Preterm infants

AIM:
The aim of this study was to investigate fathers' emotional experiences of their infant's preterm birth and subsequent stay in neonatal intensive care unit.

BACKGROUND:
When a baby is born preterm, there is also the premature interruption of the process of preparation for fatherhood. As a result, the impact on fathers of the preterm birth can bring negative consequences for the development of father-infant relationship.

DESIGN:
A multi-method approach was used which included ethnographic observation, semi-structured interviews with fathers, a self-report questionnaire and clinical information between September 2015-March 2017.

METHOD:
Data were analysed using a mixed-method: a thematic analysis of data from the interviews and quantitative analyses to detect possible clusters of fathers' emotional experiences and associations between clusters and fathers' and/or infants' characteristics.

RESULTS:
Two clusters were identified. The "fathers-of-preterm-infants" touched their baby as soon as they were given the opportunity and without fear that they would harm their infant. They were struck by their baby's physical appearance. In contrast, the "preterm fathers" preferred not to touch their baby when first given the chance, for fear of breaking/damaging/infecting her/him. They were struck both by the baby's physical appearance and by the technology/equipment around her/him and were afraid that their infant would die. All the "fathers-of-preterm-infants", but only just over half of the "preterm fathers", were actively engaged in their infant's care. Clusters were associated with the infant's gestational age.

CONCLUSION:
Fathers of preterm infants should receive personalized support specifically addressed to them and based on the infant's gestational age.

Named an “outstanding resource” in a starred review by Library Journal, Mother Goose on the Loose (MGOL) incorporates books, rhymes, fingerplays, flannelboards, music, dance, and child-parent interaction into dynamic programs that bring whole families into the library. Her research-based approach to helping young children learn has made Diamant-Cohen’s book a bestseller, and now she’s revised and updated it to include additional research, information, and tips. Filled with ready-to-use plans and activities that build motor, music, social, emotional, and pre-literacy skills in infants and toddlers, this resource includes
planning sheets for implementing the program; guidance on designing new MGOL sessions, plus five MGOL programs with complete scripts and instructions, easily adaptable as needed; ways to adapt MGOL for different cultures and languages and to address social justice concerns;
suggestions for incorporating digital media such as tablets;
tips for communicating with parents, library administrators, and stakeholders; research findings on the learning process for infants and toddlers, including the importance of repetition, ritual, play, reading, movement, and music; and links to additional online resources such as music, sample participant surveys, and promotional tools.
Librarians, educators, and caregivers across the country have already found MGOL easy to learn and easy to present, and so will you!

Oral  thrush  also  known  as  Oral  Moniliasis,  Oral  Candidiasis,  or
Oral Candida  albicans infection)  is a fungal  infection of the  oral
mucosa and tongue with Candida albicans. Causes a whitish lesion
that adheres to an underlying erythematous area. The lesion  may
slightly bleed and become painful when it is scraped.

Introduction: The preterm infants’ developmental outcomes depend on biological and environmental risk factors. The environmental factors include prolonged parental separation, less exposure to early mother/ father–infant interactions and the parents’ ability to respond to the trauma of premature birth. In the case of premature birth, the father’s ability to take an active part in the care of the infant from the start is essential. The parents’ emotional closeness to the preterm infant hospitalised in the neonatal intensive care unit (NICU) may be crucial to the well-being of the newborn, the development of mutual regulation, the establishment of a functioning parent–infant affective relationship and the parents’ confidence in their ability to provide care for their baby.
Methods and analysis: This is a mixed-method, observational and longitudinal study. The methodological strategy will include: (1) ethnographic observation in a level III NICU located in Italy for a duration of 18 months; (2) 3-minute video recordings of mother–infant and father–infant interaction in the NICU; (3) a semistructured interview with fathers during the infants’ hospital stay; (4) 3-minute video recordings of mother–infant and father–infant face-toface interaction in the laboratory at 4 months of corrected age; (5) self-report questionnaires for parents on depression and quality of the couple relationship at the approximate times of the video recording sessions.
Ethics and dissemination: The study protocol was approved by the Ethical Committee for Clinical Trials of the Verona and Rovigo Provinces. Results aim to be published in international peer-reviewed journals, and presented at relevant national and international conferences. This research project will develop research relevant to (1) the quality and modalities of maternal and paternal communication with the preterm infant in the NICU; (2) the influence of maternal/paternal social stimulation on the infant behavioural states; (3) the quality and modalities of paternal support to the partner and possible influences on mother–infant relationship.

