Friday, 30 March 2012 14:33

Grief – Quick Recovery Key

Becoming a parent of a preemie can result in, for good reason, feelings of grief and high levels of distress, which is similar to that of parents who have a child with a chronic illness (e.g. epilepsy or cerebral palsy). According to new research, the faster a mother of a preemie can overcome the feelings of grief they are experiencing the better the chances of developing secure attachment between baby and mother.

Experiencing a preterm birth has been described as an “emotional crisis” that is characterized by feelings of loss and grief, which can continue for months even after discharge from the neonatal intensive care unit (NICU). Mother’s of preemies must adapt her expectations and hopes for her baby in difficult and uncertain situations, and must mourn the loss of her hoped-for baby, while also trying to embrace the baby she has.

A history of unresolved grief experienced by mothers about their baby’s diagnosis has been associated with insecure infant-mother attachment. Most of this research has been carried out on chronic medical conditions or disabilities, such as Down syndrome, autism, and cerebral palsy. Persistent feelings of grief can affect a parent’s capacity to respond sensitively and contingently to baby’s cues. According to attachment theory a parent’s interactive behaviour influences later emotional development in the child. For example, contingently responsive and sensitive parenting contributes to secure attachment and therefore better social and emotional development. On the other hand, interactions lacking sensitivity and responsiveness are associated with insecure attachment.

A recent study undertaken by Prachi Shah M.D., assistant professor in the Department of Pediatrics and Communicable Diseases at the University of Michigan C. S. Mott Children’s Hospital, aimed to investigate the association between mothers’ unresolved grief regarding their preterm birth and infant-mother attachment security. The study involved 74 preemies (i.e. born less than 36 weeks gestation) and their mothers and the analysis included assessment of neonatal and socioeconomic risk at NICU discharge, maternal depression, Reaction to Preterm Birth Interview findings, and quality of parenting at 9 months postterm, and infant-mother attachment at postterm age of 16 months.

Study conclusion –The study found that unresolved grief related to a preterm birth is associated with the development of insecure infant-mother attachment. Importantly, mothers with resolved grief after preterm birth are 3 times more likely to have secure infant-attachment compared with preterm mothers with unresolved grief. Mothers who demonstrated more positive interactions with their infants were also more likely to have securely attached infants. There researchers suggested that successfully getting over grief may require the mother to redirect her expectations and hopes for her child during uncertain circumstances, and mourn the “hoped-for child” as she still embraces the child she has.

Published in Industry News
Monday, 31 December 2012 13:02

Persistent Language Problems

Babies born premature have poorer language abilities when compared to their peers at seven years of age, a Murdoch Childrens Research Institute study has found.

Researchers investigated language abilities in 198 children born very preterm (less than 32 weeks) and very low birth weight (less than 1500 grams) at seven years of age and compared their performance with 70 children who were born at term. Researchers also looked for white matter abnormalities as they hypothesised those children born preterm would demonstrate impaired language function because of the presence of diffuse white matter abnormalities.

The study, which is published in Journal of Pediatrics, found the group of children born very premature performed significantly worse than the children born at term on all language areas assessed including spoken word awareness, semantics, grammar, discourse and pragmatics.

The study showed that white matter abnormality occurring during the neonatal period was a key predictive factor for four out of five language areas seven years later. White matter abnormalities were associated with performance in phonological awareness, semantics, grammar, and discourse.

However, the results indicated that other factors associated with prematurity are also likely to influence language ability. Researchers said it's possible that environmental factors provide additional influence on language abilities; however, say further research is needed to understand the most significant determinants of cognitive skills.

Lead researcher, A/Professor Peter Anderson said the study highlights that families should closely monitor their child's language development.

The study, which is published in Journal of Pediatrics, found the group of children born very premature performed significantly worse than the children born at term on all language areas assessed including spoken word awareness, semantics, grammar, discourse and pragmatics.

"Language development is a clinically important area of development concern in these children. Paying close attention to a premature babies' language development is essential for parents so that discrepancies from normal development can be discovered and addressed during early childhood."

Researchers from the Institute are now developing a new preventive intervention for premature babies, which they hope will enhance language development, along with other functional outcomes.

Published in Industry News
Friday, 10 May 2013 14:01

Preemies School-age

Extremely preterm babies or extremely small prems are still behind their term born counterparts in relation to intellectual, educational, and behavioral outcomes by the time they reach school-age.

