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1.
Pediatr Transplant ; 28(6): e14841, 2024 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-39129441

RESUMEN

BACKGROUND: Solid organ transplant recipients experience a period of unique vulnerability during adolescence, when normative developmental changes intersect with health-related variables to influence psychological health. METHODS: This article builds on previous reviews of psychological health in solid organ transplant recipients and proposes opportunities for clinical intervention during adolescence. RESULTS: Transplant recipients often experience neurocognitive changes, particularly with respect to executive functions, that impact health management tasks and autonomous care. Recipients should be monitored for the development of anxiety, depression, and posttraumatic stress symptoms during adolescence, which in turn can negatively impact adherence to immunosuppression. Recent research in posttraumatic growth and resiliency factors may represent a promising avenue of intervention, leveraging normative developmental processes during this time period. CONCLUSIONS: As pediatric transplant providers, adolescence represents a developmental period for targeted interventions to foster adjustment and adherence and promote a successful transition to adult care.


Asunto(s)
Trasplante de Órganos , Receptores de Trasplantes , Humanos , Adolescente , Receptores de Trasplantes/psicología , Trasplante de Órganos/psicología , Salud Mental , Trastornos por Estrés Postraumático/psicología , Trastornos por Estrés Postraumático/etiología , Transición a la Atención de Adultos , Depresión/etiología , Ansiedad
2.
bioRxiv ; 2024 Jul 09.
Artículo en Inglés | MEDLINE | ID: mdl-39026736

RESUMEN

Purpose: Fentanyl, a highly potent synthetic opioid, is a major contributor to the ongoing opioid epidemic. During adulthood, fentanyl is known to induce pronounced sleep and circadian disturbances during use and withdrawal. Children exposed to opioids in utero are likely to develop neonatal opioid withdrawal syndrome, and display sleep disturbances after birth. However, it is currently unknown how neonatal opioid withdrawal from fentanyl impacts sleep and circadian rhythms in mice later in life. Methods: To model neonatal opioid withdrawal syndrome, mice were treated with fentanyl from postnatal days 1 through 14, analogous to the third trimester of human gestation. After weaning, fentanyl and saline treated mice underwent non-invasive sleep and circadian rhythm monitoring during adolescence postnatal days 23 through 30. Results: Neonatal fentanyl exposure led to reduced duration of wake and a decrease in the number of bouts of non-rapid eye movement sleep. Further, neonatally exposed mice displayed an increase in the average duration of rapid eye movement sleep bouts, reflecting an overall increase in the percent time spent in rapid eye movement sleep across days. Conclusions: Neonatal fentanyl exposure leads to altered sleep-wake states during adolescence in mice.

3.
J Pediatr Psychol ; 48(6): 583-592, 2023 07 05.
Artículo en Inglés | MEDLINE | ID: mdl-37159522

RESUMEN

OBJECTIVE: The objective of this study is to investigate the effects of maternal perinatal depression symptoms and infant treatment status for neonatal abstinence syndrome (NAS) on maternal perceptions of infant regulatory behavior at 6 weeks of age. METHODS: Mothers and their infants (N = 106; 53 dyads) were recruited from a rural, White cohort in Northeast Maine. Mothers in medication-assisted treatment (methadone) and their infants (n = 35 dyads) were divided based on the infant's NAS pharmacological treatment (n = 20, NAS+ group; n = 15, NAS- group) and compared with a demographically similar, nonexposed comparison group (n = 18 dyads; COMP group). At 6 weeks postpartum, mothers reported their depression symptoms Beck Depression Inventory-2nd Edition) and infant regulatory behaviors [Mother and Baby Scales (MABS)]. Infant neurobehavior was assessed during the same visit using the Neonatal Network Neurobehavioral Scale (NNNS). RESULTS: Mothers in the NAS+ group showed significantly higher depression scores than the COMP group (p < .05) while the NAS- group did not. Across the sample, mothers with higher depression scores reported higher infant "unsettled-irregularity" MABS scores, regardless of group status. Agreement between maternal reports of infant regulatory behaviors and observer-assessed NNNS summary scares was poor in both the NAS+ and COMP groups. CONCLUSIONS: Postpartum women in opioid recovery with infants requiring pharmacological intervention for NAS are more at risk for depression which may adversely influence their perceptions of their infants' regulatory profiles. Unique, targeted attachment interventions may be needed for this population.


