Adverse Perinatal Conditions Research Articles

Is the expression of placental epithelial and lymphoid markers associated with the perinatal outcomes in preeclampsia?

This study aimed to investigate the association of the epithelial and lymphoid immune markers with the adverse perinatal conditions such as early-onset preeclampsia (EOPE), fetal growth restriction (FGR) and intrauterine fetal death (IUFD) in preeclampsia in the placentae of preeclamptic patients. A total of 60 pregnant patients were included in this study. The immunohistochemistry method was used to determine the expression levels of CD4, CD8, CD4 / CD8, CD68, P53, MDM2, CK18, CK19, E-cadherin, and β-catenin. In our study, the increase in E-cadherin expression in the preeclamptic fetal-maternal placental region was associated with EOPE and FGR development preeclampsia and the decrease in the expression of CD4 and CD8, which are involved in the local immunomodulation, was associated with IUFD. Our data reveal that the increase in the expression of CK18, CK19, E-cadherin, and β-catenin and the decrease in CD4 and CD8 play a role in the pathogenesis of preeclampsia.

Lifetime lung function trajectories and COPD: when the train derails

Increasing recognition that chronic respiratory disease originates in early life has shifted the paradigm away from traditional concepts of chronic obstructive pulmonary disease (COPD) as solely a smoker's disease. 1 Martinez FD Early-life origins of chronic obstructive pulmonary disease. N Engl J Med. 2016; 375: 871-878 Crossref PubMed Scopus (277) Google Scholar Building on Fletcher and Peto's landmark publication highlighting smoking-related decline of FEV1, 2 Fletcher C Peto R The natural history of chronic airflow obstruction. BMJ. 1977; 1: 1645-1648 Crossref PubMed Scopus (1800) Google Scholar multiple cohort studies have since implicated altered lung function trajectories originating in childhood in the accelerated development of lung disease. 3 Berry CE Billheimer D Jenkins IC et al. A distinct low lung function trajectory from childhood to the fourth decade of life. Am J Respir Crit Care Med. 2016; 194: 607-612 Crossref PubMed Scopus (114) Google Scholar , 4 Lange P Celli B Agustí A et al. Lung-function trajectories leading to chronic obstructive pulmonary disease. N Engl J Med. 2015; 373: 111-122 Crossref PubMed Scopus (346) Google Scholar , 5 McGeachie MJ Yates KP Zhou X et al. Patterns of growth and decline in lung function in persistent childhood asthma. N Engl J Med. 2016; 374: 1842-1852 Crossref PubMed Scopus (350) Google Scholar , 6 Stern DA Morgan WJ Wright AL Guerra S Martinez FD Poor airway function in early infancy and lung function by age 22 years: a non-selective longitudinal cohort study. Lancet. 2007; 370: 758-764 Summary Full Text Full Text PDF PubMed Scopus (429) Google Scholar This work has revealed that many individuals tend to track along a lung function percentile established in childhood, such that those who begin life at a lower lung function percentile because of adverse perinatal or chronic childhood respiratory conditions are hindered from reaching maximal peak lung function as young adults. Even with the normal age-related rate of lung function decline, these individuals stay on a path with an increased lifetime risk for COPD. Importantly, multiple identified early-life risk factors—including those experienced in utero—alter developmental programming, affecting the timing and course of progression to chronic lung disease. 7 Postma DS Bush A van den Berge M Risk factors and early origins of chronic obstructive pulmonary disease. Lancet. 2015; 385: 899-909 Summary Full Text Full Text PDF PubMed Scopus (318) Google Scholar Lifetime spirometry patterns of obstruction and restriction, and their risk factors and outcomes: a prospective cohort studyTo our knowledge, this is the first study to characterise lifetime phenotypes of obstruction and restriction simultaneously using objective data-driven techniques and unique life course spirometry measures of FEV1/FVC ratio and FVC from childhood to middle age. Mixed and obstructive-only patterns indicate those who might benefit from early COPD interventions. Those with the restrictive-only pattern had evidence of true lung restriction and were at increased risk of multimorbidity by middle age. Full-Text PDF

Adverse perinatal conditions and the developmental origins of thyroid dysfunction-Lessons from Animal Models.

