Effects Of Preterm Birth Research Articles

Abstract 16422: Lower Mitochondrial-derived Peptide Humanin in Young Adults Born Preterm vs. Term and Association With Left Ventricular Ejection Fraction

Introduction: Preterm (PT) birth is associated with increased risk of cardiovascular diseases (CVD) and heart failure. We previously reported left ventricular (LV) mitochondrial dysfunction in a rat model mimicking the deleterious conditions associated with PT birth. Whether mitochondrial function is altered in humans born PT and associated with LV function changes is unknown. We aimed to determine if serum humanin levels, a mitochondrial-derived peptide with cytoprotective effects, are altered in humans born PT and are associated with impaired myocardial function. Methods: Data were obtained from 55 young adults born PT (<30 weeks of gestational age, GA) compared to 54 full-term (T) controls of the same age. Serum humanin levels were determined by ELISA and LV ejection fraction (LVEF) by echocardiography. Results are shown as median (interquartile range) and comparisons between groups were performed using non-parametric tests. Results: Individuals were evaluated at 23.3 (21.4, 25.3) years, and age and sex distribution were similar between groups. Median GA was 27.5 (26.2, 28.4) weeks in the PT group. Humanin levels (pg/ml) were 132.9 (105.1, 189.3) and 161.1 (123.6, 252) in the PT and the T groups, respectively (p=0.0414). LVEF was within the normal range and similar between groups. Lower LVEF was associated with lower humanin levels (p<0.001), and this association was observed both in the term (p=0.002) and the preterm (p=0.047) groups. Conclusions: Serum humanin levels are lower in adult born PT. Since lower humanin levels are also associated with lower LVEF, our results suggest that mitochondrial alterations could play a role in the long-term adverse cardiovascular consequences of PT birth. Humanin analogs improve LV function in experimental models. Our results pave the way for future studies exploring humanin as a therapeutic avenue for the prevention and treatment of CVD in individuals born PT.

Mind-Mindedness and Parenting Stress: A Cross-Sectional Study in a Cohort of Mothers of 3-Month-Old Full-Term and Preterm Infants

The preterm birth of a child is a sudden event that can disturb the overall family system and its functioning. Many studies have been conducted with the aim of exploring how and the degree to which this event affects the early mother–infant dyadic relationship and maternal well-being, with often mixed findings. The present study investigates the combined effect of preterm birth and parenting stress on mind-mindedness, a parenting dimension that captures how parents represent and treat their children as separate individuals with their own mental states and activities. A hundred and ten mothers and their three-month-old infants (preterm = 54; full-term = 56) participated in the study. Mind-mindedness was assessed by coding mothers’ comments about infant’s mental states during dyadic face-to-face interaction. Parenting stress was evaluated with the Parenting Stress Index Short Form questionnaire. Mothers of preterm infants reported similar levels of appropriate and non-attuned mind-related comments to mothers of full-term infants. The reported parenting stress levels were also comparable. Interestingly, only mothers of preterm infants who reported higher stress in parenting showed more non-attuned comments during the interaction. The results underline the need to address preterm birth as a complex event, going beyond group differences and considering its interplay with other risk or protective factors in shaping children’s and parents’ adjustments and well-being.

Early postnatal maternal trait anxiety is associated with the behavioural outcomes of children born preterm

Maternal ante- and postnatal anxiety have been associated with children's socio-emotional development. Moreover, maternal anxiety has been studied as both a contributing factor and consequence of preterm birth, and children born preterm are more likely to develop behavioural problems compared to term-born controls. This study investigated the association between maternal anxiety measured soon after birth and mental health in 215 ex-preterm children, born at <33 weeks, who participated in the Evaluation of Preterm Imaging Study. Children were followed-up at a median age of 4.6 years (range 4.2–6.6), and received behavioural and cognitive evaluation. Maternal trait anxiety was assessed with the Spielberger State-Trait Anxiety Index at term corrected age. Primary outcome measures were children's Strengths and Difficulties Questionnaire (SDQ) and Social Responsiveness Scale 2 (SRS-2) scores, indicative of generalised psychopathology and autism symptomatology, respectively. IQ was assessed with the Wechsler Preschool and Primary Scales of Intelligence. The final sample, after excluding participants with missing data and multiple pregnancy (n = 75), consisted of 140 children (51.4% male). Results showed that increased maternal trait anxiety at term corrected age was associated with children's higher SDQ scores (β = 0.25, 95% CI 0.09–0.41, p = 0.003, f2 = 0.08) and SRS-2 scores (β = 0.15, 95% CI 0.02–0.28, p = 0.03, f2 = 0.04). Our findings indicate that children born preterm whose mothers are more anxious in the early postnatal period may show poorer mental health outcomes at pre-school age. Further research is needed to investigate preventative measures that can be offered to high-risk premature babies and their families.

