[Show abstract][Hide abstract]ABSTRACT: The Tromsø Intervention Study on Preterms evaluates an early, sensitizing intervention given to parents of prematurely born children (birth-weight < 2000 g). The current study investigated the potential influence of the intervention on children's self-reported and parental proxy-reported quality of life (QoL) at children's age of nine.
Participants were randomized to either intervention (PI, n = 72) or preterm control (PC, n = 74) in the neonatal care unit, while healthy term-born infants were recruited to a term reference group (TR, n = 75). The intervention was a modified version of the Mother-Infant Transaction Program, and comprised eight one-hour sessions during the last week before discharge and four home visits at 1, 2, 4 and 12 weeks post-discharge. The two control groups received care in accordance with written guidelines drawn up at the hospital. Participants and parents reported QoL independently on the Kinder Lebensqualität Fragebogen (KINDL) questionnaire. Differences between groups were analyzed by SPSS; Linear Mixed Models and parent-child agreement were analyzed and compared by intra-class correlations within each group.
On average, children in all groups reported high levels of well-being. The PI children reported better physical well-being than the PC children (p = 0.002). In all other aspects of QoL both the PI and the PC children reported at similar levels as the term reference group. PI parents reported better emotional wellbeing (p = 0.05) and a higher level of contentment in school (p = 0.003) compared with PC parents. Parent-child agreement was significantly weaker in the PI group than in the PC group on dimensions such as emotional well-being and relationships with friends (p < 0.05). PI parents reported QoL similar to parents of terms on all aspects except the subscale self-esteem, while PC parents generally reported moderately lower QoL than TR parents.
This early intervention appears to have generated long-lasting positive effects, improving perceived physical well-being among prematurely born children and parent's perception of these children's QoL in middle childhood.
Clinical Trials Gov NCT00222456 .
Full-text · Article · Dec 2015 · Health and Quality of Life Outcomes
[Show abstract][Hide abstract]ABSTRACT: Background and aims Postnatal growth restriction is common among very preterm infants (VPI). Optimising enteral feeding is of critical importance to improve neurodevelopmental outcome. We assessed the effect of a feeding regimen with a high enteral volume intake.
Design Retrospective population based study of all VPI (GA < 30 weeks) discharged from a single NICU between 2005–2010. Baseline clinical data, enteral volume intake and postnatal growth data were collected. Weight at birth/discharge and at 1 year of corrected age was converted to standard deviation (SD; Z) scores.
Results 99 infants were included. Infants who died (15/99; 15%) had lower mean GA than infants who survived to discharge (24.9 weeks vs. 27.3 weeks). For all infants enteral nutrition was commenced within first 48 h. Two infants developed surgical NEC, both survived. Daily enteral volume of fortified breast milk was 180–200 ml/kg from 3 weeks of age and until self-regulation. Seven infants were transferred to other units < 34 weeks. Among the other 77 infants the mean (SD) Z-scores for weight were; at birth -0.37 (-0.27), at discharge -0.42 (-0.53) and at 1 year corrected age -0.46 (-0.60). The prevalence of SGA (< 10 centile) at birth (13/77; 17%) was similar to SGA prevalence at discharge (14/77; 18%).
Conclusions The rate of postnatal growth restriction was lower than previously reported in similar patient populations. We believe a high enteral volume intake is a safe method to increase energy and protein delivery and thus improve the nutritional status of very preterm infants.
Full-text · Article · Oct 2014 · Archives of Disease in Childhood
[Show abstract][Hide abstract]ABSTRACT: Objective Examine the effect of an early intervention programme on cognitive outcome at 7 and 9 years in children with birth weight (BW) <2000 g.
Design A randomised controlled trial of a modified version of the Mother–Infant Transaction Program.
Setting A single tertiary neonatal unit.
Patients 146 infants were randomised into a preterm control group (74) or a preterm intervention group (72).
