Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.038
Filtrar
1.
Sci Rep ; 10(1): 8115, 2020 05 15.
Artigo em Inglês | MEDLINE | ID: mdl-32415164

RESUMO

Germinal matrix hemorrhage (GMH) is a detrimental form of neonatal CNS injury. Following GMH-mediated eNOS inhibition, inflammation arises, contributing to GMH-induced brain injury. We investigated the beneficial effects of Serelaxin, a clinical tested recombinant Relaxin-2 protein, on brain injury after GMH in rats. We investigated whether effects of Serelaxin are mediated by its ability to activate the GMH-suppressed eNOS pathway resulting in attenuation of inflammatory marker overproduction. GMH was induced by intraparenchymal injection of bacterial collagenase (0.3U). Seven day old Sprague-Dawley rat pups (P7) were used (n = 63). GMH animals were divided in vehicle or serelaxin treated (3 µg once, 30 µg once, 30 µg multiple, i.p., starting 30 after GMH and then daily). Sham operated animals were used. We monitored the developmental profile working memory and spatial function (T-maze and open field test respectively). At day 28, all rats underwent MRI-scans for assessment of changes in cortical thickness and white matter loss. Effects of Serelaxin on eNOS pathway activation and post-GMH inflammation were evaluated. We demonstrated that Serelaxin dose-dependently attenuated GMH-induced developmental delay, protected brain and improved cognitive functions of rats after GMH. That was associated with the decreased post-GMH inflammation, mediated at least partly by amelioration of GMH-induced eNOS inhibition.


Assuntos
Hemorragia Cerebral/complicações , Disfunção Cognitiva/prevenção & controle , Deficiências do Desenvolvimento/prevenção & controle , Inflamação/prevenção & controle , Óxido Nítrico Sintase Tipo III/metabolismo , Relaxina/administração & dosagem , Relaxina/metabolismo , Animais , Animais Recém-Nascidos , Disfunção Cognitiva/etiologia , Disfunção Cognitiva/patologia , Deficiências do Desenvolvimento/etiologia , Deficiências do Desenvolvimento/patologia , Feminino , Inflamação/etiologia , Inflamação/patologia , Masculino , Óxido Nítrico Sintase Tipo III/genética , Ratos , Ratos Sprague-Dawley , Relaxina/genética
2.
Plast Reconstr Surg ; 145(5): 1241-1248, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32332546

RESUMO

BACKGROUND: Reports of neurodevelopmental delays in adolescents with metopic craniosynostosis have ranged from 15 to 61 percent. Previously, event-related potentials have correlated preoperative radiographic severity with language deficiencies in infancy. This study sought to characterize neurocognitive testing at cranial maturity and correlate outcomes to preoperative radiographic severity. METHODS: Patients diagnosed with metopic craniosynostosis who underwent surgical correction in infancy completed a neurodevelopmental battery evaluating age-normalized intelligence quotient, academic achievement, and visuomotor integration. Data were stratified by preoperative endocranial bifrontal angle (moderate, >124 degrees; severe, <124 degrees). Multiple variable regression was used to control measured intelligence and achievement for age at surgery, age at testing, parental education, and income. Significance was set at p < 0.05. RESULTS: Twenty patients completed neurodevelopmental testing. Mean intelligence quotient was 111.7 ± 13 and academic achievement was similar to national averages (word reading, 53.4 percent; reading comprehension, 53.4 percent; reading composite, 53.5 percent; spelling, 44 percent; and math, 52.9 percent). Radiographic measurements revealed 36 percent of patients with moderate phenotype and 64 percent with severe. Patients with severe phenotypes had lower intelligence quotient measures and scored more poorly in every academic measure tested. Word reading (113 versus 95; p = 0.035) and reading composite (109 versus 98; p = 0.014) reached significance. CONCLUSIONS: Overall, cranial mature patients with metopic craniosynostosis had above average intelligence quotient and academic achievement near the national mean. Long-term neurocognitive function was correlated to preoperative radiographic severity in metopic craniosynostosis, with more severe cases performing worse. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.


Assuntos
Sucesso Acadêmico , Craniossinostoses/diagnóstico , Deficiências do Desenvolvimento/diagnóstico , Procedimentos Cirúrgicos Reconstrutivos , Crânio/diagnóstico por imagem , Adolescente , Criança , Craniossinostoses/complicações , Craniossinostoses/cirurgia , Deficiências do Desenvolvimento/etiologia , Deficiências do Desenvolvimento/prevenção & controle , Feminino , Humanos , Lactente , Testes de Inteligência , Masculino , Período Pré-Operatório , Radiografia , Índice de Gravidade de Doença , Resultado do Tratamento
3.
Phys Ther ; 100(8): 1343-1352, 2020 08 12.
Artigo em Inglês | MEDLINE | ID: mdl-32329778

RESUMO

OBJECTIVE: The aim of this project is to study the effect of a physical therapist intervention provided in the first months of life on developmental outcomes of infants born very preterm. Secondary aims are to investigate the impact of intervention timing on the efficacy and impact of the intervention on infants with and without cerebral palsy. METHODS: This study is a multisite longitudinal controlled trial comparing developmental outcomes from infants in the Supporting Play, Exploration, and Early Development Intervention (SPEEDI)_Late or SPEEDI_Early group to a usual care group. SETTINGS ARE URBAN: Urban and rural areas surrounding 2 academic medical centers. There will be 90 preterm infants enrolled in this study born at <29 weeks of gestation. SPEEDI is a developmental intervention provided by collaboration between a physical therapist and parent to support a child's motor and cognitive development. The primary outcome measure is the Bayley Scale of Infant and Toddler Development Cognitive and Gross Motor Scaled Scores. Secondary measures include behavioral coding of early problem solving skills, the Gross Motor Function Measure, and Test of Infant Motor Performance. IMPACT: More than 270,000 infants are born very preterm in the United States each year, 50% of whom will have neurological dysfunction that limits their ability to keep pace with peers who are typically developing. This study is a step toward understanding the impact that intensive developmental intervention could have in this population in the first months of life.


