopment and neuromotor trajectories in very preterm born children up to 11 years of age: PIPARI Study

Very preterm birth is a risk for brain injury and abnormal neurodevelopment. While the incidence of cerebral palsy has decreased due to advances in perinatal and neonatal care, the rate of less severe neuromotor problems continues to be high in very prematurely born children. Neonatal brain imaging can aid in identifying children for closer follow-up and in providing parents information on developmental risks. This thesis aimed to study the predictive value of structural brain magnetic resonance imaging (MRI) at term age, serial neonatal cranial ultrasound (cUS), and structured neurological examinations during the longitudinal follow-up for the neurodevelopment of very preterm born children up to 11 years of age as a part of the PIPARI Study (The Development and Functioning of Very Low Birth Weight Infants from Infancy to School Age). A further aim was to describe the associations between regional brain volumes and long-term neuromotor profile. The prospective follow-up comprised of the assessment of neurosensory development at 2 years of corrected age, cognitive development at 5 years of chronological age, and neuromotor development at 11 years of age. Neonatal brain imaging and structured neurological examinations predicted neurodevelopment at all age-points. The combination of neurological examination and brain MRI or cUS improved the predictive value of neonatal brain imaging alone. Decreased brain volumes associated with neuromotor performance. At the age of 11 years, the majority of the very preterm born children had age-appropriate neuromotor development and after-school sporting activities. Long-term clinical follow-up is recommended at least for all very preterm infants with major brain pathologies.Pikkukeskosten neuromotorinen pitkäaikaiskehitys 11 vuoden ikään saakka ja sitä ennustavat tekijät: PIPARI-tutkimus Pikkukeskosuus on riski aivovauriolle ja poikkeavalle kehitykselle. Vaikka CP-vamman esiintyvyys on alkuvaiheen tehohoidon kehittymisen myötä vähentynyt, lievempiä neuromotorisia ongelmia esiintyy edelleen merkittävästi pikkukeskosina syntyneillä lapsilla. Varhaiset aivojen kuvantamistutkimukset voivat auttaa tunnistamaan pitkäaikaisseurantaa tarvitsevat lapset sekä antamaan vanhemmille tietoa kehitykseen liittyvistä riskeistä. Tämän väitöskirjatyön tavoitteena oli selvittää lasketun ajan aivojen rakenteellisen magneettitutkimuksen, sarjoittaisen aivojen ultraäänitutkimuksen, ja pitkäaikaisseurannan aikana tehtyjen yksityiskohtaisten neurologisten tutkimusten ennustearvo pikkukeskosten kehitykselle 11 vuoden ikään asti osana PIPARI–tutkimusta (Pienipainoisten riskilasten käyttäytyminen ja toimintakyky imeväisiästä kouluikään). Tavoitteena oli myös kuvailla aivotilavuuksien yhteys neuromotoriseen pitkäaikaiskehitykseen. Prospektiivinen seuranta sisälsi neurosensorisen kehityksen arvioinnin 2 vuoden korjatussa iässä, kognitiivisen kehityksen arvioinnin 5 vuoden kronologisessa iässä, sekä neuromotorisen kehityksen arvioinnin 11-vuotiaana. Varhaiset aivojen kuvantamistutkimukset sekä yksityiskohtaiset neurologiset tutkimukset ennustivat pikkukeskosten pitkäaikaiskehitystä kaikissa ikäpisteissä. Neurologisten tutkimustulosten yhdistäminen aivojen magneettitutkimuksen tai ultraäänitutkimusten löydöksiin paransi yksittäisen kuvantamistutkimuksen ennustearvoa. Pienemmät aivotilavuudet liittyivät heikompaan neuromotoriseen suoriutumiseen. Suurimmalla osalla pikkukeskosina syntyneistä lapsista oli ikätasoinen neuromotorinen kehitys ja liikuntaharrastus 11-vuotiaana. Pitkäaikaista kliinistä seurantaa suositellaan ainakin kaikille niille pikkukeskosille, joilla on todettu vaikea aivovaurio.Siirretty Doriast

Vision-tuotesarjan kokoonpanoprosessin materiaalivirtojen, läpimenoajan ja layoutin kehittäminen : Spheros-Parabus Oy