A study conducted in Victoria led by the Royal Women's Hospital followed up 189 extremely preterm or extremely low birth weight babies (less than 28 weeks gestation or weighing less than 1,000g) and 173 term born children at school-age. The areas assessed were intellectual ability, spelling, reading, mathematics, and a range of behavioral outcomes.

They found that 71% of the preterm born children had a cognitive, educational, or behavioral impairment at 8 years of age. In addition, up to 47% showed multiple areas of concern. These rates are much higher than that of the term born group which was 42% and 16% respectively. The major areas of concern were reading and spelling impairment which were double the rates in preemies compared with children born full term. The researchers also reported that 15% of the prems had a significant neurosensory impairment such as cerebral palsy.

Parents also completed questionnaires about their children which revealed that the preterm group had more behavioral problems including higher rates of hyperactivity, inattention, emotional problems, and peer relationship problems.

The positive message from this research is that the majority of babies born so early and small are now surviving without major disabilities.

This research highlights the need for early identification of children likely to have difficulties and early intervention strategies need to be employed to help these children before school-age.

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
Monday, 07 July 2014 11:49

Preterm Birth Breakthrough: Infections

Estimates of preterm birth in Australia suggest one in 12 or approximately 8% of Australian babies is born preterm. The incidence worldwide is even higher, approximately 10%, meaning around 15 million babies are born preterm annually. The estimated cost is very high and Australia spends approximately $500 million per year on their care, whilst the United States spends more than $17 billion.

One of the causes of preterm birth is intrauterine infection or inflammation caused by infection. Experts in the field hypothesise that vaginal microorganisms break the cervical barrier, colonise the fetal membranes, and infect the amniotic cavity. The expectant mother's auto-immune response consistenting of a vigorous inflammatory reaction results in preterm birth.

An incredible breakthrough achieved at the University of Western Australia, King Edward Memorial Hospital, has described the ability of an antibiotic - solithromycin - to potentially cross the placenta and kill infections responsible for many preterm births. Professor Jeffrey Keelan estimated that up to 30% of preterm births could be prevented using this new antibiotic, solithromycin. Most of the benefits would be attributed to saving the very early prems.

The research behind this exciting breakthrough involved measurements in sheep and the crossover from sheep to human placentas is about 50% compared with only 2-4% for older antibiotics and it's 10 to 100 times stronger. Researchers report that the next step is to, confirm that in pregnant women, that the antibiotic crosses the placenta and destroys harmful bacteria. If research grants are successful clinical trials will take place between Western Australia and the United States.

This is a significant finding as currently used antibiotics are largely ineffective at destroying harmful bacteria or are unable to cross the placenta at high enough levels, thereby unable to prevent the preterm birth from occuring.

Published in Industry News

The Victorian Brain Infants Studies (VIBeS) began a very important research project in January 2005, which aimed to establish if receiving developmental care at home was more beneficial than the current standard care, the study is known as the VIBeS Plus program.

There are around 3,000 very low birth weight (less than 1500 grams) or very preterm infants (less than 30 weeks gestational age) born each year in Australia. Survival rates for these very preterm infants have improved dramatically in the last few decades to be greater than 85%, however a significant proportion of children experience movement, behavioural or social problems which have life-long consequences. Early intervention programs, such as the VIBeS Plus program may reduce these risks. To date, the success of these programs has not been fully established.

The original VIBeS Plus study was a randomised control trial of a preventative care intervention. There were 120 families who participated and were randomised to either the “intervention group” or “control group”. The intervention designed by the Victorian Infant Brain Studies (VIBeS) team, consisted of 9 visits over the first year of life, conducted by 2 teams comprising a psychologist and a physiotherapist who were specially trained to deliver the intervention program. The intervention aimed to educate the primary caregivers about infant self-regulation and techniques for improving postural stability, coordination, and strength and to support the parents’ mental health and parent infant relationship throughout the first year. Each session lasted ~1.5 to 2.0 hours and was conducted in the family home, with a few exceptions in which the infants were seen in the hospital. Both groups were offered an MRI scan of their infant's brain at term corrected age.

Many of the neurobehavioral impairments described in preterm children persist into adolescence and adulthood. Further, caregivers of very preterm survivors experience high rates of mental health problems. Studies examining the effectiveness of early developmental intervention programs designed to reduce the burden of developmental problems report short-term benefits for infants and their caregivers.

