Maturation of the cardiac autonomic regulation system, as function of gestational age in a cohort of low risk preterm infants born between 28 and 32 weeks of gestation

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Israeli-Mendlovic Hadas ◽  
Mendlovic Joseph ◽  
Zuk Luba ◽  
Katz-Leurer Michal
Keyword(s):  
Preterm Infants ◽  
Gestational Age ◽  
Autonomic Regulation ◽  
Low Risk ◽  
Sympathetic System ◽  
Regulation System ◽  
Cardiac Autonomic Regulation ◽  
Significant Difference ◽  
The Impact ◽  
Over Time

Abstract Objectives The maturation of the sympathetic nervous system (SNS) occurs steadily throughout gestation while the myelinated vagus has accelerated maturation periods, between 25 and 32 weeks of gestation and a further increase around 37–38 weeks of gestation. The aim was to quantify the cardiac autonomic regulation maturation, as a function of gestational age (GA) in a cohort of low risk preterm infants born between 28 and 32 weeks of gestation by assessing heart rate variability (HRV) at week 32, and at week 35 postmenstrual age (PMA). Methods Forty preterm infants were recruited, 24 h recordings of breathing rate and RR intervals were obtained at week 32 and week 35 PMA. Results A significant difference was noted between preterm infants born before 32 weeks GA and preterm infants born at week 32; the latter present higher HRV values throughout the follow-up period. No significant change over time was noted for the parasympathetic HRV measures while a significant increase was found in the sympathetic system. Moreover, a significant interaction effect of time and system was found, the increase in values of the sympathetic system over time was significantly larger than the change noted in the vagal HRV measures. Conclusion Given the beneficial influence of vagal tone on health and developmental outcomes in preterm infants, the findings of the current study highlight the need for further studies on the impact of specifics gestational age on vagal development and later assessing interventions associate with its continue development and maturation at these specific periods.

scholarly journals Quality of life assessments in clinical practice using either the EORTC-QLQ-C30 or the SEIOQL-DW: a randomized study

2021 ◽  
Vol 5 (1) ◽  
Author(s):  
Åsa Kettis ◽  
Hanna Fagerlind ◽  
Jan-Erik Frödin ◽  
Bengt Glimelius ◽  
Lena Ring
Keyword(s):  
Quality Of Life ◽  
Clinical Practice ◽  
Significant Difference ◽  
Patient Reported ◽  
Health Related Qol ◽  
Health Related ◽  
Secondary Outcomes ◽  
The Impact ◽  
Over Time

Abstract Background Effective patient-physician communication can improve patient understanding, agreement on treatment and adherence. This may, in turn, impact on clinical outcomes and patient quality of life (QoL). One way to improve communication is by using patient-reported outcome measures (PROMs). Heretofore, studies of the impact of using PROMs in clinical practice have mostly evaluated the use of standardized PROMs. However, there is reason to believe that individualized instruments may be more appropriate for this purpose. The aim of this study is to compare the effectiveness of the standardized QoL-instrument, the European Organization for Research and Treatment of Cancer Quality of Life C-30 (EORTC-QOL-C30) and the individualized QoL instrument, the Schedule for the Evaluation of Individual Quality of Life-Direct Weighting (SEIQoL-DW), in clinical practice. Methods In a prospective, open-label, controlled intervention study at two hospital out-patient clinics, 390 patients with gastrointestinal cancer were randomly assigned either to complete the EORTC-QOL-C30 or the SEIQoL-DW immediately before the consultation, with their responses being shared with their physician. This was repeated in 3–5 consultations over a period of 4–6 months. The primary outcome measure was patients’ health-related QoL, as measured by FACIT-G. Patients’ satisfaction with the consultation and survival were secondary outcomes. Results There was no significant difference between the groups with regard to study outcomes. Neither intervention instrument resulted in any significant changes in health-related QoL, or in any of the secondary outcomes, over time. This may reflect either a genuine lack of effect or sub-optimization of the intervention. Since there was no comparison to standard care an effect in terms of lack of deterioration over time cannot be excluded. Conclusions Future studies should focus on the implementation process, including the training of physicians to use the instruments and their motivation for doing so. The effects of situational use of standardized or individualized instruments should also be explored. The effectiveness of the different approaches may depend on contextual factors including physician and patient preferences.

