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PubMed1995

Stress responsivity in exercisers and non-exercisers during different phases of the menstrual cycle.

It has been suggested that, premenstrually, women are more vulnerable to the effects of stress. It has also been proposed that the fitter the individual is, the less the body responds to, and the more quickly it recovers from, a stressful experience. The present study investigated whether premenstrual sensitivity to a stressful laboratory task would be attenuated in women who exercised. Responses to the task across the menstrual cycle were studied in 20 women who exercised regularly and 20 women who were sedentary. Heart rate and blood pressure as well as subjective mood responses were measured in each of three phases: premenstrual, menstrual and postmenstrual. Exercising and sedentary women differed in sensitivity to stress: heart rate responsivity to stress was less in exercisers, but mood fluctuation was greater. Menstrual cycle phase, by contrast, influenced general levels of heart-rate and mood, but did not affect responsivity to stress or performance. These findings suggest that the menstrual cycle and physical exercise have independent effects on cardiovascular and emotional state.

Adaptation, Psychological↗

PubMed1989

Cutaneous hypersensitivity following peripheral tissue damage in newborn infants and its reversal with topical anaesthesia.

The flexion reflex threshold has been used as a measure of sensation in a group of premature infants born at 27-32 weeks postmenstrual age. The threshold in an area of local tissue damage created by routine heel lances was half the threshold on the intact heel on the other side. This indicated a hypersensitivity to tissue damage analogous to tenderness or hyperalgesia reported in adults. In a double-blind study, treatment of the damaged area with the topical anaesthetic cream, EMLA, was found to reverse this hypersensitivity or in other words increase the flexion reflex threshold. Treatment with placebo had no effect. The results show that the newborn infant central nervous system is capable of mounting a chronic pain response to local injury which can be reduced by local anaesthetic.

Anesthetics, Local↗

PubMed1993

The relationship between mood and sexuality in women using an oral contraceptive as a treatment for premenstrual symptoms.

This study investigated the effects of a triphasic oral contraceptive (OC) on mood and on sexual interest in a group of 45 women with premenstrual complaints. Subjects made daily ratings of mood and sexual interest for one baseline cycle and were then randomly assigned to receive either placebo or OC for 3 mo. Women who received the OC reported decreased sexual interest during the menstrual and postmenstrual phases of the cycle. The predominant effect of both the OC and the placebo on mood was one of improvement, particularly during the premenstrual phase. There was little evidence of co-variation of mood and sexual interest in either group. Although the mechanism for the adverse effects of the OC on levels of sexual interest in unknown, it is clear that this effect was not simply a consequence of pill-induced negative mood change. The findings provide evidence that mood and sexual desire are dissociable and suggest that OCs can have direct effects on women's sexuality.

Adolescent↗

PubMed1990

Postural development in very low birth weight and normal birth weight infants.

In this study the seven postural responses selected by Vojta to evaluate neuromotor development were applied to 68 very low birth weight (VLBW) (greater than 1500 g) infants and to 28 healthy infants of normal birth weight (less than 2500 g). Of the 68 VLBW infants, 41 were small for gestational age and 27 appropriate for gestational age. All infants were examined between 37 and 40 weeks postmenstrual age. They were all later assessed on the Griffiths Mental Developmental Scale at 12 and 18 months. There were significant differences in postural reactions between the two groups which confirmed the lower tone and greater extension previously described in very low birth weight infants. An important finding in the study was that poor head and trunk righting noted at four months corrected age in very low birth weight infants, was associated with less developed locomotion at 12 and 18 months as assessed by the Griffiths Mental Developmental Scale. Thus, a delay in maturation in very low birth weight infants which was apparent from the assessment of postural responses in early infancy was still identifiable on the locomotor subscales at 12 and 18 months. Five of Vojta's responses were shown to be useful as part of the neurological assessment of high risk infants.