Interventions The intervention consisted of eight sessions shortly before discharge and four home visits by specially trained nurses focusing on the infants’ unique characteristics, temperament, developmental potential and the interaction between infants and parents.
Main outcome measures Outcomes were assessed with the Wechsler Intelligence Scale for Children (WISC-III).
Results Mean BWs were 1396 (429) g in the intervention group and 1381(436) g in the control group. After adjusting for the possible clustering effects of twin pairs and maternal education, there were no significant differences in WISC-III scores at age 7 or 9. The mean difference was 4.1 points (95% CI −1.5 to 9.8 points) in favour of the intervention group at 7 years and 2.2 points (95% CI −3.4 to 7.6 points) at 9 years. At 7 years, a 6.8 points difference in the Verbal Comprehension Index (95% CI 0.5 to 13.0 points) was found in favour of the intervention group. Loss to follow-up at age 7 and 9 was 11% and 14%, respectively.
Conclusions This intervention programme did not have a sustained significant effect on overall cognitive outcomes in preterm children at age 7 and 9.
Trial registration number The trial has been registered at http://www.clinicaltrials.gov (identifier NCT00222456).
Full-text · Article · Sep 2014 · Archives of Disease in Childhood - Fetal and Neonatal Edition
[Show abstract][Hide abstract]ABSTRACT: There is an increased risk of heart failure and pulmonary edema in pregnancies complicated by hypertensive disorders. However, in a previous study we found that pregnancy protects against fibrosis and preserves angiogenesis in a rat model of angiotensin II induced cardiac hypertrophy. In this study we test the hypothesis that pregnancy protects against negative effects of increased afterload.
Pregnant (gestational day 5.5-8.5) and non-pregnant Wistar rats were randomized to transverse aortic constriction (TAC) or sham surgery. After 14.2±0.14 days echocardiography was performed. Aortic blood pressure and left ventricular (LV) pressure-volume loops were obtained using a conductance catheter. LV collagen content and cardiomyocyte circumference were measured. Myocardial gene expression was assessed by real-time polymerase chain reaction.
Heart weight was increased by TAC (p<0.001) but not by pregnancy. Cardiac myocyte circumference was larger in pregnant compared to non-pregnant rats independent of TAC (p = 0.01), however TAC per se did not affect this parameter. Collagen content in LV myocardium was not affected by pregnancy or TAC. TAC increased stroke work more in pregnant rats (34.1±2.4 vs 17.5±2.4 mmHg/mL, p<0.001) than in non-pregnant (28.2±1.7 vs 20.9±1.5 mmHg/mL, p = 0.06). However, it did not lead to overt heart failure in any group. In pregnant rats, α-MHC gene expression was reduced by TAC. Increased in the expression of β-MHC gene was higher in pregnant (5-fold) compared to non-pregnant rats (2-fold) after TAC (p = 0.001). Nine out of the 19 genes related to cardiac remodeling were affected by pregnancy independent of TAC.
This study did not support the hypothesis that pregnancy is cardioprotective against the negative effects of increased afterload. Some differences in cardiac structure, function and gene expression between pregnant and non-pregnant rats following TAC indicated that afterload increase is less tolerated in pregnancy.
[Show abstract][Hide abstract]ABSTRACT: To compare patient comfort in preterm infants treated with heated humidified high flow nasal cannulae (HHHFNC) versus nasal continuous positive airway pressure (NCPAP).
Randomised cross-over trial (2×24 h).
Single tertiary neonatal unit.
20 infants less than 34 weeks postmenstrual age treated with NCPAP due to mild respiratory illness.
After parental consent, infants were randomised to 24 h of treatment with NCPAP or HHHFNC followed by 24 h of the alternate therapy.
Primary outcome was patient comfort assessed by the EDIN (neonatal pain and discomfort) scale. Secondary outcomes were respiratory parameters (respiratory rate, FiO2, SpO2, TcPCO2), ambient noise, salivary cortisol and parental assessments of their child.