Nutritional, hormonal, and environmental status during development can predispose the individual to obesity and endocrine diseases later in life, an association known as metabolic programming. In general, weight loss or gain are seen in thyroid disorders, and thyroid function can be affected by body adiposity. In addition, hyper- and hypothyroidism can be related to metabolic programming. Our aim was to gather evidence that regardless of the type or critical window of metabolic imprinting, offspring exposed to certain adverse perinatal conditions have a higher risk of developing thyroid dysfunction. We reviewed literature data that relate insults occurring during pregnancy and/or lactation to short- and long-term offspring thyroid dysfunction in animal models. Few studies have addressed the hypothalamic-pituitary-thyroid axis and thyroid dysfunction related to metabolic programming. The literature shows that under- and overnutrition, exposure to endocrine disruptors, early weaning, maternal thyroid disease and maternal high-fat diet can induce alterations in offspring thyroid function in a sex-dependent manner. Based on the few available data, mainly in rodent models, we can conclude that diet, hormones, and environmental contaminants are related to the developmental origins of later thyroid dysfunction by interrupting the normal maturation of the thyroid gland.

Cardiac magnetic resonance imaging: insights into developmental programming and its consequences for aging.

Cardiovascular diseases (CVD) are important consequences of adverse perinatal conditions such as fetal hypoxia and maternal malnutrition. Cardiac magnetic resonance imaging (CMR) can produce a wealth of physiological information related to the development of the heart. This review outlines the current state of CMR technologies and describes the physiological biomarkers that can be measured. These phenotypes include impaired ventricular and atrial function, maladaptive ventricular remodeling, and the proliferation of myocardial steatosis and fibrosis. The discussion outlines the applications of CMR to understanding the developmental pathways leading to impaired cardiac function. The use of CMR, both in animal models of developmental programming and in human studies, is described. Specific examples are given in a baboon model of intrauterine growth restriction (IUGR). CMR offers great potential as a tool for understanding the sequence of dysfunctional adaptations of developmental origin that can affect the human cardiovascular system.

Adverse perinatal conditions and receiving a disability pension early in life.

ObjectiveThe number of young adults on disability pension (DP) is increasing in European countries, creating a need to understand the related risk factors. This study aimed to determine whether adverse perinatal conditions are associated with receiving a DP early in life.MethodsThis longitudinal cohort study consisted of all persons (N = 453,223) born in Sweden during 1973–1977, observed from 1991 through 2010 when they were aged between 16 and 37 years. Statistics Sweden provided linked national data on the children and their parents. We used logistic regression to assess the association between perinatal health conditions (birth defect, Apgar score, and small for gestational age) and receiving a DP, adjusting for maternal education and the sex of the child.ResultsNew recipients of DP were significantly more likely to have had a birth defect (adjusted odds ratio [AOR] 2.74, 95% CI: 2.49–3.00), to have had low Apgar score (AOR 2.12, 95% CI: 1.77–2.52), to have been small for gestational age (AOR 1.73, 95% CI: 1.54–1.94) and to be females (AOR 1.55, 95% CI: 1.46–1.64). Higher maternal education was associated with lower odds of receiving a DP (AOR 0.74, 95% CI: 0.69–0.79) for those with high school education and (AOR 0.67, 95% CI: 0.59–0.75) for those with university education. Age-stratified analysis confirmed increased odds of receiving a DP among those with birth defects and small for gestational age, but this effect reduced with increasing age. Apgar score was significantly associated with starting to receive a DP at ages 16–18 and 19–29, but not at ages 30–33. Women had lower odds of receiving a DP at ages 16–18 (AOR 0.73, 95% CI: 0.64–0.85); however, this reversed from age 19 and upwards (AOR 1.53, 95% CI: 1.41–1.67) and (AOR 2.16, 95% CI: 1.95–2.40) for the age groups of 19–29 and 30–33, respectively. Persons with high maternal education were less likely to receive a DP regardless of age at receiving a DP.ConclusionHaving a birth defect was the strongest indicator of receiving a DP during early adulthood, followed by small for gestational age and low Apgar score. Overall, the effects of the studied perinatal health conditions were pronounced in those who received a DP at 16–18 years, but this effect weakened with increasing age at receiving a DP. Our findings suggest that policies and programs geared at promoting optimal health at birth might contribute to a reduction in receiving a DP.

