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PubMed1995

Brief report: four years after a preterm birth: children's development and their mothers' beliefs and expectations.

Examined the development of preterm-born 4 1/2-year-olds who lived in environments free from socioeconomic disadvantages often associated with deleterious outcomes. Beliefs and expectations of their mothers were also assessed. Thirty-two preterm and 41 comparison children and their mothers participated. Results indicated that although the preterm children were performing at or above age norms on most measures, they scored lower than comparison children in receptive vocabulary, syntactic complexity, articulation, and visual-motor skill. In addition, preterm and comparison group mothers differed in some beliefs and expectations. Results suggest that a preterm birth remains a factor in development during the preschool period, even in a social environment most likely to provide compensatory mechanisms for preterm birth.

Analysis of Variance↗

PubMed1996

Cardiorespiratory reactivity during the Brazelton Scale in term and preterm infants.

Determined the relationship between behaviour measured with the Brazel zelton Scale and simultaneously recorded cardiorespiratory activity. The Brazelton Scale was administered and videotaped in a sample of 22 term and 22 preterm infants at term conceptional age. The videotapes were coded off line with a computer interface to time lock behavior and physiological activity for the duration of four alert, non-crying conditions. Term infants showed increases in heart rate and breathing rate when unswaddled and cuddled following cry and increases in respiratory sinus arrhythmia (RSA) during orientation and swaddling. Preterm infants showed the same general trend as term infants in heart rate and breathing rate. However, RSA decreased during orientation in preterm infants. On behavioral scores, preterm infants showed lower scores on self-regulation and a higher cost of attention. Correlations between behavior and physiological activity showed lower RSA associated with enhanced behavioral scores for the preterm infants. Results of this study are consistent with the hypothesis that attentional responsivity in the preterm infant may be at the expense of physiological stability.

Crying↗

PubMed1998

Characteristics of women with clinical intra-amniotic infection who deliver preterm compared with term.

The authors sought to determine whether demographic factors, labor characteristics, and labor management for intra-amniotic infection (IAI) are different for IAI cases who deliver preterm compared with IAI cases who deliver at term. From 1990 through 1994, 610 women with intra-amniotic infection and 747 controls were enrolled from five hospitals in King County, Washington state. Intra-amniotic infection was diagnosed by fever 37.8 degrees C with two of the following signs: maternal or fetal tachycardia, uterine tenderness, elevated peripheral white blood cell count, and purulent amniotic fluid. Preterm IAI cases were significantly more likely than term IAI cases to have membrane rupture before contractions (odds ratio (OR) = 6.1) and prolonged membrane rupture (> 24 hours) (OR = 31.0). Term cases were more likely to experience a prolonged second stage of labor. After accounting for differences in labor characteristics, preterm IAI was less likely to be managed with a cesarean delivery, prolonged internal monitoring, or induction of labor and more likely to be managed with antimicrobials and antipyretics. When compared with preterm births without IAI, preterm IAI cases were more likely to be managed with labor augmentation. The authors believe that labor characteristics of women with preterm IAI and the risk of neonatal sepsis deserve further study.

Adolescent↗

PubMed1998

Effects of physical activity on preterm birth.

The authors conducted a cohort study of low income women to determine the effect of physical activity on the risk of preterm birth. Women were sampled prenatally from four clinic sites and were scheduled for delivery at the University of Maryland Medical Systems (UMMS). Women who delivered infants at UMMS but who had received no prenatal care were also eligible. Preterm delivery was defined as a delivery prior to 37 completed weeks gestation. After adjusting for confounders, the odds of preterm delivery were increased for women who climbed stairs > or = 10 times per day (odds ratio (OR) = 1.60, 95% confidence interval 1.05-2.46) and for women who engaged in purposive walking > or = 4 days per week (OR = 2.10, 95% CI 1.38-3.20). Leisure-time exercise (> or = 60 days in the first and second trimesters combined) had a protective effect on preterm delivery (OR = 0.51, 95% CI 0.27-0.95). Television viewing had a U-shaped relation with preterm delivery (ORs (95% CI): < 15 hours, 2.09 (1.21-3.61); 29-42 hours, 1.50 (0.84-2.67); > 42 hours, 3.05 (1.75-5.40)). While the results support current recommendations regarding leisure-time activities, activities of daily living appear to increase risk of preterm delivery among low income women. These findings and those for television watching warrant further investigation.