scholarly journals The Management of Myelomeningocele Study: Short-Term Neonatal Outcomes

2020 ◽  
Vol 47 (12) ◽  
pp. 865-872 ◽  
Author(s):  
Natalie E. Rintoul ◽  
Roberta L. Keller ◽  
William F. Walsh ◽  
Pamela K. Burrows ◽  
Elizabeth A. Thom ◽  
...  
Keyword(s):  
New England ◽  
Gestational Age ◽  
Periventricular Leukomalacia ◽  
Ductus Arteriosus ◽  
Outcome Data ◽  
Neonatal Outcomes ◽  
Increased Risk ◽  
Significant Difference ◽  
The Impact ◽  
Prenatal Surgery

<b><i>Introduction:</i></b> The Management of Myelomeningocele Study was a multicenter randomized trial to compare prenatal and standard postnatal repair of myelomeningocele (MMC). Neonatal outcome data for 158 of the 183 randomized women were published in <i>The New England Journal of Medicine</i> in 2011. <b><i>Objective:</i></b> Neonatal outcomes for the complete trial cohort (<i>N</i> = 183) are presented outlining the similarities with the original report and describing the impact of gestational age as a mediator. <b><i>Methods:</i></b> Gestational age, neonatal characteristics at delivery, and outcomes including common complications of prematurity were assessed. <b><i>Results:</i></b> Analysis of the complete cohort confirmed the initial findings that prenatal surgery was associated with an increased risk for earlier gestational age at birth. Delivery occurred before 30 weeks of gestation in 11% of neonates that had fetal MMC repair. Adverse pulmonary sequelae were rare in the prenatal surgery group despite an increased rate of oligohydramnios. There was no significant difference in other complications of prematurity including patent ductus arteriosus, sepsis, necrotizing enterocolitis, periventricular leukomalacia, and intraventricular hemorrhage. <b><i>Conclusion:</i></b> The benefits of prenatal surgery outweigh the complications of prematurity.

Influence of Ear Protectors on the Sleep of Preterm Newborns: A Randomized Controlled Clinical Study

2018 ◽  
Vol 29 (4) ◽  
pp. 260-267
Author(s):  
Mônica Hiromi Sato ◽  
Mavilde da Luz Gonçalves Pedreira ◽  
Ariane Ferreira Machado Avelar ◽  
Miriam Harumi Tsunemi ◽  
Kelly Cristina Sbampato Calado Orsi ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Gestational Age ◽  
Total Sleep Time ◽  
Sleep Time ◽  
Exclusion Criteria ◽  
Randomized Controlled ◽  
Significant Difference ◽  
Controlled Clinical Study ◽  
Preterm Newborns ◽  
Current Weight

The purpose of this study was to compare the effect of ear protectors on the sleep of preterm newborns during the “quiet” times in intermediate care nursery. This was a clinical, randomized, controlled crossover study conducted in two neonatal units in São Paulo, Brazil. The sample consisted of preterm infants who met the inclusion and exclusion criteria for the study. Polysomnography and unstructured observation were used for data collection. Twenty-four preterm infants with a mean gestational age of 33.2 weeks and current weight of 1.747 g were analyzed. There was no significant difference in the total sleep time of preterm infants with and without the use of ear protectors. Newborns with lower gestational age showed a significant reduction in total sleep time with the use of ear protectors ( p < .05). The use of ear protection did not increase the total sleep time for preterm infants.

Screening for Congenital Adrenal Hyperplasia: The Delfia Screening Test Overestimates Serum 17-Hydroxyprogesterone in Preterm Infants

PEDIATRICS ◽  
1996 ◽  
Vol 97 (1) ◽  
pp. 100-102 ◽  
Author(s):  
Saad Al Saedi ◽  
Heather Dean ◽  
William Dent ◽  
Elizabeth Stockl ◽  
Catherine Cronin
Keyword(s):  
Congenital Adrenal Hyperplasia ◽  
Preterm Infants ◽  
Gestational Age ◽  
Adrenal Hyperplasia ◽  
Blood Spots ◽  
Healthy Infants ◽  
Extraction Step ◽  
Postconceptional Age ◽  
17 Hydroxyprogesterone ◽  
Over Time