40 Duration of Neonatal Oxygen Supplementation Associated with Higher Hemoglobin and Higher Blood Pressure in Young Adults Born Preterm

Abstract Introduction/Background Although erythropoiesis is impaired and anemia frequent in neonates born preterm, hematopoiesis in adults born preterm has not been previously studied. We hypothesize that adverse neonatal events durably affect erythropoiesis regulation, leading to a difference in hemoglobin levels in young adults born preterm compared to those born term. Objectives We thus aimed to evaluate hemoglobin and erythropoietin levels in young adults born preterm, to identify neonatal events associated with erythropoiesis in adulthood and to examine the relationships of hemoglobin levels with respiratory function and blood pressure. Design/Methods This study included 101 young adults (ages 18-29 years) born preterm (≤29 weeks of gestation) and 105 full-term controls. We measured office blood pressure using automated oscillometric device, complete blood count, serum erythropoietin levels (ELISA) and pulmonary function test. Group comparisons were performed using Student’s t or Mann-Whitney U tests. Correlations were assessed using Pearson’s coefficient and test. We performed a mediation analysis to assess the relationship between blood pressure, hemoglobin levels and preterm birth. Results Tobacco use and sex adjusted hemoglobin levels were 5.3 (95% CI: 2.9, 7.7) g/L higher in preterm-born individuals compared to controls (Table). We did not observe a difference in erythropoietin levels (7.3±3.4 and 8.12±3.40 U/L in the term and the preterm groups, respectively, p=0.102). Duration of oxygen supplementation in the neonatal period was independently associated with higher hemoglobin levels in the preterm group. In adults born preterm with bronchopulmonary dysplasia, airflow limitation was associated with higher hemoglobin levels. Both systolic (SBP) and diastolic (DBP) blood pressure were increased in individuals born preterm (p=0.042 and p=0.0008, respectively). Higher hemoglobin levels were associated with higher SBP and DBP, independently of term or preterm status. Mediation analysis (Figure) suggests that hemoglobin increase contributes to 37% and 32% of the effect of preterm birth on SBP and DBP, respectively. Conclusion While erythropoietin levels are similar between groups, hemoglobin levels are higher in young adults born preterm, especially in cases of bronchopulmonary dysplasia and airflow limitation. Hemoglobin increase is associated with elevated blood pressure in this population. Understanding mechanisms of impaired erythropoiesis regulation in adults born preterm will be important in designing antihypertensive approaches specific to this population. Results shown as mean ± SD or medians (25%-75%) and comparisons were performed using Student’s t test or Mann-Whitney U test, when appropriate. Systolic blood pressure (SBP). B. Diastolic blood pressure (DBP). Hb: hemoglobin. ACME: Average Causal Mediation Effect. B: unstandardized regression coefficient. All estimations are adjusted for sex.

Incidence, risk factors and consequences of preterm birth \u2013 findings from a multi-centric observational study for 14\u2009months in Nepal

BackgroundPreterm birth is a worldwide epidemic and a leading cause of neonatal mortality. In this study, we aimed to evaluate the incidence, risk factors and consequences of preterm birth in Nepal.MethodsThis was an observational study conducted in 12 public hospitals of Nepal. All the babies born during the study period were included in the study. Babies born < 37 weeks of gestation were classified as preterm births. For the association and outcomes for preterm birth, univariate followed by multiple regression analysis was conducted.ResultsThe incidence of preterm was found to be 93 per 1000 live births. Mothers aged less than 20 years (aOR 1.26;1.15–1.39) had a high risk for preterm birth. Similarly, education of the mother was a significant predictor for preterm birth: illiterate mothers (aOR 1.41; 1.22–1.64), literate mothers (aOR 1.21; 1.08–1.35) and mothers having basic level of education (aOR 1.17; 1.07–1.27). Socio-demographic factors such as smoking (aOR 1.13; 1.01–1.26), use of polluted fuel (aOR 1.26; 1.17–1.35) and sex of baby (aOR 1.18; 1.11–1.26); obstetric factors such as nulliparity (aOR 1.33; 1.20–1.48), multiple delivery (aOR 6.63; 5.16–8.52), severe anemia during pregnancy (aOR 3.27; 2.21–4.84), antenatal visit during second trimester (aOR 1.13; 1.05–1.22) and third trimester (aOR 1.24; 1.12–1.38), < 4 antenatal visits during pregnancy (aOR 1.49; 1.38–1.61) were found to be significant risk factors of preterm birth. Preterm has a risk for pre-discharge mortality (10.60; 9.28–12.10).ConclusionIn this study, we found high incidence of preterm birth. Various socio-demographic, obstetric and neonatal risk factors were associated with preterm birth. Risk factor modifications and timely interventions will help in the reduction of preterm births and associated mortalities.Trial registrationISRCTN30829654.