We found no differences between HHHFNC and NCPAP in mean cumulative EDIN score (10.7 vs 11.1, p=0.25) or ambient noise (70 vs 74 dBa, p=0.18). Parents assessed HHHFNC treatment as significantly better in the three domains, 1) child satisfied, 2) parental contact and interaction and 3) possibility to take part in care. Mean respiratory rate over 24 h was lower during HHHFNC than CPAP (41 vs 46, p=0.001). Other respiratory parameters were similar.
Using EDIN scale, we found no difference in patient comfort with HHHFNC versus NCPAP. However, parents preferred HHHFNC, and during HHHFNC respiratory rate was lower than during NCPAP.
Full-text · Article · Nov 2013 · Archives of Disease in Childhood - Fetal and Neonatal Edition
[Show abstract][Hide abstract]ABSTRACT: Knowledge about early physiotherapy to preterm infants is sparse, given the risk of delayed motor development and cerebral palsy.
A pragmatic randomized controlled study has been designed to assess the effect of a preventative physiotherapy program carried out in the neonatal intensive care unit. Moreover, a qualitative study is carried out to assess the physiotherapy performance and parents' experiences with the intervention. The aim of the physiotherapy program is to improve motor development i.e. postural control and selective movements in these infants. 150 infants will be included and randomized to either intervention or standard follow-up. The infants in the intervention group will be given specific stimulation to facilitate movements based on the individual infant's development, behavior and needs. The physiotherapist teaches the parents how to do the intervention and the parents receive a booklet with photos and descriptions of the intervention. Intervention is carried out twice a day for three weeks (week 34, 35, 36 postmenstrual age). Standardized tests are carried out at baseline, term age and at three, six, 12 and 24 months corrected age. In addition eight triads (infant, parent and physiotherapist) are observed and videotaped in four clinical encounters each to assess the process of physiotherapy performance. The parents are also interviewed on their experiences with the intervention and how it influences on the parent-child relationship. Eight parents from the follow up group are interviewed about their experience. The interviews are performed according to the same schedule as the standardized measurements. Primary outcome is at two years corrected age.
The paper presents the protocol for a randomized controlled trial designed to study the effect of physiotherapy to preterm infants at neonatal intensive care units. It also studies physiotherapy performance and the parent's experiences with the intervention.
[Show abstract][Hide abstract]ABSTRACT: The aim of this study was to examine the effectiveness of an early intervention program on behavioral outcomes at corrected age of 5 years for children with birth weights (BWs) of <2000 g.
A randomized controlled trial of a modified version of the Mother-Infant Transaction Program was performed. Outcomes were measured by the Child Behavior Check List report (parents) and Strengths and Difficulties Questionnaire at 5 years (parents and preschool teachers).
A total of 146 infants were assigned randomly (intervention group: 72 infants; reference group: 74 infants). A term group was recruited (75 infants). The mean BWs were 1396 ± 429 g for the intervention group, 1381 ± 436 g for the control group, and 3619 ± 490 g for the term reference group. Parents in the intervention group reported significantly fewer behavioral problems measured by both instruments at 5 years. There were no differences in behavior problems reported by preschool teachers. Significantly more children in the preterm control group scored within the clinical area of both instruments.
This modified version of the Mother-Infant Transaction Program led to fewer behavioral problems reported by parents at corrected age of 5 years for children with BWs of <2000 g.