In-utero and perinatal influences on suicide risk: a systematic review and meta-analysis

Adverse in-utero and perinatal conditions might contribute to an increased suicide risk throughout the lifespan; however, existing evidence is sparse and contradictory. We aimed to investigate in-utero and perinatal exposures associated with suicide, suicide attempt, and suicidal ideation. We did a systematic review and meta-analysis and searched MEDLINE, Embase, and PsycINFO from inception to Jan 24, 2019, for population-based prospective studies that investigated the association between in-utero and perinatal factors and suicide, suicide attempt, and suicidal ideation. Only papers published in English in peer-reviewed journals were considered. Two researchers independently extracted formal information (eg, country, year, duration of follow-up) and number of cases and non-cases exposed and non-exposed to each risk factor. We calculated pooled odds ratios (ORs) with 95% CIs using random-effects models and used meta-regression to investigate heterogeneity. This study was registered with PROSPERO, number CRD42018091205. We identified 42 eligible studies; they had a low risk of bias (median quality score 9/9 [IQR 8-9]). Family or parental characteristics, such as high birth order (eg, for fourth-born or later-born vs first-born, pooled OR 1·51 [95% CIs 1·21-1·88]), teenage mothers (1·80 [1·52-2·14]), single mothers (1·57 [1·31-1·89]); indices of socioeconomic position, such as low maternal (1·36 [1·28-1·46]) and paternal (1·38 [1·27-1·51]) education; and fetal growth (eg, low birthweight 1·30 [1·09-1·55] and small for gestational age 1·18 [1·00-1·40]) were associated with higher suicide risk. Father's age, low gestational age, obstetric characteristics (eg, caesarean section), and condition or exposure during pregnancy (eg, maternal smoking or hypertensive disease) were not associated with higher suicide risk. Similar patterns of associations were observed for suicide attempt and suicidal ideation; however, these results were based on a lower number of studies. In meta-regression, differences in length of follow-up explained most between-study heterogeneity (inital I2 ranged from 0 to 79·5). These findings suggest that prenatal and perinatal characteristics are associated with increased suicide risk during the life course, supporting the developmental origin of health and diseases hypothesis for suicide. The low number of studies for some risk factors, especially for suicide attempt and ideation, leaves gaps in knowledge that need to be addressed. The mechanisms underlying the reported associations and their causal nature still remain unclear. Horizon 2020 (EU).

Variants of the OLIG2 Gene are Associated with Cerebral Palsy in Chinese Han Infants with Hypoxic-Ischemic Encephalopathy.

Cerebral palsy (CP) is a leading cause of neurological disability among young children. Congenial and adverse perinatal clinical conditions, such as genetic factors, perinatal infection, and asphyxia, are risk factors for CP. Oligodendrocyte transcription factor (OLIG2) is a protein that is expressed in brain oligodendrocyte cells and is involved in neuron repair after brain injury. In this study, we employed a Chinese Han cohort of 763 CP infants and 738 healthy controls to study the association of OLIG2 gene polymorphisms with CP. We found marginal association of the SNP rs6517135 with CP (p = 0.044) at the genotype level, and the association was greatly strengthened when we focused on the subgroup of CP infants who suffered from hypoxic-ischemic encephalopathy (HIE) after birth, with p = 0.003 (OR = 0.558) at the allele level and p = 0.007 at the genotype level, indicating a risk-associated role of the T allele of the SNP rs6517135 under HIE conditions. The haplotype CTTG for rs6517135-rs1005573-rs6517137-rs9653711 in OLIG2 was also significantly associated with the occurrence of CP in infants with HIE (p = 0.01, OR = 0.521). Our results indicate that in the Han Chinese population, the polymorphisms of OLIG2 were associated with CP, especially in patients who had suffered HIE injury. This finding could be used to develop personalized care for infants with high susceptibility to CP.