The effect of preterm birth, recurrent laryngeal nerve lesion, and postnatal maturation on hyoid and thyroid movements, and their coordination in infant feeding

Movements of the hyoid and thyroid are critical for feeding. These structures are often assumed to move in synchrony, despite evidence that neurologically compromised populations exhibit altered kinematics. Preterm infants are widely considered to be a neurologically compromised population and often experience feeding difficulties, yet measuring performance, and how performance matures in pediatric populations is challenging. Feeding problems are often compounded by complications arising from surgical procedures performed to ensure the survival of preterm infants, such as damage to the recurrent laryngeal nerve (RLN) during patent ductus arteriosus correction surgery. Here, we used a validated infant pig model for infant feeding to test how preterm birth, postnatal maturation, and RLN lesion interact to impact hyoid and thyroid excursion and their coordination. We filmed infant pigs when feeding using videofluorscopy at seven days old (1–2 months human equivalent) and 17 days old (6–9 months human equivalent) and tracked movements of the hyoid and thyroid on both days. We found that preterm birth impacted the coordination between hyoid and thyroid movements, but not their actual excursion. In contrast, excursion of the two structures increased with postnatal age in term and preterm pigs. RLN lesion decreased thyroid excursion, and primarily impacted hyoid movements by increasing variation in hyoid excursion. This work demonstrates that RLN lesion and preterm birth have distinct, but pervasive effects on feeding performance in infants, and suggest that interventions targeted towards reducing dysphagia should be prescribed based off the etiology driving dysphagia, rather than the prognosis of dysphagia.

Neurodevelopmental origins of social competence in very preterm children

Social problems are an important feature of the preterm behavioral phenotype but are diverse and multidimensional. A model of social competence comprised of the three interrelated components of social cognition, social interaction, and social adjustment is useful in conceptualizing these problems. Weaknesses in social cognition in very preterm (VPT) children, although rarely studied, are found on tasks involving interpretation of social cues. Difficulties in social interaction in VPT infants and young children are documented by structured observations of their interactions with adults. Problems in social adjustment are endorsed on parent and teacher ratings of VPT infants and youth and on self-reports of VPT adults. These multiple deficits likely stem from early disruptions in neural development, are related to other consequences of preterm birth, and subject to postnatal environment influences. Further research is needed to more fully account for the effects of VPT birth on the development of social competence.

The Effect of Preterm Birth and Recurrent Laryngeal Nerve Lesion on Palatopharyngeal Arch Function During Feeding