Objective. To compare 17-hydroxyprogesterone (17-OHP) levels measured by quantitative serum radioimmunoassay (RIA), including an extraction step, and by screening fluoroimmnoassay (FIA) on blood spots in preterm infants. Methods. Subjects were 39 healthy infants born at less than 31 weeks' gestational age. Each infant had weekly blood sampling, and RIA and FIA were performed on each sample. Results. Two hundred twenty-seven samples were taken at 28 to 41 weeks' postconceptional age. Mean ± SD 17-OHP measured by RIA was 11.4 ± 11.1 nmol/L (0.4 ± 0.4 µg/dL), and decreased over time. Mean ± SD 17-OHP measured by FIA was 38.96 ± 37.3 nmol/L, greater than 17-OHP (RIA). Log(δFIA-RIA) was inversely related to postconceptional age (R2 = .39). Conclusion. Screening FIA of blood spots overestimates levels of 17-OHP in preterm infants and should not be used to determine the likelthood of congenital adrenal hyperplasia in this population. We have abandoned FIA screening for congenital adrenal hyperplasia in infants weiging less than 1500 g.

113 Effects of Sleep on Intrusive Symptoms and Emotion Reactivity in a Laboratory-Based Film Analogue Study

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A46-A46
Author(s):  
Anna Marie Nguyen ◽  
Rebecca Campbell ◽  
Abigail Vance ◽  
Ellen Leen-Feldner
Keyword(s):  
Sleep Deprivation ◽  
Control Group ◽  
Significant Interaction Effect ◽  
Emotion Reactivity ◽  
Negative Valence ◽  
Significant Difference ◽  
Regulation Strategies ◽  
Acute Sleep Deprivation ◽  
The Impact ◽  
Over Time

Abstract Introduction Recent literature highlights the need to focus on the impact of intrusive symptoms as a possible risk factor for the development and maintenance of PTSD. Cognitive and sleep models also contribute to the further understanding of intrusive symptoms. Further emotion work emphasizes that disgust is an emotion closely associated with the emergence of posttraumatic stress symptomology following traumatic events. Methods This study utilized a film eliciting disgust to examine the effects of acute sleep deprivation on the intensity of intrusive symptoms and emotion reactivity. Forty-nine college students were randomly assigned to sleep as usual or an acute sleep deprivation after watching a disturbing film. It was hypothesized that, relative to the control group, participants who were acutely sleep deprived would report higher frequency of intrusive symptoms and higher negative valence. Results Findings were partially consistent with hypotheses. There were no group or interaction effects on intrusive symptoms, although participants across both groups reported significant decreases in negative valence and intrusive symptoms across the study (F(1, 47) = 10.30, p &lt; 0.01). There was a significant interaction effect between sleep group and self-reported negative valence, where individuals in the sleep deprived group reported significantly higher valence than individuals in the control group, despite significant decreases in negative valence over time (F(1, 48) = 7.869, p &lt; 0.01). Conclusion Possible mechanisms that may contribute to the significant difference in valence may be due to higher order emotion regulation strategies that are compromised due to sleep loss. However, the significant decreases in negative valence and intrusive symptoms over time may be due to methodological factors or the type of sleep manipulation. Further work can address these challenges by using a larger sample size or examining the effects of chronic, partial sleep deprivation. Support (if any):

scholarly journals Effect of tetracycline treatment regimens on antibiotic resistance gene selection over time in nursery pigs

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Kaare Græsbøll ◽  
Inge Larsen ◽  
Julie Clasen ◽  
Anna Camilla Birkegård ◽  
Jens Peter Nielsen ◽  
...  
Keyword(s):  
Gene Selection ◽  
Efflux Pump ◽  
Animal Health ◽  
Antibiotic Resistance Gene ◽  
Response To Treatment ◽  
Nursery Pigs ◽  
Gene Abundance ◽  
Significant Difference ◽  
The Impact ◽  
Over Time

