Comparing long-term educational effects of two early childhood health interventions.

We compare the educational effects of two medical protocols that mitigate long-term consequences of prematurity or low birth weight. The two protocols are Traditional Care (TC), which uses incubators, and Kangaroo Mother Care (KMC) which replaces incubators for 24-hour skin-to-skin contact between newborns and caregivers. We concentrate on educational outcomes addressing contradictory results in previous contributions. We use a randomized controlled trial implemented in 1993 that randomly assigned children to either TC or KMC. OLS results suggest that KMC children spent more time in preschool, had fewer temporary school absences, and showed lower math test scores. Both groups observed similar effects on high-school graduation and language test scores. We correct for attrition, small sample, and multiple outcomes. Effects on preschool attendance and school absenteeism are robust, particularly for more vulnerable infants (birth weight ≤ 1,800 g). The other effects lose statistical significance due to multiple outcome testing or attrition corrections.

Sex-specific association of high maternal psychological stress during pregnancy on newborn birthweight.

Birthweight is an important predictor of newborn health and has been linked to maternal psychological stress during pregnancy. However, it is unclear whether prenatal stress affects birthweight similarly for both male and female infants. We used a well-established pregnancy cohort to investigate the impact of high maternal psychological stress during pregnancy on birthweight as a function of infant sex. Overall, 5702 mother-newborn pairs were analysed. Of these, 198 mothers reported high levels of stress using the Psychological Stress Measure (nine-items version; PSM-9). Maternal psychological stress was assessed between the 24th and 28th week of gestation and analyses were performed jointly and independently as a function of neonatal sex (separate analyses for male and female infants). Newborns exposed to high maternal psychological stress during pregnancy (a score above 26 measured using the PSM-9 questionnaire, corresponding to >97.5th percentile) were compared to newborns of mothers who reported lower stress. ANCOVAs revealed that high levels of maternal stress during pregnancy were linked to infant birthweight as a function of infant sex. Male infants of mothers who reported high levels of stress had a greater birthweight whereas female infants had a lower birthweight under the same conditions, in comparison to mothers who did not report greater levels of stress. Although the effect size is small, these results underline the possibility that male and female fetuses may use different strategies when adapting to maternal adversity and highlight the need to consider infant sex as a moderator of the association between maternal psychological stress during pregnancy and infant birthweight.

Kangaroo mother care had a protective effect on the volume of brain structures in young adults born preterm.

AIM: The protective effects of Kangaroo mother care (KMC) on the neurodevelopment of preterm infants are well established, but we do not know whether the benefits persist beyond infancy. Our aim was to determine whether providing KMC in infancy affected brain volumes in young adulthood. METHOD: Standardised cognitive, memory and motor skills tests were used to determine the brain volumes of 20-year-old adults who had formed part of a randomised controlled trial of KMC versus incubator care. Multivariate analysis of brain volumes was conducted according to KMC exposure. RESULTS: The study comprised 178 adults born preterm: 97 had received KMC and 81 were incubator care controls. Bivariate analysis showed larger volumes of total grey matter, basal nuclei and cerebellum in those who had received KMC, and the white matter was better organised. This means that the volumes of the main brain structures associated with intelligence, attention, memory and coordination were larger in the KMC group. Multivariate lineal regression analysis demonstrated the direct relationship between brain volumes and duration of KMC, after controlling for potential confounders. CONCLUSION: Our findings suggest that the neuroprotective effects of KMC for preterm infants persisted beyond childhood and improved their lifetime functionality and quality of life.

Impact of maternal prenatal psychological stress on birth weight.