Activities of Daily Living↗

PubMed1995

Epidemiology of preterm delivery in two birth cohorts with an interval of 20 years.

The occurrence and determinants of preterm delivery were studied in two population-based birth cohorts from northern Finland. In the first cohort of 1966 there were 11,475 singleton deliveries and in the later cohort of 1985-1986, 8,888. The overall incidence (percentage) of preterm deliveries fell from 9.1 to 4.8, including a reduction from 8.8 to 3.4 for spontaneous preterm deliveries. For iatrogenic ones, however, there was an increase from 0.3 to 1.4. The relative risks, associated with such known maternal determinants as unmarried status, smoking, low educational level, age over 34 years, unwantedness of the pregnancy, and poor earlier obstetric history, had about the same level in these two series. However, despite a favorable change in the distribution of most of these determinants over the 20 years, only a small part of the decrease of the total incidence of preterm delivery could be attributed to these changes, as a consistent and substantial reduction occurred in the incidence of spontaneous preterm birth in all categories of each single determinant. The increase in the proportion of iatrogenic preterm deliveries was accompanied by these being more common at lower than at higher socioeconomic levels in 1985-1986, whereas the social gradient appeared to be reversed in 1966.

Cohort Studies↗

PubMed2005

Sleep architecture in term and preterm infants beyond the neonatal period: the influence of gestational age, steroids, and ventilatory support.

STUDY OBJECTIVE: To examine (1) sleep architecture of infants at varied risk for sudden infant death syndrome, (2) delays or advances in preterm infants at term postmenstrual age, (3) whether ventilatory support and gestational age alter sleep, (4) whether steroids alter sleep, (5) confounding influences of sex, small for gestational age, and maternal smoking. DESIGN: Overnight polysomnography. DEPENDENT VARIABLES: Percentage of active sleep, quiet sleep, indeterminate, and awake time per total recording time; mean and longest duration of state epochs; number of episodes > or = 10 minutes; and sleep efficiency. SETTING: Collaborative Home Infant Monitoring Evaluation (CHIME). PARTICIPANTS: Two hundred one preterm and 198 term infants between 33 and 58 weeks postmenstrual age during polysomnography. Fifty-one term infants with an apparent life-threatening event without known etiology (apnea of infancy), 59 subsequent siblings of babies who died of sudden infant death syndrome, and 88 healthy term infants. RESULTS: Tracings of infants with apnea of infancy and healthy term infants were similar. Subsequent siblings of babies who died of sudden infant death syndrome spent less time in quiet sleep. Preterm infants (< or = 37 weeks postmenstrual age) exhibited immature architecture compared with infants of term postmenstrual age. The latter exhibited similar sleep except that they had a lower percentage of quiet sleep and longer mean indeterminate and longest indeterminate episodes. Preterm infants with the youngest gestational age lagged behind older preterm infants. Neither sex nor use of steroids affected sleep. Assisted ventilation was associated with a delay in maturation, small-for-gestational age status with increased active sleep, and smoking with increased awake time. CONCLUSION: With few exceptions, asymptomatic premature infants do not exhibit significant delays in sleep architecture compared with term infants at comparable postmenstrual age. The preterm infant with an early gestational age and morbidity exhibited delayed sleep architecture.

Anti-Inflammatory Agents↗

PubMed2003

Epithelial cell-derived neutrophil-activating peptide-78 is present in fetal membranes and amniotic fluid at increased concentrations with intra-amniotic infection and preterm delivery.

