Monday, 31 March 2014 13:52

Preterm Infants: Visual Processing

An Australia research project looking at the long-term outcome of preterm birth on visual processing has found that despite advances in medical care improving the survival rate of high-risk extremely low birth weight and/or extremely preterm infants, visual morbidity is still relatively high compared with controls in late adolescence.

 

Ocular growth and development differ between extremely low birth weight (ELBW, ,1000 g) or extremely preterm (EP, gestational age ,28 weeks) and term children and may have long-term negative consequences for visual function. Visual sensory and perceptual skills are important for a range of functions and everyday activities, such as classroom learning, overall school performance,successful social interaction, and social cognition. Consequently, understanding the nature and frequency of visual deficits in ELBW/EP children is vital to inform adequate and appropriately targeted clinical follow-up and to increase focus on developing avenues for remediation.

The study involved following up 228 extremely preterm survivors born in Victoria in 1991 and 1992 and 166 randomly selected normal birth weight controls. The participants were assessed between the ages of 14 and 20 years of age. Visual acuity, stereopsis, convergence, color perception, and visual perception were assessed and contrasted between groups.

The researchers reported that adolescents born extemely preterm had worse visual acuity, poorer depth perception, and more problems with visual perception. Given the potential importance of visual perceptual skills to more complex tasks and academic achievement, these results have important clinical relevance.

Published in Industry News
Friday, 23 November 2012 10:19

Brain Growth & Preemies

Neuroscientists in the US have found that the rate of brain growth in the weeks before preterm babies reach their expected due date is related to their cognitive (thinking and learning) abilities as children. It was found that between 24 to 44 weeks postmentrual age (PMA) that the rate of cerebral cortical growth is able to predict complex cognitive functioning but not motor skills in later childhood. Postmentrual age refers to your preemies gestational weeks plus their chronological age.

The study involved performing a magnetic resonance imaging (MRI) scan of the brain of 82 preterm infants up to 8 times. They also took part in a battery of neuropsychological tests at age 2 and 6 years.

The results indicate that the period before a full term brith, the last gestational weeks in the uterus, are critical for brain development, so for preemie babies the more the cerebral cortex grows early in life the better their outcome when they reach 6 years of age.

Published in Industry News
Monday, 09 May 2011 18:59

Oxygen Level & Preemies

Premature babies have underdeveloped lungs when they are born and so often require supplemental oxygen to survive. However, the level of oxygen needed to help preemies without causing other health problems has been a cause of much debate. A scientific publication in the New England Journal of Medicine has concluded that higher oxygen concentrations improve survival, but also note that this is not necessarily without risks.

 

Published in Industry News
Sunday, 01 June 2014 11:40

Stem Cells Could Help Preterm Infants

Premature babies have underdeveloped lungs and often have difficulty breathing by themselves. Respiratory distress syndrome and chronic lung disease are the most common breathing difficulties related to preterm birth.

Difficulty breathing due to underdeveloped lungs is often a common consequence of preterm birth that needs immediate attention. Respiratory distress syndrome, also called hyaline membrane disease (HMD), is the most common lung disorder in preterm infants. Preterm infants do not produce enough of a slippery, protective substance called surfactant, which helps the lungs inflate with air and keeps them from collapsing, when the infant tries to breathe in air, after birth, by themself. Preterm infants with respiratory distress syndrome are treated with exogenous surfactant and has been shown to decrease neonatal mortality in very low birth weight and preterm infants. Where possible steroids are given to mother’s before a preterm delivery to help prevent problems associated with underdeveloped organs and lung immaturity.

Early difficulties with breathing and the need for ventilation can result in chronic lung disease (CLD), also called bronchopulmonary dysplasia (BPD), which is common in babies born preterm. CLD is a disorder that results from inflammation, injury, and scarring of the airways and the alveoli.

New research which has focused on lung problems associated with preterm birth has reported some fascinating findings. Dr. Bernard Thébaud, who is a pediatrician at the Children’s Hospital of Eastern Ontario and The Ottawa Hospital, published a paper in the medical journal Circulation reporting findings that showed that damaged lungs of preterm infants can be safely repaired using stem cells and regenerative medicine. This is the first study to demonstrate the use of vascular progenitor cells (stem cells that make blood vessels) for this purpose.

Research findings so far are based on research conducted on lab animals but the next phase of the study will begin working on opportunities for clinical trials.