Apgar Score↗

PubMed1991

Growth and motor development in fetuses of women with type-1 diabetes. III. First trimester quantity of fetal movement patterns.

Delayed emergence of movement patterns and disturbances in the development of behavioural states are often observed in the fetuses of diabetic women. The developmental course of specific fetal movement patterns was studied in 20 women with type-1 diabetes during the first trimester of pregnancy. The aim was to investigate whether maternal diabetes also has an effect on the rate of occurrence and temporal patterning of fetal movements. Real-time ultrasound recordings with a duration of 1 h were made once a week between the 7th and 17th week postmenstrual age in order to quantify fetal movements. The data were compared to those obtained in a group of uncomplicated pregnancies. The developmental trends in the occurrence of movement patterns were similar to those in the control fetuses, with the exception of startles. Before the 9th week of gestation, fetal movements occurred less frequently; this was related to the quality of maternal glucose control. After 12 weeks, the overall incidence was higher than in the control group, due to an increase in the incidence of breathing movements. The rate of breathing movements was generally slower than in the control group.

Blood Glucose↗

PubMedDate not supplied

Developmental course of general movements in early infancy. I. Descriptive analysis of change in form.

In order to describe the developmental changes of general movements (GM) in early infancy and to relate them to changes in other aspects of the neurological repertoire, the spontaneous motility in supine position was recorded on video tape at 4-week intervals in a group of twenty-two full-term healthy infants aged 2-18 weeks. Each follow-up session included a neurological examination. In newborn infants GM have a 'writhing' quality. The movements are characterized by a tight appearance, a relatively slow speed and a limited amplitude. The 'writhing' character of the GM is gradually broken down into a so-called 'fidgety' quality. These GM are typified by an ongoing flow of small movements occurring irregularly all over the body. The transformation of GM from a 'writhing' character into a 'fidgety' character was related more closely to postmenstrual than to postnatal age. 'Fidgety' GM were almost constantly present at the age of 8-12 weeks. In the third month very rapid arm movements ('swipes' and 'swats') occurred. The developmental changes in the form of the GM and those of the neurological repertoire showed no significant correlation. This demonstrates that within the normal CNS the various functional modules develop autonomously.

Age Factors↗

PubMed1993

General movements in early infancy: what do they tell us about the nervous system?

Developmental changes in muscle coordination patterns of normal and abnormal general movements (GMs) are described. GMs were studied simultaneously with video-recording and polymyography (polyEMG). GMs of normal full-term infants gradually lose their neonatally slow and 'writhing' character, to be turned into the elegant flow of small movements of 'fidgety' GMs at the age of 2-3 months. This transformation coincides with changes in the polyEMG. Tonic background activity decreases concurrent with a reduction in amplitude and duration of phasic bursts. The coordination between antagonistic muscles does not change, co-activation remains the prevailing pattern. Secondly, preliminary results on healthy preterms (n = 6) are presented. At the examination age of 33-34 weeks postmenstrual age the preterms showed so-called 'preterm' GMs, which are characterized by variation and graceful complexity. EMG burst duration was significantly longer during 'preterm' GMs than during 'writhing' GMs of full-term newborns. The percentage of co-activation during 'preterm' GMs varied considerably. The polyEMG of 'writhing' GMs of two preterms, who were followed longitudinally, differed from that of 'writhing' GMs of full-terms. At 'fidgety' age the EMG differences between preterms and full-terms had disappeared. Finally the first results on abnormal GMs are reported. A synchronized onset of muscle activity in all extremity muscles and 'packaging' of EMG-bursts into subunits of 5-8 Hz. seemed to be specific properties of these abnormal GMs. This could indicate a loss of supraspinal control.

Electromyography↗

PubMed1993

Developmental features of the brain in preterm and fullterm infants on MR imaging.