Asunto(s)
Síndrome de Abstinencia Neonatal , Efectos Tardíos de la Exposición Prenatal , Recién Nacido , Embarazo , Lactante , Femenino , Humanos , Síndrome de Abstinencia Neonatal/tratamiento farmacológico , Síndrome de Abstinencia Neonatal/diagnóstico , Efectos Tardíos de la Exposición Prenatal/diagnóstico , Metadona/uso terapéutico , Analgésicos Opioides , Madres
4.
Adv Child Dev Behav ; 60: 199-228, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33641794

RESUMEN

The aim of this chapter is to examine the role of sleep and cognition in the context of the cumulative risk model examining samples of at-risk infants and maternal-infant dyads. The cumulative risk model posits that non-optimal developmental outcomes are the result of multiple factors in a child's life including, but not limited to, prenatal teratogenic exposures, premature birth, family socioeconomic status, parenting style and cognitions as well as the focus of this volume, sleep. We highlight poor neonatal sleep as both an outcome of perinatal risk as well as a risk factor to developing attentional and cognitive capabilities during early childhood. Outcomes associated with and contributing to poor sleep and cognition during infancy are examined in relation to other known risks in our clinical population. Implications of this research and recommendations for interventions for this population are provided.


Asunto(s)
Síndrome de Abstinencia Neonatal , Trastornos Relacionados con Opioides , Complicaciones del Embarazo , Analgésicos Opioides/uso terapéutico , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Síndrome de Abstinencia Neonatal/tratamiento farmacológico , Trastornos Relacionados con Opioides/tratamiento farmacológico , Embarazo , Complicaciones del Embarazo/tratamiento farmacológico , Sueño
5.
J Pediatr Gastroenterol Nutr ; 72(3): 417-424, 2021 03 01.
Artículo en Inglés | MEDLINE | ID: mdl-33560758

RESUMEN

OBJECTIVE: Learning health systems (LHS) integrate research, improvement, management, and patient care, such that every child receives "the right care at the right time...every time," that is, evidence-based, personalized medicine. Here, we report our efforts to establish a sustainable, productive, multicenter LHS focused on pediatric liver transplantation. METHODS: The Starzl Network for Excellence in Pediatric Transplantation (SNEPT) is the first multicenter effort by pediatric liver transplant families and providers to develop shared priorities and a shared agenda for innovation in clinical care. This report outlines SNEPT's structure, accomplishments, and challenges as an LHS. RESULTS: We prioritized 4 initial projects: immunosuppression, perioperative anticoagulation, quality of life, and transition of care. We shared center protocols/management to identify areas of practice variability between centers. We prioritized actionable items that address barriers to providing "the right care at the right time" to every pediatric liver transplant recipient: facilitating transparency of practice variation and the connection of practices to patient outcomes, harnessing existing datasets to reduce the burden of tracking outcomes, incorporating patient-reported outcomes into outcome metrics, and accelerating the implementation of knowledge into clinical practice. This has allowed us to strengthen collaborative relationships, design quality improvement projects, and collect pilot data for each of our priority projects. CONCLUSIONS: The field of pediatric liver transplantation can be advanced through application of LHS principles. Going forward, SNEPT will continue to unite patient advocacy, big data, technology, and transplant thought leaders to deliver the best care, while developing new, scalable solutions to pediatric transplantation's most challenging problems.


Asunto(s)
Aprendizaje del Sistema de Salud , Trasplante de Hígado , Niño , Familia , Humanos , Mejoramiento de la Calidad , Calidad de Vida
6.
J Clin Psychol Med Settings ; 27(1): 48-53, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-30993576

RESUMEN

This pilot study examined changes in cancer-related post-traumatic stress symptoms (PTSS) across time for siblings of children with cancer. Siblings (N = 32; aged 8-18) completed a measure of anxiety, the Child PTSD Symptom Scale (CPSS), and the PTSD section of the Structured Clinical Interview for DSM-IV-TR (SCID) at twelve (SD = .9) and eighteen months (SD = 1.3) post-diagnosis. Moderate-to-severe PTSS was reported by 12 siblings (38%) at T1 and 7 (22%) at T2. Cluster analysis of PTSS data revealed five patterns: Few symptoms, stable across time (31%, n = 10); Mild symptoms, decreasing across time (16%, n = 5); Mild, stable symptoms (28%, n = 9); Moderate/severe symptoms, decreasing across time but remaining moderate (19%, n = 6); and Moderate/severe, stable symptoms (6%, n = 2). SCID data and anxiety scores distinguished siblings in the final two clusters from those with more favorable PTSS levels/trajectories. Additional research with larger samples is needed to validate these trajectories and examine factors that distinguish siblings with consistently elevated cancer-related PTSS from those with mild or significantly improving symptoms.