Adverse Perinatal Conditions Associated With Prenatally Detected Fetal Echogenic Bowel in Nova Scotia

ObjectiveThis study sought to estimate the association of adverse perinatal outcomes with pregnancies complicated by fetal echogenic bowel. MethodsData for pregnancies complicated with echogenic bowel identified in the second trimester were derived from the tertiary referral IWK Health Centre (Halifax, NS) Viewpoint Ultrasound Database augmented by medical chart review. The study was undertaken between 2003 and 2014. Rates of positive cytomegalovirus and toxoplasmosis infection were determined using maternal serology and amniocentesis results. Rates of intrauterine growth restriction, abnormal karyotype, cystic fibrosis, antenatal bleeding, and bowel abnormalities were also determined. Neonatal information included newborn urine culture results and postnatal genetic testing. Univariate analyses compared rates of infection with isolated echogenic bowel and echogenic bowel with other ultrasound findings, with statistical significance set at P< 0.05. ResultsThere were 422 pregnancies identified prenatally with echogenic bowel (82% had isolated echogenic bowel). Of these, 92 (22%) had at least one of the foregoing associated abnormalities. Three percent of women had serologic test results positive for cytomegalovirus or toxoplasmosis, with <1% documented newborn infections. Cystic fibrosis and other genetic diagnoses were observed in 8%, intrauterine growth restriction in 14%, antenatal bleeding in 19%, and bowel abnormalities in 3% of the cases of echogenic bowel. Pregnancies with isolated echogenic bowel had an 80% reduction in risk for these significant outcomes, in contrast to a four- to 11-fold increased risk of specific outcomes when additional ultrasound findings were present. ConclusionAn overall rate of adverse conditions of 22% with prenatally detected echogenic bowel serves to inform women and health care providers and emphasizes the importance of careful screening fetal ultrasound studies and timely referral for comprehensive assessment with findings of echogenic bowel for evaluation for associated findings.

Neonatal exposure to high oxygen levels leads to impaired ischemia-induced neovascularization in adulthood

Adverse perinatal conditions can lead to developmental programming of cardiovascular diseases. Prematurely born infants are often exposed to high oxygen levels, which in animal models has been associated with endothelial dysfunction, hypertension, and cardiac remodeling during adulthood. Here we found that adult mice that have been transiently exposed to O2 after birth show defective neovasculariation after hindlimb ischemia, as demonstrated by impaired blood flow recovery, reduced vascular density in ischemic muscles and increased tissue damages. Ischemic muscles isolated from mice exposed to O2 after birth exhibit increased oxidative stress levels and reduced expression of superoxide dismutase 1 (SOD1) and vascular endothelial growth factor (VEGF). Pro-angiogenic cells (PACs) have been shown to have an important role for postnatal neovascularisation. We found that neonatal exposure to O2 is associated with reduced number of PACs in adults. Moreover, the angiogenic activities of both PACs and mature mouse aortic endothelial cells (MAECs) are significantly impaired in mice exposed to hyperoxia after birth. Our results indicate that neonatal exposure to high oxygen levels leads to impaired ischemia-induced neovascularization during adulthood. The mechanism involves deleterious effects on oxidative stress levels and angiogenic signals in ischemic muscles, together with dysfunctional activities of PACs and mature endothelial cells.

Structural Brain Network Reorganization and Social Cognition Related to Adverse Perinatal Condition from Infancy to Early Adolescence.