Normal development and maturation in pre- and postnatal periods were studied using MR imaging. For this purpose, we performed MR imaging at a postmenstrual age of 37-44 weeks in both low-risk preterm and fullterm infants and assessed the myelination pattern and the dimension of the pituitary gland, corpus callosum, pons and cerebellar vermis. There were no differences in stages of myelination and the size of these structures in both groups. MR imaging was also performed in infants with various cerebral injuries. Focal or diffuse areas of hyperintensity on T2-weighted images and delayed myelination were the commonly observed abnormal findings in these infants.

Brain↗

PubMed1995

Volumetric analysis of the normal infant brain and in intrauterine growth retardation.

Twenty-eight infants with postmenstrual ages (PMA) in the range of 32-80 weeks were investigated. Twenty were newborn; among these the observed birth weight divided by the expected weight ranged from 0.31 to 1.1. Axial magnetic resonance images were recorded with a triple spin-echo sequence and the volumes were determined by encircling each structure of interest on every slice. Segmentation into grey matter, white matter and CSF was done by semi-automatic discriminant analysis. Growth charts for the cerebrum, cerebellum, corpora striata, thalami, ventricles, and grey and white matter are provided for infants with appropriate birth weight. The striatal (P = 0.02) and thalamic (P < 0.001) percentage of the hemispheric volume decreased with age, whereas the ratio of grey matter to white matter (G/W-ratio) increased (P = 0.01). In the neonatal patients, brain volumes were independently associated with both PMA and the degree of growth retardation. It was calculated that the hemispheric volume was reduced by from 16% to 23% if the total bodyweight was reduced by 40%. The G/W-ratio was found to be independently associated with the PMA (P < 0.05) and the degree of IUGR (P < 0.1) suggesting that fetal growth retardation reduces grey matter volume more than white matter.

Birth Weight↗

PubMed1996

Rhythmical leg movements in low-risk and brain-damaged preterm infants.

The characteristics of rhythmical kicking movements of preterm infants with documented brain damage (BD), who later showed a severe motor impairment, are described and compared with those of low-risk (LR) preterm infants. Spontaneous movements were videotaped for 60 min in the incubator or in a warmer. A first group of 6 BD and 6 LR infants was observed at 31-35 weeks of postmenstrual age (PMA) and a second group (6 BD, 6 LR) at 37-39 weeks. Bouts of rhythmical kicks, defined as leg movements repeated in the same form at least three times at regular short intervals, were analysed during periods of activity. The results indicated non-significant differences between BD and LR infants at 31-35 weeks of PMA. In contrast, some differences were observed at 37-39 weeks. These differences were not due to leg movement frequency, but to inter-leg coordination and to temporal organisation of the kicking cycles. LR infants exhibited more alternate-leg movements and fewer semi-both-leg movements (simultaneous flexion and non-simultaneous extension) than BD infants. In LR cases the duration of the pause between flexion and extension was shorter, whereas flexion and extension periods were similar for all infants. Although there were significant differences, quantitative analysis of kicking characteristics was not clinically useful because of the large overlap in findings between the two groups. On the other hand Gestalt evaluation of general movements of the same videorecordings showed a closer correlation with the presence of brain lesions and with neurological outcome.

Brain Diseases↗

PubMedDate not supplied

Magnetic resonance imaging in preterm infants.

Magnetic resonance imaging was performed in 9 preterm infants at 37-43 weeks postmenstrual age. They all were born at 26-35 weeks gestation. Myelination was graded according to its most cephalic location. Myelination pattern 2 (myelination observed in the posterior limb of the internal capsule and adjacent structures of the thalamus and lenticular nucleus) was demonstrated in 2 infants, pattern 3 (myelination of the corona radiata) in 3 infants, and pattern 4 (myelination of the centrum semiovale) in 4 infants. Bilateral low intensity areas were found on T1-weighted images in 7 infants and a ribbon-like, high intensity was observed in 5. These findings revealed a wide variety of magnetic resonance imaging appearance in apparently normal preterm infants. Caution is needed in interpreting the pathologic nature of such features in preterm infants during the perinatal period.