Opinnäytetyö tehtiin toimeksiantona turkulaiselle bussien kattoluukkuja valmistavalle Spheros-Parabus Oy:lle. Työn tavoitteena on heidän Vision-tuotesarjansa kokoonpanoprosessin kehittäminen materiaalivirtojen, layoutin ja läpimenoajan kannalta. Vision-tuotesarjalla tarkoitetaan heidän kattoluukkuperhettään, jossa luukkuelementti on lasinen. Lasiluukun tuotanto ei ole yhtä pitkälle kehitettyä kuin muiden kattoluukkujen tuotanto. Osasyynä tähän on lasiluukkujen myynnin suhteellisen pieni volyymi, joka on alle 5 % kattoluukkujen kokonaismyynnistä. Tulevaisuudessa myynnin uskotaan kuitenkin lisääntyvän huomattavasti ja tästä syystä lasiluukkusolua sekä -tuotannon prosessia päätettiin alkaa kehittämään. Tällöin myynnin kehittymiseen on varauduttu jo etukäteen ja tilausmäärien lisääntyessä tuotantomääriä saadaan helposti lisättyä. Omat haasteensa prosessiin luo paitsi pienempi volyymi verrattuna muihin tuotteisiin, mutta myös itse lasiluukun prosessi. Arvoa lisäävän työn osuus koko prosessista on todella pieni, koska tietyissä vaiheissa on aikamääre, jonka odottaminen on oleellinen osa prosessia. Näissä vaiheissa työntekijät pystyvät tekemään muita töitä, mutta itse tuotteen arvo ei kasva mitenkään. Tutkimus aloitettiin lasiluukkusolun prosessiin tutustumisella. Tämän jälkeen sen nykytila kartoitettiin tutkien tuotteiden ja materiaalien liikkumista, jalostumista sekä tähän käytettävää työn määrää ja aikaa. Kartoittamisessa käytettiin hyväksi sekä mittaustuloksia että työntekijöiden kokemuksia prosessista. Tarkemman tutkimuksen kohteeksi otettiin myös luukun prosessin osana oleva liimaus ja sen mahdollinen kehittäminen joko uusilla liimoilla tai liimausliitosta tukevilla menetelmillä. Tutkimuksessa esitellään erilaisia vaihtoehtoja, joilla tuotantoa pystytään kehittämään, sekä suurimmat saavutettavat hyödyt. Nämä parannukset keskittyvät liimauksen menetelmien muuttamiseen sekä layoutin uudistamiseen, jotka taas vaikuttavat läpimenoaikojen ja materiaalivirtojen lisäksi myös koko prosessiin.This Bachelor’s thesis was commissioned a company named Spheros-Parabus Ltd that manufactures roof hatches for busses in Turku. The topic of the research was to develop the assembly process of the company’s Vision product family including material flows, layout and lead-time. Vision is a roof hatch family that differs from other hatches for the hatch element which is made of glass. The production of the glass hatch is not as developed as production of other roof hatch models. One reason to this is that the sales volume is quite low, under 5 % of total sales of all roof hatches. Sales are predicted to grow in the future and this was the reason to start the development process of glass hatch production. This way the company has already prepared for the growth of sales and it is easy to increase the production output in compliance with the amount of orders. Besides the sales volume being low compared to total sales, there are also other challenges in the process. The value adding share of the work is small compared to the whole working process. This is because there are stages in the process, which include a time restriction which has to be passed before proceeding to the next stage. While waiting an employee can work with other products in different stages of the process, but this will not add value to the product waiting to get to the next stage. The research was started by becoming acquainted with the production process of the glass hatch. The next step was to investigate the present state of the process, including the flow of materials and products, but also the use of work and time. The experience of the employees and measurements of the process were used to get to this point. One part in which the research also focused on was the gluing stage of the production. There are different possible ways to develop it by changing the glue to another or by supporting the bond with other methods. The different alternatives to develop the production and also the biggest benefits concerning them are presented in this research. These improvement proposals concentrate on changing the methods in the glueing process and renewing the layout. These changes will have effects not only on lead-time and materials flows, but also on the whole process

Altered temporal connectivity and reduced meta-state dynamism in adolescents born very preterm

Adolescents born very preterm have an increased risk for anxiety, social difficulties and inattentiveness, i.e. the ‘preterm behavioural phenotype’. The extreme end of these traits comprises the core diagnostic features of attention and hyperactivity disorders and autism spectrum disorder, which have been reported to show aberrant dynamic resting-state functional network connectivity. This study aimed to compare this dynamism between adolescents born very preterm and controls. A resting-state functional magnetic resonance imaging was performed on 24 adolescents born very preterm (gestational agePeer reviewe

Hammersmith Infant Neurological Examination and long-term cognitive outcome in children born very preterm

Aim To study the association between the Hammersmith Infant Neurological Examination (HINE) at age 2 years and neurocognition at age 11 years in children born very preterm. We hypothesized that the HINE at 2 years would be associated with neurocognition, that is, neurological, motor, and cognitive outcomes at 11 years. Method A total of 174 children (mean gestational age 29.0wks, SD 2.7; minimum 23.0, maximum 35.9; 95 [55%] males, 79 [45%] females) born very preterm (birthweight Results The HINE global score was associated with the results of the TINE (odds ratio [OR]=0.9, 95% confidence interval [CI] 0.8-0.9, p=0.001), MABC-2 (beta=1.4, 95% CI 0.7-2.2, p Interpretation A higher HINE global score at 2 years was associated with better general intelligence at 11 years even in children without CP. The HINE may be a useful tool to detect children at risk for later cognitive impairment.Peer reviewe