Feeding in infant mammals requires the precise coordination of multiple oropharyngeal structures, including the palatopharyngeal arch. During a typical swallow, the activity of the palatopharyngeus muscle produces constriction of the arches and lowers the soft palate, which may be responsible for flipping of the epiglottis to cover the airway. Most research on the role of the palatopharyngeal arches in swallowing has been limited to pharyngeal manometry, which provides insight into the relative pressures in the oropharynx during swallowing. Studies using manometry in preterm infants, or in those with iatrogenic sequelae such as recurrent laryngeal nerve (RLN) damage, suggest differences in function, but not on how the structures in the oropharynx move to contribute to those changes in function. In this study, we assessed palatopharyngeal arch kinematics during feeding by using our validated infant pig model to determine the impact of birth status (preterm versus term), lesion status (lesioned RLN versus intact) and their interaction on feeding performance. We placed tantalum radio‐opaque beads into relevant anatomical structures of 16 infant pigs, including the palatopharyngeal arches, the tongue, the hard and soft palate, and the nose. We recorded feeding at both seven and 17 days postnatal via biplanar high‐speed videofluoroscopy (100fps) across a total of 584 swallows. Using XMALab, we tracked the three‐dimensional movement of the arches relative to a rigid body comprised of the markers in the hard palate and the nose. We then used custom MATLAB code to calculate the three‐dimensional excursion of the arches during a swallow, as well as the timing of constriction initiation, and the point of maximal constriction during a swallow. We found that preterm infants had more variable arch excursion than term infants, and RLN lesion increased excursion for both term and preterm infants although there were minimal differences in arch excursion within an age between term and preterm infants. Term infants also reached maximal arch constriction later than preterm infants, most likely due to their larger arch excursion and larger bolus volume. Lesion infants, both term and preterm, also had delayed maximal arch constriction during swallows, although day 17 term lesion infants reached maximal constriction earlier than term day 17 infants. Lesion resulted in delayed initiation of arch constriction, which did not change with age, although older term infants exhibited later arch constriction initiation than older preterm infants. Our results show that preterm birth and RLN lesion have distinct yet pervasive effects on infant feeding. Altered feeding performance in these neurologically compromised infants may be due in part to changes in the activity of the palatopharyngeal arches.Support or Funding InformationNIH R01HD088561

Effect of pre-term birth on oxidative stress responses to normoxic and hypoxic exercise

Pre-term birth is a major health concern that occurs in approximately 10% of births worldwide. Despite high incidence rate, long-term consequences of pre-term birth remain unclear. Recent evidence suggests that elevated oxidative stress observed in pre-term born infants could persist into adulthood. Given that oxidative stress is known to play an important role in response to physical activity and hypoxia, we investigated whether oxidative stress responses to acute exercise in normoxia and hypoxia may be differently modulated in pre-term vs. full-term born adults. Twenty-two pre-term born and fifteen age-matched full-term born controls performed maximal incremental cycling tests in both normoxia (FiO2: 0.21) and normobaric hypoxia (FiO2: 0.13; simulated altitude of 3800 m) in blinded and randomized manner. Plasma levels of oxidative stress (advanced oxidation protein products [AOPP] and malondialdehyde), antioxidant (ferric reducing antioxidant power, glutathione peroxidase, catalase [CAT] and superoxide dismutase [SOD]) and nitrosative stress markers (nitrotyrosine, nitrite and total nitrite and nitrate [NOx]) were measured before and immediately after each test. AOPP (+24%, P<0.001), CAT (+38%, P<0.001) and SOD (+12%, P=0.018) and NOx (+17%, P=0.024) significantly increased in response to exercise independently of condition and birth status. No difference in response to acute exercise in normoxia was noted between pre-term and full-term born adults in any of measured markers. Hypoxic exposure during exercise resulted in significant increase in AOPP (+45%, P=0.008), CAT (+55%, P=0.019) and a trend for an increase in nitrite/nitrate content (+35%, P=0.107) only in full-term and not pre-term born individuals. These results suggest that prematurely born adult individuals exhibit higher resistance to oxidative stress response to exercise in hypoxia.

The long-term impacts of preterm birth and associated morbidities on bone health in preschool children: a prospective cross-sectional study from Turkey

Objective To evaluate the impact of preterm birth on bone health in preschool children. Methods A total of 166 preschool children (aged 7–8 years) born preterm (n = 86, <37-week gestation) and at term (n = 80, ≥37 weeks of gestation) in our hospital were included in this prospective cross-sectional study. Data on antenatal, perinatal, and early postnatal characteristics and maternal obstetric history were obtained from medical records. Bone densitometry data including total bone mineral content (BMC), bone mineral density (BMD; total, lumbar, and femoral), z-scores, and bone loss were collected for each participant. Results Current height, weight, and BMI values were significantly lower in the preterm group (p < .001). Serum calcium, phosphorus and alkaline phosphatase (ALP) levels did not differ among groups, whereas VitD3 levels were significantly higher in the preterm group (p = .039). The mean total BMC, total BMD, lumbar (L2–L4) BMD, femur BMD, total z-score, and L2–L4 z-score values were significantly lower for the preterm group, whereas the total, lumbar, and femoral bone loss were significantly higher (p < .001), regardless of the severity of prematurity. Intraventricular hemorrhage (IVH) and retinopathy were significantly associated with lower total BMC (p = .004, p = .012, respectively). Fortified breastfeeding was associated with lumbar bone loss (p = .043), and formula feeding was associated with both femur and lumbar bone loss (p = .006, p = .012, respectively). Conclusions Our findings revealed long-term adverse effects of preterm birth on bone health, with significantly lower anthropometric values (weight, height, and BMI), lower scores for total BMC, BMD (total, lumbar, femoral), and z-scores (total, femur), along with higher bone loss (total, lumbar, femoral) and higher rates of osteopenia and osteoporosis in preschool children born preterm (whether moderate or very preterm) compared with those born at term. Exclusive breastfeeding appears to reduce the likelihood of long-term bone loss in preterm infants