[Show abstract][Hide abstract]ABSTRACT: Background and Aims: Prenatal inflammation and the fetal inflammatory response have been associated with preterm birth and subsequent neonatal lung and brain disorders. However, there is a paucity of information about the relation between prenatal infections and cognitive outcome in preterm children. The aim of this study was to examine the effect of prenatal inflammation on cognitive outcome at 5 years corrected age in low birthweight children.Methods: Placentas from mothers who gave birth to an infant with birth weight < 2000 g and participated in a randomised controlled trial of an early intervention program were examined regarding the presence of histological chorioamnionitis (HCA). At 5 years corrected age cognitive outcomes was assessed with Wechslers Preschool and Primary Scale of Intelligence-Revised (WPPSI).Results: A total of 124 infants were included. Mean birth weight was 1397 g (SD 409) and mean gestational age 30.1 w (SD 3.1). Placental histology showed no signs of HCA in 42 (34%), mild HCA in 62 (50%) and severe HCA in 20 (16%) of the placentas. WPPSI scores were available for 113 children. There were no significant differences between the HCA groups in WPPSI verbal, performance or full-scale IQ adjusted for gestational age and possible intervention effect.Conclusion: HCA is not independently associated with cognitive outcomes at 5 years in low birth weight children.
Full-text · Article · Nov 2011 · Pediatric Research
[Show abstract][Hide abstract]ABSTRACT: Background and aims: Extra-uterine growth restriction is common among very preterm infants (VPI). Optimising enteral feeding is of critical importance to improve neurodevelopmental outcome. We aimed to assess the effect of a feeding regimen with a high enteral volume intake.
Full-text · Article · Nov 2011 · Pediatric Research
[Show abstract][Hide abstract]ABSTRACT: Temperamental regulatory competence and social communication in term and preterm infants at 12 months corrected age was studied in a randomized controlled intervention trial aimed at enhancing maternal sensitive responsiveness. Surviving infants <2000 g from a geographically defined area were randomized to an intervention (71) or a control group (69), and compared with term infants (74). The intervention was a modified version of the "Mother-Infant Transaction Program". Regulatory competence was measured with the Infant Behavior Questionnaire, and social communication with the Early Social Communication Scales. Preterm intervention infants with low regulatory competence had higher responding to joint attention than preterm control infants. A sensitizing intervention may moderate the association between temperament and social communication, and thus allow an alternative functional outlet for preterm infants low in regulatory competence. The finding may have implications for conceptualizations of the role of early sensitizing interventions in promoting important developmental outcomes for premature infants.
[Show abstract][Hide abstract]ABSTRACT: To evaluate clinical practice of volume-targeted ventilation (VTV).
Internet-based survey of all 50 tertiary neonatal units in Australia, New Zealand, Sweden, Denmark, Finland and Norway.
Response rate was 100%. VTV was routinely used in 25 (50%) units; 15/25 (60%) in Australasia and 10/25 (40%) in the Nordic countries. The most common reason given for using VTV was that it reduces bronchopulmonary dysplasia (13/25; 52%). The median (IQR) of upper limits of target tidal volume were (1) for initial ventilation of preterm infants with respiratory distress syndrome 5.0 (4.6-6.0) ml/kg and (2) for infants with ventilator-dependent bronchopulmonary dysplasia 6.0 (5.0-8.0) ml/kg. The median (IQR) maximum peak inspiratory pressure limit units were prepared to use in VTV-mode was 35 (30-42.5) cm H(2)O.
Half of the units used VTV routinely, but with a considerable variation in VTV practice. More studies are required to establish best VTV practice.
Full-text · Article · Mar 2011 · Archives of Disease in Childhood - Fetal and Neonatal Edition
[Show abstract][Hide abstract]ABSTRACT: To examine the prevalence of neurodevelopmental disability and the predictive value of pre-, peri-, and postnatal data on neurologic, sensory, cognitive, and motor function in children born extremely preterm.
This was a prospective observational study of all infants born in Norway between 1999 and 2000 with gestational ages between 22 and 27 weeks or birth weights between 500 and 999 g. Cognitive function was assessed with the Wechsler Preschool and Primary Scale of Intelligence-Revised, motor function with the Movement Assessment Battery for Children, and severity of cerebral palsy with the Gross Motor Function Classification for Cerebral Palsy. Disabilities were described as mild, moderate, or severe.