CONTEXT: Human and bovine colostrum (HBC) administration has been linked to beneficial effects on morbidity and mortality associated with necrotizing enterocolitis (NEC). OBJECTIVES: To determine the effectiveness and safety of HBC for reducing NEC, mortality, sepsis, time to full-feed and feeding intolerance in preterm infants. DATA SOURCES: We conducted searches through Medline, Embase, Cumulative Index of Nursing and Allied Health Literature, Cochrane Central Register of Controlled Trials, and gray literature. STUDY SELECTION: Randomized controlled trials comparing human or bovine colostrum to placebo. DATA EXTRACTION: Two reviewers independently did screening, review, and extraction. RESULTS: Eight studies (385 infants) proved eligible. In comparison with placebo, HBC revealed no effect on the incidence of severe NEC (relative risk [RR]: 0.99; 95% confidence interval [CI] 0.48 to 2.02, I 2 = 2.2%; moderate certainty of evidence), all-cause mortality (RR: 0.88; 95% CI 0.39 to 1.82, I 2 = 0%; moderate certainty), culture-proven sepsis (RR: 0.78; 95% CI 0.53 to 1.14, I 2 = 0%; moderate certainty), and feed intolerance (RR: 0.97; 95% CI 0.37 to 2.56, I 2 = 55%; low certainty). HBC revealed a significant effect on reducing the mean days to reach full enteral feed (mean difference: −3.55; 95% CI 0.33 to 6.77, I 2 = 41.1%; moderate certainty). The indirect comparison of bovine versus human colostrum revealed no difference in any outcome. LIMITATIONS: The number of patients was modest, whereas the number of NEC-related events was low. CONCLUSIONS: Bovine or human colostrum has no effect on severe NEC, mortality, culture-proven sepsis, feed intolerance, or length of stay. Additional research focused on the impact on enteral feeding may be needed to confirm the findings on this outcome.

Increased rates of cesarean section, as seen currently worldwide, are associated with negative consequences on maternal and child health. Aim: to evaluate the rate and neonatal short term prognosis after cesarean section versus vaginal delivery. Material and methods: The retrospective, cohort study included all neonates admitted in the Neonatology I Dpt., Maternity Hospital Sibiu, between 01.01.2011-30.12.2012. Neonatal data was collected from the electronic database and the outcomes of the infants delivered operatively were compared to those of the vaginally born infants. Results: Newborns delivered by cesarean section, compared to those vaginally born, had significantly lower gestational age, Apgar scores at 1 minute, and increased risk for transient tachypnea, persistent pulmonary hypertension, and hypoglycemia. Conclusion: Most of the results are similar with data reported in the literature but a larger study and stratified analysis may help a better identification of the risk factors associated with cesarean delivery at different gestational age.

Background
It is widely acceptable to involve parents in decision-making about resuscitation for extremely preterm infants (EPI) in the ‘grey zone’. However, there are different views about where the boundaries of the grey zone should lie. The aim of this study was to compare resuscitation thresholds for EPI between neonatologists in UK, Sweden and the Netherlands.

Methods
We distributed an online survey to consultant neonatologists and neonatal registrars/fellows with clinical scenarios in which parents requested resuscitation/non-resuscitation. Respondents were asked about the lowest gestational age/worst prognosis at which they would provide resuscitation and about the highest gestational age/best prognosis at which they would withhold resuscitation. Further scenarios assessed influence of the condition at birth, or consideration of available healthcare resources.

Results
The survey was completed by 162 neonatologists (30% response rate). There was a significant difference between countries; the grey zone for most UK respondents was 23.0 – 23.6/24 weeks, compared with 22.0 - 22.6/23 weeks in Sweden and 24.0-25.6/26 weeks in Netherlands. Resuscitation thresholds were higher if an infant was born in poor condition. There was wide variation in the prognosis that warranted resuscitation/non-resuscitation. Consideration of resource scarcity did not alter responses.

Conclusions
This survey found significant differences in approach to resuscitation of EPI with a spectrum from most (Sweden) to least proactive (Netherlands). Most survey respondents indicated shifts in decision-making attached to particular weeks of gestation. Despite the different approaches to decisions in the three countries, there was relatively little difference between countries in neonatologists’ prognostic thresholds for resuscitation.