OBJECTIVE: The study aimed to evaluate the impact of prenatal maternal stress on birth weight using a large cohort of predominantly White women living in an urban area. METHOD: Women were recruited between 2005 and 2010. Data collection took place between the 24th and the 28th week of gestation. The Measure of Psychological Stress (MSP-9), a validated tool to assess stress symptoms, was used to collect data on prenatal maternal stress (independent variable). Birth weight (dependent variable) was classified as low birth weight (<2,500 g), normal birth weight (2,500-4,000 g), and macrosomia (>4,000 g). Adjusted odds ratios (aOR) were obtained after performing multivariate logistic regressions adjusted for potential cofounders. At the final stage, 5,721 women were included in analysis. RESULTS: When compared with women experiencing low stress, participants with high stress scores were at increased risk of delivering a newborn with low birth weight before adjustment (OR = 2.06, 95% CI [1.04, 4.09]), but after adjustment, only a nonsignificant trend remained. However, women experiencing intermediate and high levels of stress were at increased risk of delivering a newborn with macrosomia, even after adjustment (aOR = 1.23, [1.02, 1.49]) and (aOR = 1.76, [1.11, 2.77]) compared to those who scored low on the psychological stress scale. CONCLUSION: Women exposed to high psychological stress during the second trimester (24th to 28th weeks) of pregnancy have a 1.8-fold increased risk for delivering a newborn with macrosomia when compared to women exposed to low psychological stress. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Randomised controlled trial on the impact of kinesthetic stimulation on early somatic growth of preterm infants in Kangaroo position.

AIM: Evaluation of early growth in preterm infants receiving kinesthetic stimulation with massage in Kangaroo position or in incubator. METHODS: A cohort of 66 infants between 30 and 33 weeks of gestational age (GA), born at a university hospital in 2013 in Bogota, were randomised when eligible to intervention. We measured weight gain (g/kg/day) at five days and 15 days postrandomisation and weight at 40 weeks, according to chronological age at randomisation. RESULTS: Daily weight gain was significantly higher (p = 0.02) with kinesthetic stimulation in Kangaroo position with a growth at five days of 11.0 g/kg/day (95% CI 5.7;16.3) and at 15 days of 12.1 g/kg/day (95% CI 10.4;13.7) versus 2.1 g/kg/day (95% CI -3.1;7.4) at five days and 9.4 g/kg/day (95% CI 7.7;11.1) at 15 days in incubator. Weight at 40 weeks was higher (p = 0.05) in Kangaroo position group (2.904 g) than in incubator group (2.722 g) (95% CI 2.784;3.007). Daily weight gain according to chronological age at randomisation was higher when kinesthetic stimulation initiates before five days of life in Kangaroo position with 1.53 g/kg/day (95% CI 5.9;9.0) versus -11.9 g/kg/day (95% CI -19.0;-4.8) in incubator. CONCLUSION: Early kinesthetic stimulation in Kangaroo position reduces the initial weight loss in infants between 30-33 weeks born without major health problems.

Altered transcallosal inhibition evidenced by transcranial magnetic stimulation highlights neurophysiological consequences of premature birth in early adulthood.

BACKGROUND AND OBJECTIVE: A very preterm birth can induce deleterious neurophysiological consequences beyond childhood; alterations of the corpus callosum (CC) are reported in adolescents born very preterm along with cognitive impairments. The question remains whether neurophysiological alterations are still detectable in adulthood such as an alteration in CC inhibitory function. The aim of the present study was thus to examine transcallosal inhibition in young adults born very preterm compared to counterparts born at term. STUDY PARTICIPANTS & METHODS: Transcallosal inhibition was probed by measuring the ipsilateral silent period (iSP) using transcranial magnetic stimulation (TMS) in 13 young adults born at 33w of gestation or less (20 ±â€¯3. 2y) and 12 young adults born at term (22 ±â€¯1. 75y). Single high-intensity TMS were delivered to the primary motor cortex (M1) ipsilateral to the preactivated first dorsal interosseous (FDI) muscle. Occurrence, latency, and duration of iSP were measured in the FDI EMG activity, for both hemispheres alternatively (10-12 trials each) along with their resting motor threshold (RMT). RESULTS: In individuals born very preterm as compared to individuals born at term, ISP occurred less frequently (p < .0001), its latency was longer (p = .004), especially in the non-dominant hemisphere, its duration shorter (p < .0001), and RMT was higher in the non-dominant M1 than in the dominant. CONCLUSIONS: Impairment of transcallosal inhibition along with asymmetry of M1 excitability in young adults born very preterm as compared to those born at term underline that neurophysiological consequences of a preterm birth can still be detected in early adulthood.

The long-term effects of the Kangaroo Mother Care intervention on cognitive functioning: Results from a longitudinal study.