Adverse conditions during fetal life have been associated to both structural and functional changes in neurodevelopment from the neonatal period to adolescence. In this study, connectomics was used to assess the evolution of brain networks from infancy to early adolescence. Brain network reorganization over time in subjects who had suffered adverse perinatal conditions is characterized and related to neurodevelopment and cognition. Three cohorts of prematurely born infants and children (between 28 and 35 weeks of gestational age), including individuals with a birth weight appropriated for gestational age and with intrauterine growth restriction (IUGR), were evaluated at 1, 6, and 10 years of age, respectively. A common developmental trajectory of brain networks was identified in both control and IUGR groups: network efficiencies of the fractional anisotropy (FA)-weighted and normalized connectomes increase with age, which can be related to maturation and myelination of fiber connections while the number of connections decreases, which can be associated to an axonal pruning process and reorganization. Comparing subjects with or without IUGR, a similar pattern of network differences between groups was observed in the three developmental stages, mainly characterized by IUGR group having reduced brain network efficiencies in binary and FA-weighted connectomes and increased efficiencies in the connectome normalized by its total connection strength (FA). Associations between brain networks and neurobehavioral impairments were also evaluated showing a relationship between different network metrics and specific social cognition-related scores, as well as a higher risk of inattention/hyperactivity and/or executive functional disorders in IUGR children.

Alteraciones en la nutrición fetal y en las etapas tempranas de la vida. Su repercusión sobre la salud en edades posteriores

Obesity is a universal problema which affects all ages. It increases signigicantly in pregnant women. There is consistent epidemiological evidence that some adverse perinatal conditions are associated to a high risk for a future metabolic syndrome and related problems. Fetal programming and development are currently accepted concepts; however, the mechanisms involved are being investigated. Epigenetic disturbances, adipogenesis programming and appetite/saciety mechanisms are among the outstanding situations. The importance of early weight gain, of feeding habits during the first months of life are assessed, all of which influence the preference of persons for certain foods. Based on these facts, special programs for prevention should be implanted in order to optimize neonatal health and to reduce the occurrence of disease in adults.

A meta-analysis of mortality data in Italian contaminated sites with industrial waste landfills or illegal dumps.

Adverse effects of waste management represent a public health issue. Mortality meta-analysis in Italian National Priority Contaminated Sites (NPCSs) with industrial waste landfills or illegal dumps is presented. 24 NPCSs include industrial waste landfills or illegal dumps. Class 1 (10 NPCSs with industrial waste landfills) and Class 2 (14 NPCSs with illegal dumps) were categorized. Random-effects model meta-analyses of Standardized Mortality Ratios non-adjusted (SMRs) and adjusted for Deprivation (DI-SMRs) computed for each CS (1995-2002) were performed for overall 24 NPCSs and the two classes. The North- Southern gradient was considered. 24 CSs pooled-SMRs are significantly increased in both genders for cancer of liver (men: SMR=1.13; women: SMR=1.18), bladder (men: SMR=1.06; women: SMR=1.11), and for cirrhosis (men: SMR=1.09; women: SMR=1.13). In Class 2 the increase is confirmed in both genders for liver and bladder cancers and for cirrhosis and in men only for lung cancer. Congenital anomalies and adverse perinatal conditions are not increased. The results are consistent with the hypothesis of adverse health effects of non-adequately managed hazardous waste. Causal interpretation is not allowed, but the meta-analytic approach provides more confidence in the findings.

Перинатальное программирование артериальной гипертензии у ребенка

There is a growing number of evidence linking fetal intrauterine malnutrition, other adverse events or exposures and arterial hypertension during the following life. After important epidemiological studiesfrom many countries, research now focuses on mechanisms of organ dysfunction and on refining the understanding of the interaction between common elements ofadverse perinatal conditions and normal development. This review focused on advances in comprehension of the influence of intrauterine malnutrition on developmental programming of hypertension. Significant decrease in nephrons number was demonstrated as a result of fetal asymmetrical growth restriction syndrome both in human and experimental animal model. The role of malnutrition and dexametasone induced rennin-angiotensin system inhibition in fetal and newborn nephrogenesis is discussed. Recent studies have revealed important mechanisms of altered vascular function and structure as well as sympathetic regulation of the cardiovascular system in perinatal hypertension models. Some of adverse effects on nephrogenesis and blood pressure regulation could be reversed by special diet and treatment during first two years of life. While the complexity of the interactions between antenatal and postnatal influences on blood pressure is increasingly recognized, the importance of early postnatal life in modulating developmental programming offers the hope of a critical 1000 days window of opportunity to reverse programming and prevent or reduce child hypertension.

Developmental programming and hypertension.