Intra-amniotic secretion and abundance of epithelial cell-derived neutrophil-activating peptide (ENA)-78, a potent chemoattractant and activator of neutrophils, was studied in the context of term and preterm parturition. Staining of ENA-78 immunoperoxidase was localized predominantly to chorionic trophoblasts and amniotic epithelium in term and preterm gestational membranes, with weaker and less consistent staining in decidual cells. The abundance of ENA-78 in membrane tissue homogenates was significantly increased ( approximately 4-fold) with term labor in amnion (n = 15), and with preterm labor ( approximately 30-fold) in amnion and choriodecidua (n = 31). In amnion tissue homogenate extracts, ENA-78 levels were positively correlated with the degree of leukocyte infiltration (r2 = 0.481). In amniotic fluids, median ENA-78 levels from pregnancies with preterm labor without intra-amniotic infection were significantly lower (P < 0.01 by ANOVA) than those from pregnancies with preterm deliveries with infection; levels in samples derived from term pregnancies were similar before and after labor. Production of ENA-78 by amnion monolayers was stimulated in a concentration-dependent fashion by both interleukin-1beta and tumor necrosis factor alpha. Production of ENA-78 by choriodecidual explants was increased modestly after 2-4 h of exposure to lipopolysaccharide (5 microg/ml). An immunoreactive doublet ( approximately 8 kDa) was detected in choriodecidual explant-conditioned media by immunoblotting. We conclude that ENA-78, derived from the gestational membranes, is present in increased abundance in the amniotic cavity in response to intrauterine infection and, hence, may play a role in the mechanism of infection-driven preterm birth and rupture of membranes secondary to leukocyte recruitment and activation.

Amniotic Fluid↗

PubMed2002

Preterm labour.

Studies in the past year have clarified the roles of inflammatory mediators in preterm labour. Exploration of possible genetic predisposition is just beginning. Ultrasound measurement of cervical length has the potential to predict women at risk of preterm delivery several weeks before it occurs. Biochemical testing such as fetal fibronectin can possibly increase its predictive value and differentiate true preterm labour from more innocent preterm contractions. The use of antibiotics for preterm premature rupture of membranes has been clarified with the ORACLE I trial, which shows health benefits for the neonate with the use of erythromycin, whereas antibiotics do not seem to play a beneficial role in spontaneous preterm labour without evidence of clinical infection. There have been further studies suggesting that agents other than beta-agonists are preferable for acute tocolysis and that repeated doses of corticosteroids should be used with caution.

Adrenal Cortex Hormones↗

PubMed2000

Infection and preterm labor.

There are many conditions, such as non-white race, young maternal age, and uterine malformations, that have been associated with preterm birth that are not amenable to intervention. Maternal cervical and intrauterine infection and inflammation may have a primary causative role in a fraction of the cases of preterm birth and preterm rupture of membranes and may also interact adversely with a variety of maternal (shortened cervix, smoking) and fetal factors (polyhydramnios, multifetal gestation) to decrease the threshold to preterm birth. Further studies are needed to better-define the link between various maternal microbial colonizations and preterm delivery, with the possibility to establish new screening and treatment recommendations. Because of the innumerable causes of preterm birth, a new strategy of targeted treatment of cervical or vaginal infections may lead to only a modest reduction in the incidence of this devastating problem of modern obstetrics.

Chronic Disease↗

PubMed2000

How to diagnose preterm labor: a clinical dilemma.