This study aimed to evaluate the long-term effects of the Kangaroo Mother Care (KMC) intervention on the intellectual and attentional functioning of young adults born with low birth weight. Three hundred infants were randomly assigned at birth in one of two interventions, KMC or traditional care (TC), and completed cognitive tests at adulthood (19-21 years after recruitment). The main results show that participants with a neurological vulnerability at 6 months had higher IQ and sustained attention scores at adulthood if they had received KMC than if they had received TC.

Cortisol and blood pressure levels decreased in fathers during the first hour of skin-to-skin contact with their premature babies.

AIM: Premature birth is an extremely stressful experience. In 2013 to 2014, we explored the physiological stress responses of fathers during their first skin-to-skin contact (SSC) with their new baby. METHODS: We recruited 49 fathers whose partners had given birth to a premature baby of up to 33 weeks and three days. The study, in the neonatal intensive care unit (NICU) of a Quebec hospital, measured the physiological stress responses of the fathers before and after they first experienced SSC with their new baby. Cortisol levels and blood pressure were measured, and a generalised estimating equation was used for the data analysis. RESULTS: The fathers' cortisol levels decreased from 10.55 nmol/L, with a 95% confidence interval (95% CI) of 9.61-11.59 at the beginning of the experiment to 8.26 nmol/L (95% CI: 7.51-9.07) after 75 minutes. Meanwhile, their systolic blood pressure decreased from 135.16 mmHg (95% CI: 130-140) to 125.25 mmHg (95% CI: 121-129). CONCLUSION: Fathers who held their baby in SSC for the first time showed a significant reduction in physiological stress responses. Our findings support hospital practices that enable fathers to experience their first intimate contact with their newborn infant in the NICU.

Social dominance in children with cerebral palsy during a problem-solving task with peers.

PURPOSE: Children with cerebral palsy tend to have poorer social competence outcomes than their peers without a disability in mainstream school settings. To understand their social competence, this study compared children with cerebral palsy with paired children without cerebral palsy with respect to their ability to access resources, defined here as "social dominance", in a problem-solving situation. METHOD: Children with cerebral palsy were randomly paired to a peer (teammate) and put in a competitive context where each team of two children was instructed to solve an impossible problem. To control for social status, a sociometric measure was administered previously in the classroom (Social Preference score). Behaviors related to social dominance (prosocial and coercive behaviors) were coded using an observation scale validated for this study. RESULTS: The results showed that regardless of social status, children with cerebral palsy were less socially dominant than controls without cerebral palsy. Furthermore, their teams seemed to be less dominant than teams composed of two controls. CONCLUSIONS: The lower social competence in children with cerebral palsy could be partly explained by their reduced social dominance behavior in activities requiring speed and fluidity as an expression of executive functions. This might be viewed as a marker for social risks in the integration process at school. Implications for rehabilitation Gross Motor Function Classification System level I or II cerebral palsy is a condition that affects not only motor abilities but also social competence in children. Lower social competence in children with cerebral palsy could be partly explained by reduced social dominance behavior in activities such as problem solving with peers. To improve social competence, rehabilitation interventions should include social participation opportunities in which children with cerebral palsy are encouraged to take an active role in the activity.

Sociometric status and the attribution of intentions in a sample of adolescents with cerebral palsy.

Purpose To examine how cerebral palsy (CP) and sociometric status at age 10 explain the development of a cognitive bias across two groups of adolescents aged 15. Method Children with CP (N = 60) and without CP (N = 57) are part of a follow-up study. Three categories of sociometric status (popular, average, rejected) were obtained by conducting a class-wide interview in the class of the target children at age 10. At 15 years old, the same children (CP and non-CP) were asked to complete the Home Interview With Child questionnaire measuring a cognitive bias (hostile attribution of intentions (AI)). Results Children with CP, especially girls, were significantly more rejected and less popular than controls at age 10. At age 15, among all participants, sociometric rejected and popular children tended to have a higher percentage of hostile AI than sociometric average children. Conclusions There were no significant results for the combined effect of CP and sociometric status on the development of hostile AI at age 15. However, knowing the risk incurred by children with CP of being socially rejected, attention should be paid in the rehabilitation process to opportunities for social participation to facilitate the development of social competence. Implications for Rehabilitation Level I or II cerebral palsy (CP) is a condition that affects not only motor abilities but also social competence in children. Sociometric status in a group tends to affect the development of the ability to interprete intentions of others during adolescence. Sociometric measures in the class of children with CP could be a useful tool in the rehabilitation process in order to better define social participation opportunities. To improve social participation attempts, rehabilitation interventions should target social initiating skills, flexibility in interpreting peers' behaviours, and ability to react effectively to negative peer treatment.