The Effect of Preterm Birth on Renal Development and Renal Health Outcome.

Preterm birth is associated with adverse renal health outcomes including hypertension, chronic kidney disease, and an increased rate of progression to end-stage renal failure. This review explores the antenatal, perinatal, and postnatal factors that affect the functional nephron mass of an individual and contribute to long-term kidney outcome. Health-care professionals have opportunities to increase their awareness of the risks to kidney health in this population. Optimizing maternal health around the time of conception and during pregnancy, providing kidney-focused supportive care in the NICU during postnatal nephrogenesis, and avoiding accelerating nephron loss throughout life may all contribute to improved long-term outcomes. There is a need for ongoing research into the long-term kidney outcomes of preterm survivors in mid-to-late adulthood as well as a need for further research into interventions that may improve ex utero nephrogenesis.

Effect of preterm birth on morphosyntactic development.

Background: Preterm children are at risk of deficits in language, including grammatical skills. The main purpose of this survey was to investigate whether Persian-speaking children born preterm differ in their morphosyntax ability compared to full-term children. Methods: Morphosyntactic performance was assessed in 86 Persian-speaking children (43 healthy preterm and 43 full-term children) aged 4 and 5 years using the Persian Developing Sentence Scoring (PDSS). Participants were matched for age, gender, and gestational age. Results: The healthy preterm children who participated in this study were significantly outperformed by the full-term children in the morphosyntactic evaluation (p<0.05). Furthermore, their grammatical skills, based on PDSS, were not as developed as 4 to 5-year-old full-term children. Gender, in general, and gestational age had no effect on the PDSS scores of preterm children (p>0.05). Conclusion: Preterm children, regardless of gestational age, are at risk of morphosyntax impairments, which may not be recovered during the normal development. Therefore, grammatical evaluation and treatment seem to be necessary for these children.

Effect of preterm birth on morphosyntactic development

Effect of preterm birth on morphosyntactic development

Vaginal progesterone combined with cervical pessary in preventing preterm birth: a meta-analysis

Objective Vaginal progesterone and cervical pessary are both shown to be effective in preventing preterm. We conducted a meta-analysis to evaluate whether the combination of these two interventions has any additional benefit in preventing preterm birth and improving perinatal outcomes in asymptomatic women with a singleton gestation who had a midtrimester sonographic short cervix compared with vaginal progesterone alone. Methods Five databases were searched from their inception to 21 February 2019. We estimated relative risk (RR) and 95% confidence intervals (CIs) for dichotomous outcomes. The primary outcome was preterm birth <34 weeks, and second outcomes included low birth weight (LBW) delivery, perinatal death, and neonatal intensive care unit (NICU) admission. Results Three RCTs with a total of 820 participants were identified. Cervical pessary had no significant prevention effect of preterm birth when combined with vaginal progesterone compared to the control group with vaginal progesterone alone (RR = 0.91; 95% CI, 0.47–1.77). No significant difference has been revealed between groups in LBW delivery (RR = 1.13; 95% CI, 0.86–1.48), perinatal death (RR = 1.27; 95% CI, 0.58–2.78) and NICU admission (RR = 1.24; 95% CI, 0.84–1.85). Conclusions Comparing with vaginal progesterone alone, cervical pessary plus vaginal progesterone did not reduce the rates of preterm birth at <34 weeks of gestation. There was no difference in LBW delivery, perinatal death, and NICU admission. We need more evidence to balance the benefit and side effects on the combination of vaginal progesterone and cervical pessary for preventing preterm birth.