Asphyxia Neonatorum↗

PubMed1989

Cyclical mastopathy: an evaluation of methods of assessment.

We have evaluated three methods of assessing patients with cyclical breast symptoms (cyclical mastopathy--CM). One method, a screening questionnaire, was used to identify women with CM, and two others, a symptom severity questionnaire and a daily diary, were used prospectively to record the severity of symptoms in relation to the menstrual cycle. The screening questionnaire was assessed for test-retest reliability and for agreement between the recalled severity of symptoms and those recorded during prospective measurement. The symptom severity questionnaire and diary were assessed by examining their ability to discriminate between pre- and postmenstrual phases of the menstrual cycle, differences in symptom severity at these times being the cardinal feature of CM. Test-retest reliability of premenstrual symptoms by the screening questionnaire gave correlation coefficients over 0.70 for 9 of the 11 items assessed. The symptom severity questionnaire showed significant differences between pre- and post-menstrual scores for 8 of the 11 items assessed and the diary for each of the 2 items assessed. Comparison of symptom severity as recalled and as prospectively recorded showed only modest agreement. These results show that the instruments used to assess symptom severity performed satisfactorily but that the screening questionnaire used to identify women with CM, although reliable, correlated only moderately well with prospective measurement.

Adolescent↗

PubMed2006

NICU nurses' knowledge and discharge teaching related to infant sleep position and risk of SIDS.

UNLABELLED: Infants requiring neonatal intensive care are often placed prone during their acute illness. After hospital discharge the American Academy of Pediatrics (AAP) recommends supine sleep position to reduce the risk of Sudden Infant Death Syndrome (SIDS). Little is known about nursing knowledge and practice regarding best sleep positions for infants as they transition from neonatal intensive care to home. OBJECTIVE: To explore and describe neonatal intensive care unit (NICU) nurses' knowledge and practice in the NICU, and to determine the content of parent instruction regarding infant sleep position at discharge. STUDY DESIGN: This survey was conducted in 2 phases. In Phase I, a questionnaire was designed and completed by 157 neonatal nurses currently practicing in Level III and IV NICUs in the state of New York. After content analysis of responses and item revisions, a panel of experts reviewed questionnaire items. Phase II involved completion of the final questionnaire by 95 NICU nurses in 4 additional hospitals. The combined results of Phase I and II are reported. RESULTS: Of 514 questionnaires distributed, 252 (49%) were completed and analyzed. During NICU hospitalization, nurse respondents identified prone position as the best general sleep position for preterm infants (65%) followed by either prone or side-lying (12%). The nurses' assessment of the infants' readiness for supine sleep position at the time of NICU discharge varied. Most nurses responded that preterm infants were ready to sleep supine anytime (29%), close to discharge (13%), when maintaining their body temperature in an open crib (25%), between 34 to 36 weeks postmenstrual age (PMA) (15%), after 37 weeks PMA (13%), and when the infant's respiratory status was stable (6%). Typical sleep positions chosen for full-term infants in the NICU were supine (40%), side or supine (30%), all positions (18%), side (8%), prone or side (3%), and prone (1%). Frequently cited reasons to place full-term infants to sleep prone were: reflux (45%), upper airway anomalies (40%), respiratory distress (29%), inconsolability (29%), and to promote development (17%). At NICU discharge, 52% of nurses instructed parents to place their infants in the supine position for sleep. The most common nonsupine sleep positions recommended by nurses at discharge were either supine or side (38%), and exclusive side positioning (9%). CONCLUSIONS: Nearly 95% of respondents identified a nonsupine sleep position as optimal for hospitalized preterm infants. Further, only 52% of neonatal nurses routinely provide discharge instructions that promote supine sleep positions at home. This study suggests that nursing self-reports of discharge teaching practices are inconsistent, and in some cases in direct conflict with the national "Back to Sleep" recommendations, which emphasize that the supine position is the safest position for healthy full-term and preterm infants after hospital discharge.