Mitä PIPARI-tutkimus on opettanut pikkukeskosten pitkäaikaiskehityksestä

English summaryPeer reviewe

Fewer maternal depression symptoms after the Close Collaboration with Parents intervention : Two-year follow-up

Aim To test whether the implementation of the Close Collaboration with Parents intervention at a neonatal intensive care unit (NICU) decreases depression symptoms of mothers up to two years after the delivery of preterm infants. Methods We used a non-equivalent two-group design, comparing mothers of very low birthweight infants in the same NICU before (2001–2006) and after (2011–215) the intervention. The unit carried out the educational intervention (2009–2012) that was targeted at its healthcare team and aimed to improve their skills to collaborate with parents. Maternal depression symptoms were measured using the Edinburgh Postnatal Depression Scale (EPDS) six months and two years after the expected birth date of the infant. Results We found a median difference of 2.56 (95% CI from 1.64 to 3.48) in EPDS at the two-year follow-up between the pre-intervention and post-intervention groups, p < 0.001. Furthermore, we found no interaction between measurement time-points and group, implying that the intervention effect on maternal depression symptoms was similar at the six-month and two-year time-points. Conclusion The intervention seems to have long-term preventive effects on maternal depressive symptoms. This effect is of clinical significance as prolonged maternal depression associates with adverse child outcomes.© 2022 The Authors. Acta Paediatrica published by John Wiley & Sons Ltd on behalf of Foundation Acta Paediatrica. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.fi=vertaisarvioitu|en=peerReviewed

Associations between Language at 2 Years and Literacy Skills at 7 Years in Preterm Children Born at Very Early Gestational Age and/or with Very Low Birth Weight

Preterm children (bor

Hammersmith Infant Neurological Examination and long-term cognitive outcome in children born very preterm

Aim: To study the association between the Hammersmith Infant Neurological Examination (HINE) at age 2 years and neurocognition at age 11 years in children born very preterm. We hypothesized that the HINE at 2 years would be associated with neurocognition, that is, neurological, motor, and cognitive outcomes at 11 years.Method: A total of 174 children (mean gestational age 29.0wks, SD 2.7; minimum 23.0, maximum 35.9; 95 [55%] males, 79 [45%] females) born very preterm (birthweight ≤1500g/gestational age Results: The HINE global score was associated with the results of the Touwen neurological examination (odds ratio [OR]=0.9, 95% confidence interval [CI] 0.8-0.9, p=0.001), MABC-2 (β=1.4, 95% CI 0.7-2.2, pInterpretation: A higher HINE global score at 2 years was associated with better general intelligence at 11 years even in children without CP. The HINE may be a useful tool to detect children at risk for later cognitive impairment. What this paper adds A Hammersmith Infant Neurological Examination (HINE) global score at 2 years was associated with long-term neurocognitive function. Severe cognitive impairment was significantly more common in 11-year-old children with complex minor neurological dysfunction compared to typically developing children. The HINE performed at 2 years detects risks of cognitive impairment at 11 years in children born very preterm. A higher HINE score at 2 years was associated with better general intelligence at 11 years.</p

Implementation of neurally adjusted ventilatory assist and high flow nasal cannula in very preterm infants in a tertiary level NICU

Preterm infants treated with invasive ventilation are often affected by bronchopulmonary dysplasia, brain structure alterations, and later neurodevelopmental impairment. We studied the implementation of neurally adjusted ventilatory assist (NAVA) and high flow nasal cannula (HFNC) in a level III neonatal unit, and its effects on pulmonary and central nervous system outcomes. This retrospective cohort study included 193 surviving infants born below 32 weeks of gestation in preimplementation (2007-2008) and postimplementation (2016-2017) periods in a single study center in Finland. The proportion of infants requiring invasive ventilation decreased from 67% in the pre- to 48% in the postimplementation period (p = 0.009). Among infants treated with invasive ventilation, 68% were treated with NAVA after its implementation. At the same time, the duration of invasive ventilation of infants born at or below 28 weeks increased threefold compared with the preimplementation period (p = 0.042). The postimplementation period was characterized by a gradual replacement of nasal continuous positive airway pressure (nCPAP) with HFNC, earlier discontinuation of nCPAP, but a longer duration of positive pressure support. The proportion of normal magnetic resonance imaging (MRI) findings at term corrected age increased from 62% to 84% (p = 0.018). Cognitive outcome improved by one standard score between the study periods (p = 0.019). NAVA was used as the primary mode of ventilation in the postimplementation period. During this period, invasive ventilation time was significantly prolonged. HFNC led to a decrease in the use of nCPAP. The change in the respiratory support might have contributed to the improvement in brain MRI findings and cognitive outcomes