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Flowchart of the cohort of very preterm infants with neurodevelopment assessment at 20 months' corrected age
Source publication
Objective:
To determine associations between sex and neurodevelopmental outcomes in human milk-fed very preterm infants, adjusted to early measured nutrient intakes and other neonatal cofactors.
Methods:
Consecutive inborn human milk-fed infants, with gestational age <33 weeks, were eligible. In-hospital energy and protein intakes have relied on...
Context in source publication
Context 1
... study was interrupted before the calculated sample size was reached, owing to logistical constraints. The period of enrollment was from February 1 st , 2014, to February 28, 2015 (13 months), during which 156 eligible infants were identified (Figure 1). Neurodevelopment was assessed in 32 infants, with 26 very preterm (≥28 weeks) and 6 extremely preterm (<28 weeks). ...
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Background
The pharmacokinetics of vancomycin, a drug used for the treatment of methicillin-resistant Staphylococcus aureus (MRSA), varies between paediatric and adult patients.Objective
The objective of this study was to assess the pharmacokinetics of vancomycin in preterm neonates and determine the optimum dose regimen.Methods
This was a randomis...
Citations
... Although we did not observe significant associations between sex-differentiated mtDNAcn and NNNS or Bayley scores, male infants, identified as an independent risk factors for poor neurodevelopmental [29], exhibited lower NAROUSAL scores at 36 to 38 PMA and lower cognitive and motor composite scores at 1 year of age compared to female cohorts. The impaired neurodevelopment in male preterm infants may be attributed to factors such as lower energy and fat intake after birth [30], challenges in adapting to maternal stress [31], the oxidative status of the placenta [32], and brain development issues [33]. ...
Mitochondrial DNA copy number (mtDNAcn) is associated with mitochondrial function contributing various diseases. Understanding of the association between mtDNAcn and infant neurodevelopment, as well as the role of racial disparities, remains unknown. A cohort study was conducted with 55 preterm infants and a single blood sample was collected from each infant during their NICU stay to measure mtDNAcn. NICU Network Neurobehavioral Scale (NNNS) and Bayley Scale of Infant Developmental testing Edition III was assessed during NICU until 2 years of corrected age (CA). Linear regression models were performed to investigate the relationship between the clinical characteristics, neurobehavioral outcomes and mtDNAcn. Majority of our subjects were male, White, non-Hispanic, had C-section, and without preterm premature rupture of membrane (PPROM). Increased mtDNAcn was found associated with younger birth gestational age (GA), nonoptimal neurodevelopment. However, the opposite associations between mtDNAcn and neurodevelopmental outcomes were observed between Black and White infants up to 1 year of CA. Adverse early life experience, together with increased mtDNAcn in White infants, and decreased mtDNAcn in Black infants may be considered as significant positive predictors of poor early life neurodevelopmental outcomes in infants.
... (51) El sexo masculino ha sido descrito como un factor de riesgo independiente para las afecciones del neurodesarrollo en niños pretérminos por deficiencia en la adaptación al stress neonatal, al estado prooxidante en la placenta y las características morfológicas del cerebro. (52) Aunque los mecanismos no están totalmente esclarecidos, existen diferencias estructurales, celulares, moleculares, hormonales y fisiológicas que pueden explicar las diferencias entre ambos sexos en la incidencia de los trastornos del neurodesarrollo después de un evento hipóxico isquémico, en la plasticidad del sistema nervioso en cuanto a la recuperación del evento e incluso en la respuesta a las intervenciones terapéuticas administradas. En todos los casos el sexo masculino muestra mayor desventaja. ...
... Barzilay (52) menciona que se ha mostrado un mayor riesgo de afecciones neurológicas como hemorragia periventricular y leucomalacia periventricular en los recién nacidos gemelares cuando los dos son masculinos que en aquellos con ambos neonatos femeninos. ...