Asunto(s)
Actitud Frente a la Salud , Neoplasias/psicología , Hermanos/psicología , Trastornos por Estrés Postraumático/diagnóstico , Trastornos por Estrés Postraumático/psicología , Adolescente , Ansiedad , Niño , Análisis por Conglomerados , Femenino , Humanos , Masculino , Proyectos Piloto , Escalas de Valoración Psiquiátrica , Índice de Severidad de la Enfermedad
7.
Pediatr Transplant ; 23(6): e13528, 2019 09.
Artículo en Inglés | MEDLINE | ID: mdl-31328841

RESUMEN

Learning Health Networks (LHN) improve the well-being of populations by aligning clinical care specialists, technology experts, patients and patient advocates, and other thought leaders for continuous improvement and seamless care delivery. A novel LHN focused on pediatric transplantation, the Starzl Network for Excellence in Pediatric Transplantation (SNEPT), convened its inaugural meeting in September 2018. Clinical care team representatives, patients, and patient families/advocates partnered to take part in educational sessions, pain point exercises, and project identification workshops. Participants discussed the global impact of transplant from both a population and individual perspective, identifying challenges and opportunities where the Starzl Network could work to improve outcomes at scale across a variety of transplant-related conditions.


Asunto(s)
Aprendizaje del Sistema de Salud , Trasplante de Hígado/normas , Niño , Atención a la Salud , Familia , Humanos , Manejo del Dolor , Dimensión del Dolor , Pediatría/métodos , Mejoramiento de la Calidad , Indicadores de Calidad de la Atención de Salud , Resultado del Tratamiento
8.
Dev Psychobiol ; 59(5): 574-582, 2017 07.
Artículo en Inglés | MEDLINE | ID: mdl-28561904

RESUMEN

Use and abuse of prescription opioids and concomitant increase in Neonatal Abstinence Syndrome (NAS), a condition that may lead to protracted pharmacological treatment in more than 60% of infants, has tripled since 2000. This study assessed neurobehavioral development using the NICU Network Neurobehavioral Scale in 6-week old infants with prenatal methadone exposure who did (NAS+; n = 23) or did not (NAS-; n = 16) require pharmacological treatment for NAS severity determined by Finnegan Scale. An unexposed, demographically similar group of infants matched for age served as comparison (COMP; n = 21). NAS+, but not NAS- group, had significantly lower scores on the regulation (p < .01) and quality of movement (p < .01) summary scales than the COMP group. The NAS+ and NAS- groups had higher scores on the stress-abstinence scale than the COMP group (p < .05). NAS diagnosis (NAS +) was associated with poorer regulation and quality of movement at 6 weeks of age compared to infants without prenatal methadone exposure from the same demographic.


Asunto(s)
Conducta del Lactante/efectos de los fármacos , Metadona/uso terapéutico , Antagonistas de Narcóticos/uso terapéutico , Síndrome de Abstinencia Neonatal/tratamiento farmacológico , Adulto , Femenino , Humanos , Lactante , Conducta del Lactante/fisiología , Recién Nacido , Masculino , Metadona/farmacología , Antagonistas de Narcóticos/farmacología , Síndrome de Abstinencia Neonatal/psicología , Tratamiento de Sustitución de Opiáceos , Adulto Joven
9.
Cardiol Young ; 27(8): 1447-1454, 2017 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-28376931

RESUMEN

OBJECTIVE: Standardised developmental screening tools are important for the evaluation and management of developmental disorders in children with CHD; however, psychometric properties and clinical utility of screening tools, such as the Ages & Stages Questionnaires, Third Edition (ASQ-3), have not been examined in the CHD population. We hypothesised that the ASQ-3 would be clinically useful for this population. Study design ASQ-3 developmental classifications for 163 children with CHD at 6, 12, 24, and/or 36 months of age were compared with those obtained from concurrent developmental testing with the Bayley Scales of Infant and Toddler Development, Third Edition. RESULTS: When ASQ-3 screening failure was defined as ⩾1 SD below the normative mean, specificity (⩾81.9%) and negative predictive value (⩾81.0%) were high across ASQ-3 areas. Sensitivity was high for gross motor skills (79.6%), increased with age for communication (35.7-100%), and generally decreased with age for problem solving (73.1-50.0%). When ASQ-3 screening failure was defined as ⩾2 SD below the normative mean, specificity (⩾93.6%) and positive predictive value (⩾74.5%) were generally high across ASQ-3 areas, but sensitivity was low (31.1%) to fair (62.8%). The ASQ-3 showed improved accuracy in predicting delays over clinical risk factors alone. CONCLUSIONS: The ASQ-3 appears to be a clinically useful tool for screening development in children with CHD, although its utility varied on the basis of developmental area and time point. Clinicians are encouraged to refer children scoring ⩾1 SD below the normative mean on any ASQ-3 area for formal developmental evaluation.


