Highlights in this issue

Abstract

Only a minority of pregnant women who abuse alcohol, drugs or medication are recognised by healthcare providers and receive the help they need. Prenatal substance exposure leads to a wide range of problems, but we lack reliable tools to detect the early effects. This study by Anni Lehikoinen et al 1 is the first to show that a decrease in head circumference was already evident during mid-pregnancy in alcohol- or drug-exposed foetuses. This literature review by Deedee Kommers et al 2 raises awareness of the consequences of suboptimal bonding as a result of prematurity. The authors found that suboptimal bonding significantly impaired hormonal, epigenetic and neuronal development, but that these impairments could be reversed by bonding interventions. The findings suggest that neonatal intensive care units should focus more on interventions that optimise bonding. Martha Welch discusses the mechanisms behind the nurture phenomenon in the accompanying editorial 3. The Infant Behavioral Assessment and Intervention Program (IBAIP) aims to support responsive interaction between parents and their preterm and low-birthweight infants. This longitudinal randomised study by Janeline Van Hus et al, found that the early gains in motor development after IBAIP still remained at five years of age and infants with bronchopulmonary dysplasia gained particular benefits from the intervention 4. Readers will also be interested to see Karli Treyvaud's commentary 5 and the editorial by Björn Westrup 6, who points out that it is important to provide supportive interventions that encourage development after the neonatal intensive care period. Moreover, Paola Oras et al report that skin-to-skin contact is associated with earlier breastfeeding attainment (7). This study by Philipp Deindl et al 8 compared the neurodevelopmental outcomes of extremely preterm infants before and after the implementation of a protocol to manage neonatal pain and sedation in two neonatal intensive care units in Austria. Opiate exposure was increased after the protocol was implemented, but no changes were seen in neurodevelopmental outcomes while the infants were in hospital or at 12 months of age. Ricardo Carbajal 9 and Sunny Anand 10 discuss the findings. More than 7000 male circumcisions are performed in Scandinavia every year, and over the last two decades, 74 procedures have resulted in complications that were reported to the health authorities in these countries. Four cases involved severe bleeding and circulatory shock, and one of these led to the death of the child. On the basis of their analysis of these severe cases, Gertrud Edler et al 11 conclude that circumcision should only be performed at hospitals with a 24-hour emergency department.