Web-based follow-up tool (ePIPARI) of preterm infants-study protocol for feasibility and performance.

BACKGROUND: Preterm infants have a risk of health and developmental problems emerging after discharge. This indicates the need for a comprehensive follow-up to enable early identification of these problems. In this paper, we introduce a follow-up tool "ePIPARI - web-based follow-up for preterm infants". Our future aim is to investigate whether ePIPARI is a feasible tool in the follow-up of preterm infants and whether it can identify children and parents in need of clinical interventions. METHODS: ePIPARI includes eight assessment points (at term age and at 1, 2, 4, 8, 12, 18, and 24 months of corrected age) when the child´s health and growth, eating and feeding, neurodevelopment, and parental well-being are evaluated. ePIPARI consists of several widely used, standardized questionnaires, in addition to questions typically presented to parents in clinical follow-up visits. It also provides video guidance and written information about age-appropriate neurodevelopment for the parents. Parents of children born before 34 weeks of gestation during years 2019-2022 are being invited to participate in the ePIPARI study, in which web-based follow-up with ePIPARI is compared to clinical follow-up. In addition, the parents of children born before 32 weeks of gestation, who reached the corrected age of two years during 2019-2021 were invited to participate for the assessment point of 24 months of ePIPARI. The parents are asked to fill in the online questionnaires two weeks prior to each clinical follow-up visit. DISCUSSION: The web-based tool, ePIPARI, was developed to acquire a sensitive and specific tool to detect infants and parents in need of further support and clinical interventions. This tool could allow individualized adjustments of the frequency and content of the clinical visits. TRIAL REGISTRATION: ClinicalTrials.cov, NCT05238168 . Registered 11 April 2022 - Retrospectively registered.

Continuous positive airway pressure treatment may negatively affect auditory maturation in preterm infants.

AIM: Nasal continuous positive airway pressure (CPAP) devices generate loud noise, which might harm auditory function and maturation. The function of auditory pathways can be examined by using brainstem auditory evoked potential (BAEP) and brainstem audiometry (BA) recordings. Our objective was to study whether CPAP treatment during the neonatal period is associated with abnormalities in BAEP and BA recordings. METHODS: Included in this retrospective study were preterm infants (birth weight ≤1500 g and/or gestational age ≤32 weeks) born between 2002 and 2006 with a comprehensive clinical background and follow-up data, including the duration of CPAP treatment (n = 162). BAEP and BA were recorded near the mean corrected age of one month. The following variables from BAEP and BA examinations were analysed: latencies of BAEP components I, III, V, interpeak intervals (IPI) I-V, I-III, III-V (ms), amplitude I and V (µV), amplitude ratio I/V and BA thresholds. RESULTS: In the adjusted analysis, a longer CPAP treatment leads to longer latencies of BAEP component III (p = 0.01) and V (p = 0.02) in the right ear. CONCLUSION: CPAP treatment may impair the auditory maturation and processing mediated via the dominant right ear. The hearing and neurodevelopment of the children who are treated with CPAP should be followed.

Neonatal brainstem auditory function associates with early receptive language development in preterm children.

AIM: To study whether auditory function measured with brainstem auditory evoked potential and brainstem audiometry recordings in the neonatal period associates with language development 1 year later in preterm infants. METHODS: This retrospective study included 155 preterm infants (birthweight ≤1500 g and/or birth ≤32 gestational weeks) born between 2007 and 2012 at the Turku University Hospital. Auditory function was recorded in neonatal period. Information of language development was gathered at the mean corrected age of 1 year by using the Finnish version of the MacArthur Communicative Development Inventory. RESULTS: Slower auditory processing (longer interpeak interval, IPI I-V) in the right ear in the neonatal brainstem auditory evoked potential recording associated with smaller receptive lexicon size at 1 year (P = .043). Infants with longer IPI I-V were more likely to have a deviant (≤17 words) receptive lexicon size (P = .033). The absence of a contralateral response with right ear stimulation increased the risk for deviant lexicon size (P = .049). CONCLUSION: The results suggest that impaired auditory function in the neonatal period in preterm infants may lead to a poorer receptive language outcome 1 year later. Auditory pathway function assessment provides information for the identification of preterm children at risk for weak language development.

Bullying Among International Adoptees: Testing Risks and Protective Factors.