The long term impact of being born premature has received limited scientific investigation. Studies that have been carried out, focus on outcomes in childhood, with very few considering the impact on adult physical health. Three case studies are presented here, investigating differences in adult minor illness and psychological variables between adult participants born preterm, fullterm but small and fullterm with normal birthweight. This is a retrospective design using questionnaires and checklist to gather relevant information. Minor illness symptoms, daily hassles, anxiety, depression and general self-efficacy were measured. The participant born preterm scored higher on all measures. Data were applied to the Equilibrium Model for Minor Illness. Being born early appears to have a greater impact on later adult outcomes measured than being born fullterm but small or fullterm but of normal weight. In this article the authors reflect upon possible explanations for the different outcome...

Background: Preterm birth affects 8% to 11% of the population and conveys a significant risk of developmental delays. Intervention programs that support child development have been shown to have a positive impact on early motor and cognitive development and on parental well-being. However, these programs are often difficult to implement in a real-life setting due to lack of resources. Hence, our multidisciplinary team developed Mieux Agir au Quotidien (MAQ) to teach developmentally supportive care to parents of preterm infants with the goal of improving child development and parental outcomes. Our intervention included 3 in-person workshops that occurred prior to hospital discharge and a Web-based platform with written and videotaped materials that addressed 5 main themes: (1) infant behavioral cues, (2) flexion positioning; (3) oral feeding support, (4) parent-infant interactions, and (5) anticipation of developmental milestones.

Background

Parent ratings on questionnaires may provide valid and cost-effective tools for screening cognitive development of children at risk of developmental delay.
Aims

In this study, we examined the convergent validity of combining parent-based reports of non-verbal cognitive abilities (PARCA3) and verbal abilities (CDI-III) in relation to the Bayley-III cognitive scale in 3-year-olds born late pre-term.
Methods

Mothers of 185 late-preterm children were asked to complete the PARCA3 and the CDI-III shortly before children reached age three; children were then assessed using the Bayley-III close to their third birthday.
Results

The two maternal questionnaires were significantly and moderately correlated with the Bayley-III cognitive scores. Together the maternal ratings accounted for 15% of the variance in the Bayley-III cognitive scores, after controlling for other covariates in regression analysis. In particular, the PARCA3 contributed significantly to explain variance in the Bayley-III cognitive scores when controlling for the CDI-III. However, the CDI-III was also independently associated with the Bayley-III cognitive scores.
Conclusions

Parent ratings of child cognition and language together may provide cost-effective screening of development in “at risk” preschoolers.

OBJECTIVE: This study was conducted to determine the frequency of otitis media in preterm neonates using otoendoscopy and tympanometry.
STUDY DESIGN: Prospective study.
SETTING: Wayne State University, Hutzel Women's Hospital Neonatal Intensive Care Unit.
SUBJECTS AND METHODS: Eighty-six preterm infants were included (gestational age <36 weeks). Otoendoscopy and tympanometry were performed to detect the presence of otitis media. Kappa statistic and logistic regression were used for statistical analysis.
RESULTS: Otoendoscopy was performed in 85 patients. The frequency of otoendoscopy-diagnosed otitis media was 72.9% (62/85). Tympanometry could be performed on 69.76% of the ears. There was 73.5% agreement between the findings of tympanometry and those of otoendoscopy. The association between the presence of otitis media and gestational age at birth was statistically significant. The lower the gestational age, the higher the frequency of otoendoscopy-diagnosed otitis media (P = .001).
CONCLUSION: Otoendoscopically diagnosed otitis media is frequent in preterm neonates. There was agreement between the results of tympanometry and those of otoendoscopy. The frequency of otitis media increased with lower gestational age.

Background
Appropriate tools are essential to support a clinician’s decision to refer very preterm infants to developmental resources. Streamlining the use of developmental assessment or screen- ing tools to make clinical decisions offers an alternative methodology to help to choose the most effective way to assess this very high-risk population.
Objective
To examine the influence of the Ages and Stages Questionnaire-3rd edition (ASQ3) and the Bayley Scales of Infant Development-3rd edition (Bayley-III) scores within a clinically-based decision-making process.
Methods
This retrospective cohort study includes children born at less than 29 weeks gestation who had completed both psychologist-administered Bayley-III and physician-observed ASQ3 assessments at 18 months corrected age. Theoretical referral decisions (TRDs) based on each assessment results were formulated, using cut-off scores between the lower first and second standard deviation values and below the lower second standard deviation values. TRDs to refer to developmental resources were evaluated in light of the multidisciplinary team’s actual final integrated decisions (FID).
Results
Complete data was available for 67 children. The ASQ3 and the Bayley-III had similar pre- dictive value for the FID, with comparable kappa values. Comparisons of the physicians’ and psychologists’ TRDs with the FIDs demonstrated that the ASQ3 in conjunction with the medical and socio-familial findings predicted 93% of referral decisions.Conclusion
Taking into consideration potential methodological biases, the results suggest that either ASQ3 or Bayley-III, along with socio-environmental, medical and neurological assessment, are sufficient to guide the majority of clinicians’ decisions regarding referral for specialty ser- vices. This retrospective study suggests that the physician-supervised ASQ3 may be suffi- cient to assess children who had been extremely preterm infants for referral purposes. The findings need to be confirmed in a larger, well-designed prospective study to minimize and account for potential sources of bias.