There is a growing body of evidence linking adverse events or exposures during early life and adult-onset diseases. After important epidemiological studies from many parts of the world, research now focuses on mechanisms of organ dysfunction and on refining the understanding of the interaction between common elements of adverse perinatal conditions, such as nutrition, oxidants, and toxins exposures. This review will focus on advances in our comprehension of developmental programming of hypertension. Recent studies have unraveled important mechanisms of oligonephronia and impaired renal function, altered vascular function and structure as well as sympathetic regulation of the cardiovascular system. Furthermore, interactions between prenatal insults and postnatal conditions are the subject of intensive research. Prematurity vs. intrauterine growth restriction modulate differently programming of high blood pressure. Along with antenatal exposure to glucocorticoids and imbalanced nutrition, a critical role for perinatal oxidative stress is emerging. While the complexity of the interactions between antenatal and postnatal influences on adult blood pressure is increasingly recognized, the importance of postnatal life in (positively) modulating developmental programming offers the hope of a critical window of opportunity to reverse programming and prevent or reduce related adult-onset diseases.

Impact de l'âge gestationnel et du poids de naissance sur le devenir cardiovasculaire à long terme

Purpose Intra-uterine growth restriction and preterm birth can lead to cardiovascular diseases in adulthood. Current knowledge and key points Preterm birth and intra-uterine growth restriction induce long-term changes in organ development such as arterial system and kidney function. Among these changes, the impairment of arterial wall structure or properties occurring in low birth weight babies, as a result of preterm birth and intra-uterine growth restriction, may lead on a long-term to an elevation of arterial pressure and arterial stiffness. These notions are still not completely understood and seem of high importance in regard to the high frequency in preterm birth and intra-uterine growth restriction. Future prospects and projects Identifying clinical, paraclinical markers and better understanding a link between adverse perinatal conditions and cardiovascular diseases might improve actions for preventing cardiovascular diseases in adulthood in this population.

Adverse perinatal conditions in hearing‐impaired children in a developing country

Prevailing adverse perinatal conditions in developing countries have been associated with substantial mortality, but little evidence exists on their impact on permanent childhood disabilities and morbidity due to limitations in clinical investigations and medical records. This study aims to identify the possible association between parent-reported adverse perinatal conditions and permanent hearing loss, in order to establish service needs within current maternal and child health programmes. Structured questionnaires were administered to 363 parents of deaf children and 309 parents of normal-hearing children in an inner city area of Lagos, Nigeria. The parents were from all social classes. After a multivariable logistic regression analysis, birth asphyxia [OR 20.45; 95% CI 6.26, 66.85], difficult delivery [OR 8.09; 95% CI 2.76, 23.68], neonatal jaundice [OR 2.45; 95% CI 1.25, 4.79] and neonatal seizures [OR 2.30; 95% CI 1.09, 4.85] were associated with permanent hearing loss. Consanguineous marriages [OR 6.69; 95% CI 2.72, 16.46] and family history of deafness [OR 6.27; 95% CI 2.07, 18.97] also emerged as additional risk factors for permanent hearing loss. In addition, parents of children in state-owned schools for the deaf were significantly more likely to belong to higher social classes compared with normal-hearing children in mainstream state-owned schools. There is a need to incorporate services for the early detection of permanent hearing loss into current maternal and child healthcare programmes in developing countries.

Letter to the Editors: The burden of neonatal jaundice and sepsis in developing countries