Of 371 eligible children, 306 (82%) were examined at a mean (SD) age of 5 years and 10 (4) months. For gestational age less than 28 weeks (n = 239), 26 (11%) children had cerebral palsy alone (n = 21) or in combination with blindness (n = 3) or deafness (n = 2); 1 was blind and 1 was deaf. Of the remaining children, the mean full-scale IQ was 94 ± 15, and significant predictors were (values given as the difference in IQ points [95% confidence intervals]) high maternal education (9.6 [5.7-13.4]), preeclampsia (-7.7 [-12.7 to -2.7]), and retinopathy of prematurity higher than grade 2 (-17.5 [-27.1 to -8.0]). Movement Assessment Battery for Children scores were positively associated with gestational age and prenatal steroids and negatively associated with being small for gestational age, male gender, and having retinopathy of prematurity. Moderate to severe neurodevelopmental disability was more common for gestational ages 25 weeks or less (28 of 87 children) than for 26 to 27 weeks (12 of 152 children; P < .001) and 28 weeks or more (7 of 67 children; P = .001).
The outcome was poorer for children with gestational ages of 25 weeks or less compared with those with gestational ages between 26 and 27 weeks. For those without cerebral palsy, blindness, or deafness, however, gestational age had a limited association with cognitive and motor function.
[Show abstract][Hide abstract]ABSTRACT: The goal was to examine the effectiveness of an early intervention on cognitive and motor outcomes at corrected ages of 3 and 5 years for children with birth weights (BWs) of <2000 g.
A randomized controlled trial of a modified version of the Mother-Infant Transaction Program was performed. Outcomes were assessed with the Bayley Scales of Infant Development II and the Wechsler Preschool and Primary Scale of Intelligence-Revised at 3 and 5 years, respectively. McCarthy Scales of Children's Abilities and the grooved pegboard test were used to test motor outcomes at 5 years.
A total of 146 infants were assigned randomly (intervention group: 72 infants; control group: 74 infants). The mean BWs were 1396 ± 429 g for the intervention group and 1381 ± 436 g for the control group. After adjustment for maternal education, a nonsignificant difference in Mental Developmental Index scores at 3 years of 4.5 points (95% confidence interval: -0.3 to 9.3 points) in favor of the intervention group was found, whereas the intervention effect on full-scale IQ scores at 5 years was 6.4 points (95% confidence interval: 0.6-12.2 points). Significantly more children in the intervention group had IQ scores of ≥ 85 at 3 and 5 years. There were no differences between the groups with respect to motor outcomes.
This modified version of the Mother-Infant Transaction Program improved cognitive outcomes at corrected age of 5 years for children with BWs of <2000 g.
[Show abstract][Hide abstract]ABSTRACT: Extreme prematurity carries a high risk of neurosensory disability.
Examine which information obtained pre-, peri- and postnatally may be predictive of neurosensory disabilities at 2 years of age.
Prospective observational study of all infants born in Norway in 1999 and 2000 with gestational age (GA) 22-27 completed weeks or birth weight (BW) of 500-999 g.
Incidence of neurosensory disabilities.
Of 373 surviving children, 30 (8%) had major neurosensory disabilities (26 CP, 6 blind, 3 deaf), and a further 46 (12%) had minor visual or hearing disabilities. The rate of major neurosensory disabilities was 19 of 99 (19%) for children with GA 23-25 vs. 8 of 189 (4%) for GA 26-27 weeks (p<0.001). In a multivariable model, only morbidities detected in the neonatal intensive care unit (NICU) were associated with major neurosensory disabilities; adjusted odds ratios (95% confidence intervals) were 68.6 (18.7, 252.2) for major abnormalities on cerebral ultrasound, 6.8 (1.7, 27.4) for retinopathy of prematurity (ROP) grade>2, 3.2 (1.0, 9.7) for ROP grade 1-2, 6.5 (1.9, 22.3) for prolonged use (> or = 21 days) of steroid treatment for lung disease and 3.1 (1.0, 9.4) for clinical chorioamnionitis. The visual outcome was strongly related to the degree of ROP (p<0.001), and all who had a normal hearing screen in the NICU had normal hearing at 2 years.