Assuntos
Desenvolvimento Infantil/fisiologia , Deficiências do Desenvolvimento/prevenção & controle , Intervenção Médica Precoce/métodos , Terapia por Exercício/métodos , Lactente Extremamente Prematuro/crescimento & desenvolvimento , Ludoterapia/métodos , Paralisia Cerebral/diagnóstico , Paralisia Cerebral/reabilitação , Pré-Escolar , Humanos , Lactente , Recém-Nascido , Estudos Longitudinais , Transtornos Motores/prevenção & controle , Destreza Motora/fisiologia , Resolução de Problemas , Fatores de Tempo
4.
Intellect Dev Disabil ; 58(2): 139-157, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32240047

RESUMO

People with intellectual and developmental disabilities (IDD) often rely on Medicaid-funded services and supports to facilitate their daily living. The financial investment for these services is significant, yet little work has been conducted to understand how these investments affect life outcomes. This pilot study used a novel data integration approach to offer initial insights about how Medicaid expenditures relate to outcomes using Medicaid claims data, results of the National Core Indicators consumer survey, and data from the Supports Intensity Scale (SIS). Findings suggested that subpopulations of people with IDD who also had high behavioral needs or high medical needs had significantly higher expenditures than individuals with more typical SIS-assessed support needs. Regression analyses suggested mixed outcomes based on the factors we considered, including a finding that people with IDD who lived in sponsored residential care homes were more likely to engage in inclusive activities in the community than those who lived in larger congregate settings, or those who lived in a family home. Results of this pilot, when brought to scale, will be useful in examining the performance of state IDD service systems over time.


Assuntos
Deficiências do Desenvolvimento , Deficiência Intelectual , Avaliação de Resultados em Cuidados de Saúde , Adolescente , Adulto , Idoso , Deficiências do Desenvolvimento/economia , Deficiências do Desenvolvimento/prevenção & controle , Feminino , Humanos , Deficiência Intelectual/economia , Deficiência Intelectual/prevenção & controle , Masculino , Medicaid , Pessoa de Meia-Idade , Projetos Piloto , Estados Unidos , Adulto Jovem
5.
Arch Dis Child Fetal Neonatal Ed ; 105(6): 587-592, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32241810

RESUMO

OBJECTIVE: To evaluate the cost-effectiveness of two rates of enteral feed advancement (18 vs 30 mL/kg/day) in very preterm and very low birth weight infants. DESIGN: Within-trial economic evaluation alongside a multicentre, two-arm parallel group, randomised controlled trial (Speed of Increasing milk Feeds Trial). SETTING: 55 UK neonatal units from May 2013 to June 2015. PATIENTS: Infants born <32 weeks' gestation or <1500 g, receiving less than 30 mL/kg/day of milk at trial enrolment. Infants with a known severe congenital anomaly, no realistic chance of survival, or unlikely to be traceable for follow-up, were ineligible. INTERVENTIONS: When clinicians were ready to start advancing feed volumes, infants were randomised to receive daily increments in feed volume of 30 mL/kg (intervention) or 18 mL/kg (control). MAIN OUTCOME MEASURE: Cost per additional survivor without moderate to severe neurodevelopmental disability at 24 months of age corrected for prematurity. RESULTS: Average costs per infant were slightly higher for faster feeds compared with slower feeds (mean difference £267, 95% CI -6928 to 8117). Fewer infants achieved the principal outcome of survival without moderate to severe neurodevelopmental disability at 24 months in the faster feeds arm (802/1224 vs 848/1246). The stochastic cost-effectiveness analysis showed a likelihood of worse outcomes for faster feeds compared with slower feeds. CONCLUSIONS: The stochastic cost-effectiveness analysis shows faster feeds are broadly equivalent on cost grounds. However, in terms of outcomes at 24 months age (corrected for prematurity), faster feeds are harmful. Faster feeds should not be recommended on either cost or effectiveness grounds to achieve the primary outcome.


Assuntos
Análise Custo-Benefício , Custos Diretos de Serviços , Nutrição Enteral/economia , Nutrição Enteral/métodos , Lactente Extremamente Prematuro , Recém-Nascido de muito Baixo Peso , Deficiências do Desenvolvimento/diagnóstico , Deficiências do Desenvolvimento/prevenção & controle , Idade Gestacional , Humanos , Recém-Nascido , Fatores de Tempo , Resultado do Tratamento
6.
Neonatal Netw ; 39(1): 16-23, 2020 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-31919289

RESUMO

PURPOSE: The purpose of this study was to identify the long-term developmental effects of a NICU music therapy intervention, Multimodal Neurologic Enhancement, provided to preterm infants in the NICU. DESIGN: Prospective randomized controlled study with one control group and one experimental group. SAMPLE: Participants were medically stable preterm infants with a birth age of 31 and 6/7 weeks or less, admitted to a level-III NICU. A total of 84 participants were enrolled, and 48 completed the study. MAIN OUTCOME VARIABLE: Post-discharge developmental scores on the Mullen Scales of Early Learning: AGS Edition. RESULTS: The experimental group performed significantly better than the control group on the Visual Reception and Early Learning Composite scores.