Revista Cubana de Pediatría. 2021;93(4):e1631 Esta obra está bajo una licencia https://creativecommons.org/licenses/by-nc/4.0/deed.es_ES 1 Artículo de revisión Epigenética, sexo masculino y enfermedades neonatales Epigenetic, male sex and neonatal disease RESUMEN Introducción: Estudios recientes han demostrado diferencias entre el sexo femenino y el masculino y su influencia en aspectos básicos de la biología, los cuales podrían influir a su vez, en la etiología y fisiopatología de enfermedades en la etapa neonatal. Es conocido que los cambios en la regulación epigenética por factores que afectan la exposición del cortisol fetal muestra efectos específicos según el tipo de sexo. Objetivo: Determinar la posible relación entre los cambios epigenéticos, el sexo masculino y las enfermedades neonatales. Métodos: Se realizó una búsqueda bibliográfica en Pubmed, Scielo, LILACS y en la plataforma Clínica Key entre los años 2017-2020, en idioma inglés y español. Se utilizaron diferentes palabras clave como diferencias sexuales, sexo masculino, epigenética y enfermedades neonatales. Análisis e integración de la información: En esta revisión se abordan aspectos como la epigenética en el desarrollo humano y su relación con el sexo, el papel de la placenta y su relación con el sexo fetal, las complicaciones perinatales y su relación con el sexo masculino. Además, se abordan las afecciones respiratorias, las afecciones neurológicas y otras de la etapa neonatal vinculadas con el sexo y la posible relación con los mecanismos epigenéticos. Conclusiones: El sexo masculino es un factor predisponente en la prevalencia de determinadas enfermedades neonatales. La epigenética puede estar involucrada en la aparición de muchas Revista Cubana de pediatría. 2021;93(4):e1631 Esta obra está bajo una licencia https://creativecommons.org/licenses/by-nc/4.0/deed.es_ES 2 enfermedades neonatales moduladas por el sexo por mecanismos aun no bien esclarecidos. Investigaciones futuras pudieran arrojar mayor conocimiento sobre la etiopatogenia de estas enfermedades y su forma de abordarlas. Palabras clave: diferencias sexuales; sexo masculino; epigenética y enfermedades neonatales. ABSTRACT Introduction: Recent studies have confirmed differences among the female and male sex and their influence in basic aspects of biology, which can also impact in the etiology and physiopathology of diseases in the neonatal stage. It is known that changes in the epigenetic regulation due to factors that affect the exposition to fetal cortisol show specific effects according to the type of sex. Objective: Determine the possible relation among the epigenetic changes, male sex and the neonatal diseases. Methods: It was carried out a bibliographic search in Pubmed, Scielo, LILACS and in the platform called Clínica Key, in the period 2017-2020, in English and Spanish languages. The following key words were used: sexual differences, male sex, epignetic and neonatal diseases. Analysis and Integration of the information: This review deals with aspects as epigenetic in human development and its relation with sex, the role of placenta and its relation with fetal sex, perinatal complications and their relation with male sex. In addition, the review also mentions respiratory conditions, neurologic conditions and others of the neonatal stage related with sex and the possible relation with epigenetic mechanisms. Conclusions: Male sex is a predisposing factor in the prevalence of certain neonatal diseases. Epigenetic can be involved in the onset of many neonatal diseases modulated by the sex due to mechanisms that are not clear yet. Future researches might show more knowledge on the etiopathogenesis of these disease and the way to approach them.
... Due to the previously reported impact of sex on prematurity and on language, sex was included in analyses as a biological variable (60)(61)(62). Group differences in sex distribution and differences in outcomes such as language scores and structural connectivity for females vs. males were investigated. ...