Abstract Background The majority of antimicrobials given during the production of pigs are given to nursery pigs. The influence of antimicrobial use on the levels of antimicrobial resistant (AMR) genes is important to quantify to be able to assess the impact of resistance on the food chain and risk to human and animal health. Results This study investigated the response on the levels of nine AMR genes to five different treatment strategies with oxytetracycline, and the dynamics of gene abundance over time by following 1167 pigs from five different farms in Denmark. The results showed no significant difference between treatments and an increase in abundance for the efflux pump encoding tet(A) gene and the genes encoding the ribosomal protection proteins tet(O) and tet(W) tetracycline resistant genes following treatment, while tet(M) showed no response to treatment. However, it was also observed that the levels of tet(O), tet(W), and ermB in some farms would drift more over time compared to a single treatment-course with antibiotic. Conclusion This study underlines the large variation in AMR levels under natural conditions and the need for increased investigation of the complex interactions of antimicrobial treatment and other environmental and managerial practices in swine production on AMR gene abundance.

scholarly journals Reference Percentiles and Changes over Time for Total Thyroxine in Preterm Infants: A Retrospective Cohort Study

Diagnostics ◽  
2020 ◽  
Vol 10 (7) ◽  
pp. 475
Author(s):  
Claudia M. Flores-Robles ◽  
Ernesto Roldan-Valadez ◽  
Nayeli Martínez-Cruz ◽  
Lidia Arce-Sánchez ◽  
Ana L. Priego-Zurita ◽  
...  
Keyword(s):  
Cohort Study ◽  
Preterm Infants ◽  
Gestational Age ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Reference Ranges ◽  
Screening Programs ◽  
Cutoff Values ◽  
Total Thyroxine ◽  
Over Time

Hypothyroxinemia of prematurity increases the rate of false-positive results in total thyroxine (tT4)-based screening programs for congenital hypothyroidism. The use of specific cutoff values for preterm infants has been proposed, but data on tT4 reference ranges in this population are limited. The primary aim was to establish reference percentiles for tT4 in dried blood spots among Mexican preterm infants. Secondary aims included a comparison of the change of tT4 concentrations over time according to gestational age and to discuss its impact on tT4-based screening programs. This was a retrospective cohort study; 1561 preterm infants were included. Percentile 10th for tT4 concentration at 24–27, 28–30, 31–34, and 35–36 weeks of gestational age, measured in the first week of life was: 47.6, 56.6, 82.3, and 117.1 nmol/L, respectively. tT4 concentrations were compared in three different time points: first week of life, 2–3 weeks of life, and term-corrected gestational age (38 weeks of gestation), progressively increased in infants below 30 weeks, remained stable in infants from 31 to 34 weeks, and decreased in late preterm newborns (35–36 weeks). This study suggests that preterm infants may require the use of lower tT4 cutoff values in newborn screening.

A Longitudinal Analysis of Efficacy Expectations and Exercise in Older Adults

2004 ◽  
Vol 18 (4) ◽  
pp. 331-344 ◽  
Author(s):  
Barbara Resnick
Keyword(s):  
Older Adults ◽  
Physical Health ◽  
Self Efficacy ◽  
Outcome Expectations ◽  
Analysis Of Covariance ◽  
Regular Exercise ◽  
Significant Difference ◽  
Efficacy Expectations ◽  
The Impact ◽  
Over Time

The purpose of this study was to consider the longitudinal changes in self-efficacy and outcome expectations for exercise and the impact of these variables on maintaining regular exercise over a 4-year period in a group of older adults living in a continuing care retirement community. There were 78 individuals who completed all four surveys. The participants had at least a high school education, and the majority were Caucasian (99%), female (83%) and either widowed or never married (80%). The mean age of the participants was 84.4 ± 5.1 years. Based on repeated measure analysis of covariance, controlling for mental and physical health, there was not a statistically significant difference in self-efficacy expectations (F = 2.0, p > .05) or outcome expectations (F = 2.2, p > .05) over time. There was a statistically significant decrease in exercise over time (F = 9.9, p < .05). Using path analysis it was demonstrated that self-efficacy expectations, outcome expectations, and physical health directly and indirectly influenced maintenance of regular exercise. Age, gender, and mental health had a limited and inconsistent influence on maintenance of exercise. Future research and clinical work should focus on developing and testing interventions that strengthen both self-efficacy and positive outcome expectations in older adults to facilitate maintenance of exercise behavior over time.

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