Effect Of Preterm Delivery Research Articles

Quality of Life of Mothers and Fathers 4 to 6 Months After Birth: The Effect of a Very Preterm Delivery.

The sparse literature on the effect of a preterm delivery on parents' quality of life (QoL) yields inconsistent results, restricting their analysis to mothers. The present study aimed to assess the effect of a very preterm delivery on parents' gender-specific perception of QoL, 4 to 6 months after birth. A total of 117 parents of very preterm infants hospitalized at birth in a level III Neonatal Intensive Care Unit, and 214 parents of never hospitalized full-term infants born in a public maternity, both located in the North of Portugal, participated in the study, 4 to 6 months after delivery (November 2013-June 2015). The Portuguese version of the World Health Organization Quality of Life - BREF Inventory was applied and scores were transformed to reflect a 0 to 100 scale. The mean [standard deviation (SD)] of overall QoL ranged between 72.1 (13.3) among mothers of full-term infants and 74.6 (12.5) among mothers of very preterm infants. The perception of QoL was not significantly different among parents of very preterm and full-term infants, according to gender. The highest scores were observed in the psychological and physical dimensions, for both mothers and fathers. The lack of differences on the perception of QoL among mothers and fathers of very preterm and full-term infants, highlights the need to deeply understand and explore the influence of accommodation mechanisms, the extended family/community and health policies on parental QoL trajectories.

Insulin Concentration in Human Milk in the First Ten Days Postpartum: Course and Associated Factors.

Human milk (HM) is better tolerated than formula in preterm infants. Insulin, which is naturally present in HM but not in formula, has been suggested as a key factor for feeding tolerance, as it appears to stimulate intestinal maturation. Its precise concentrations during the early postnatal period, however, remains unknown. The objective of this study was to assess the natural timecourse of the HM insulin concentration during the first ten days postpartum. The effect of preterm delivery, maternal obesity, and diurnal rhythm were also assessed. HM was collected from 31 non-diabetic mothers (21 preterm [gestational age (GA) < 37 weeks]; 10 at-term [GA ≥ 37 weeks]) on ≥ 4 time-points per day during the first five days, and once on the tenth day postpartum. The HM insulin concentration declined rapidly within the first three days postpartum (day 1: 516 [312-1058] pmol/L; day 3: 157 [87-299] pmol/L), after which the concentration remained relatively stable. The insulin concentrations were higher in HM from obese mothers than from non-obese mothers (P < 0.001). Preterm delivery did not significantly affect HM insulin concentrations when adjusted for maternal pre-pregnancy body mass index category (P = 0.270). Diurnal rhythm was characterized by an insulin concentration decline throughout the night (P = 0.001), followed by an increase in the morning (P = 0.001). The HM insulin concentration declines rapidly in the first three days postpartum, follows a diurnal rhythm, and is higher in obese mothers compared to non-obese mothers. HM insulin concentrations are not affected by preterm delivery.

Preterm delivery and risk for early language delays: a sibling-control cohort study.

Studies suggest that preterm delivery is a risk factor for early language delays, but knowledge is scarce about the persistence of the delays and whether the association is of a linear kind. To resolve this, effects of confounding risk factors that are both shared within a family and pregnancy specific need to be distinguished from effects of preterm delivery. Our study examines the association between early gestational age and language outcomes, using a sibling-control design. The sample comprises 22,499 siblings from the Norwegian Mother and Child Birth Cohort Study, recruited between 1999 and 2008. Mothers rated child language comprehension and production at 18 and 36 months. Analyses compared siblings discordant on gestational age group (early preterm, delivery at week 22-33; late preterm, 34-36; early term, 37-38; full term, >38) and type of onset of delivery (spontaneous; provider-initiated), and compared these findings with conventional cohort analyses. The findings revealed inverse linear relations between the gestational age groups, and persistent but diminishing language delays. Effects of preterm delivery were substantial on both language production and comprehension at 18 months. By 36 months, the effects of preterm delivery were weaker, but still extensive, in particular for language production in provider-initiated births. When comparing sibling-control with cohort analyses, preterm group was less important among spontaneous births, but remained important in provider-initiated births. Familial and pregnancy risk factors partly explained this. Distinctive factors seem to underlie effects of preterm delivery across spontaneous and provider-initiated births.