The clinician is faced with many dilemmas in the diagnosis of preterm labor. The tools at hand (no pun intended) yield subjective information and it is difficult to distinguish true labor from false labor. Because preterm labor is multifactorial in cause and can occur in primiparas, estimating risk for the individual patient is difficult. The cause of the preterm labor in the majority of patients is idiopathic; in this group, the use of salivary estriol as a biochemical marker for preterm labor can increase the accuracy of the diagnosis of true labor. It may also lend confidence to the diagnosis of false labor and may allay anxiety and prevent unnecessary interventions. On the horizon are two noninvasive methods: the EMG, to evaluate uterine contractility, and the collascope, to evaluate the cervix. Both show promise and may provide a more objective assessment of risk for preterm delivery among women with symptoms of preterm labor.

Collagen↗

PubMed2003

Effects of neurobehavioral assessment on feeding and weight gain in preterm neonates.

Neonatal intensive care unit personnel and parents often are concerned that developmental assessment will tire preterm neonates and impair their feeding ability and subsequent weight gain. Therefore, the amount of fluid consumed by 108 preterm neonates (<or=36.5 wk gestational age) was compared before and after administration of the Neurobehavioral Assessment of the Preterm Infant (NAPI). In addition, the weight gain of 35 preterm neonates who were administered the NAPI was compared with that of a matched control group of 35 preterm neonates who were not administered the NAPI. There were no differences in the amount of fluid consumed before and after NAPI administration, and there were no differences in weight gain between neonates who were and were not administered the NAPI. The effects of NAPI administration did not differ as a function of gestational age group. Therefore, the NAPI can be administered safely to preterm neonates without affecting feeding performance or weight gain.

Drinking↗

PubMedDate not supplied

Growth, biochemical status, and mineral metabolism in very-low-birth-weight infants receiving fortified preterm human milk.

We compared the growth, biochemical status, and mineral status of 30 very-low-birth-weight infants randomly assigned to receive preterm human milk (Group I, 10 infants) from their own mothers, fortified preterm human milk (Group II, 8 infants), or a high-caloric-density premature formula (Group III, 12 infants). Added to the infant's own mother's milk, a human milk fortifier at full strength provided additional protein (60:40 whey/casein, 0.7 g/dl), calories (4 kcal/oz), and minerals. Volume of intake, feeding tolerance, and complications were similar in the three groups. Infants receiving fortified preterm human milk showed growth, biochemical status, and mineral status similar to those receiving high-caloric-density formula, but infants receiving fortified preterm human milk grew faster (12.0 +/- 3.2 vs. 8.9 +/- 1.1 days/300 g, p less than 0.05), had higher serum protein (4.6 +/- 0.5 vs. 4.2 +/- 0.2 g/dl, p less than 0.05), and tended to have better mineral status (higher serum calcium, lower alkaline phosphatase, and higher serum phosphorus, none individually significant) than infants receiving preterm human milk alone. This study supports previous observations that fortified preterm human milk provides nutritional advantages for very-low-birth-weight infants.

Body Height↗

PubMed1992

Antral and duodenal motor responses to duodenal feeding in preterm and term infants.

In the fasting state, antral motor activity is similar in preterm and term infants, but the antral responses to feeding have not been compared in preterm and term infants. The purpose of this study was to use low-compliance, continuous perfusion manometry to compare antral and duodenal feeding responses in 13 preterm and nine term infants within the first 14 days of life. Confirming our previous studies, fasting antral motor activity was similar in preterm and term infants, but duodenal activity differed. Individual duodenal cluster activity was of shorter duration in preterm than in term infants (p less than 0.01). Motor activity in antrum and duodenum changed in both groups of infants in response to an intraduodenal milk infusion of 4 ml/kg/2 h; however, the nature of the change varied in the two regions. In term infants, the number of antral pressure waves, the duration of antral clusters, and the antral motility index decreased by one third or more during feeding when compared with fasting (all p less than 0.05). In contrast to the decrease in antral activity in response to feeding, the duodenal motility index and cluster activity increased significantly during feeding compared with fasting (both p less than 0.05). The divergent response of antral and duodenal motor activity in response to feedings was also seen in preterm infants. Antral pressure waves, the duration of antral clusters, and the antral motility index were decreased during feeding (all p less than 0.005 or less).(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed1994

Changes in the fatty acid composition of preterm and term human milk from 1 week to 6 months of lactation.