This study examined the risks and protective factors for experiencing bullying and especially racist bullying among internationally adopted children in Finland. Factors examined were related to children's background, adoptive family, children's social problems and social skills, and their associations with bullying experiences. About 56.9% of children reported bullying victimization and 24.2% racist bullying victimization. Boys were at bigger risk of becoming bullied (B = 0.14, p < .05), as were children with disability (B = 0.11; p < .05). The continent of birth (European; B = 0.51; p < .001) and adoptive family's lower socioeconomic status (SES; B = 0.16; p < .05) were associated with increased victimization. Child's social problems increased the likelihood of victimization for both general (B = 0.59, p < .001) and racist bullying (B = 0.10, p < .001). Child's social skills appeared as a protective factor against general bullying (B = 3.87; p > .001). This study shows that interventions for tackling children's social problems and improving their social skills may reduce children's risk for bullying involvement.

Parental depressive symptoms as a risk factor for child depressive symptoms; testing the social mediators in internationally adopted children.

Parental depressive symptoms have shown to be associated with offspring depression but much of the research has been focused on maternal depression. The aim of our study was to investigate the extent to which depressive symptoms of both parents associate with offspring depressive symptoms and whether social factors mediate these associations using data from adopted children with no shared genetic background. Data were derived from the Finnish Adoption survey study (a subsample of adopted children aged between 9 and 12 years, n = 548). Parental depressive symptoms were measured using short version of the General Health Questionnaire and Children's Depression Inventory (CDI) was used to measure depressive symptoms in adoptees. Paternal depressive symptoms were related to the total CDI (B = 0.33, p = 0.05) and two dimensions of offspring depressive symptoms: negative mood (B = 0.10, p = 0.03) and interpersonal problems (B = 0.06, p = 0.009). These associations remained significant even when adjusted for child's age and gender, age at adoption, type of placement before adoption, continent of birth and adoptive family's SES. No associations were found between maternal and any dimensions of offspring depressive symptoms. No information about the mental health of biological parents was available. We interpret the results as demonstrating that intergenerational transmission of depressive symptoms is not solely related to shared genes. Also, the results highlight the association of paternal depression with offspring depressive symptoms.

Child and family-related predictors of psychological outcomes in children adopted from abroad; what is the role of caregiver time?

International adoptees need to cope with stressful transitions and to develop secure attachment with their caregivers at the same time. Although most children adopted from abroad adjust fine, they are at increased risk of psychological problems. We investigated whether both child and family-related factors are associated with later psychological problems and whether the length of time spent at home after adoption before daycare moderates these associations among internationally adopted children in Finland (FinAdo, Finnish Adoption Study). The sample consisted of 1,265 children (708 girls, 557 boys) who arrived in Finland before they started school (mean age 2 years at arrival). Later behavioral problems were measured using the Child Behavior Check List (CBCL). According to our results, male gender, older age, child's early clinical symptoms (problems of sensory processing) and single parenthood were associated with later behavioral problems measured by CBCL scores. Longer stay at home before the start of daycare or school modified these results. Longer stay at home was associated with less later behavioral externalizing problems in girls but not in boys compared to those who spent a shorter time at home.

Health-related quality of life in very low birth weight children at nearly eight years of age.

AIM: This study examined the impact of prematurity-related morbidity on the health-related quality of life (HRQoL) of premature children at eight years of age, compared to term born controls of same age. METHODS: We focused on 155 premature, very low birth weight (VLBW) infants weighing up to 1500 g who were born from 2001 to 2006 in Turku University Hospital, Finland, and compared them with 129 full-term controls. Cognitive development and length was assessed at five years of age and the children self-reported 17 dimensions of HRQoL at eight years of age. The VLBW group was subdivided into healthy children and those with prematurity-related morbidities. RESULTS: Our findings showed that 64.5% of the VLBW children did not have prematurity-related morbidities. The HRQoL of the healthy preterm VLBW children was very good and did not differ significantly from the controls. However, the VLBW children with one or more morbidities had significantly lower scores in nine of the 17 HRQoL dimensions than the children in the control group. CONCLUSION: The majority of the VLBW children survived without prematurity-related morbidities, and their HRQoL was very good and similar to the control children. The main goal of neonatal care for preterm infants should be to prevent long-term morbidities.

High lipoprotein(a) concentrations are associated with impaired endothelial function in children.