Children born extremely preterm (<28 weeks gestation) are at risk for language delay or disorders. Decreased structural connectivity in preterm children has been associated with poor language outcome. Previously, we used multimodal imaging techniques to demonstrate that increased functional connectivity during a stories listening task was positively associated with language scores for preterm children. This functional connectivity was supported by extracallosal structural hyperconnectivity when compared to term-born children. Here, we attempt to validate this finding in a distinct cohort of well-performing extremely preterm children (EPT, n = 16) vs. term comparisons (TC, n = 28) and also compare this to structural connectivity in a group of extremely preterm children with a history of language delay or disorder (EPT-HLD, n = 8). All participants are 4–6 years of age. We perform q-space diffeomorphic reconstruction and functionally-constrained structural connectometry (based on fMRI activation), including a novel extension enabling between-groups comparisons with non-parametric ANOVA. There were no significant differences between groups in age, sex, race, ethnicity, parental education, family income, or language scores. For EPT, tracks positively associated with language scores included the bilateral posterior inferior fronto-occipital fasciculi and bilateral cerebellar peduncles and additional cerebellar white matter. Quantitative anisotropy in these pathways accounted for 55% of the variance in standardized language scores for the EPT group specifically. Future work will expand this cohort and follow longitudinally to investigate the impact of environmental factors on developing language networks and resiliency in the preterm brain.
... (51) El sexo masculino ha sido descrito como un factor de riesgo independiente para las afecciones del neurodesarrollo en niños pretérminos por deficiencia en la adaptación al stress neonatal, al estado prooxidante en la placenta y las características morfológicas del cerebro. (52) Aunque los mecanismos no están totalmente esclarecidos, existen diferencias estructurales, celulares, moleculares, hormonales y fisiológicas que pueden explicar las diferencias entre ambos sexos en la incidencia de los trastornos del neurodesarrollo después de un evento hipóxico isquémico, en la plasticidad del sistema nervioso en cuanto a la recuperación del evento e incluso en la respuesta a las intervenciones terapéuticas administradas. En todos los casos el sexo masculino muestra mayor desventaja. ...
... Barzilay (52) menciona que se ha mostrado un mayor riesgo de afecciones neurológicas como hemorragia periventricular y leucomalacia periventricular en los recién nacidos gemelares cuando los dos son masculinos que en aquellos con ambos neonatos femeninos. ...
Introducción:
Estudios recientes han demostrado diferencias entre el sexo femenino y el masculino y su influencia en aspectos básicos de la biología, los cuales podrían influir a su vez, en la etiología y fisiopatología de enfermedades en la etapa neonatal. Es conocido que los cambios en la regulación epigenética por factores que afectan la exposición del cortisol fetal muestra efectos específicos según el tipo de sexo.
Objetivo:
Determinar la posible relación entre los cambios epigenéticos, el sexo masculino y las enfermedades neonatales.
Métodos:
Se realizó una búsqueda bibliográfica en Pubmed, Scielo, LILACS y en la plataforma Clínica Key entre los años 2017-2020, en idioma inglés y español. Se utilizaron diferentes palabras clave como diferencias sexuales, sexo masculino, epigenética y enfermedades neonatales.
Análisis e integración de la información:
En esta revisión se abordan aspectos como la epigenética en el desarrollo humano y su relación con el sexo, el papel de la placenta y su relación con el sexo fetal, las complicaciones perinatales y su relación con el sexo masculino. Además, se abordan las afecciones respiratorias, las afecciones neurológicas y otras de la etapa neonatal vinculadas con el sexo y la posible relación con los mecanismos epigenéticos.
Conclusiones:
El sexo masculino es un factor predisponente en la prevalencia de determinadas enfermedades neonatales. La epigenética puede estar involucrada en la aparición de muchas enfermedades neonatales moduladas por el sexo por mecanismos aun no bien esclarecidos. Investigaciones futuras pudieran arrojar mayor conocimiento sobre la etiopatogenia de estas enfermedades y su forma de abordarlas.
... In Brazil, although unofficial translations of the instrument already existed, they were used mainly in research contexts (12) . In recent years, a study was carried out to translate and adapt the instrument to provide evidence of the convergent validity and reliability of the Brazilian version in children aged 12 to 42 months in the Southeast region. ...