Using capillary gas chromatography, we analyzed the fatty acid composition of human milk from 23 women who had delivered prematurely and 16 women who had delivered at term. Milk samples were obtained at 1, 2, 4, 12, and 26 weeks after delivery. The relative amounts of saturated and monounsaturated fatty acids in preterm and term milk remained stable throughout the 6 months of lactation. The proportions of linoleate (18:2n-6) and alpha-linolenate (18:3n-3) were similar in preterm and term milk and showed an increasing trend from transitional (8.7-9.9% and 0.9-1.1% of total fatty acids, respectively) to mature milk (9.9-11.8% and 1.2-1.5%, respectively). The proportions of the major long-chain polyunsaturated fatty acids (LCP), 20:3n-6, 20:4n-6, 22:5n-3 and 22:6n-3, were highest at 1 week and decreased thereafter in both types of milk. In term milk, the proportion of LCP continued to decrease from 1 month to 6 months, whereas in preterm milk it was fairly constant. Consequently, at 6 months of lactation, the relative content of arachidonate (20:4n-6) was 1.5 times (p < 0.05) and that of docosahexaenoate (22:6n-3) was two times higher (p < 0.01) in preterm than in term milk. We conclude that in long-term lactation, preterm human milk provides a significantly higher relative supply of LCP than term human milk. This higher LCP content may be of special benefit to the development of a preterm infant.

Analysis of Variance↗

PubMed1999

Protein hydrolysate formula maintains homeostasis of plasma amino acids in preterm infants.

BACKGROUND: Plasma amino acid concentrations were measured in preterm infants who were fed either a new hydrolyzed cow's milk protein formula or a standard preterm infant formula. It was hypothesized that feeding with the hydrolysate results in preprandial amino acid concentrations that are significantly different from the concentrations found when feeding with the standard formula. METHODS: Fifteen preterm infants, median gestational age, 29 weeks (range, 24-32 weeks); birth weight, 1241 g (range, 660-1900 g); and postnatal age, 18 days (range, 7-54 days) receiving full enteral feedings (>150 ml/kg x day), were enrolled. The intervention was randomized allocation to the formula with hydrolyzed or natural cow's milk protein (the whey/casein ratio was 60:40 in both formulas). In a crossover design, each formula was fed for 5 days, and plasma amino acids were analyzed on day 4 or 5 of each 5-day period. RESULTS: In spite of the 12% higher amino acid intake with hydrolysate formula, the median individual plasma amino acid concentrations were virtually identical with both formulas, and they were within the 10th and the 90th percentile of the reference of levels in the umbilical cord artery after elective cesarean delivery or of breast-fed newborn infants. The median concentrations of lysine and aspartic acid were higher with hydrolyzed formula feeding (p<0.05; two-tailed Mann-Whitney test). With both formulas, single amino acid concentrations were out of the reference values. CONCLUSION: Virtually identical plasma amino acid concentration patterns were measured with the new hydrolyzed preterm infant formula and the standard preterm infant formula, but longitudinal studies are required before the studied protein hydrolysate can be recommended for preterm feeding in general.

Amino Acids↗

PubMed2002

Influence of dietary cholesterol on vitamin d metabolism in formula-fed preterm neonates.