Особливості вагітності, пологів, стану плода та новонародженого у жінок з невиношуванням в анамнезі (Ретроспективний аналіз)

Perinatal aspects of miscarriage, despite advances in the study of the pathogenetic mechanisms of prematurity of pregnancy, continue to be leading in modern obstetrics. The issues of forecasting, prevention and prevention of perinatal complications require a clear understanding of the mechanism of the impact of the threat of spontaneous miscarriage and premature birth on the fetus. The objective: to study the frequency and causes affecting the main indicators of the results of preterm pregnancy to improve organizational measures aimed at the prevention of perinatal and obstetric complications and improve medical care for preterm infants. Materials and methods. We conducted a retrospective clinical and statistical analysis of 1976 histories of pregnancy and childbirth of women who were treated and delivered in the Kiev City Maternity Hospital No. 3 for 2014–2018 years. Particular attention was paid to the analysis of indicators of the fetal biophysical profile, which was performed in 140 pregnant women. For in-depth study of the causes and consequences of preterm birth, we analyzed the results of 83 histomorphological studies of placenta in preterm birth. Results. The main factors of the development of miscarriage, according to the results obtained by us are the young and late reproductive age of pregnant women, low social status, late registration in the women’s clinic, concomitant extragenital and gynecological pathology. Prior to the main pregnancy complications in the examined pregnant women, the threat of abortion in the first and second trimesters and the threat of premature birth preceding hospitalization were considered. Childbirth was burdened with premature rupture of the fetal bladder, abnormalities of labor, manual examination of the walls of the uterine cavity. Early neonatal period in premature newborns was complicated by pathology caused primarily by immaturity of organs and systems. Pathomorphological examination of the placenta after premature birth revealed a cell-parenchymal type of placental insufficiency. Analysis of the results of immunological reactivity showed an increase in alloantigens of fetal origin in pregnant women with miscarriage. Conclusion. A retrospective clinical and statistical analysis of the frequency and course of preterm birth over the past five years revealed a number of social, medical and biological factors that contribute to the induction of prematurity and adversely affect the functional state of the fetus and, accordingly, may have a prognostic character. Key words: pregnancy, miscarriage, premature birth, fetal biophysical profile, perinatal complications.

Preterm birth in evolutionary context: a predictive adaptive response?

Preterm birth is a significant public health problem worldwide, leading to substantial mortality in the newborn period, and a considerable burden of complications longer term, for affected infants and their carers. The fact that it is so common, and rates vary between different populations, raising the question of whether in some circumstances it might be an adaptive trait. In this review, we outline some of the evolutionary explanations put forward for preterm birth. We specifically address the hypothesis of the predictive adaptive response, setting it in the context of the Developmental Origins of Health and Disease, and explore the predictions that this hypothesis makes for the potential causes and consequences of preterm birth. We describe how preterm birth can be triggered by a range of adverse environmental factors, including nutrition, stress and relative socioeconomic status. Examining the literature for any associated longer-term phenotypic changes, we find no strong evidence for a marked temporal shift in the reproductive life-history trajectory, but more persuasive evidence for a re-programming of the cardiovascular and endocrine system, and a range of effects on neurodevelopment. Distinguishing between preterm birth as a predictive, rather than immediate adaptive response will depend on the demonstration of a positive effect of these alterations in developmental trajectories on reproductive fitness.This article is part of the theme issue ‘Developing differences: early-life effects and evolutionary medicine'.

475: Postpartum cervical insufficiency - a novel cause or consequence of preterm birth?

A short cervix is a risk factor for preterm delivery (PTD). Cervical recuperation postpartum however, is still an enigma. We aimed to establish the normal cervical recovery postpartum and investigate differences in cervical recuperation regarding term vs PTD, the influence of parity, mode of delivery and cervical manipulations. The study was conducted between June 2016 to June 2018. Following informed consent, trans-vaginal cervical length (CL) measurements were performed by a single observer (R.L) at 8, 24 and 48 hours postpartum. CL at the second trimester, prophylactic progesterone, demographic characteristics, obstetric history, parity, delivery outcomes, previous cervical manipulations and induction mode, were obtained from the patient's’ medical records. Our cohort included 714 women. The average CL, 48 hours postpartum, following term deliveries was 35.2± 3.5 mm. Parity: The most rapid cervical recovery was demonstrated following the 2nd delivery (39.7±2.5 mm). A significant delay in cervical recovery was observed from the 4th delivery and above (27.8±2.7 mm; p=0.013) (Fig 1A). Preterm delivery: Women delivered before 34 weeks of gestational (n=119) demonstrated an abnormal cervical recovery when compared to deliveries between 34-37 (n=97) weeks and term deliveries (n=498) (17.2±1.9 mm vs 32.4±3.6 mm vs 35.2±3.5 mm respectively P<0.0001) (Fig 1B). No differences were demonstrated between the groups regarding demographic characteristics and CL at midtrimester. Mode of induction: 156 patients underwent medical induction (Dinoprostone or Pitocin) and 88 underwent mechanical induction by cervical ripening balloon (CRB). Abnormal cervical recovery was demonstrated in the CRB group (26.3±1.9 mm vs. 35.2±2.7 mm respectively P=0.012) (Fig 1C). This study gives a novel insight regarding cervical recuperation postpartum. Nomograms of postpartum cervical recovery have been firstly established. Early spontaneous PTD is associated with pathological cervical recovery which might imply “true” cervical insufficiency. Increased parity and mechanical inductions may cause damage to the cervix Although the clinical implications of delayed postpartum cervical recuperation has not been elucidated, it might imply future cervical insufficiency and possible increased risk of preterm birth.