Assuntos
Deficiências do Desenvolvimento/prevenção & controle , Comportamento do Lactente/fisiologia , Recém-Nascido Prematuro , Unidades de Terapia Intensiva Neonatal/organização & administração , Musicoterapia/métodos , Desenvolvimento Infantil , Feminino , Humanos , Recém-Nascido , Tempo de Internação , Estudos Longitudinais , Masculino , Projetos Piloto , Gravidez , Estudos Prospectivos , Valores de Referência , Centros de Atenção Terciária , Resultado do Tratamento
7.
Fisioter. Pesqui. (Online) ; 27(1): 48-56, jan.-mar. 2020. tab, graf
Artigo em Português | LILACS | ID: biblio-1090408

RESUMO

RESUMO O objetivo deste estudo foi avaliar o desenvolvimento motor de crianças de quatro a 17 meses e investigar sua associação com fatores de risco sociodemográficos. Estudo transversal, descritivo, composto por crianças de quatro a 17 meses provenientes da unidade de internação pediátrica de um hospital público de Porto Alegre (RS), clinicamente estáveis e com alta breve prevista. Para a avaliação dos fatores de risco sociodemográficos foi utilizado um questionário elaborado pelas pesquisadoras, que abordou fatores biológicos, sociais e ambientais. Para a avaliação do desenvolvimento motor foi utilizada a Alberta Infant Motor Scale na versão traduzida, adaptada e validada para a população brasileira. Para a análise estatística foi utilizado o teste t de Student e o teste qui-quadrado, com nível de significância de 5% (p≤0,05). De um total de 110 crianças avaliadas, o desempenho motor se mostrou aquém do esperado em mais da metade delas (63,6%, n=70). Houve associação estatisticamente significativa entre o desenvolvimento motor e vacinas atrasadas (p=0,005), convivência com tabagistas em casa (p=0,047) e recebimento de benefício socioeconômico (p=0,036). Conclui-se que esses fatores sociais podem estar associados a fatores de risco ao desenvolvimento motor de crianças de quatro a 17 meses.


RESUMEN El presente estudio tuvo el objetivo de evaluar el desarrollo motor de niños de 4 a 17 meses de edad e investigar su asociación con factores de riesgo sociodemográficos. Es un estudio transversal, descriptivo, en el cual participaron niños de 4 a 17 meses de la unidad de hospitalización pediátrica de un hospital público en Porto Alegre (Brasil), clínicamente estables y con la espera de recibir el alta pronto. Para la evaluación de los factores de riesgo sociodemográficos, se utilizó un cuestionario desarrollado por los investigadores, que abordó los factores biológicos, sociales y ambientales. Para la evaluación del desarrollo motor, se utilizó la Alberta Infant Motor Scale en la versión traducida, adaptada y validada para la población brasileña. En el análisis estadístico, se aplicaron la prueba t de Student y la prueba chi-cuadrado, con un nivel de significación del 5% (p≤0,05). De 110 niños evaluados, más de la mitad de ellos (63,6%, n=70) tuvieron rendimiento motor inferior a lo esperado. Hubo una asociación estadísticamente significativa entre el desarrollo motor y las vacunas tardías (p=0,005), la convivencia con fumadores en el hogar (p=0,047) y el recibimiento de beneficios socioeconómicos (p=0,036). Se concluye que estos factores sociales pueden estar asociados con factores de riesgo para el desarrollo motor de niños de 4 a 17 meses.


ABSTRACT This study aimed to evaluate the motor development of children aged four to 17 months and investigate its association with sociodemographic risk factors. This is a cross-sectional descriptive study conducted with clinically stable children aged four to 17 months from the pediatric inpatient unit of a public hospital in Porto Alegre, RS, and whose hospital discharge would happen soon. For the evaluation of sociodemographic risk factors, a questionnaire developed by the researchers was used which addressed biological, social and environmental factors. The Alberta Infant Motor Scale (AIMS), in its version translated, adapted and validated to Brazilian Portuguese, was used in the evaluation of motor development. In statistical analysis, Student's t-test and Chi-square test were used with significance level of 5% (p≤0.05) for all tests. From a total of 110 evaluated children, motor performance was lower than expected in more than half of them (63.6%, n=70). Motor development presented statistically significant associations with delayed vaccines (p=0.005), cohabitation with smokers (p=0.047), and receiving socioeconomic benefits (p=0.036). In conclusion, social factors such as delayed vaccines, cohabitation with smokers and receiving socioeconomic benefits may be associated with risk factors related to motor development of children aged four months to 17 months old.


Assuntos
Humanos , Masculino , Feminino , Lactente , Desenvolvimento Infantil , Vulnerabilidade Social , Destreza Motora/fisiologia , Fatores Socioeconômicos , Poluição por Fumaça de Tabaco , Deficiências do Desenvolvimento/prevenção & controle , Deficiências do Desenvolvimento/reabilitação , Deficiências do Desenvolvimento/epidemiologia , Epidemiologia Descritiva , Estudos Transversais , Inquéritos e Questionários , Fatores de Risco , Transtornos Motores/diagnóstico , Transtornos Motores/prevenção & controle , Transtornos Motores/reabilitação , Transtornos Motores/epidemiologia
8.
Plast Reconstr Surg ; 145(1): 117e-125e, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31592950