OBJECTIVES: Supplementation of preterm formulas with cholesterol could help to mimic the fat composition of human milk. However, this could possibly influence vitamin D 25-hydroxylation because this reaction is catalyzed in part by the mitochondrial cytochrome P-450, the enzyme responsible for the 27-hydroxylation of cholesterol. The purpose of this study was to verify whether the addition of cholesterol to preterm formulas could interfere with vitamin D metabolism in preterm neonates. METHODS: In a prospective study, 30 preterm neonates were randomly assigned to a low (< 0.03 g/L), medium (0.15 g/L), or high (0.30 g/L) cholesterol-content preterm formula until theoretical term (i.e., 40 weeks post-conceptional age). Anthropometric data and serum hydroxy-vitamin D and 1,25 dihydroxy-vitamin D concentrations were measured at study entry and theoretical term. In a subgroup of 14 subjects, serum cholesterol and lymphocyte 3-hydroxy-3-methylglutaryl coenzyme A reductase mRNA were also assessed. RESULTS: (median [25, 75 centiles]): At theoretical term, there were no significant differences in serum hydroxy-vitamin D concentrations among the three groups, even after adjustment for confounding variables (65 [50, 78] nmol/L, 79 [59, 86] nmol/L, and 67 [43, 103] nmol/L, respectively, = 0.65) or 1,25 dihydroxy-vitamin D ( = 0.88). Furthermore, there were no significant differences in 3-hydroxy-3-methylglutaryl coenzyme A reductase mRNA copy numbers. CONCLUSIONS: In preterm neonates fed formulas with a cholesterol content similar to or higher than that of human milk, we did not observe deleterious effects on vitamin D metabolism. However, long-term effects of cholesterol supplementation require further studies.

Bottle Feeding↗

PubMed1988

Response of preterm infants to diphtheria-tetanus-pertussis vaccine.

The American Academy of Pediatrics recommendation that immunization of preterm infants with diphtheria-tetanus-pertussis (DTP) vaccine should begin at 2 months after birth, regardless of gestational age, is based on limited data. A prospective study was conducted to determine the immunogenicity and safety of DTP vaccine in preterm infants. One hundred ten preterm and 146 full term infants received doses of DTP at 2, 4 and 6 months after birth. Adjusted analysis of the antibody responses indicated that after three doses mean titers among preterm infants to each vaccine component were comparable to those of full term infants. Adjusted analysis of the incidence of adverse events indicated that the risk of adverse events in preterm infants was not significantly higher than that in full term infants. DTP vaccine is immunogenic and safe in preterm infants when the series is initiated at 2 months after birth, and this study supports the current recommendation of the American Academy of Pediatrics.

Antibody Formation↗

PubMed1995

Transmission of Ureaplasma urealyticum from mothers to full and preterm infants.

This study assessed maternal genital colonization and subsequent neonatal transmission rate of Ureaplasma urealyticum in pregnant women in an average socioeconomic population. In addition very low birth weight infants were assessed to determine whether the presence of U. urealyticum correlated with increased risk of developing respiratory problems. The study group consisted of 108 sequential full term mothers and 104 preterm mothers delivering in a tertiary care hospital in central Canada. The genital carriage rates (assessed using placental sampling) of ureaplasmas in term and preterm mothers were 25.9 and 19.2%, respectively (P = 0.3185). Acquisition of ureaplasmas in the neonatal respiratory tract of neonates occurred significantly (P = 0.0182) more often in preterm neonates (11 of 130; 8.5%) than in term neonates (2 of 110; 0.9%). Very low birth weight (VLBW) infants (< or = 1500 g) were at greater risk (P = 0.042) of acquiring ureaplasmas in their respiratory tracts (5 of 26; 19%) than larger preterm neonates (6 of 104; 5.8%). All VLBW infants with respiratory colonization by ureaplasmas (5 of 5) developed bronchopulmonary dysplasia compared with 33% (7 of 21) of VLBW neonates without ureaplasmas (P = 0.028). This difference in bronchopulmonary dysplasia development among VLBW infants was independent of further stratification by birth weight. These VLBW neonates with ureaplasmas also stayed significantly (P = 0.037) longer in the neonatal intensive care unit (43.6 +/- 10.4 days) than did other preterm neonates (22.1 +/- 20.8 days). Our results demonstrate that VLBW preterm neonates have increased risk of acquiring U. urealyticum.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