Although prevailing adverse perinatal conditions in devel-oping countries are readily associated with mortality, theyalso portend significant risks for the well being of survivingchildren and their families. Measuring the full burden ofthese conditions besides the incidence of infant mortalityremains a continuing challenge because of the dearth oflongitudinal studies on the developmental profile of thesurvivors. The study by Gordon et al. (2005), althoughlimited to neonatal jaundice and neonatal sepsis, is animportant contribution to the much needed database forthis region and certainly complements more commonreports on the neurodevelopmental outcomes in pre-termor low-birthweight infants. However, the incidence ofpermanent hearing impairment would appear to have beenunder-reported because neither otoacoustic emissions(OAE) nor auditory brainstem response (ABR) evaluationwas conducted. As unconjugated hyperbilirubinaemia is anestablished risk factor for sensorineural hearing loss,objective hearing assessment would have been valuableespecially in the light of the growing trend towards earlyhearing detection and intervention.In my ongoing pilot programme on infant hearingscreening in Lagos, Nigeria consisting of a two-stagescreening with transient evoked OAE and automated ABRfollowed by confirmatory test with diagnostic ABR, six(21.4%) of the 28 full-term infants (total screened: 761infants 300 lmol/l) without sepsis andunderwent exchange blood transfusion. Two of these werekernicteric and had severe bilateral hearing loss with poorneck control. The third baby had mild bilateral hearing losswith no other noticeable neurological deficits. Two babieshad neonatal jaundice (<300 lmol/l) along with sepsis andwere found to have moderate bilateral hearing loss. Thisobservation may suggest that the presence of neonatalsepsis increases the risk of hearing loss where total serumbilirubin level is <300 lmol/l. Although this threshold isnot universal or absolute (Dennery et al. 2001), thisobservation warrants further investigation. The sixth babyhad neonatal jaundice of unknown severity, which wastreated with traditional medicine at the herbal home wherethe baby was born and was diagnosed with severeunilateral hearing loss.It was unlikely that most of these children would havebeen detected early enough for optimal intervention (JointCommittee on Infant Hearing 2000) solely throughparental suspicion/concern because hearing loss associatedwith jaundice characteristically affects the high frequencyregion which compromises speech discrimination andunderstanding rather than audibility (Newton 2001).The use of objective and age-appropriate screening tech-nologies should therefore be encouraged to identifyhidden sensory disorders more accurately especially whereearly detection enhances developmental outcomes.Bolajoko O. Olusanya

Journeys from childhood to midlife: risk, resilience, and recovery.

The latest report from the Kauai Longitudinal Study addresses 2 fundamental questions of interest to pediatricians and health care professionals: 1) What are the long-term effects of adverse perinatal and early child-rearing conditions on individuals’ physical, cognitive, and psychosocial development at midlife? 2) Which protective factors allow most individuals who are exposed to multiple childhood risk factors to make a successful adaptation in adulthood?1 The Kauai Longitudinal Study has monitored the impact of a wide array of biological, psychological, and social risk factors on the lives of a multiracial cohort of 698 individuals who were born in 1955 on the Hawaiian island of Kauai, from the perinatal … Reprint requests to (E.E.W.) Department of Human and Community Development, University of California, Davis, CA 95616. E-mail: eewerner{at}ucdavis.edu

Journeys from childhood to midlife: risk, resilience, and recovery

The latest report from the Kauai Longitudinal Study addresses 2 fundamental questions of interest to pediatricians and health care professionals: 1) What are the long-term effects of adverse perinatal and early child-rearing conditions on individuals’ physical, cognitive, and psychosocial development at midlife? 2) Which protective factors allow most individuals who are exposed to multiple childhood risk factors to make a successful adaptation in adulthood?1 The Kauai Longitudinal Study has monitored the impact of a wide array of biological, psychological, and social risk factors on the lives of a multiracial cohort of 698 individuals who were born in 1955 on the Hawaiian island of Kauai, from the perinatal … Reprint requests to (E.E.W.) Department of Human and Community Development, University of California, Davis, CA 95616. E-mail: eewerner{at}ucdavis.edu

Adverse perinatal conditions and the inner ear

Epidemiological studies in a number of Western countries have attributed 6–14% of sensorineural hearing impairment from birth or early childhood to problems relating to the birth process [1–4]. In spite of this association it is not always clear in individual instances whether adverse perinatal conditions identified subsequently have been causative of a hearing loss or not. It is possible that the hearing impairment was the consequence of an earlier intrauterine insult or is a coincidental finding. Infants carrying genetic mutations for hearing loss may coincidentally experience perinatal stress. It is therefore important to investigate the cause of a hearing loss discovered in infancy irrespective of the history of the infant having experienced adverse conditions surrounding the time of birth.