VIBeS Plus previously demonstrated that at 2 years the early preventive care program improved preterm infants’ behavioural outcomes and reduced primary caregivers’ anxiety and depression. The follow-up study conducted at age 4 years showed that home-based preventive care over the first year had selective long-term benefits. There were meaningful differences in the thinking and learning, language and motor scores between treatment groups. Also, children in the intervention group showed less attention problems, such as ADHD, and behavior difficulties as well as increased competence compared with the controls.

Given the important role of parenting on child development, it is possible that the full benefits of this preventive care program will not be observed until later in development. Thus it is vital to determine whether early preventative care programs have long-term benefits beyond early development and preschool years. VIBeS Plus are currently following up this group of preterm children at school-age. Follow-up at school age is ideal for assessing the usefulness of this program, as this is when brain development and social maturation are relatively stable, and when the social demands of the environment (primary school) are also relatively consistent.

Published in Industry News
Sunday, 08 December 2013 15:10

Algorithm Predicts Premature Births

About three decades ago, my girlfriend came to the world as a preemie, born in the 33rd week of pregnancy. She weighed only 3.7 lbs. For the record: every birth before the 37th week of gestation is considered preterm and hence risky. There were no complications, and she grew up healthily and normally. The truth is: there is a lot that could have gone wrong. There are things the doctors didn't know in the 1980ies.

One of these things is that during the last weeks of gestation, the development of the unborn's cerebral cortex takes place. Earlier this year, resesarchers of the King's College London have published a study in PNAS that shows the effect of preterm births on the developing brain: it can cause inferior cognitive performance in infants. Visual-spatial processing, decision making and working memory might all be affected. In order to assess this, the lead author, KCL's David Edwards, investigated the growth and density of nerve cells using diffusion MRI (dMRI).

Moreover, there are strong indications preterm births are a risk factor for sudden infant death, autism, ADHD and cerebral palsy. The CDC names preterm births as a risk factor for cerebral palsy, too. Breaking Bad co-star RJ Mitte suffers from a mild form of cerebral palsy. It remains unclear, though, whether his condition was caused by preterm birth or not. A recent study suggests that also exposition to phthalates (contained in food, industry and hygiene products) are one of the causes for preterm deliveries.

But hope is underway. In a recent study published in PLOS ONE, computer scientist Paul Fergus and his team of researchers have found a way to predict preterm births using machine learning and the right data. They obtained the data by harnessing electrohysterography (EHG), that is measurng electrical signals of uterine activity. This method has been used before to measure the contractions during labour.

What Fergus' algorithm does is classify the recorded signals into term and preterm signals. The trick is to measure the uterine signals early on. The paper states that "distinct contraction-related, electrical uterine activity is present early on in pregnancy, even when a woman is not in true labour." The amount of these signals increases steadily during the pregnancy and shoots up during the last three to four days.

The new method is still prone to errors and produces results of varying quality, depending on the underlying data. The number of examined records suggests Fergus was not exactly using big data. 300 records of which only 38 were preterm records. Fergus himself states in the conclusion of his paper, that the low number of preterm records didn't allow the machine learning classifiers to learn properly. Even though, the concept works and seems promising. Once all errors have been eliminated, the technique could predict a "Yes" or "No" to answer the question "Will my child be born on term?" The resarchers suggest to further improve the quality of the algorithm's outcome in the future: The answer could then be how many weeks remain until the birth.

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
Saturday, 27 October 2012 13:27

Caffeine & Preterm Infants

Caffeine therapy is frequently used to reduce apnea in infants born preterm. It has been shown to improve both short- and long-term outcomes in preemies born less than 1,250 grams. In an Australia study called Caffeine in Apnea of Prematurity (CAP for short) the proportion of infants with lung injury called bronchopulmonary dysplasia (BPD) was lower when caffeine treatment started within the first 10 days of life compared with a placebo. Additionally, these researchers found that at 18 months preemies were less likely to be developmentally delayed or have cerebral palsy.

It is thought that the improvement in neurological outcome for preterm babies who have received caffeine therapy is due to the effect on cerebral white matter. Researchers from the CAP study reported that preemies who received caffeine for apnea may have more mature cerebral white matter organization. They also suggest that caffeine may be exerting a direct neuroprotective effect

The CAP study is now in the process of looking at the long-term outcome following caffeine treatment and will perform neuropsychological, lung functioning, and imaging analyzes on these children at age 11 years.

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
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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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