Preterm birth alters the maturation of the GABAergic system in the human prefrontal cortex

Developmental changes in GABAergic and glutamatergic systems during frontal lobe development have been hypothesized to play a key role in neurodevelopmental disorders seen in children born very preterm or low birth weight, but the associated cellular changes have not yet been identified. Here we studied the molecular development of the GABAergic system specifically in the dorsolateral prefrontal cortex, a region that that has been implicated in neurodevelopmental and psychiatric disorders. The maturation state of the GABAergic system in this region was assessed in human post-mortem brain samples, from term infants ranging in age from 0 to 8 months (n=17 male, 9 female). Gene expression was measured for 47 GABAergic genes and used to calculate a maturation index. This maturation index was significantly more dynamic in male than female infants. To evaluate the impact of premature birth on the GABAergic system development, samples from one-month-old term (n=9 male, 4 female) and one-month corrected-age (n=8 male, 6 female) very preterm infants, were compared using the same gene list and methodology. The maturation index for the GABAergic system was significantly lower in male preterm infants, with major alterations in genes linked to GABAergic function in astrocytes, suggesting astrocytic GABAergic developmental changes as a new cellular mechanism underlying preterm brain injury.

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The Impact of Neonatal Morbidities on Smooth Pursuit Eye Movements in Very Preterm Infants

Pediatric Research ◽

10.1038/pr.2011.577 ◽

2011 ◽

Vol 70 ◽

pp. 352-352 ◽

Cited By ~ 2

Author(s):

K Strand Brodd ◽

K Rosander ◽

H Grönqvist ◽

G Holmström ◽

B Strömberg ◽

...

Keyword(s):

Eye Movements ◽

Preterm Infants ◽

Smooth Pursuit ◽

Smooth Pursuit Eye Movements ◽

Very Preterm Infants ◽

Very Preterm ◽

Pursuit Eye Movements ◽

The Impact

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AEEG Developmental Developmental Changes During the First Three Days After Birth in Very Preterm Infants

Pediatric Research ◽

10.1038/pr.2011.257 ◽

2011 ◽

Vol 70 ◽

pp. 32-32

Author(s):

G Natalucci ◽

C F Hagmann ◽

V Bernet ◽

H U Bucher ◽

V Rousson ◽

...

Keyword(s):

Preterm Infants ◽

Developmental Changes ◽

Very Preterm Infants ◽

Very Preterm

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Body Composition in Very Preterm Infants: Role of Neonatal Characteristics and Nutrition in Achieving Growth Similar to Term Infants

Neonatology ◽

10.1159/000450882 ◽

2016 ◽

Vol 111 (3) ◽

pp. 214-221 ◽

Cited By ~ 10

Author(s):

Geneviève Tremblay ◽

Christine Boudreau ◽

Sylvie Bélanger ◽

Odette St-Onge ◽

Etienne Pronovost ◽

...

Keyword(s):

Body Composition ◽

Preterm Infants ◽

Term Infants ◽

Very Preterm Infants ◽

Very Preterm

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Impact of macro-socioeconomic determinants on perinatal healthcare quality for very preterm infants

European Journal of Public Health ◽

10.1093/eurpub/ckz186.006 ◽

2019 ◽

Vol 29 (Supplement_4) ◽

Author(s):

J Doetsch ◽

S C S Marques ◽

T Krafft ◽

H Barros

Keyword(s):