Brain and behavior relationships in preterm children

Although initial follow up studies of preterm children focused on outcomes such as cerebral palsy and intellectual disability, over time we have learned that social and emotional problems also may be consequences of preterm birth and that these problems may be associated with brain injury. In this volume of The Journal, Duncan et al studied extremely preterm toddlers at 18-22 months of age. Social difficulties and problem behaviors were described in 26-34% of children. Social competence was linked with cerebellar lesions on magnetic resonance imaging. The results of this study are consistent with the growing consensus that the cerebellum is important for social development in infancy and childhood (Cerebellum 2016;15:34-7). Although social development is complex and likely multifactorial, it is important for pediatricians to know that injury to the brain, including the cerebellum, may lead to difficulties with social-emotional development in toddlers (Front Psychol 2016;7:80). Parents' concerns may reflect more than a stage of development or parenting difficulties. More research is needed about how to best intervene to help children with these problems, but in the meantime, pediatricians can provide increased sensitivity to parental concerns, anticipatory guidance, and referrals for children with more significant difficulties. Article page 148 ▶ Behavioral Deficits at 18-22 Months of Age Are Associated with Early Cerebellar Injury and Cognitive and Language Performance in Children Born Extremely PretermThe Journal of PediatricsVol. 204PreviewTo investigate associations in toddlers born extremely preterm (<28 weeks) between neonatal neuroimaging and 18- to 22-month developmental and behavioral outcomes. Full-Text PDF

Preventing bronchopulmonary dysplasia: new tools for an old challenge.

Bronchopulmonary dysplasia (BPD) is the most prevalent chronic lung disease in infants and presents as a consequence of preterm birth. Due to the lack of effective preventive and treatment strategies, BPD currently represents a major therapeutic challenge that requires continued research efforts at the basic, translational, and clinical levels. However, not all very low birth weight premature babies develop BPD, which suggests that in addition to known gestational age and intrauterine and extrauterine risk factors, other unknown factors must be involved in this disease's development. One of the main goals in BPD research is the early prediction of very low birth weight infants who are at risk of developing BPD in order to initiate the adequate preventive strategies. Other benefits of determining the risk of BPD include providing prognostic information and stratifying infants for clinical trial enrollment. In this article, we describe new opportunities to address BPD's complex pathophysiology by identifying prognostic biomarkers and develop novel, complex in vitro human lung models in order to develop effective therapies. These therapies for protecting the immature lung from injury can be developed by taking advantage of recent scientific progress in -omics, 3D organoids, and regenerative medicine.

The Human Microbiome and Child Growth - First 1000 Days and Beyond.

The assembly of microbial communities within the gastrointestinal tract during early life plays a critical role in immune, endocrine, metabolic, and other host developmental pathways. Environmental insults during this period, such as food insecurity and infections, can disrupt this optimal microbial succession, which may contribute to lifelong and intergenerational deficits in growth and development. Here, we review the human microbiome in the first 1000 days - referring to the period from conception to 2 years of age - and using a developmental model, we examine the role of early microbial succession in growth and development. We propose that an 'undernourished' microbiome is intergenerational, thereby perpetuating growth impairments into successive generations. We also identify and discuss the intertwining host-microbe-environment interactions occurring prenatally and during early infancy, which may impair the trajectories of healthy growth and development, and explore their potential as novel microbial targets for intervention.