Bedding and Linens↗

PubMed2006

A descriptive study of mothers' experiences feeding their preterm infants after discharge.

PURPOSE: The purpose of this study was to explore mothers' perceptions of their experiences in feeding their preterm infants in the early weeks after hospital discharge. SUBJECTS: Twenty-seven mothers whose preterm infants were part of a larger study of feeding readiness participated. DESIGN: A qualitative, descriptive approach was used to explore mothers' experiences in feeding their preterm infants after hospital discharge. METHODS: A convenience sample of mothers of preterm infants were interviewed 2 to 3 weeks after hospital discharge. Data were generated by semi-structured interview and analyzed by searching for thematic patterns in the data. Mothers were asked to describe their experiences feeding their infants, their perceptions of how their infants' feeding ability had changed since discharge, and the meanings they gave to these changes. The interviews were audiotaped and transcribed. Agreement of themes between the investigators was achieved. MAIN OUTCOME MEASURES: Three themes emerged from the interviews: interpreting infant behaviors, managing the feeding process, and realizing knowledge gaps. PRINCIPAL RESULTS: Mothers struggle with infant feeding in the first few weeks after discharge and experience a period of transition before comfort develops. CONCLUSIONS: Nursing interventions should include anticipatory guidance to mothers about feeding their infants after discharge and more concrete information regarding infant cues of hunger and satiation. Follow-up visits after discharge should include a review of the current feeding regimen, information regarding feeding progression, and reinforcement about changing infant behaviors as the preterm infant approaches 40 weeks postmenstrual age.

Adult↗

PubMed2026

Rates, Timing, and Predictors of Retreatment Across Risk-Cohorts in Retinopathy of Prematurity: Intravitreal Bevacizumab Injection Versus Laser.

OBJECTIVE: To characterize rates, timing, and predictors of retinopathy of prematurity (ROP) retreatment among infants treated with primary laser or intravitreal bevacizumab injection. DESIGN: Retrospective consecutive, comparative clinical study. PARTICIPANTS: Infants who underwent initial treatment for treatment-warranted ROP (TW-ROP) with either intravitreal bevacizumab or laser photocoagulation between 2017 and 2023. METHODS: Patients were stratified into two treatment groups: primary laser group vs primary bevacizumab group. MAIN OUTCOME MEASURES: Retreatment within the first 3 months (0-90 days) was assessed and classified as early (≤30 days) or late (31-90 days). RESULTS: Two hundred and thirty eight eyes of 122 infants were treated for ROP; of those, 181 (76.1%) eyes of 93 (76.2%) patients were included. There were 116 (64.1%) eyes in the bevacizumab group, and 65 (35.9%) eyes in the laser group. Thirty-three (18.2%) eyes-all micro- or nano-premature (<27 weeks GA and/or <800 grams)-required retreatment for TW-ROP. Sixteen (8.8%) required early retreatment at a median postmenstrual age (PMA) of 40.4 weeks (IQR, 38.44-43.3). There were differences in the proportion of early retreated infants (21.5% for laser vs 1.7% for injection, P < .001). Seventeen (9.4%) eyes required late retreatment. The median PMA at late retreatment was 45.6 weeks (IQR, 43.7-47.4). Infants in the bevacizumab group had lower odds of retreatment within three months than those with laser (OR, 0.23; 95% CI, 0.06-0.82). Similarly, patients in the bevacizumab group had lower odds of requiring early retreatment compared to those with laser (OR, 0.08; 95% CI, 0.04-0.18). Within eyes with retreatment, infants in the bevacizumab group had a later PMA at retreatment than those in the laser group (B = 6.81; 95% CI: 4.68-8.93). AROP was associated with earlier PMA at retreatment (B = -7.72; 95% CI, -9.36 to -6.10). CONCLUSION: In this study, early retreatment was low (8.8%), with most eyes initially treated with laser (21.5%) rather than bevacizumab (1.7%). Aggressive ROP was associated with earlier retreatment, highlighting its role as a marker of more severe disease. Compared to laser, bevacizumab was associated with lower overall and early retreatment, and delayed need for additional intervention when necessary. All retreatments occurred in micro- or nano-premature infants, suggesting that medium-to-low risk infants may require less strict post-treatment monitoring.