RESUMO

BACKGROUND: De novo or rare transmitted mutations in the SMAD6 gene affect 7 percent of midline nonsyndromic synostosis patients. This study aimed to determine the neurocognitive sequelae of SMAD6 synostosis. METHODS: Nonsyndromic synostosis patients 6 years or older with SMAD6 mutations and non-SMAD6 nonsyndromic synostosis controls were recruited. All patients completed a double-blinded neurodevelopmental battery (i.e., Wechsler Fundamentals, Wechsler Abbreviated Scale of Intelligence, Beery-Buktenica Developmental test), and parents/guardians completed behavioral surveys (Behavior Rating Inventory of Executive Function and Behavior Rating System for Children). RESULTS: Twenty-eight patients participated: 10 known SMAD6 patients (average age, 10 years; 1 female; eight metopic and two sagittal; nine treated with cranial vault remodeling and one treated with strip craniectomy) and 18 non-SMAD6 controls (age, 9.5 years; three female; 12 metopic and six sagittal; 17 treated with cranial vault remodeling and one treated with strip craniectomy). There were no differences between any demographics. Testing age, surgical age, parental education, and household income correlated with cognition (p < 0.05). After controlling for these factors, SMAD6 patients performed worse on numerical operations (p = 0.046), performance intelligence quotient (p = 0.018), full-scale intelligence quotient (p = 0.010), and motor coordination (p = 0.043) compared to age/race/gender/synostosis/operation-matched controls. On behavioral surveys, SMAD6 patients scored worse on 14 assessments, including aggression, communication, and behavior. CONCLUSIONS: This prospective double-blinded study revealed that neuropsychiatric development of nonsyndromic synostosis may be under genetic control. SMAD6 mutations led to poorer mathematics, performance intelligence quotient, full-scale intelligence quotient, and motor coordination, even after controlling for exogenous factors. Genetic testing may be critical for advocating early adjunctive neurodevelopmental therapy. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.


Assuntos
Craniossinostoses/cirurgia , Craniotomia/métodos , Deficiências do Desenvolvimento/genética , Procedimentos Cirúrgicos Reconstrutivos/métodos , Proteína Smad6/genética , Estudos de Casos e Controles , Criança , Comportamento Infantil , Desenvolvimento Infantil , Pré-Escolar , Craniossinostoses/complicações , Craniossinostoses/genética , Deficiências do Desenvolvimento/diagnóstico , Deficiências do Desenvolvimento/prevenção & controle , Método Duplo-Cego , Feminino , Seguimentos , Humanos , Lactente , Testes de Inteligência , Mutação com Perda de Função , Masculino , Estudos Prospectivos , Crânio/cirurgia , Resultado do Tratamento
9.
Ann Nutr Metab ; 75(2): 139-143, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31743911

RESUMO

BACKGROUND: Hunger, food insecurity, stunting, anemia, overweight, and noncommunicable diseases (NCDs) may coexist in the same person, household, and community in Latin America and the Caribbean (LAC). The double burden of malnutrition (DBM) is an important cause of disability and premature death, which could be addressed with comprehensive policies such as the Plan of Action for the Prevention of Obesity in Children and Adolescents. This paper summarizes the main policies and actions aimed to prevent undernutrition and obesity. SUMMARY: Several countries are implementing the Plan of Action, Caribbean Public Health Agency is actively supporting Ministries of Health, Education, and Sport to develop school nutrition policies and strategies to create health-promoting environments at school and in their surrounding communities. Chile is implementing the comprehensive child protection system "Chile Crece Contigo" that integrates health, social development, and educational activities to optimize growth and childhood cognitive-motor development. Brazil is implementing policies and plans to commit to international targets regarding food and nutrition security, NCDs and their risk factors. Key Messages: The DBM exists in the Americas and contributes to disability and premature death. The Region is making progress implementing policies and actions addressing the DBM. However, stronger political will and leadership are needed to enact legislation and policies that create and support enabling -environments.


Assuntos
Política de Saúde , Promoção da Saúde , Desnutrição/epidemiologia , Fenômenos Fisiológicos da Nutrição Materna , Hipernutrição/epidemiologia , Complicações na Gravidez/epidemiologia , Adolescente , Adulto , Região do Caribe/epidemiologia , Efeitos Psicossociais da Doença , Países em Desenvolvimento , Deficiências do Desenvolvimento/prevenção & controle , Dieta , Exercício Físico , Feminino , Transtornos da Nutrição Fetal/epidemiologia , Transtornos da Nutrição Fetal/prevenção & controle , Abastecimento de Alimentos , Promoção da Saúde/organização & administração , Humanos , Fórmulas Infantis , Recém-Nascido , América Latina/epidemiologia , Desnutrição/prevenção & controle , Marketing/legislação & jurisprudência , Serviços de Saúde Materna/organização & administração , Micronutrientes/administração & dosagem , Micronutrientes/deficiência , Hipernutrição/prevenção & controle , Cuidado Pré-Concepcional/organização & administração , Gravidez , Complicações na Gravidez/prevenção & controle , Cuidado Pré-Natal/organização & administração , Prevalência , Determinantes Sociais da Saúde
10.
PLoS Med ; 16(10): e1002952, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31665140