These research findings have huge implications for the treatment of lung disease in preterm infants as well as the potential regeneration of other organs and other lung diseases in adult populations. This research is very important, not just for the short-term benefits but also the potential long-term benefits. For example, a lack of oxygen to other parts of the preemie infant’s body can result in other difficulties. For example, lack of oxygen can affect brain and eye development. Respiratory problems are the most common cause of death in preterm infants, although these problems have lessened over time, and they also have a large effect on other health outcomes. That is, they are related to high rates of cognitive (thinking and reasoning), motor skills, educational, and behavioural difficulties.

Research such as this could be a great step in lessening the burden and stress for families of preterm infants who often have to deal with many and varied many challenges.

Published in Industry News
Monday, 11 July 2011 19:05

Alcohol Risk for Preterm Birth

A recent study conducted by the Centre for Addiction and Mental Health has confirmed that heavy alcohol consumption during pregnancy increases the risk for low birth weight, preterm birth, and small size for gestational age.

 

Published in Industry News
Friday, 02 December 2011 10:27

Breastfeeding & Pain in Preemies

Not only is pain in preemie babies upsetting annd stressful for parents, if pain is not managed well it can have serious negative consequences, both short- and long-term. It can affect preemie babies' ongoing sensitivity to pain, stress arousal systems, and brain development. In the neonatal intensive care unit (NICU) pain associated with procedures such as pricking for blood tests are managed with interventions such as skin-to-skin care, swaddling, nesting, pacifiers, nonnutritive sucking, and sweet tastes. Breastfeeding, a natural, simple alternative, offers simultaneously the pain-reducing components of familiar odor, maternal skin-to-skin contact, sucking, and the ingestion of breast milk. In babies who are born full term, it has been reported that breastfeeding during painful procedures can reduce the pain response by 80 to 90% without producing any negative side effects. This approach had not been evaluated in preemie babies, in part due to a concern preemie babies may associate breastfeeding with pain, which could affect their ability to feed effectively and gain weight, as well impact mother-baby bonding.

Recently, a randomized control trial conducted by investigators from the Child & Family Research Institute at BC Children's Hospital and The University of British Columbia in Vancouver, BC, had their results of a study investiagting this very issue in PAIN (which is a scientific journal).

This research study looked at whether breastfeeding during the painful procedure would have a negative impact on the development of breastfeeding skills, and whether preemie babies who had more mature breastfeeding behaviors would have lower pain scores and heart rates during blood collection than less experienced feeders.

The results from the study showed that for the preemie group as a whole, breastfeeding did not reduce either behavioral or physiological pain during blood collection. But importantly, there were negative affects on breastfeeding skill development either. Preemie babies who were more advanced in their ability to feed did have significantly lower behavioral pain scores.

Published in Industry News
Wednesday, 02 November 2011 12:26

NICU Stress

As parents of premature babies well know, their tiny immature baby is likely to spend at least some time in the neonatal intensive care unit (NICU). The NICU is where premature babies will receive specialized medical care allowing time for immature organs to develop sufficiently.

Although there are a number of factors that are associated with poorer developmental outcomes in very premature babies little is understood about the exposure to stress in the neonatal intensive care unit. A new study has focussed on this topic by examining neonatal infant stress and its effect on brain development.

This study involved 44 premature babies born less than 30 weeks gestation and trained nurses recorded procedures and cares. Stress was measured using a tool called the Neonatal Infant Stressor Scale (NISS), which consists of 36 interventions that contribute to infant stress. These premature babies then undertook a magnetic resonance imaging (MRI) scan to evaluate the relationship between brain structure and function and infant exposure to stress.

The findings of this study suggest that for premature babies exposure to stressors in the neonatal intensive care unit is associated with reduced brain size. It is not clear what the long-term consequences are and the authors suggest that further research of stress exposure on the premature baby brain is needed to improve outcomes for premature babies.

Published in Industry News
Friday, 05 August 2011 16:56

Blind Kids Catch Wave

Retinopathy of prematurity is a disorder of the eye that preterm infants are most at risk for in the neonatal period. Retinopathy of prematurity (ROP) is a disease affecting the growth of blood vessels of the retina of preterm infants; it can be mild with no visual deficits, or it can be severe resulting in retinal detachment and blindness.

 

Published in Industry News
Wednesday, 20 February 2013 11:42

Psychiatric Risk for Preemies

BABIES born very preterm, before 32 weeks' gestation, have higher rates of psychiatric disorders by school age compared with their peers.

A study by the Murdoch Childrens Research Institute in Melbourne shows a number of factors that predict which very preterm children are at higher risk. These factors include brain abnormalities soon after birth, a history of social-emotional problems and social risk.

Social risk factors include family structure, education of primary caregiver, language spoken at home and mother's age when the child was born.