Asunto(s)
Cardiopatías Congénitas/diagnóstico , Tamizaje Masivo/métodos , Encuestas y Cuestionarios , Distribución por Edad , Factores de Edad , Procedimientos Quirúrgicos Cardíacos , Preescolar , Femenino , Estudios de Seguimiento , Cardiopatías Congénitas/epidemiología , Cardiopatías Congénitas/cirugía , Humanos , Lactante , Recién Nacido , Masculino , Morbilidad/tendencias , Pronóstico , Curva ROC , Estudios Retrospectivos , Estados Unidos/epidemiología
10.
Am J Addict ; 26(1): 42-49, 2017 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-27983768

RESUMEN

BACKGROUND AND OBJECTIVES: There is significant variability in severity of neonatal abstinence syndrome (NAS) due to in utero opioid exposure. Our previous study identified single nucleotide polymorphisms (SNPs) in the prepronociceptin (PNOC) and catechol-O-methyltransferase (COMT) genes that were associated with differences in NAS outcomes. This study looks at the same SNPs in PNOC and COMT in an independent cohort in an attempt to replicate previous findings. METHODS: For the replication cohort, full-term opioid-exposed newborns and their mothers (n = 113 pairs) were studied. A DNA sample was obtained and genotyped for five SNPs in the PNOC and COMT genes. The association of each SNP with NAS outcomes (length of hospitalization, need for pharmacologic treatment, and total opioid days) was evaluated, with an experiment-wise significance level set at α < .003 and point-wise level of α < .05. SNP associations in a combined cohort of n = 199 pairs (replication cohort plus 86 pairs previously reported), were also examined. RESULTS: In the replication cohort, mothers with the COMT rs4680 G allele had infants with a reduced risk for treatment with two medications for NAS (adjusted OR = .5, p = .04), meeting point-wise significance. In the combined cohort, infants with the PNOC rs4732636 A allele had a reduced need for medication treatment (adjusted OR 2.0, p = .04); mothers with the PNOC rs351776 A allele had infants who were treated more often with two medications (adjusted OR 2.3, p = .004) with longer hospitalization by 3.3 days (p = .01). Mothers with the COMT rs740603 A allele had infants who were less often treated with any medication (adjusted OR .5, p = .02). Though all SNP associations all met point wise and clinical significance, they did not meet the experiment-wise significance threshold. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE: We found differences in NAS outcomes depending on PNOC and COMT SNP genotype. This has important implications for identifying infants at risk for severe NAS who could benefit from tailored treatment regimens. Further testing in a larger sample is warranted. This has important implications for prenatal prediction and personalized treatment regimens for infants with NAS. (Am J Addict 2017;26:42-49).


Asunto(s)
Analgésicos Opioides/efectos adversos , Catecol O-Metiltransferasa/genética , Madres , Síndrome de Abstinencia Neonatal/genética , Precursores de Proteínas/genética , Receptores Opioides/genética , Alelos , Femenino , Genotipo , Humanos , Recién Nacido , Masculino , Síndrome de Abstinencia Neonatal/diagnóstico , Polimorfismo de Nucleótido Simple/genética
11.
Dev Psychobiol ; 56(5): 1119-28, 2014 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-24019057

RESUMEN

Developmental features of the P2 auditory ERP in a change detection paradigm were examined in infants prenatally exposed to methadone. Opiate dependent pregnant women maintained on methadone replacement therapy were recruited during pregnancy (N = 60). Current and historical alcohol and substance use, SES, and psychiatric status were assessed with a maternal interview during the third trimester. Medical records were used to collect information regarding maternal medications, monthly urinalysis, and breathalyzer to confirm comorbid drug and alcohol exposures. Between birth and 4 months infant ERP change detection performance was evaluated on one occasion with the oddball paradigm (.2 probability oddball) using pure-tone stimuli (standard = 1 kHz and oddball = 2 kHz frequency) at midline electrode sites, Fz, Cz, Pz. Infant groups were examined in the following developmental windows: 4-15, 16-32, or 33-120 days PNA. Older groups showed increased P2 amplitude at Fz and effective change detection performance at P2 not seen in the newborn group. Developmental maturation of amplitude and stimulus discrimination for P2 has been reported in developing infants at all of the ages tested and data reported here in the older infants are consistent with typical development. However, it has been previously reported that the P2 amplitude difference is detectable in neonates; therefore, absence of a difference in P2 amplitude between stimuli in the 4-15 days group may represent impaired ERP performance by neonatal abstinence syndrome or prenatal methadone exposure.