Neuroimaging and the preterm infant brain

In this issue of Journal of Pediatric Neuroradiology, Leijser et al. [1] explore the correlation between morphology of the intracranial vasculature and cerebral blood flow velocity, non-invasively respectively assessed using magnetic resonance angiography (MRA) and Doppler ultrasound in term-born infants and preterm infants at term equivalent age. Preterm birth is increasing and the rate of neurodevelopmental impairment, including motor and neurocognitive impairment, remains high in survivors [2]. Clinicians routinely need to provide parents and caregivers with prognostic information for these vulnerable newborns. Prediction of cognitive outcome early in life is of paramount importance to plan targeted cognitive intervention and neurorehabilitation. Non-invasive imaging techniques, in particular ultrasound, have been widely used in clinical practice to provide prognostic information. Magnetic resonance imaging (MRI) is less widely available and more expensive; however, the use of 3 Tesla field strength scanners and parallel imaging technique has significantly decreased exam duration and the need for sedation in the newborn population. Knowledge of the prognostic value of cranial ultrasound and MRI relies on a relatively small number of studies [3]. While normal ultrasound or MRI studies predict a low risk of future motor impairment in preterm infants, the prognostic implications of many abnormal findings, as well as of morphological and functional differences between term and preterm infants detected by ultrasound and MRI are not well understood. Therefore, there is a strong need to better comprehend the prognostic correlates of neuroimaging findings in preterm newborns. Previous neuroimaging studies have identified differences in cortical folding, gray matter volume, and white matter abnormalities between preterm and term born infants [4–7]. Dr. Leijser and her group focus their attention on the functional and morphological differences of the intracranial vasculature in these two groups of infants in the absence of overt brain pathology. After investigating the effects of preterm delivery on neonatal cerebral vasculature using MRA [8], the authors examine the correlation between vascular morphology assessed using MRA and functional metrics obtained using Doppler ultrasound [1]. This work is important for several reasons. First, a functional and morphological evaluation of the developing intracranial vasculature is only feasible using non-invasive imaging techniques, because post-mortem assessment of the brain cannot assess vascular geometry and functionality. Alterations in cerebral blood flow play a crucial role in the development of hypoxic-ischemic injury in preterm and term newborns and the cerebral flood flow velocity data provided in this paper may serve as a reference for many potential applications in research and clinical practice. Understanding patterns of cerebrovascular morphology and cerebral blood flow velocity in preterm neonates and their correlation with neurological outcome could be proven useful in the future to identify infants at risk of developmental and cognitive deficit. *Address for correspondence: Maria Vittoria Spampinato, Department of Radiology and Radiological Sciences, Medical University of South Carolina, 96 Jonathan Lucas Street, MSC 323, Charleston, SC, USA. Tel.: +1 843 792 0209; Fax: +1 843 792 1705; E-mail: spampin@ musc.edu. Journal of Pediatric Neuroradiology 2 (2012) 69–70 DOI 10.3233/PNR-2012-012 IOS Press 69

511: The effect of preterm delivery on fetuses with gastroschisis

511: The effect of preterm delivery on fetuses with gastroschisis

Preterm delivery and asthma: A systematic review and meta-analysis

Accumulating evidence suggests that reduced duration of pregnancy predicts increased risk of asthma, but the studies published have been inconsistent. We sought to synthesize the evidence on the relation between preterm delivery and the risk of asthma later in life and to assess differences between the studies as potential sources for heterogeneity of the results. We conducted a MEDLINE search (until the end of May 2005). The outcome was asthma. The determinant of interest was preterm delivery defined as a gestational age of less than 37 weeks. We identified 19 articles that provided estimates for the meta-analysis. The summary effect estimates for asthma (fixed-effects odds ratio, 1.074 [95% CI, 1.072-1.075]; heterogeneity P = .000; random-effects odds ratio, 1.366 [95% CI, 1.303-1.432]) showed an increased risk in relation to preterm delivery, with substantial heterogeneity between study-specific estimates. The effect of preterm delivery on asthma was stronger in cross-sectional studies; studies with broad outcome criteria, a small sample size, and a younger study population; and studies conducted in English-speaking populations, outside Europe, and published more recently. In metaregression, adjusting for other determinants, the effect estimate was significantly associated only with the mean age of the study population. The weight of evidence shows that preterm babies have an increased risk of asthma compared with term babies. Recognition of prematurity as a determinant of asthma emphasizes the importance of active treatment of physiologic airflow obstruction and a need for special preventive measures against known environmental determinants of asthma in preterm babies.