OBJECTIVE: To examine the association between familial high lipoprotein(a), or Lp(a), concentrations and endothelial function in children participating in the Special Turku Coronary Risk Factor Intervention Project study. STUDY DESIGN: Seven-month-old children (n = 1062) with their families were randomized to a risk intervention group or to a control group. The intervention group received individualized dietary counseling to reduce the total cholesterol concentration. Children's Lp(a) and lipid values were measured repeatedly. At age 11 years, children were recruited to an ultrasound study of the flow-mediated dilation (FMD) of the brachial artery. The association between relative peak FMD and Lp(a) concentration was examined in 198 control and 193 intervention group children by linear regression analyses adjusted for sex, total cholesterol concentration, and basal artery diameter. The analyses were made in both the control and intervention groups and in the familial risk children who had a parent with Lp(a) concentration greater than 250 mg/l. RESULTS: Lp(a) concentrations were similar at age 11 years in the intervention and control groups. In all control children, FMD (%) associated inversely with Lp(a) concentration: (ß [%/1000 mg/L] = -3.74, 95% CI [-6.43, -1.45]; P = .007) and in 68 familial risk children (ß = -4.92, 95% CI [-8.18, -1.66]; P = .0037). In the intervention group the associations were lacking (P > .5), and FMD in the children with high Lp(a) concentrations (>500 mg/L, n = 12) had no attenuation (P = .027). CONCLUSIONS: Familial high Lp(a) concentration is associated with attenuated endothelial function. This association may be mitigated by an early lifestyle intervention. TRIAL REGISTRATION: ClinicalTrials.gov: NCT00223600.

Associations between attachment-related symptoms and later psychological problems among international adoptees: results from the FinAdo study.

We examined the associations between attachment-related symptoms (symptoms of reactive attachment disorder (RAD), symptoms of disinhibited social engagement disorder (DSED), and clinging) and later psychological problems among international adoptees. The study population comprised internationally adopted children (591 boys and 768 girls, 6-15 years) from the ongoing Finnish Adoption (FinAdo) study. Data were gathered with self-administered questionnaires both from adoptive parents and from adoptees aged over 9 years. Attachment-related symptoms were measured using of a short (8-item) questionnaire and later behavioral/emotional problems were assessed using the Child Behavior Checklist (CBCL) and the Five to Fifteen (FTF) scale for attention-deficit/hyperactivity disorder (ADHD) symptoms. RAD and DSED symptom subscales were associated with an increased risk of emotional and behavioral problems and ADHD. Especially the mixed type of attachment-related symptoms was strongly associated with later emotional and behavioral problems.

The prevalence and predictive value of weak language skills in children with very low birth weight--a longitudinal study.

AIM: Previous findings regarding the prevalence and predictive value of weak language skills in preterm children with very low birth weight (VLBW) are unclear. This study analysed the prevalence of weak language skills, the predictive value of early weak language skills on later weak language skills, and the sensitivity and specificity of cognitive scores for identifying concurrent weak language skills in a longitudinal sample of VLBW children (n = 141) and their full-term controls (n = 146). METHODS: Data on language skills and cognitive development were gathered at two and five years of age. Weak language skills were defined by the 10th percentile value of the controls. RESULTS: In VLBW children, the prevalence of weak language skills varied between 16% and 18% at 2 years of age (controls: 8 to 10%) and between 20% and 27% at 5 years of age (controls: 10%). Early weak language skills predicted later weak language skills in VLBW children. Cognitive scores were specific, but their sensitivity for identifying concurrent weak language skills was low. CONCLUSION: The prevalence of weak language skills in VLBW children increased during the follow-up period and was higher than the controls. Language-sensitive methods should be used in the clinical follow-up of VLBW children.

Effect of antenatal growth on brain white matter maturation in preterm infants at term using tract-based spatial statistics.

BACKGROUND: White matter maturation of infants can be studied using diffusion tensor imaging (DTI). DTI of the white matter of the infant brain provides the best available clinical measures of brain tissue organisation and integrity. OBJECTIVE: The purpose of this study was to compare white matter maturation between preterm infants born small for gestational age (SGA) and preterms with weight appropriate for gestational age (AGA) at birth. MATERIALS AND METHODS: A total of 36 preterm infants were enrolled in the study (SGA, n = 9). A rater-independent method called tract-based spatial statistics (TBSS) was used to assess white matter maturation. RESULTS: When measured by TBSS, the AGA infants showed higher fractional anisotrophy values in several white matter tracts than the SGA infants. Areas with significant differences included anterior thalamic radiation, corticospinal tract, forceps major and minor, inferior fronto-occipital fasciculus, inferior longitudinal fasciculus, superior longitudinal fasciculus, uncinate fasciculus, and superior longitudinal fasciculus (temporal part). No significant difference was found for mean diffusivity. CONCLUSION: As an objective and user-independent method, TBSS confirmed that preterm infants with impaired antenatal growth have impaired white matter maturation compared to preterm infants with normal antenatal growth. The differences were mainly detected in radiations that are myelinated first.