RESUMO

BACKGROUND: Nutritional supplements may improve development of infants born small (preterm or small for gestational age [SGA]) but may increase the risk of later metabolic disease. We conducted a systematic review and meta-analysis to assess the effects of macronutrient supplements for infants born small on later development and metabolism. METHODS AND FINDINGS: We searched OvidMedline, Embase, Cochrane CENTRAL, and Cochrane Database of Systematic Reviews from inception to April 1, 2019, and controlled-trials.com, clinicaltrials.gov, and anzctr.org.au. Randomised or quasirandomised trials were included if the intention was to increase macronutrient intake to improve growth or development of infants born small and assessed post-discharge outcomes. Co-primary outcomes were cognitive impairment and metabolic risk, evaluated in toddlers (<3 years), childhood (3 to 8 years), and adolescence (9 to 18 years). Two reviewers independently extracted data. Quality was assessed using the Cochrane Risk of Bias tool, and data were pooled using random-effect models. Twenty-one randomised and one quasirandomised trial of variable methodological quality involving 3,680 infants were included. In toddlers born small, supplementation did not alter cognitive impairment (relative risk [RR] 1.00; 95% confidence interval [CI] 0.67 to 1.49; P = 0.99), and there were no differences in cognitive scores (mean difference [MD] 0.57; 95% CI -0.71 to 1.84; P = 0.38) or motor scores (MD 1.16; 95% CI -0.32 to 2.65; P = 0.12) between supplemented and unsupplemented groups. However, fewer supplemented children had motor impairment (RR 0.76; 95% CI 0.62 to 0.94; P = 0.01). In subgroup analyses, supplementation improved cognitive scores in boys (MD 5.60; 95% CI 1.07 to 10.14; P = 0.02), but not girls born small (MD -2.04; 95% CI -7.04 to 2.95; P = 0.42), and did not alter cognitive or motor scores in the subgroup of children born SGA. In childhood, there was no difference in cognitive impairment (RR 0.81; 95% CI 0.26 to 2.57; P = 0.72) or cognitive scores (MD 1.02; 95% CI -1.91 to 3.95; P = 0.50) between supplemented and unsupplemented groups. There were also no differences in blood pressure, triglyceride, and low-density lipoprotein (LDL) concentrations (all P > 0.05). However, supplemented children had lower fasting glucose (mmol/L: MD -0.20; 95% CI -0.34 to -0.06; P = 0.005) and higher high-density lipoprotein (HDL) concentrations (mmol/L: MD 0.11; 95% CI 0.02 to 0.19; P = 0.02). In subgroup analyses, there was no evidence of differences in blood pressure between supplemented and unsupplemented groups in boys or girls born small, or in SGA children. In adolescence, there was no difference between supplemented and unsupplemented groups in blood pressure, triglycerides, LDL and HDL concentrations, fasting blood glucose, insulin resistance, and fasting insulin concentrations (all P > 0.05). Limitations include considerable unexplained heterogeneity, low to very low quality of the evidence, and limited data beyond early childhood. CONCLUSIONS: In this systematic review and meta-analysis of randomised trials, we found no evidence that early macronutrient supplementation for infants born small altered later cognitive function, although there was some evidence that supplementation may decrease motor impairment in toddlers. Contrary to the findings from observational studies, evidence from randomised trials suggests that early macronutrient supplementation for infants born small improves some metabolic outcomes in childhood. PROSPERO REGISTRATION: CRD42019127858.


Assuntos
Deficiências do Desenvolvimento/terapia , Suplementos Nutricionais , Doenças Metabólicas/terapia , Nutrientes , Adolescente , Criança , Pré-Escolar , Deficiências do Desenvolvimento/complicações , Deficiências do Desenvolvimento/prevenção & controle , Feminino , Idade Gestacional , Humanos , Fenômenos Fisiológicos da Nutrição do Lactente , Recém-Nascido , Doenças do Recém-Nascido , Recém-Nascido Prematuro , Recém-Nascido Pequeno para a Idade Gestacional , Masculino , Doenças Metabólicas/complicações , Doenças Metabólicas/prevenção & controle , Gravidez , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
11.
N Engl J Med ; 381(15): 1434-1443, 2019 10 10.
Artigo em Inglês | MEDLINE | ID: mdl-31597020

RESUMO

BACKGROUND: Observational data have shown that slow advancement of enteral feeding volumes in preterm infants is associated with a reduced risk of necrotizing enterocolitis but an increased risk of late-onset sepsis. However, data from randomized trials are limited. METHODS: We randomly assigned very preterm or very-low-birth-weight infants to daily milk increments of 30 ml per kilogram of body weight (faster increment) or 18 ml per kilogram (slower increment) until reaching full feeding volumes. The primary outcome was survival without moderate or severe neurodevelopmental disability at 24 months. Secondary outcomes included components of the primary outcome, confirmed or suspected late-onset sepsis, necrotizing enterocolitis, and cerebral palsy. RESULTS: Among 2804 infants who underwent randomization, the primary outcome could be assessed in 1224 (87.4%) assigned to the faster increment and 1246 (88.7%) assigned to the slower increment. Survival without moderate or severe neurodevelopmental disability at 24 months occurred in 802 of 1224 infants (65.5%) assigned to the faster increment and 848 of 1246 (68.1%) assigned to the slower increment (adjusted risk ratio, 0.96; 95% confidence interval [CI], 0.92 to 1.01; P = 0.16). Late-onset sepsis occurred in 414 of 1389 infants (29.8%) in the faster-increment group and 434 of 1397 (31.1%) in the slower-increment group (adjusted risk ratio, 0.96; 95% CI, 0.86 to 1.07). Necrotizing enterocolitis occurred in 70 of 1394 infants (5.0%) in the faster-increment group and 78 of 1399 (5.6%) in the slower-increment group (adjusted risk ratio, 0.88; 95% CI, 0.68 to 1.16). CONCLUSIONS: There was no significant difference in survival without moderate or severe neurodevelopmental disability at 24 months in very preterm or very-low-birth-weight infants with a strategy of advancing milk feeding volumes in daily increments of 30 ml per kilogram as compared with 18 ml per kilogram. (Funded by the Health Technology Assessment Programme of the National Institute for Health Research; SIFT Current Controlled Trials number, ISRCTN76463425.).