The effect of preterm birth on neonatal cerebral vasculature studied with magnetic resonance angiography at 3 Tesla

Preterm birth is associated with a high incidence of neurodevelopmental deficits. Magnetic resonance imaging (MRI) has proved to be a valuable tool for monitoring development in the preterm brain. We used a dedicated time-of-flight (TOF) magnetic resonance angiography (MRA) protocol at 3 Tesla (3T) optimized to assess morphological characteristics of the neonatal cerebral vessels associated with preterm birth in a sample of 37 infants. We found statistically significant decreased tortuosity in all proximal segments of the cerebral vasculature (anterior, middle and posterior cerebral arteries) in the preterm infants imaged at term equivalent age compared to the term born infants, with no differences in vessel diameter between the two groups. This distinct phenotype of decreased tortuosity was shown to persist until 18 months of age in longitudinal MRA studies in infants born preterm, suggesting that this is not a delay in maturation. Biparietal head diameter measurements were significantly smaller in the preterm at term infants and were inversely correlated with middle cerebral artery tortuosity measurements in both the term born and the preterm at term infants. To our knowledge, this is the first systematic MRA study on the effect of preterm delivery on neonatal cerebral vasculature. Our intention is to build on the findings of this study by combining the data with other measurements of brain growth and vascular haemodynamics to understand more about the interdependence of vessel and brain development and their relationship to prematurity.

Myelomeningocele in fetal rabbit: effect of preterm delivery and corticosteroid treatment

Myelomeningocele in fetal rabbit: effect of preterm delivery and corticosteroid treatment

The effects of preterm delivery and mechanical ventilation on human lung growth

The effects of preterm birth and mechanical ventilation on growth of the alveolar region of the lung were assessed by morphometric and/or quantitative biochemical methods in the lungs from 104 perinatal and infant autopsies. The lungs of 4 preterm infants who died at 4–16 weeks age without having received mechanical ventilation were large relative to body weight but showed normal alveolar number and alveolar surface area. Infants treated by mechanical ventilation for hyaline membrane disease (HMD) and who died at ages from 1 week up to 14 months showed impairment in alveolar development evidenced by low alveolar number and a low alveolar surface area. Lung volume and total lung DNA values were relatively normal. Dilated alveolar ducts were a feature at all ages with emphysematous changes apparent in the longest surviving infants. Biochemical features included a high concentration of hydroxyproline, reflecting collagen, and a high desmosine concentration, reflecting elastin, in infants dying at less than 60 weeks postconceptional age. Changes in the lungs of infants ventilated at low pressures for conditions other than HMD were of a similar nature but less severe than those seen in the HMD group. These findings indicate that preterm birth alone may have little adverse influence on lung development but that conditions necessitating mechanical ventilation may lead to permanent impairment in alveolar development. We postulate that the standard technique of applying positive pressure ventilation may itself lead to impaired alveolar growth, although the effect is enhanced by concomitant HMD and BPD.

Effects of preterm delivery on the timing and rate of switch-over from fetal to adult erythropoiesis; direct determination by estimation of HbF and HbA in reticulocytes : B.M. Holland, H.M. Phillips, J.G. Jones, A.L.M. Abdel-Moiz and C.A.J. Wardrop, Paediatric Department, Queen Mother's Hospital, Glasgow, Haematology Department, University of Wales College of Medicine and Biochemistry Department, University College, Cardiff, U.K. (Introduced

Effects of preterm delivery on the timing and rate of switch-over from fetal to adult erythropoiesis; direct determination by estimation of HbF and HbA in reticulocytes : B.M. Holland, H.M. Phillips, J.G. Jones, A.L.M. Abdel-Moiz and C.A.J. Wardrop, Paediatric Department, Queen Mother's Hospital, Glasgow, Haematology Department, University of Wales College of Medicine and Biochemistry Department, University College, Cardiff, U.K. (Introduced