Lead researcher, clinical psychologist Dr Karli Treyvaud says the results offer hope as the risk factors can be identified early in life, increasing the opportunity for intervention.

The study, which included 177 very preterm children (VPT) and 65 children born at term, found almost one quarter of the VPT children were diagnosed with a psychiatric disorder by age seven. This is three times higher than their peer group.

The most common diagnoses were anxiety disorders (11 per cent), attention deficit hyperactivity disorder (10 per cent) and autism spectrum disorders (4.5 per cent).

The rate of autism among children born pre-term was about four times higher than recent Australian population estimates. Dr Treyvaud said the 11 per cent of children born pre-term in the study who had anxiety disorders compared with 8 per cent for those born full-term.

For ADHD, the 10 per cent of children born pre-term who had the condition compared with 3 per cent born full-term.

Published in Industry News
Saturday, 21 April 2012 13:32

Controversial: Too Small?

"I missed out on that joyful, happy moment that most people have, because I was so profoundly overcome with, she's so early."

A sentiment many parents of preemies will no doubt relate to. Every now and then, you will read articles in the news, or there might be a story on TV that discusses the issue of, “How small is too small?”

Medical and technological advances have ensured the chance of preterm babies surviving have increased significantly over the past 20 years, further still the limits of what babies at what gestational age can survive are often pushed to the extreme. Preterm babies born less than 25 weeks, sometimes called micropreemies, can invoke discussion about the moral, ethical, and financial ramifications of pushing for survival at any cost. This is true for doctors and parents themselves. For example, the question, “what level and type of care should be provided to the tiniest preterm babies?”, is often posed.

In Japan, babies born at 22 weeks are considered capable of sustaining life, in Australia, the attitude is to try an actively give the baby a chance of survival, whereas other countries advocate for “compassionate care” prior to 25 weeks gestation due to the low chance of survival. In Sweden, Norway, Finland, they don't resuscitate a baby under 25 weeks’ gestation. They say we're going to use that money for prenatal care. In the United States, babies born at 22 weeks are not resuscitated. At 25 weeks, every baby is resuscitated because more than 75% survive.

Despite the fact that medical advances improve the chance of a preterm baby surviving at younger and younger gestational ages; the stats still are not great for the tiniest of these babies, the questionable zone is usually 23 to 24 weeks; preemies born at 23 to 24 weeks have around 15-40% chance of survival but for those micropreemies who make it they also have a 30-50% chance of having a severe disability, such as cerebral palsy, intellectual impairment, blindness, deafness, or a combination of these, and a further 25-40% will have mild to moderate disabilities such as subtle forms of visual impairment, mild cerebral palsy affecting motor control, chronic asthma, learning difficulties, and behavior problems like attention deficit disorder.

Some parents of babies born at 22 weeks want everything done possible to help their baby survive, while sometimes parents of babies born at 23-24 weeks ask that nothing aggressive be done. It can be a very difficult decision for parents to make. The overwhelming portrayal of preterm babies in the media is the “miracle survival” of such tiny babies. It is rare for discussion of the potential long-term difficulties associated with such an early birth. Phyllis Dennery, chief of neonatology and newborn services at the University of Pennsylvania and Children's Hospital of Philadelphia, explains that "It's very dangerous to make this out to be a wonderful success, the reality is often quite different."

Often part of the discussion revolves around the costs involved in keeping these tiny preemie babies alive and the ongoing cost of their treatment and care. According to some estimates the average cost of care of a preterm baby in the neonatal intensive care unit (NICU) is US$4,000 to $5,000 per day. In the United States the estimated annual societal economic burden associated with preterm birth was in excess of $26.2 billion in 2005, or $51,600 per infant born preterm. For some countries such as Sweden, Norway, Finland, that don't resuscitate a baby under 25 weeks, instead advocate the use of that money for prenatal care of babies with a better chance of surviving and better chance of long-term outcomes.

A major issue is that many people don’t understand the consequences, both short- and long-term of giving birth too soon. Once a preterm baby survives many think that’s the end of it.

"We tend to think that prematurity is a problem that the minute you walk out of the nursery it's over. That's the furthest thing from the truth. More and more studies are coming out that there are long-term consequences of prematurity. If you look at lung growth, brain growth, these are all altered by the fact that you are born too early. Prematurity is with you for the rest of your life."

Published in Industry News
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Preemie, Premmie, or Prem?

Most babies spend between 38 and 42 weeks in their mother’s uterus. So, technically a preterm birth, preemie, premmie, or prem, is an infant who is born less than 37 completed gestational weeks. 


Read More: Defining Preterm birth


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