Background: Preterm newborn birth is usually a challenge for the mother and the family. The mother feels inadequate for the care of her newborn and her self-esteem decreases. In this regard, this study aimed to determine the effect of Kangaroo Mother Care (KMC) on the self-esteem of mothers of preterm newborns.

The aim of the study was to investigate the effects of live singing on the biophysiological functions, weight gain, head circumference, body length, and duration of hospitalization of preterm infants hospitalized in a neonatal intensive care unit (NICU) in Greece. Forty-one preterm infants 25-33 + 6 days of PCA took part in the study. 14 infants were assigned to the Mother Singing group (MS) in which mothers sang to their infants for 15 minutes every day during the fourteen-day intervention, 13 to the Music Therapist Singing group (MTS) in which a music therapist sang to the infants for 15 minutes every day during the fourteen-day intervention, and 14 in the control group (CG) which did not receive any additional intervention. Infants of both MS and MTS presented statistically significant improvements in heart rate and blood oxygen saturation, compared to CG. No significant differences between groups were found in weight, head circumference, body length, and duration of hospitalizat...

Importance  Despite increasing emphasis on conservative management of patent ductus arteriosus (PDA) in preterm infants, different pharmacotherapeutic interventions are used to treat those developing a hemodynamically significant PDA.

Objectives  To estimate the relative likelihood of hemodynamically significant PDA closure with common pharmacotherapeutic interventions and to compare adverse event rates.

Data Sources and Study Selection  The databases of MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials were searched from inception until August 15, 2015, and updated on December 31, 2017, along with conference proceedings up to December 2017. Randomized clinical trials that enrolled preterm infants with a gestational age younger than 37 weeks treated with intravenous or oral indomethacin, ibuprofen, or acetaminophen vs each other, placebo, or no treatment for a clinically or echocardiographically diagnosed hemodynamically significant PDA.

Data Extraction and Synthesis  Data were independently extracted in pairs by 6 reviewers and synthesized with Bayesian random-effects network meta-analyses.

Main Outcomes and Measures  Primary outcome: hemodynamically significant PDA closure; secondary: included surgical closure, mortality, necrotizing enterocolitis, and intraventricular hemorrhage.

Results  In 68 randomized clinical trials of 4802 infants, 14 different variations of indomethacin, ibuprofen, or acetaminophen were used as treatment modalities. The overall PDA closure rate was 67.4% (2867 of 4256 infants). A high dose of oral ibuprofen was associated with a significantly higher odds of PDA closure vs a standard dose of intravenous ibuprofen (odds ratio [OR], 3.59; 95% credible interval [CrI], 1.64-8.17; absolute risk difference, 199 [95% CrI, 95-258] more per 1000 infants) and a standard dose of intravenous indomethacin (OR, 2.35 [95% CrI, 1.08-5.31]; absolute risk difference, 124 [95% CrI, 14-188] more per 1000 infants). Based on the ranking statistics, a high dose of oral ibuprofen ranked as the best pharmacotherapeutic option for PDA closure (mean surface under the cumulative ranking [SUCRA] curve, 0.89 [SD, 0.12]) and to prevent surgical PDA ligation (mean SUCRA, 0.98 [SD, 0.08]). There was no significant difference in the odds of mortality, necrotizing enterocolitis, or intraventricular hemorrhage with use of placebo or no treatment compared with any of the other treatment modalities.

Conclusions and Relevance  A high dose of oral ibuprofen was associated with a higher likelihood of hemodynamically significant PDA closure vs standard doses of intravenous ibuprofen or intravenous indomethacin; placebo or no treatment did not significantly change the likelihood of mortality, necrotizing enterocolitis, or intraventricular hemorrhage.