Assuntos
Deficiências do Desenvolvimento/prevenção & controle , Nutrição Enteral/métodos , Fórmulas Infantis , Doenças do Prematuro/prevenção & controle , Recém-Nascido Prematuro , Recém-Nascido de muito Baixo Peso , Leite Humano , Pré-Escolar , Nutrição Enteral/efeitos adversos , Enterocolite Necrosante/prevenção & controle , Seguimentos , Humanos , Recém-Nascido , Recém-Nascido Prematuro/crescimento & desenvolvimento , Recém-Nascido de muito Baixo Peso/crescimento & desenvolvimento , Unidades de Terapia Intensiva Neonatal , Tempo de Internação , Sepse/prevenção & controle
12.
PLoS Med ; 16(9): e1002920, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31560687

RESUMO

BACKGROUND: Approximately 250 million (43%) children under the age of 5 years in low- and middle-income countries (LMICs) are failing to meet their developmental potential. Risk factors are recognised to contribute to this loss of human potential. Expanding understanding of the risks that lead to poor outcomes and which protective factors contribute to resilience in children may be critical to improving disparities. METHODS AND FINDINGS: The Drakenstein Child Health Study is a population-based birth cohort in the Western Cape, South Africa. Pregnant women were enrolled between 20 and 28 weeks' gestation from two community clinics from 2012 to 2015; sociodemographic and psychosocial data were collected antenatally. Mothers and children were followed through birth until 2 years of age. Developmental assessments were conducted by trained assessors blinded to background, using the Bayley-III Scales of Infant and Toddler Development (BSID-III), validated for use in South Africa, at 24 months of age. The study assessed all available children at 24 months; however, some children were not able to attend, because of loss to follow-up or unavailability of a caregiver or child at the correct age. Of 1,143 live births, 1,002 were in follow-up at 24 months, and a total of 734 children (73%) had developmental assessments, of which 354 (48.2%) were girls. This sample was characterised by low household employment (n = 183; 24.9%) and household income (n = 287; 39.1% earning 1 domain affected, and 75 (10.2%) had delay in all domains. Bivariate and multivariable analyses revealed several factors that were associated with developmental outcomes. These included protective factors (maternal education, higher birth weight, and socioeconomic status) and risk factors (maternal anaemia in pregnancy, depression or lifetime intimate partner violence, and maternal HIV infection). Boys consistently performed worse than girls (in cognition [ß = -0.74; 95% CI -1.46 to -0.03, p = 0.042], receptive language [ß = -1.10; 95% CI -1.70 to -0.49, p < 0.001], expressive language [ß = -1.65; 95% CI -2.46 to -0.84, p < 0.001], and fine motor [ß = -0.70; 95% CI -1.20 to -0.20, p = 0.006] scales). There was evidence that child sex interacted with risk and protective factors including birth weight, maternal anaemia in pregnancy, and socioeconomic factors. Important limitations of the study include attrition of sample from birth to assessment age and missing data in some exposure areas from those assessed. CONCLUSIONS: This study provides reliable developmental data from a sub-Saharan African setting in a well-characterised sample of mother-child dyads. Our findings highlight not only the important protective effects of maternal education, birth weight, and socioeconomic status for developmental outcomes but also sex differences in developmental outcomes and key risk and protective factors for each group.


Assuntos
Comportamento Infantil , Desenvolvimento Infantil , Deficiências do Desenvolvimento/epidemiologia , Determinantes Sociais da Saúde , Fatores Socioeconômicos , Fatores Etários , Peso ao Nascer , Pré-Escolar , Deficiências do Desenvolvimento/fisiopatologia , Deficiências do Desenvolvimento/prevenção & controle , Deficiências do Desenvolvimento/psicologia , Escolaridade , Feminino , Humanos , Masculino , Saúde Materna , Fatores de Proteção , Medição de Risco , Fatores de Risco , Fatores Sexuais , África do Sul/epidemiologia
13.
Nutrients ; 11(9)2019 Aug 30.
Artigo em Inglês | MEDLINE | ID: mdl-31480225

RESUMO

Extremely preterm babies are at increased risk of less than optimal neurodevelopment compared with their term-born counterparts. Optimising nutrition is a promising avenue to mitigate the adverse neurodevelopmental consequences of preterm birth. In this narrative review, we summarize current knowledge on how nutrition, and in particular, protein intake, affects neurodevelopment in extremely preterm babies. Observational studies consistently report that higher intravenous and enteral protein intakes are associated with improved growth and possibly neurodevelopment, but differences in methodologies and combinations of intravenous and enteral nutrition strategies make it difficult to determine the effects of each intervention. Unfortunately, there are few randomized controlled trials of nutrition in this population conducted to determine neurodevelopmental outcomes. Substantial variation in reporting of trials, both of nutritional intakes and of outcomes, limits conclusions from meta-analyses. Future studies to determine the effects of nutritional intakes in extremely preterm babies need to be adequately powered to assess neurodevelopmental outcomes separately in boys and girls, and designed to address the many potential confounders which may have clouded research findings to date. The development of minimal reporting sets and core outcome sets for nutrition research will aid future meta-analyses.


Assuntos
Encéfalo/crescimento & desenvolvimento , Desenvolvimento Infantil , Deficiências do Desenvolvimento/prevenção & controle , Nutrição Enteral/métodos , Lactente Extremamente Prematuro/crescimento & desenvolvimento , Feminino , Humanos , Recém-Nascido , Masculino
14.
BMJ Open ; 9(9): e031362, 2019 09 11.
Artigo em Inglês | MEDLINE | ID: mdl-31511293