Twenty-year Follow-up of Kangaroo Mother Care Versus Traditional Care.

BACKGROUND AND OBJECTIVES: Kangaroo mother care (KMC) is a multifaceted intervention for preterm and low birth weight infants and their parents. Short- and mid-term benefits of KMC on survival, neurodevelopment, breastfeeding, and the quality of mother-infant bonding were documented in a randomized controlled trial (RCT) conducted in Colombia from 1993 to 1996. The aim of the present study was to evaluate the persistence of these results in young adulthood. METHODS: From 2012 to 2014, a total of 494 (69%) of the 716 participants of the original RCT known to be alive were identified; 441 (62% of the participants in the original RCT) were re-enrolled, and results for the 264 participants weighing ≤1800 g at birth were analyzed. The KMC and control groups were compared for health status and neurologic, cognitive, and social functioning with the use of neuroimaging, neurophysiological, and behavioral tests. RESULTS: The effects of KMC at 1 year on IQ and home environment were still present 20 years later in the most fragile individuals, and KMC parents were more protective and nurturing, reflected by reduced school absenteeism and reduced hyperactivity, aggressiveness, externalization, and socio-deviant conduct of young adults. Neuroimaging showed larger volume of the left caudate nucleus in the KMC group. CONCLUSIONS: This study indicates that KMC had significant, long-lasting social and behavioral protective effects 20 years after the intervention. Coverage with this efficient and scientifically based health care intervention should be extended to the 18 million infants born each year who are candidates for the method.

Risk for preterm and very preterm delivery in women who were born preterm.

OBJECTIVE: To evaluate whether women who themselves were born preterm are at increased risk of preterm delivery and, if so, whether known maternal complications of preterm birth such as hypertension or diabetes explain this risk. METHODS: We conducted a population-based cohort study of all women born preterm (51,148) and term (823,991) in Québec, Canada, between 1976 and 1995; after frequency matching 1:2 preterm to term, we examined the relationship of preterm birth between women and their offspring. RESULTS: The study included 7,405 women who were born preterm (554 before 32 weeks of gestation and 6,851 at 32-36 weeks of gestation) and 16,714 women born term, who delivered 12,248 and 27,879 newborns, respectively. Overall, 14.2% of women born before 32 weeks of gestation, 13.0% of 32-36 weeks of gestation, and 9.8% of those born term delivered prematurely at least once during the study period, including 2.4%, 1.8%, and 1.2%, respectively, who delivered very preterm (both P<.001 for trend). After adjustment for factors including own birth weight for gestational age and pregnancy complications, the overall odds of preterm first live delivery associated with being born preterm was elevated by 1.63-fold (95% confidence interval [CI] 1.22-2.19) for women born before 32 weeks of gestation and 1.41-fold (95% CI 1.27-1.57) for those born at 32-36 weeks of gestation relative to women born term. CONCLUSION: Women who themselves were born preterm are at increased risk of delivering their neonates prematurely. This is independent of prematurity risks associated with hypertension and diabetes. LEVEL OF EVIDENCE: II.

Pregnancy complications among women born preterm.

BACKGROUND: Adults who were born with low birth weights are at increased risk of cardiovascular and metabolic conditions, including pregnancy complications. Low birth weight can result from intrauterine growth restriction, preterm birth or both. We examined the relation between preterm birth and pregnancy complications later in life. METHODS: We conducted a population-based cohort study in the province of Quebec involving 7405 women born preterm (554 < 32 weeks, 6851 at 32-36 weeks) and a matched cohort of 16 714 born at term between 1976 and 1995 who had a live birth or stillbirth between 1987 and 2008. The primary outcome measures were pregnancy complications (gestational diabetes, gestational hypertension, and preeclampsia or eclampsia). RESULTS: Overall, 19.9% of women born at less than 32 weeks, 13.2% born at 32-36 weeks and 11.7% born at term had at least 1 pregnancy complication at least once during the study period (p < 0.001). Women born small for gestational age (both term and preterm) had increased odds of having at least 1 pregnancy complication compared with women born at term and at appropriate weight for gestational age. After adjustment for various factors, including birth weight for gestational age, the odds of pregnancy complications associated with preterm birth was elevated by 1.95-fold (95% confidence interval [CI] 1.54-2.47) among women born before 32 weeks' gestation and 1.14-fold (95% CI 1.03-1.25) among those born at 32-36 weeks' gestation relative to women born at term. INTERPRETATION: Being born preterm, in addition to, and independent of, being small for gestational age, was associated with a significantly increased risk of later having pregnancy complications.