Purpose:
to verify if the performance of pre-school children born prematurely and at term in the Bayley-III language subtest differs and to identify whether variables gestational age, birth weight, socioeconomic level, and maternal education are determinant in the outcome of language development.
Methods:
Descriptive cross-sectional case-control study in which 36 pre-school children born prematurely and 27 born at term were evaluated concerning language development by the Bayley III subtest. Preschoolers between 18 and 36 months of chronological age were considered; with no syndromes or genetic, sensory, neurological, auditory, or visual impairments; and had not previously undergone speech therapy. Mann-Whitney, Fisher's Exact, and binary logistic regression tests were used for statistical analysis.
Results:
the groups' performance did not differ either by the composite score (p = .701) or by the classification based on the percentile (p = .225). Gestational age, birth weight, and socioeconomic status did not influence the outcome of language development. However, maternal education was significant (p = .014) in the binary logistic regression model, suggesting that the mother having studied until basic education increases the chance of having a child underperforming in the Bayley III language subtest 6.31 times.
Conclusion:
there was no difference between the groups in the Bayley-III language subtest and only maternal education influenced the outcome of language development.
... Due to the known differential effect of sex on prematurity and language outcomes, sex was included in analyses as a biological variable [61][62][63]. Group differences in sex distribution and differences in outcomes such as language scores and network strength for females versus males were investigated. ...
Extreme prematurity (EPT, <28 weeks gestation) is associated with language problems. We previously reported hyperconnectivity in EPT children versus term children (TC) using magnetoencephalography (MEG). Here, we aim to ascertain whether functional hyperconnectivity is a marker of language resiliency for EPT children, validating our earlier work with a distinct sample of contemporary well-performing EPT and preterm children with history of language delay (EPT-HLD). A total of 58 children (17 EPT, 9 EPT-HLD, and 32 TC) participated in stories listening during MEG and functional magnetic resonance imaging (fMRI) at 4–6 years. We compared connectivity in EPT and EPT-HLD, investigating relationships with language over time. We measured fMRI activation during stories listening and parcellated the activation map to obtain “nodes” for MEG connectivity analysis. There were no significant group differences in age, sex, race, ethnicity, parental education, income, language scores, or language representation on fMRI. MEG functional connectivity (weighted phase lag index) was significantly different between groups. Preterm children had increased connectivity, replicating our earlier work. EPT and EPT-HLD had hyperconnectivity versus TC at 24–26 Hz, with EPT-HLD exhibiting greatest connectivity. Network strength correlated with change in standardized scores from 2 years to 4–6 years of age, suggesting hyperconnectivity is a marker of advancing language development.
... On the other hand, modulating role to sociodemographic factors about the later development of preterm infants has not been studied in depth. Different authors found that the male sex has a greater incidence of births below week 37 and a higher risk for neurological development (Drevenstedt et al., 2008;Macedo & Cardoso, 2019;Romeo et al., 2015;Skiöld et al., 2014). Additionally, maternal age, advanced or too early, is associated with greater complications in pregnancy and in the child. ...
... Attending to gender, girls obtaining best outcomes in the three development areas, being more accentuated in the motor area. This result also agrees with Romeo et al. (2015) where the Mental Development Index was better in girls, and those of Macedo and Cardoso (2019), where at 20 months of age corrected with Bayley scales, girls obtained better scores in the Mental Development Index and in the Motor area, although this result did not reach statistical significance. These results may be influenced by a small number of girls in the extreme preterm group compared to boys. ...
Background
In the last decades, the birth of premature babies has increased, it is important to know the impact of certain variables, especially in the most vulnerable groups.
Purpose
To analyse the relationship of gestational age (GA), weight and sex of the children, as well as the educational level and age of the parents with the cognitive, motor and language development of a group of very preterm births, assessed at 36 months.