Trial Registration  PROSPERO Identifier: CRD42015015797

Electroencephalogram (EEG) was used to investigate brain electrical activity of full-term and preterm infants at 4 and 12 months of age as a functional response mechanism to structured optic flow and random visual motion. EEG data were recorded with an array of 128-channel sensors. Visual evoked potentials (VEPs) and temporal spectral evolution (TSE, time-dependent amplitude changes) were analysed. VEP results showed a significant improvement in full-term infants' latencies with age for forwards and reversed optic flow but not random visual motion. Full-term infants at 12 months significantly differentiated between the motion conditions, with the shortest latency observed for forwards optic flow and the longest latency for random visual motion, while preterm infants did not improve their latencies with age, nor were they able to differentiate between the motion conditions at 12 months. Differences in induced activities were also observed where comparisons between TSEs of the motion conditions and a static non-flow pattern showed desynchronised theta-band activity in both full-term and preterm infants , with synchronised alpha-beta band activity observed only in the full-term infants at 12 months. Full-term infants at 12 months with a substantial amount of self-produced locomotor experience and neural maturation coupled with faster oscillating cell assemblies, rely on the perception of structured optic flow to move around efficiently in the environment. The poorer responses in the preterm infants could be related to impairment of the dorsal visual stream specialized in the processing of visual motion.

OBJECTIVE:

To evaluate outcomes of women with prior ultrasound-indicated cerclage, who in their subsequent pregnancy were either followed by transvaginal ultrasound cervical length screening or received a planned history-indicated cerclage.
METHODS:

Multicenter cohort study of singleton gestations with a prior ultrasound-indicated cerclage performed from 1994 to 2014. We evaluated three pregnancies in the study participants: first pregnancy with prior spontaneous preterm birth at less than 37 weeks of gestation; second pregnancy with ultrasound-indicated cerclage for cervical length 25 mm or less; and the third index pregnancy managed with either transvaginal ultrasound cervical length screening with ultrasound-indicated cerclage for cervical length 25 mm or less or planned history-indicated cerclage. The primary outcome was incidence of spontaneous preterm birth at less than 37 weeks of gestation. We planned a subgroup analysis for women who delivered at less than 32 weeks of gestation compared with 32 weeks of gestation or greater in their prior ultrasound-indicated cerclage pregnancy.
RESULTS:

Of 102 singleton gestations included, 38 (37.3%) were followed with transvaginal ultrasound cervical length screening and 64 (62.7%) underwent history-indicated cerclage. Of 38 women in the transvaginal ultrasound group, 18 (47.4%) underwent ultrasound-indicated cerclage for cervical length 25 mm or less. After adjusting for confounders, the rate of spontaneous preterm birth at less than 37 weeks of gestation was similar between transvaginal ultrasound cervical length screening and history-indicated cerclage groups (36.8% compared with 43.8%; adjusted odds ratio 0.77, 95% confidence interval 0.47-1.45). Secondary outcomes were also similar in both groups. All women (n=7) who delivered at less than 32 weeks of gestation in their prior pregnancy and subsequently had transvaginal ultrasound screening received ultrasound-indicated cerclage in the index pregnancy compared with only 35.5% of women who delivered at 32 weeks of gestation or greater in their prior pregnancy.
CONCLUSION:

Women with prior ultrasound-indicated cerclage have similar outcomes if they receive either transvaginal ultrasound cervical length screening with ultrasound-indicated cerclage for cervical length 25 mm or less or planned history-indicated cerclage in the subsequent pregnancy. Less than 50% of the transvaginal ultrasound cervical length screening group require a repeat ultrasound-indicated cerclage in the subsequent pregnancy.

Preterm birth affects 8% to 11% of the population and conveys a significant risk of developmental delays. Intervention programs that support child development have been shown to have a positive impact on early motor and cognitive development and on parental well-being. However, these programs are often difficult to implement in a real-life setting due to lack of resources. Hence, our multidisciplinary team developed Mieux Agir au Quotidien (MAQ) to teach developmentally supportive care to parents of preterm infants with the goal of improving child development and parental outcomes. Our intervention included 3 in-person workshops that occurred prior to hospital discharge and a Web-based platform with written and videotaped materials that addressed 5 main themes: (1) infant behavioral cues, (2) flexion positioning; (3) oral feeding support, (4) parent-infant interactions, and (5) anticipation of developmental milestones. This study aimed to test the feasibility and acceptability of th...