Private Sector ◽

Preterm Infants ◽

Economic Crisis ◽

Healthcare Quality ◽

Wage Distribution ◽

Very Preterm Infants ◽

Socioeconomic Determinants ◽

Very Preterm ◽

Secondary Stage ◽

The Impact

Abstract The WHO identified the importance of macro-socioeconomic determinants and the political context as interlinked key factors affecting health equity. The 2008 economic crisis was associated with a significant low-birth-weight increase in Portugal, 2007-2014. The Economic Adjustment Programme (EAP), implemented to economize non-essential health care costs (2011-2014), substantially affected healthcare delivery and occupational environment of Healthcare Professionals (HCPs). This study aims to analyse the impact observed by HCPs of the economic crisis and EAP on equitable quality of perinatal healthcare for very preterm infants in Portugal. A Qualitative study design with 21 HCPs in clinical settings equally distributed among Portuguese mainland were selected according to their response. Semi-structured interviews were conducted between October 2018-April 2019 until saturation point was achieved. A content analysis was performed using Nvivo2011 software. Preliminary results on macro-socioeconomic determinants, classified and conceptualized into a three-stage-effect framework, disclosed an interrelation between factors impacting perinatal healthcare quality, according to HCPs. Primary-stage: increase in working hours and patient-ratio per HCPs, cuts in salaries and investment, increasing waiting time and HCPs demotivation. Secondary-stage: burnout, work-absence, time constraints, decreasing quality and consultation availability. Tertiary-stage: HCPs Brain-drain to private sector, double-shifts in public-private sector, increasing inadequacy of transmissivity within sector communication. The economic crisis and EAP were perceived to have modified equitable perinatal healthcare quality for very preterm infants in Portugal. Increased private-public sector transparency to maximise quality assurance, equal HCP wage distribution to sustain capability, strengthening of social maternity protection strategies to enhance socioeconomic equity in perinatal healthcare, is recommended. Key messages The added value is the disclosure of an in-depth understanding on the interrelation of macro-socioeconomic determinants and healthcare permitting a distinct representation from quantitative methods. The non-linearity between policy response and expected outcomes chiefly complements its comprehension and demonstrates its relevance for further research on assessing effects of austerity measures.

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Misdiagnosing Midgut Volvulus in Very Preterm Infants: What is the Impact of Delay Before Surgery?

The Indian Journal of Pediatrics ◽

10.1007/s12098-020-03446-1 ◽

2020 ◽

Vol 88 (1) ◽

pp. 89-90

Author(s):

Louise Montalva ◽

Liza Ali ◽

Alice Heneau ◽

Florence Julien-Marsollier ◽

Valérie Biran ◽

...

Keyword(s):

Preterm Infants ◽

Midgut Volvulus ◽

Very Preterm Infants ◽

Very Preterm ◽

The Impact

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The impact of prenatal and neonatal infection on neurodevelopmental outcomes in very preterm infants

Journal of Perinatology ◽

10.1038/jp.2014.79 ◽

2014 ◽

Vol 34 (10) ◽

pp. 741-747 ◽

Cited By ~ 29

Author(s):

I Lee ◽

J J Neil ◽

P C Huettner ◽

C D Smyser ◽

C E Rogers ◽

...

Keyword(s):

Preterm Infants ◽

Neonatal Infection ◽

Neurodevelopmental Outcomes ◽

Very Preterm Infants ◽

Very Preterm ◽

The Impact

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Fat trajectory after birth in very preterm infants mimics healthy term infants

Pediatric Obesity ◽

10.1111/ijpo.12472 ◽

2018 ◽

Vol 14 (3) ◽

pp. e12472 ◽

Cited By ~ 8

Author(s):

N. A. Al-Theyab ◽

T. J. Donovan ◽

Y. A. Eiby ◽

P. B. Colditz ◽

B. E. Lingwood

Keyword(s):

Preterm Infants ◽

Term Infants ◽

Very Preterm Infants ◽

Very Preterm

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Stereophotogrammetric head shape assessment in neonates is feasible and can identify distinct differences between term-born and very preterm infants at term equivalent age

Scientific Reports ◽

10.1038/s41598-021-00680-1 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Petra Santander ◽

Anja Quast ◽

Johanna Hubbert ◽

Laura Juenemann ◽

Sebastian Horn ◽

...

Keyword(s):

Body Weight ◽

Preterm Infants ◽

Total Duration ◽

Neurodevelopmental Outcome ◽

Small Sample ◽

Head Shape ◽

Term Infants ◽

Very Preterm Infants ◽

Equivalent Age ◽

Very Preterm

AbstractThe development of head shape and volume may reflect neurodevelopmental outcome and therefore is of paramount importance in neonatal care. Here, we compare head morphology in 25 very preterm infants with a birth weight of below 1500 g and / or a gestational age (GA) before 32 completed weeks to 25 term infants with a GA of 37–42 weeks at term equivalent age (TEA) and identify possible risk factors for non-synostotic head shape deformities. For three-dimensional head assessments, a portable stereophotogrammetric device was used. The most common and distinct head shape deformity in preterm infants was dolichocephaly. Severity of dolichocephaly correlated with GA and body weight at TEA but not with other factors such as neonatal morbidity, sex or total duration of respiratory support. Head circumference (HC) and cranial volume (CV) were not significantly different between the preterm and term infant group. Digitally measured HC and the CV significantly correlated even in infants with head shape deformities. Our study shows that stereophotogrammetric head assessment is feasible in all preterm and term infants and provides valuable information on volumetry and comprehensive head shape characteristics. In a small sample of preterm infants, body weight at TEA was identified as a specific risk factor for the development of dolichocephaly.