Cerebral motor function in very premature-at-birth adolescents: a brain stimulation exploration of kangaroo mother care effects.

AIM: Given that prematurity has deleterious effects on brain networking development beyond childhood, the study explored whether an early intervention such as Kangaroo Mother Care (KMC) in very preterm preemies could have influenced brain motor function up to adolescence. METHODS: Transcranial magnetic stimulation (TMS) was applied over the primary motor cortex (M1) of 39 adolescents born very prematurely (<33 weeks' gestational age, 21 having received KMC after birth, 18 Controls with no KMC) and nine adolescents born at term (>37 weeks' gestational age, >2500 g) to assess the functional integrity of motor circuits in each hemisphere (motor planning) and between hemispheres (callosal function). RESULTS: All TMS outcomes were similar between KMC and term adolescents, with typical values as in healthy adults, and better than in Controls. KMC adolescents presented faster conduction times revealing more efficient M1 cell synchronization (p < 0.05) and interhemispheric transfer time (p < 0.0001), more frequent inhibitory processes with a better control between hemispheres (p < 0.0001). CONCLUSION: The enhanced synchronization, conduction times and connectivity of cerebral motor pathways in the KMC group suggests that the Kangaroo Mother Care positively influenced the premature brain networks and synaptic efficacy up to adolescence.

Self-concept in children with cerebral palsy: is there something in the wind?

PURPOSE: The aim of this study was to compare self-concept in four groups of children distinguished by the presence/absence of either a motor impairment (with and without cerebral palsy, CP) or social adjustment problems (victimisation). METHOD: Four groups were formed: a victimised CP group (n=17), a non-victimised CP group (n=41), a victimised comparison group (n=10) and a non-victimised comparison group (n=46). Self-concept was measured using the Self-Perception Profile for Children (SPPC, Harter The Self-Perception Profile for Children. Unpublished manual. Denver, CO: University of Denver; 1985) during the school visit. Victimisation was obtained by conducting a classwide sociometric interview in the class of the target child. RESULTS: The results indicate that the groups differ depending on the domain measured. CONCLUSIONS: By identifying factors that may influence self-concept in children with CP, this study contributes new information to this subject.

Observed behaviours of pre-term children in a social play situation with classroom peers.

BACKGROUND: A number of studies have reported social adjustment problems in pre-term children. OBJECTIVES: To observe the pre-term's behaviour in an experimental situation and correlate these observed behaviours with the children's peer-rated social behaviours (withdrawal, aggression and sociability/leadership). METHODS: Of 56 pre-term children, 24 were classified as the sick pre-term (SPT) group and 32 children as the healthy pre-term (HPT) group. The comparison group comprised 56 healthy full-terms. The experimental situation used a game called Rush Hour, a labyrinth-type board game. The play situation was videotaped and behaviours (number of consecutive moves) were coded in real time. RESULTS: At 12 years of age, the sick pre-term (SPT) group exhibited fewer consecutive moves during the game than the other two groups, especially when the task became more complex (involving four consecutives moves). Moreover, the Complex Task Index was correlated with the social withdrawal score rated by peers. CONCLUSION: The at-birth sick pre-term gradually became less involved in a complex decision-making task and this was understood as a lesser ability to make a decision in a complex setting.

Social adjustment at school: Are children with cerebral palsy perceived more negatively by their peers than other at-risk children?