Preterm infants' early growth and brain white matter maturation at term age.

BACKGROUND: Normal intrauterine conditions are essential to normal brain growth and development; premature birth and growth restriction can interrupt brain maturation. Maturation processes can be studied using diffusion tensor imaging. OBJECTIVE: The aim of this study was to use tract-based spatial statistics to assess the effect that early postnatal growth from birth to 40 gestational weeks has on brain white matter maturation. MATERIALS AND METHODS: A total of 36 preterm infants were accepted in the study. Postnatal growth was assessed by weight, length and head circumference. Birth weight z-score and gestational age were used as confounding covariates. RESULTS: Head circumference catch-up growth was associated with less mature diffusion parameters (P < 0.05). No significant associations were observed between weight or length growth and diffusion parameters. CONCLUSION: Growth-restricted infants seem to have delayed brain maturation that is not fully compensated at term, despite catch-up growth.

The emergence of grammar in very-low-birth-weight Finnish children at two years of age.

It is not well understood how grammar emerges in very-low-birth-weight (VLBW) children. The main aim of the present study was to gain information on the emergence of grammar in this group at 2 ; 0. The Finnish version of the Communicative Development Inventory was used to collect data from VLBW children (N = 156) and full-term controls (N = 146). At a group level, the grammatical skills of the VLBW children were significantly weaker than those of the controls. However, when the effect of lexicon size and premature birth on the emergence of grammar was analyzed in detail, few significant differences were found between the groups. The results suggest that even though grammar emerges more slowly for the VLBW children, it emerges in a manner comparable to that of the controls, when the effect of lexicon size is taken into consideration.

Five-to-Fifteen-Parental Perception of Developmental Profile from Age 5 to 8 Years in Children Born Very Preterm.

Children born very preterm have increased risk of developmental difficulties. We examined the parental perception of developmental profile of children born very preterm at 5 and 8 years by using the parental questionnaire Five-to-Fifteen (FTF) compared to full-term controls. We also studied the correlation between these age points. The study included 168 and 164 children born very preterm (gestational age < 32 weeks and/or birth weight ≤ 1500 g) and 151 and 131 full-term controls. The rate ratios (RR) were adjusted for sex and the father's educational level. At 5 and 8 years, children born very preterm were more likely to have higher scores (more difficulties) compared to controls in motor skills (RR = 2.3, CI 95% = 1.8-3.0 at 5 years and RR = 2.2, CI 95% = 1.7-2.9 at 8 years), executive function (1.7, 1.3-2.2 and 1.5, 1.2-2.0), perception (1.9, 1.4-2.5 and 1.9, 1.5-2.5), language (1.5, 1.1-1.9 and 2.2, 1.7-2.9), and social skills (1.4, 1.1-1.8 and 2.1, 1.6-2.7), and at 8 years in learning (1.9, 1.4-2.6) and memory (1.5, 1.2-2.0). There were moderate-to-strong correlations (r = 0.56-0.76, p < 0.001) in all domains between 5 and 8 years in children born very preterm. Our findings suggest that FTF might help to earlier identify children at the greatest risk of incurring developmental difficulties persisting to school-age.

Experiences of school bullying among internationally adopted children: results from the Finnish Adoption (FINADO) Study.

This study investigated the prevalence of and factors associated with school bullying and victimization among Finnish international adoptees. The Olweus bully/victim questionnaire was sent to all 9-15-year-old children adopted in Finland between 1985 and 2007 through the mediating organizations officially approved by the Ministry of Social Affairs and Health. The children were identified through official adoption organizations. The response rate in the target sample was 49.4%: the study sample consisted of 364 children (190 girls, 52.2%). The children's background factors and symptoms of reactive attachment disorder (RAD) were evaluated using a FINADO questionnaire. Their learning difficulties and social and language skills were assessed using a standardized parental questionnaire (Five to Fifteen). Of the participants, 19.8% reported victimization by peers while 8% had bullied others. Both victimization and bullying were associated with severe symptoms of RAD at the time of adoption (RR 2.68, 95%CI 1.50-4.77 and RR 2.08, 95%CI 1.17-3.69 for victimization and bullying, respectively). Lack of social skills was associated with victimization (RR 1.74, 95%CI 1.06-2.85) but not independently with being a bully (RR 1.50, 95%CI 0.91-2.45). In a multivariate analysis the child's learning difficulties and language difficulties were not associated with either bullying others or victimization.