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Remifentanil Degradation in Umbilical Cord Blood of Preterm Infants

Anesthesiology ◽

10.1097/aln.0b013e318204e043 ◽

2011 ◽

Vol 114 (3) ◽

pp. 570-577 ◽

Cited By ~ 34

Author(s):

Lars Welzing ◽

Sabine Ebenfeld ◽

Verena Dlugay ◽

Martin H. J. Wiesen ◽

Bernhard Roth ◽

...

Keyword(s):

Cord Blood ◽

Preterm Infants ◽

Umbilical Cord ◽

Umbilical Cord Blood ◽

Pharmacokinetic Data ◽

Serum Samples ◽

Term Infants ◽

Very Preterm Infants ◽

Cord Serum ◽

Very Preterm

Background No pharmacokinetic data about remifentanil in preterm infants exist, although remifentanil is increasingly used in this especially vulnerable subgroup of pediatric patients. Unfortunately, ethical restrictions in the volume of blood that can be withdrawn for kinetic sampling nearly prohibit pharmacokinetic studies in preterm infants. Methods Because remifentanil is rapidly metabolized by nonspecific blood esterases, we collected umbilical cord serum of preterm and term infants to investigate whether the activity of nonspecific blood esterases depends on gestational age. Umbilical cord serum, buffer solution, ascorbic acid, and remifentanil were mixed in a glass vial placed in a shaking water bath at 37°C. Subsequently, serum samples were subjected to liquid chromatography-mass spectrometry-based analysis of remifentanil and its metabolite GR90291 after 0, 30, 60, 100, and 150 min. Results We analyzed umbilical cord serum samples of 34 preterm infants (24-36 gestational weeks) and six term infants. The degradation rates of remifentanil to its major metabolite GR90291 were comparable in preterm and term infants. The overall median degradation half-life of remifentanil was 143 ± (interquartile range) 47 min (minimum, 76 min; maximum, 221 min) without significant differences between very preterm infants (less than 28 gestational weeks) and term infants. The remifentanil concentration remained stable in control runs without serum. Conclusions Our study demonstrates that very preterm infants exhibit a high nonspecific esterase activity in umbilical cord blood that is comparable with that of term infants. These results support clinical experiences that remifentanil is rapidly metabolized by preterm infants without prolonged side effects.

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Introduction of a Quality Improvement Bundle Is Associated with Reduced Exposure to Mechanical Ventilation in Very Preterm Infants

Neonatology ◽

10.1159/000518392 ◽

2021 ◽

pp. 1-8

Author(s):

Stacey Chi-Yan Lo ◽

Risha Bhatia ◽

Calum T. Roberts

Keyword(s):

Mechanical Ventilation ◽

Quality Improvement ◽

Preterm Infants ◽

Demographic Data ◽

Neonatal Morbidity ◽

Very Preterm Infants ◽

Very Preterm ◽

Antenatal Steroids ◽

Cord Clamping ◽

The Impact

Introduction: Exposure to mechanical ventilation (MV) is a risk factor for bronchopulmonary dysplasia (BPD) in very preterm infants (VPTIs). We assessed the impact of a quality improvement (QI) bundle in VPTIs (<32 week gestation) on exposure to MV. Methods: We introduced a QI bundle consisting of deferred cord clamping (DCC), nasal bubble continuous positive airway pressure (bCPAP) in the delivery room (DR), and minimally invasive surfactant therapy (MIST). We compared respiratory outcomes and neonatal morbidity in historical pre-QI (July–December 2017) and prospective post-QI (February–July 2019) cohorts (QICs) of VPTIs. We pre-specified an adjusted analysis to account for the effects of gestational age, sex, antenatal steroids, and any demographic data that significantly differed between cohorts. Results: The pre-QI and post-QICs included 87 and 98 VPTIs, respectively. The post-QIC had decreased rates of MV in the DR (adjusted odds ratio [aOR] 0.26, 95% confidence interval [CI] 0.09–0.71), in the first 72 h of life (aOR 0.27, 95% CI 0.11–0.62) and during admission (aOR 0.28, 95% CI 0.12–0.66). Rates of BPD, combined BPD/death, and BPD severity were similar. The post-QIC was less likely to be discharged with home oxygen (aOR 0.27, 95% CI 0.08–0.91). Necrotising enterocolitis grade ≥2 increased (aOR 19.01, 95% CI 1.93–188.6) in the post-QIC. Conclusion: In this rapid-cycle QI study, implementation of a QI bundle consisting of DCC, early nasal bCPAP, and MIST in VPTIs was associated with reduced rates of MV in the DR, in the first 72 h of life and during admission, and reduced need for home oxygen.

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