ABSTRACT
BACKGROUND: Recent research suggests that children born after suspected preterm labor may observe a potential cluster with different attention deficit hyperactivity disorder features, depending on the time of birth. However, the evolution of symptoms and their predictors remain unknown in this population. OBJECTIVE: This study aimed to examine the trajectories of attention deficit hyperactivity disorder symptoms of children born after suspected preterm labor, between ages 2 and 6 years, considering prematurity condition and comparing with controls. In addition, this study aimed to find potential modifiable predictors of evolution to enhance prognosis. STUDY DESIGN: In this prospective cohort study, 119 mother-child pairs who experienced suspected preterm labor and 60 controls were included. Patients were divided according to prematurity condition in full term (n=27), late preterm (n=55), and very preterm (n=37). Attention deficit hyperactivity disorder symptoms were assessed at ages 2 and 6 years. The association between potential modifying factors (group, time of assessment, sex, birthweight percentile, maternal history of trauma, maternal anxiety at diagnosis, and maternal anxiety during the children's assessments) and disorder trajectories was assessed by adjusting the Bayesian mixed linear models. All analyses were performed in R (version 4.3.0; R Foundation for Statistical Computing, Vienna, Austria). RESULTS: An interaction emerged between time and group, with late-preterm neonates born after suspected preterm labor being the only group to improve from ages 2 to 6 years (-2.26 points in Conners scale per percentile decrease and 0.98 probability of effect). Another interaction between time and maternal anxiety at postnatal time assessments intensified over time (0.07 and 0.84). Predictors of symptom severity included lower weight percentile at birth (-0.2 and 0.96), male sex (-2.99 and <0.99), higher maternal anxiety at diagnosis (+0.08 and 0.99), and maternal history of trauma (+0.23 and 0.98). CONCLUSION: Unlike very-preterm and full-term children, those born late preterm showed an improvement over time, probably because late-preterm children do not carry the sequelae derived from severe prematurity but benefit from close monitoring. As maternal psychopathology emerged as a determinant modifier of course and severity, it is crucial to develop targeted psychological interventions for pregnant individuals and reevaluate monitoring programs for their offspring, regardless of prematurity.
Subject(s)
Attention Deficit Disorder with Hyperactivity , Infant, Newborn, Diseases , Obstetric Labor, Premature , Infant, Newborn , Pregnancy , Female , Humans , Male , Cohort Studies , Attention Deficit Disorder with Hyperactivity/diagnosis , Attention Deficit Disorder with Hyperactivity/epidemiology , Attention Deficit Disorder with Hyperactivity/etiology , Prospective Studies , Bayes Theorem , Obstetric Labor, Premature/diagnosis , Obstetric Labor, Premature/epidemiology , Obstetric Labor, Premature/etiologyABSTRACT
BACKGROUND: Antenatal corticosteroids reduce neonatal complications when administered to women at risk for preterm birth. Moreover, antenatal corticosteroid rescue doses are recommended for women who remain at risk after the initial course. However, there is controversy about the most appropriate frequency and the exact timing of administering additional antenatal corticosteroid doses because there are potential long-term negative effects on infants' neurodevelopment and physiological stress functioning. OBJECTIVE: This study aimed to (1) to assess the long-term neurodevelopmental effects of receiving antenatal corticosteroid rescue doses in comparison with receiving only the initial course; (2) to measure the cortisol levels of infants of mothers who received antenatal corticosteroid rescue doses; (3) to examine a potential dose-response effect of the number of antenatal corticosteroid rescue doses on children's neurodevelopment and salivary cortisol. STUDY DESIGN: This study followed 110 mother-infant pairs who underwent a spontaneous episode of threatened preterm labor until the children were 30 months old, regardless of their gestational age at birth. Among the participants, 61 received only the initial course of corticosteroids (no rescue dose group), and 49 participants required at least one rescue dose of corticosteroids (rescue doses group). The follow-up was carried out at 3 different times, namely at threatened preterm labor diagnosis (T1), when the children were 6 months of age (T2), and when the children were 30 months of corrected age for prematurity (T3). Neurodevelopment was assessed using the Ages & Stages Questionnaires, Third Edition. Saliva samples were collected for cortisol level determination. RESULTS: First, the rescue doses group showed lower problem-solving skills at 30 months of age than the no rescue doses group. Second, the rescue doses group demonstrated higher salivary cortisol levels at 30 months of age. Third, a dose-response effect was found that indicated that the more rescue doses the rescue doses group received, the lower the problem-solving skills and the higher the salivary cortisol levels at 30 months of age. CONCLUSION: Our findings reinforce the hypothesis that additional antenatal corticosteroid doses provided after the initial course may have long-term effects on the neurodevelopment and glucocorticoid metabolism of the offspring. In this regard, the results raise concerns about the negative effects of repeated doses of antenatal corticosteroids in addition to a full course. Further studies are necessary to confirm this hypothesis to help physicians reassess the standard antenatal corticosteroid treatment regimens.