Asunto(s)
Corteza Auditiva/efectos de los fármacos , Potenciales Evocados Auditivos/efectos de los fármacos , Metadona/farmacología , Narcóticos/farmacología , Síndrome de Abstinencia Neonatal/diagnóstico , Efectos Tardíos de la Exposición Prenatal/diagnóstico , Estimulación Acústica , Adulto , Corteza Auditiva/fisiopatología , Electroencefalografía , Potenciales Evocados Auditivos/fisiología , Femenino , Humanos , Lactante , Masculino , Metadona/uso terapéutico , Narcóticos/uso terapéutico , Síndrome de Abstinencia Neonatal/fisiopatología , Tratamiento de Sustitución de Opiáceos , Embarazo , Efectos Tardíos de la Exposición Prenatal/fisiopatología , Adulto Joven
12.
Clin Obstet Gynecol ; 56(1): 186-92, 2013 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-23314720

RESUMEN

Recent rise in rates of opiate replacement therapy among pregnant women have resulted in increasing number of infants requiring treatment for neonatal abstinence syndrome (NAS). Short-term and long-term developmental outcomes associated with prenatal opiate exposure are discussed, including symptoms and severity of NAS, and early cognitive and motor delays. Maternal and infant risk factors are discussed, and include patterns of maternal substance use during pregnancy, genetic risk, polysubstance exposure pharmacological treatment for NAS and breastfeeding. The importance of characterizing corollary environmental risk factors is also considered.


Asunto(s)
Síndrome de Abstinencia Neonatal/etiología , Tratamiento de Sustitución de Opiáceos/efectos adversos , Trastornos Relacionados con Opioides/complicaciones , Complicaciones del Embarazo , Efectos Tardíos de la Exposición Prenatal/etiología , Discapacidades del Desarrollo/etiología , Femenino , Humanos , Recién Nacido , Metadona/uso terapéutico , Narcóticos/uso terapéutico , Síndrome de Abstinencia Neonatal/terapia , Trastornos Relacionados con Opioides/tratamiento farmacológico , Embarazo , Complicaciones del Embarazo/tratamiento farmacológico , Atención Prenatal , Índice de Severidad de la Enfermedad
13.
Artículo en Inglés | MEDLINE | ID: mdl-19163700

RESUMEN

Knowledge of a subject's location and motion throughout an environment is of significant use to in-home health monitoring and activity recognition systems. This work develops a method of tracking a subject's location using the radio frequency (RF) signals emanating from wearable wireless sensors. It differs from other RF location tracking work in that it utilises the hardware which would already be deployed in a biomedical monitoring application. This is achieved by combining the RSSI (Received Signal Strength Indicator) and LQI (Link Quality Indicator) readings from a single basestation. It is shown that accuracy approaching that of a multiple basestation localisation deployment is achievable by using a suitable level of filtering. As a result of this work, location information can be more readily and cheaply incorporated into future biomedical monitoring applications.


Asunto(s)
Ingeniería Biomédica/métodos , Redes de Comunicación de Computadores , Monitoreo Fisiológico/instrumentación , Ondas de Radio , Procesamiento de Señales Asistido por Computador , Algoritmos , Sistemas de Computación , Computadores , Electroencefalografía/métodos , Diseño de Equipo , Humanos , Modelos Estadísticos , Monitoreo Ambulatorio/métodos , Reproducibilidad de los Resultados
14.
Conf Proc IEEE Eng Med Biol Soc ; 2006: 5362-5, 2006.
Artículo en Inglés | MEDLINE | ID: mdl-17945896

RESUMEN

We study the use of embedded and worn sensors to unobtrusively detect the activities of daily living (ADL). Our aim is to find the minimum set of sensors required to detect these basic tasks. In this exploratory work, we analyze the publicly available 'Intense Activity' dataset from the MIT PlaceLab project and study the classification of eating and meal preparation vs. other activities. We find that eating and meal preparation can be detected with an accuracy of 90% using less than 1/3 of the over 300 available sensors in the PlaceLab. If only 8 sensors are used, the accuracy is 82% which may be adequate for some applications.


Asunto(s)
Actividades Cotidianas , Evaluación Geriátrica/métodos , Viviendas para Ancianos , Vida , Monitoreo Ambulatorio/instrumentación , Reconocimiento de Normas Patrones Automatizadas , Anciano , Simulación por Computador , Computadores , Diseño de Equipo , Humanos , Monitoreo Ambulatorio/métodos , Calidad de Vida , Ondas de Radio , Reproducibilidad de los Resultados , Programas Informáticos
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