RESUMO

INTRODUCTION: Children and young people placed in out-of-home care (OoHC) are often affected by a history of trauma and adverse childhood experiences. Trauma in early childhood can impact on children's health and psychosocial development, whereas early interventions can improve children's development and placement stability. Although several interventions and practice models have been developed to improve health and psychosocial outcomes for children and young people in OoHC, there remains a lack of rigorous research examining the impact of these interventions in OoHC settings, as there are no systematic reviews examining the impact these interventions and practice models have on the children and young people they serve. We aim to conduct a comprehensive systematic review to examine the effectiveness of interventions and practice models for improving health and psychosocial outcomes in children and young people living in OoHC and to identify relevant knowledge gaps. METHODS AND ANALYSIS: Major electronic databases including Medline, Medline in-process and other non-indexed citations, Embase, Cumulative Index to Nursing and Allied Health Literature, PsycInfo, Sociological Abstracts and all Evidence-Based Medicine Reviews incorporating: Cochrane Database of Systematic Reviews, American College of PhysiciansJournal Club, Database of Abstracts of Reviews of Effects,Cochrane Central Register of Controlled Trials, CochraneMethodology Register, Health Technology Assessment and National Health Service Economic Evaluation Database, will be systematically searched for any studies published between 2008 and 2018 of interventions and practice models developed to improve health and psychosocial outcomes for children and young people in OoHC. Two independent reviewers will assess titles and abstracts for eligibility according to prespecified selection criteria and will perform data extraction and quality appraisal. Meta-analyses and/or metaregression will be conducted where appropriate. ETHICS AND DISSEMINATION: This study will not collect primary data and formal ethical approval is therefore not required. Findings from this systematic review will be disseminated in a peer-reviewed publication and conference presentations. PROSPERO REGISTRATION NUMBER: CRD42019115082.


Assuntos
Serviços de Saúde da Criança/normas , Deficiências do Desenvolvimento/prevenção & controle , Cuidados no Lar de Adoção/psicologia , Modelos Psicológicos , Adolescente , Criança , Comportamento Infantil/psicologia , Desenvolvimento Infantil , Serviços de Saúde da Criança/organização & administração , Deficiências do Desenvolvimento/psicologia , Cuidados no Lar de Adoção/normas , Humanos , Projetos de Pesquisa , Revisões Sistemáticas como Assunto , Adulto Jovem
15.
Indian Pediatr ; 56(11): 933-937, 2019 11 15.
Artigo em Inglês | MEDLINE | ID: mdl-31441434

RESUMO

OBJECTIVE: To compare development/cognition, adaptive function and maladaptive behavior of HIV-infected and HIV-exposed uninfected children between 2 to 9 years with HIV-uninfected controls. METHODS: This hospital-based cross-sectional study was conducted from November, 2013 to March, 2015. 50 seropositive HIV-infected, 25 HIV-exposed uninfected and 25 HIV-uninfected children between 2 to 9 years were administered Developmental Profile 3, Vineland Adaptive Behavior Scale 2, and Child Behavior Checklist for assessing development, adaptive function and maladaptive behaviour, respectively. Additional data were obtained by history, examination and review of records. RESULTS: Significant developmental/cognitive impairment was observed in 38 (76%), 16 (64%) and 6 (24%) HIV-infected, HIV-exposed uninfected, and HIV-uninfected children, respectively. Significant impairment in adaptive function was found in 12 (24%) and 2 (8%) HIV-infected and HIV-exposed uninfected children, respectively. Maladaptive behavior was not seen in any group. CONCLUSIONS: High magnitude of impaired development/cognition and adaptive function in HIV-exposed and HIV-infected children warrants assessment of these domains during follow-up of these children, and incorporation of interventions for these deficits in standard care for this group.


Assuntos
Adaptação Psicológica/fisiologia , Comportamento Infantil , Disfunção Cognitiva , Deficiências do Desenvolvimento , Infecções por HIV , Criança , Comportamento Infantil/fisiologia , Comportamento Infantil/psicologia , Pré-Escolar , Cognição , Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/etiologia , Disfunção Cognitiva/prevenção & controle , Correlação de Dados , Estudos Transversais , Deficiências do Desenvolvimento/diagnóstico , Deficiências do Desenvolvimento/etiologia , Deficiências do Desenvolvimento/prevenção & controle , Feminino , Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Infecções por HIV/psicologia , Soropositividade para HIV/psicologia , Humanos , Índia/epidemiologia , Masculino , Determinação de Necessidades de Cuidados de Saúde
16.
Pediatr Int ; 61(11): 1096-1102, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31328357

RESUMO

BACKGROUND: The Japanese government has established a law encouraging early detection and treatment of developmental disorders in children. Child behavior problems (CBP) tend to be recognized at school as a result of developmental disorders. The aim of this study was to identify factors associated with CBP in Japan. We hypothesized that factors other than developmental disorders are important in explaining CBP. METHODS: The study was conducted between February and March 2015. Parents of 3,515 children aged 2-5 years attending one of 34 public nursery schools in Takamatsu, Kagawa, Japan received self-administered questionnaires addressing parental socioeconomic factors, mental health, parenting style (i.e. hostile, overreactive, or lax), developmental disorders in children, and CBP. A multiple regression analysis was applied to explore associations between CBP and possible factors. RESULTS: Overall, 1,410 mothers were eligible to participate in the study. Children diagnosed with developmental disorders accounted for 7.8% of the sample, while on the Eyberg Child Behavior Inventory 17% of children had behavior problems needing clinical intervention. After adjustment for confounding factors, as well as for the diagnosis of developmental disorders, poor mental status and all three dysfunctional parenting styles had strong associations with CBP, and hostile, overreactive, and lax parenting had standardized ß-values (ß) of 0.29, 0.28, and 0.15, respectively (P < 0.01). A problematic relationship between the parents was also significantly associated with CBP (ß = -0.29, P < 0.01). CONCLUSION: When CBP are identified, parenting skills, mental health status and parental relationships should be considered along with the possibility of developmental disorders in the development of interventions.