PURPOSE: To compare three dimensions of social adjustment (social status, friendship and victimization) across four groups of children between the ages of nine and 12 who differ by their birth status (premature vs. at term) and the presence or absence of a motor impairment (with and without cerebral palsy [CP]). METHOD: All premature (n = 72) and term children (n = 118) without CP and all children with CP (premature with CP: n = 49; term with CP: n = 29) are part of a follow-up study. Social adjustment measures were obtained by conducting a classwide sociometric interview in the class of the target child. RESULTS: Irrespective of their birth status, girls with CP have more social adjustment problems than those without a disability. With respect to victimization, the results show that, irrespective of gender, both CP children and premature children (without CP) differ from their term peers (without CP). CONCLUSIONS: By comparing the four groups, we are able to qualify the impact of a visible clinical impairment such as CP versus that of extreme prematurity on social adjustment.

Visuo-motor coordination in 8-year-old children born pre-term before and after 28 weeks of gestation.

PURPOSE: This study compared the visuo-motor abilities between pre-term and full-term children. METHODS: Twenty-three 8-year-old children participated, five being born under 28 weeks gestational age (wGA) referred to as Preterms1 (mean=8 years 5 months [SD 0.3]), nine Preterms2 of 28-35 wGA (mean=7 years 9 months [SD 0.7]) and nine typically developing full-term controls (mean=8 years 6 months [SD 0.7]). All children were studied in an interhemispheric transfer time and in a visuo-manual pointing-task to test motor programming time in three conditions: unimanual pointing (dominant, non-dominant hands), mirror bimanual pointing (same direction for both hands) and opposite bimanual pointing. RESULTS: Significant differences were detected between Preterms 1 and 2, the latter being similar to controls. Preterms1 presented increases in interhemispheric time, suggesting an alteration in the transcallosal pathways. Programming time was significantly lengthened (p50.01) for dominant hand unilateral pointing and opposite bilateral pointing and it was the shortest for mirror pointing. CONCLUSIONS: A faulty programming of visuo-manual tasks is suspected in Preterms1 with potential difficulty inhibiting the non-dominant limb mirror movement. This may result from an impaired interhemispheric inhibition owing to potential corpus callosum thinning. Such measures may be used to help follow-up subtle changes in fine motor control and detect pre-terms at risk of developing long-term deficits.

The performance profile on the Wisconsin Card Sorting Test of a group of children with cerebral palsy aged between 9 and 12.

PURPOSE: The aim of this study was to determine the performance profile of a group of children with cerebral palsy (CP) on the Wisconsin Card Sorting Test (WCST). METHODS: The sample consisted of 102 children aged between 9-12, divided into two groups: the clinical group consisted of 52 children with in mainstream class (37 with hemiplegia and 15 with diplegia), while the comparison group comprised 50 children matched for class, gender, age and socioeconomic status. RESULTS: The findings showed that children with CP make more non-perseverative errors, they completed fewer categories, required more trials to complete the first category and gave fewer conceptual responses than control children. Children with diplegia are distinguished more from comparison children than children with hemiplegia. CONCLUSION: The results suggest a difficulty in initial conceptualization that could be attributable to a slow rate of information processing. Delayed maturation of the nervous system is likely to be implied.

Social adjustment of children with cerebral palsy in mainstream classes: peer perception.

The aim of this study was to describe the social experience of children with cerebral palsy (CP) in mainstream classes in Canada and compare it with that of their classmates without disability. The CP group included 25 females and 35 males (mean age 10 y 5 mo [SD 0.95], range 10 y 4 mo-10 y 10 mo) diagnosed as having hemiplegia (n=44) or diplegia (n=16) and classified as Level I on the Gross Motor Function Classification System (GMFCS). Fifty-seven comparison children, born at term and without any motor and/or sensory impairment, were recruited from the classes of the children with CP during a school visit (mean age 10 y 3 mo, [SD 1.0], range 10 y-10 y 6 mo). They were matched to children with CP for sex, age, parents' education level, and family income. Social adjustment measures (social status, reciprocated friendships, social isolation, aggression, sociability/leadership, and verbal and/or physical victimization) were obtained by conducting a class-wide sociometric interview (n=943) in the classes of the children with CP. Findings showed that children with CP (specifically females with CP and irrespective of their type of disability) had fewer reciprocated friendships, exhibited fewer sociable/leadership behaviours, and were more isolated and victimized by their peers than their classmates without a disability. This seems to suggest that females and males with CP are perceived differently from their peers in a mainstreaming context. The discussion addresses the issue of age- and sex-related differences and provides avenues of intervention relating to personal and environmental factors that could facilitate or interfere with the social experience of children with CP in a mainstream environment.