Development and predictive value of early vocalizations in very-low-birth-weight children: a longitudinal study.

The aim of the present study was to analyze early vocalization development, the predictive value of this development in terms of later language skills, and possible gender difference in early vocalization development in a selected cohort of 32 very-low-birth-weight (VLBW) children and 35 full-term controls. The data on early vocalization development were gathered using a structured maternal report method. Language skills were assessed at 2.0. No significant difference was found between the groups in the rate of early vocalization development when corrected age was used for the VLBW children. The rate of early vocalization development correlated significantly with later language performance in VLBW children. Only weak correlations were detected in the control group. We found no gender difference in early vocalization development in either of the groups. The findings suggest that the rate of early vocalization development can be used as a clinical predictor of later linguistic performance in VLBW children.

Do the Temperamental Characteristics of Both Mother and Child Influence the Well-Being of Adopted and Non-Adopted Children?

(1) Background: For decades, the temperaments of infants and small children have been a focus of studies in human development and been seen as a potential contributor to children's developmental patterns. However, less is known about the interplay between the temperamental characteristics of mothers and their children in the context of explaining variations in developmental outcomes. The aim of our study was to explore the associations-with or without genetic links-of the temperaments and psychological distress of mothers and the temperaments of children with behavioral problems in a group of internationally adopted children and their adoptive mothers and in a group of non-adopted children and their mothers. (2) Methods: Data (n = 170) were derived from the ongoing Finnish Adoption (FinAdo) follow-up study. The children included were under the age of 7 years; 74 were adopted internationally through legal agencies between October 2010 and December 2016, and the remaining 96 were non-adopted children living with their birth parents (biological group) recruited from day-care centers. We used Mary Rothbart's temperament questionnaires to assess temperament, the Child Behavior Checklist (CBCL) to obtain data on the children's behavioral/emotional problems and competencies, and the General Health Questionnaire (GHQ) to assess parental psychological distress. The study was approved by the Ethics Committee of the Hospital District of Southwest Finland, and written informed consent was obtained from the parents and the children themselves. (3) Results: The negative affectivities of both mothers and children were associated with the total CBCL and with both internalizing and externalizing problem behaviors after adjusting for age, gender, and adoption status. Both relationships remained significant when tested simultaneously, suggesting additive effects. Maternal negative affect was associated with problem behavior irrespective of child extraversion/surgency. Child extraversion/surgency was associated with lower levels of all internalizing behavioral problems when adjusted for maternal sociability. Child negative affect was associated with all behavioral problem measures irrespective of maternal sociability or maternal psychological distress. Maternal distress was associated with child problem behaviors only in children with low extraversion/surgency. (4) Limitations: The sample size was relatively small, and the information was gathered solely with questionnaires. (5) Conclusions: The results of the study may be clinically significant. Child negative affect, maternal negative affect, and maternal experienced distress, combined with low child extraversion/surgency, may increase the risk of child problem behaviors in both adoptees and non-adoptees.

Changes in objectively measured sleep among internationally adopted children in 1-year follow-up during the first years in new families.

Background: Psychosocial risks and environmental changes experienced by internationally adopted children may predict sleep problems, which are incidentally among the main concerns of adoptive parents. Several questionnaire studies have found sleep of internationally adopted children to be problematic, but none of those used an objective measure in a controlled study. Objective: To determine whether the objectively recorded sleep of internationally adopted children is worse than their controls who are living with their biological parents. Methods: To this case-control part of the Finnish Adoption Study, we recruited children who were adopted internationally to Finland between October 2012 and December 2016. Simultaneously, control children were recruited from 16 daycare centers. To assess sleep in children, actigraphy recordings were made twice, 1 year apart, between December 2013 and April 2018. In the adopted group, the first assessment took place 10 months after they had arrived in their families. The associations between adoption status and sleep parameters were analyzed using linear mixed modeling and adjusted for multiple potential confounders, including child age. Results: Seventy-eight internationally adopted children (boys 64%) aged 1-7 years and 99 controls (boys 53%) aged 2-6 years attended the first sleep recording. The recordings showed that the internationally adopted children slept longer (B = 0.48, 95% CI 0.23-0.73, P < 0.001) than the controls. There were no significant differences in sleep fragmentation or sleep efficiency between the groups. During the 1-year follow-up, the sleep patterns of the adopted children approached those of the controls. Conclusions: The internationally adopted children spent more time in bed and slept more than their control children in both recordings. However, their sleep patterns were not very different from those of their peers and the differences appeared to vanish during the first years in their new family.