Assuntos
Transtornos do Comportamento Infantil/prevenção & controle , Comportamento Infantil/psicologia , Deficiências do Desenvolvimento/prevenção & controle , Saúde Mental , Poder Familiar/psicologia , Pais/psicologia , Comportamento Problema/psicologia , Adolescente , Criança , Transtornos do Comportamento Infantil/epidemiologia , Transtornos do Comportamento Infantil/psicologia , Pré-Escolar , Estudos Transversais , Deficiências do Desenvolvimento/epidemiologia , Deficiências do Desenvolvimento/psicologia , Feminino , Humanos , Incidência , Japão/epidemiologia , Masculino , Fatores Socioeconômicos , Inquéritos e Questionários
18.
Phys Ther ; 99(6): 666-676, 2019 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-31155661

RESUMO

BACKGROUND: Infants born preterm and/or with brain injury often exhibit delays in the development of reaching and object exploration, increasing their risk of associated delays in cognitive development. OBJECTIVE: The objective of this study was to longitudinally evaluate feasibility of use of the novel Playskin Lift exoskeletal garment (Playskin; developed and trademarked by Dr. Lobo's Super Suits FUNctional Fashion and Wearable Technology Program at the University of Delaware, Newark, DE, USA), the assistive and rehabilitative effects of intervention with the garment on reaching and object exploration ability, and to relate changes in reaching and object exploration to changes in cognition during intervention for infants at risk for developmental delays. DESIGN: A multiple baseline single-case design with 1- to 2-month Baseline, 4-month Intervention, and 1-month Postintervention phases was implemented. METHODS: Ten infants born preterm and/or with brain injury, mean [SD] age 2.2 [1.3] months at the beginning of the study, were assessed biweekly throughout the study both with and without the Playskin Lift. Assessments included a Reaching Assessment and the cognitive subscale of the Bayley Scales of Infant and Toddler Development. Reaching and object exploration behaviors were coded from videos of the Reaching Assessment. Results were analyzed using multilevel modeling in SAS. RESULTS: The Playskin Lift improved infants' reaching ability, hand orientation for grasp and object exploration, and multimodal object exploration when worn within sessions, especially during the Intervention phase. The garment also improved independent reaching and object exploration across time during the Intervention phase, with retention of gains in the Postintervention phase. Improvement in reaching ability was positively related to changes in cognitive outcomes during the Intervention phase. LIMITATIONS: Limitations included modest sample size and the potential confounds of development and experience with time. CONCLUSIONS: The Playskin Lift can serve as a feasible, effective, and accessible assistive and rehabilitative device to advance reaching, object exploration, and cognition for infants at risk for future delays.


Assuntos
Desenvolvimento Infantil/fisiologia , Deficiências do Desenvolvimento/prevenção & controle , Crianças com Deficiência/reabilitação , Exoesqueleto Energizado , Recém-Nascido Prematuro , Comportamento Exploratório , Estudos de Viabilidade , Feminino , Humanos , Lactente , Recém-Nascido , Masculino
19.
Neurosciences (Riyadh) ; 24(2): 101-109, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31056541

RESUMO

OBJECTIVE: To determine the effect of family-based intervention on motor function in preterm infants. METHODS: This study was designed as a randomized controlled trial between August 2015 and September 2016. Forty-two preterm infants were randomized and split equally between the family-based intervention group, composed of a physiotherapeutic and a familial component (8 males, 8 females; mean age 91+/-3.09 days), and the traditional early intervention group (8 females, 8 males, mean age: 91.06+/-2.4 days). Both groups received a treatment program based on a neurodevelopmental approach during 3- to 12-months-old. The groups were evaluated at corrected ages of the third, sixth, ninth, twelfth, and 24th months using the Bayley Scale of Infant and Toddler Development, Third Edition (Bayley-III). RESULTS: Within-group changes over time were statistically significant using multivariate tests of fine motor (Multivariate analysis of variance (MANOVA); F=1515.27, p less than 0.001) and gross motor (MANOVA; F=1950.59, p=0.001) development. However, there was no interaction between groups in fine (MANOVA; F=0.027, p=0.872) and gross motor development (MANOVA; F=0.022, p=0.883). CONCLUSION: The early intervention approaches might support fine and gross motor function development in preterm infants in the first year of life.


Assuntos
Deficiências do Desenvolvimento/prevenção & controle , Intervenção Educacional Precoce/métodos , Família , Doenças do Prematuro/prevenção & controle , Transtornos dos Movimentos/prevenção & controle , Modalidades de Fisioterapia , Cuidadores , Deficiências do Desenvolvimento/complicações , Feminino , Humanos , Lactente , Recém-Nascido Prematuro , Masculino , Transtornos dos Movimentos/complicações , Gravidez , Nascimento Prematuro , Resultado do Tratamento
20.
J Pediatr Nurs ; 47: e10-e15, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30971361

RESUMO

PURPOSE: This study aimed to examine factors that influence developmental care practice among neonatal intensive care unit nurses. DESIGN AND METHODS: This descriptive, cross-sectional study was conducted using a questionnaire. Data were collected from 141 neonatal intensive care unit nurses from 6 hospitals in South Korea. Multiple linear regression analysis was used to examine factors influencing developmental care practice. RESULTS: This study found that professional efficacy had the largest influence on developmental care practice, followed by perception of developmental care and a task-oriented organizational culture. Clinical and educational experience regarding developmental care and working environment was not associated with developmental care practice among NICU nurses. CONCLUSIONS: To enhance nurses' practice of developmental care, enhancement of nurses' individual competency, positive perception of developmental care, and organizational efforts are required. A practical training program should be provided to nurses to promote confidence in implementing developmental care for preterm infants. IMPLICATIONS: A trained nurse should provide staff nurses with useful information on developmental care to encourage them to have a positive attitude towards developmental care. The nurse manager should create an organizational culture in which nurses perceive developmental care to be an essential nursing task in their unit.


Assuntos
Deficiências do Desenvolvimento/prevenção & controle , Recém-Nascido Prematuro , Unidades de Terapia Intensiva Neonatal/organização & administração , Enfermagem Neonatal/organização & administração , Atitude do Pessoal de Saúde , Competência Clínica , Feminino , Humanos , Recém-Nascido , Masculino , Cultura Organizacional
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...