Humans↗

PubMed2005

Distribution of sleep and wakefulness EEG patterns in 24-h recordings of preterm and full-term newborns.

The aim of this study was to evaluate the organisation of EEG patterns in 24-h recordings of preterm and near-term neonates. In particular, the distribution of the different EEG codes at different postmenstrual ages (PMA) and the variations of sleep-related EEG pattern organisation was studied, during day (8.00 a.m.-8.00 p.m.) and night (8.00 p.m.-8.00 a.m.) time. The age of appearance of different neonatal EEG patterns, previously described in literature for short lasting records, was confirmed in this 24-h study. The medium-voltage continuous EEG pattern (pattern "3") was less represented approaching term age, in coincidence with the appearance of the two low-voltage continuous patterns ("1" and "2"), which are also related to active sleep and wakefulness. Discontinuous pattern ("7") was also less represented with age, but in day-time only. The percentage of time occupied by this pattern, related to quiet sleep, was significantly higher during day-time hours, than at night.

Circadian Rhythm↗

PubMed2005

Management of infants with chronic lung disease of prematurity in Australasia.

Chronic lung disease is common in extremely preterm infants born in Australasia. In 2002, 53% of surviving infants born before 28 weeks' gestation remained either oxygen-dependent or on other respiratory support at 36 weeks' postmenstrual age. In the first weeks of life oxygenation should be kept generally "lower", although what is the most appropriate level remains uncertain. During the mid-phase of the neonatal course, functional oxygen saturation levels around 90-95% probably confer the best benefit/risk balance. The most appropriate target saturation range for infants on home oxygen also remains uncertain. Definitive data to guide clinical practice is lacking regarding the use of postnatal corticosteroids, bronchodilators, and diuretics for either the treatment or prevention of chronic lung disease. Home oxygen programmes are effective in avoiding prolonged hospitalisation for infants with chronic lung disease, but require the coordination of a large, multidisciplinary team.

Adrenal Cortex Hormones↗

PubMed2006

A controlled trial of skin-to-skin contact in extremely preterm infants.

BACKGROUND: Extremely preterm birth, even in the absence of significant neurological impairment, is associated with altered pain responses and impaired memory and behaviour. Preterm birth increases the risk of maternal depression and may impede the development of the mother-infant relationship, factors that in turn are also associated with impaired infant outcome. Mother-infant skin-to-skin contact has been recommended as a simple means of ameliorating these effects. METHODS: We conducted a pragmatic, prospective, controlled, intention-to-treat trial in two neonatal intensive care units. Infants born below 32 weeks gestation were recruited within the first week after birth and assigned to a control group receiving standard care, or an intervention group in which mothers were encouraged to provide a session of skin-to-skin contact once daily for 4 weeks. We assessed infant behaviour at time of discharge from hospital, responses to immunisation at 4 and 12 months of age, and memory, behaviour and development at 1 year corrected (postmenstrual) age. Indices of maternal depression, stress, anxiety, lactation performance and infant interaction were assessed at time of infant discharge, 4 months and 1 year. RESULTS: No significant difference was identified in any infant or maternal measure at any time point. CONCLUSIONS: Mother-infant skin-to-skin contact after extremely preterm birth results in neither benefit nor adverse consequences. Although there is no reason to dissuade mothers who wish to provide STS contact, we are unable to recommend resource allocation for the implementation of STS programmes for extremely preterm infants in a neonatal intensive care unit setting.

Adult↗