Subject(s)
Hydrocortisone , Premature Birth , Infant , Female , Infant, Newborn , Child , Pregnancy , Humans , Child, Preschool , Hydrocortisone/therapeutic use , Follow-Up Studies , Adrenal Cortex Hormones/adverse effects , Infant, PrematureABSTRACT
The similarity between retinal cells and neurons of the central nervous system allows non-invasive methods to study retinal function, such as the Electroretinogram-Pattern (PERG) to be postulated as possible biomarkers, useful and safe in the study of psychiatric pathologies such as Bipolar Disorder (BD). The objective of the present study is to characterize the differences in the results in the PERG of patients with BD and healthy subjects, as well as to evaluate a possible correlation between these results and the affective decompensations of the manic pole in the group of bipolar patients.
Subject(s)
Bipolar Disorder , Biomarkers , HumansABSTRACT
Introducción. La similitud entre las células retinianas y las neuronas del sistema nervioso central permite que métodos no invasivos de estudio de la función retiniana, como el Electrorretinograma-Patrón (PERG) se postulen como posibles biomarcadores, útiles y seguros en el estudio de patologías psiquiátricas como el Trastorno Bipolar (TB). El objetivo del presente estudio es caracterizar las diferencias en los resultados en el PERG de pacientes con TB y sujetos sanos, así como evaluar una posible correlación entre estos resultados y las descompensaciones afectivas del polo maniaco en el grupo de pacientes bipolares. Material y métodos. Se realizó un estudio transversal en una muestra de 34 pacientes bipolares en diferentes estados clínicos y 36 controles sanos. Se recogieron las variables independientes: sexo, edad, fármacos y estado clínico, medidas mediante escalas validadas y posteriormente se realizó el PERG obteniendo la variable dependiente de interés, la amplitud media de la onda P50. Resultados. Existe una diferencia estadísticamente significativa en los resultados del PERG entre pacientes con TB y controles, y también entre los diversos estados clínicos de los pacientes con TB. Asimismo, encontramos una correlación negativa entre la gravedad de la manía, y la amplitud media de la onda P50. Conclusiones. Las diferencias encontradas, tanto entre sujetos sanos y pacientes bipolares, como entre los estados afectivos dentro del TB, sugieren que las alteraciones en la función retiniana, medidas mediante PERG, pueden ser un prometedor biomarcador de rasgo y de estado en TB.(AU)
Background. The similarity between retinal cells and neurons of the central nervous system allows non-invasive methods to study retinal function, such as the Electroretinogram-Pattern (PERG) to be postulated as possible biomarkers, useful and safe in the study of psychiatric pathologies such as Bipolar Disorder (BD). The objective of the present study is to characterize the differences in the results in the PERG of patients with BD and healthy subjects, as well as to evaluate a possible correlation between these results and the affective decompensations of the manic pole in the group of bipolar patients. Material and methods. A cross-sectional study was carried out in a sample of 34 bipolar patients in different clinical states and 36 healthy controls. The independent variables were collected: sex, age, drugs and clinical status, measured using validated scales and later the PERG was performed, obtaining the dependent variable of interest, the mean amplitude of the P50 wave. Results. There is a statistically significant difference in the PERG results between BD patients and controls, and also between the various clinical states of BD patients. Likewise, we found a negative correlation between the severity of the mania and the mean amplitude of the P50 wave. Conclusions. The differences found, both between healthy subjects and bipolar patients, and between affective states within BD, suggest that alterations in retinal function, measured by PERG, may be a promising biomarker of trait and status in BD.(AU)