NICU morbidities, rather than GA or intrauterine growth are the significant predictors of major neurosensory disabilities among extreme prematurity surviving to discharge from the NICU.
No preview · Article · Sep 2010 · Early human development
[Show abstract][Hide abstract]ABSTRACT: Nordhov, S. M., Kaaresen, P. I., Rønning, J. A., Ulvund, S. E. & Dahl, L. B. (2010). A randomized study of the impact of a sensitizing intervention on the child-rearing attitudes of parents of low birth weight preterm infants. Scandinavian Journal of Psychology. The background for this study was that nurturant child-rearing attitudes are associated with positive development in low birth weight (LBW) infants. The objective was to study child-rearing attitudes and early intervention (EI) in parents of LBW infants from 12-36 months corrected age. LBW infants (BW < 2000 g) were randomized to an intervention (IG) or a control group (CG). The EI consisted of seven in-hospital sessions prior to discharge, then four home visits. A Child Rearing Practices Report was administered at 12 (mothers only), 24 and 36 months. A total of 146 infants were randomized. The mean BW in IG was 1396 (SD 429) g and 1381 (436) g in CG. The mean GA was 30.2 (3.1) weeks in IG and 29.9 (3.5) weeks in CG. Mothers in IG reported significantly more nurturant child-rearing attitudes at 12 and 24 months. There was a significant change in restrictive and nurturant attitudes over time. It was concluded that EI may lead to more nurturant child-rearing attitudes in mothers of preterms.
Full-text · Article · Feb 2010 · Scandinavian Journal of Psychology
[Show abstract][Hide abstract]ABSTRACT: To assess if growth restricted (small for gestational age, SGA) extremely preterm infants have excess neonatal mortality and morbidity.
This was a cohort study of all infants born alive at 22-27 weeks' post menstrual age in Norway during 1999-2000. Outcomes were compared between those who were SGA, defined as a birth weight less than the fifth percentile for post menstrual age, and those who had weights at or above the fifth percentile.
Of 365 infants with a post menstrual age of <28 weeks, 31 (8%) were SGA. Among infants with a post menstrual age of <28 weeks, only chronic lung disease was associated with SGA status (OR 2.7, 95% CI 1.0 to 7.2). SGA infants with a post menstrual age of 26-27 weeks had excess neonatal mortality (OR 3.8, 95% CI 1.3 to 11), chronic lung disease and a significantly higher mean number of days (age) before tolerating full enteral nutrition. SGA infants with a post menstrual age of 22-25 weeks had an excess risk of necrotising enterocolitis.
Extremely preterm SGA infants had excess neonatal mortality and morbidity in terms of necrotising enterocolitis and chronic lung disease.
No preview · Article · May 2009 · Archives of Disease in Childhood - Fetal and Neonatal Edition
[Show abstract][Hide abstract]ABSTRACT: Mothers' reports of preterm and term infants' temperament from 6 to 12 months of age were studied, with intervention and stress as predictors. Preterm infants with a birth weight <2000g were randomized to an intervention (71) or a control (69) group. A control group of healthy term infants (74) was also established. The intervention was a modified version of the "Mother-Infant Transaction Program", aimed at sensitizing caregivers to the infants' individual characteristics. Temperament was measured with the Infant Behavior Questionnaire, and stress with the Parenting Stress Index. There were no group differences in temperament at 6 or 12 months or in change during the same period. There was a strong association between stress and negative reactivity in the preterm control group at 12 months. In the preterm intervention group, there were strong negative correlations between stress and regulatory competence at 6 months. The intervention seemed to change the relationship between stress and temperament. The strength of this association indicates that the intervention sensitized mothers to the temperamental regulatory competence of their preterm infants.
Full-text · Article · Mar 2008 · Infant behavior & development