Design and methods
The research followed a descriptive, observational and cross-sectional design. Children's development was measured using the Bayley-III Scale. Descriptive analysis, bivariate and linear regression models were carried out.
Results
Although the cognitive, motor and language development is within average levels, worse results are evidenced in the group of extreme premature, as opposed to the very premature. Boys score lower than girls, with these differences being more pronounced in the motor area. It also shows how the education level of both parents is related to the levels of development at 3 years of age of children born very prematurely, especially in language.
Conclusions
Lower GA, male sex and lower parental educational level are associated with higher risk of developmental difficulties.
Practice implications
The findings of this study are relevant to clinical practice because they suggest to develop protocols of evaluation and the follow up of all premature children beyond 36 months, as well as developing specific intervention programmes for the most vulnerable of the premature groups.
... The exact reason for this male vulnerability is still unclear; some authors have considered sex hormones and differences in sex chromosome gene expression as possible factors 42 , and others have explored a possible role of sex differences in microglia number, morphology and function in the onset and modulation of inflammation and in responses to pre and perinatal insults 43 . Moreover, neurological outcome appears to be more sensitive to suboptimal nutrition in male than in female preterm infants 44 . Overall, compared with females, male infants born very preterm appear to show a less efficient coping mechanism against stress factors, with consequences on brain development. ...
Preterm very low birth weight infants (VLBWi) are known to be at greater risk of adverse neurodevelopmental outcome. Identifying early factors associated with outcome is essential in order to refer patients for early intervention. Few studies have investigated neurodevelopmental outcome in Italian VLBWi. The aim of our longitudinal study is to describe neurodevelopmental outcome at 24 months of corrected age in an eleven-year cohort of 502 Italian preterm VLBWi and to identify associations with outcome. At 24 months, Griffiths’ Mental Developmental Scales were administered. Neurodevelopmental outcome was classified as: normal, minor sequelae (minor neurological signs, General Quotient between 76 and 87), major sequelae (cerebral palsy; General Quotient ≤ 75; severe sensory impairment). 75.3% showed a normal outcome, 13.9% minor sequelae and 10.8% major sequelae (3.8% cerebral palsy). Male gender, bronchopulmonary dysplasia, abnormal neonatal neurological assessment and severe brain ultrasound abnormalities were independently associated with poor outcome on multivariate ordered logistic regression. Rates of major sequelae are in line with international studies, as is the prevalence of developmental delay over cerebral palsy. Analysis of perinatal complications and the combination of close cUS monitoring and neurological assessment are still essential for early identification of infants with adverse outcome.
Introdução: A paralisia cerebral é uma desordem crônica de déficit não progressivo do desenvolvimento motor causada por diferentes fatores etiológicos. Objetivo: Analisar o uso de toxina botulínica como uma abordagem terapêutica para o tratamento de paralisia cerebral em pacientes pediátricos. Metodologia: Trata-se de um estudo epidemiológico transversal que utilizou dados do SIA-PA do DATASUS, analisando crianças até 14 anos com diagnóstico de paralisia cerebral em 2022. Foram considerados variáveis do estudo o mês, região, faixa etária, raça/cor, sexo e tipo de atendimento. Foi utilizado o Software R para a análise dos dados. Resultados: Ao longo do ano, 12.695 crianças foram atendidas, evidenciando uma prevalência na faixa etária de 5 a 9 anos, de raça/cor branca e do sexo masculino. Análises temporais indicaram variações sazonais nos atendimentos, com maior prevalência entre agosto e setembro para crianças de 0 a 4 anos e, em abril e julho para o grupo de 5 a 9 anos, com maior concentração nas categorias quadriplégica espástica, diplégica espástica e hemiplégica espástica. Quanto ao uso da toxina botulínica, este foi mais proeminente na faixa etária de 5 a 9 anos. Conclusão: Os resultados deste estudo oferecem uma compreensão sobre o perfil de atendimento a pacientes pediátricos com paralisia cerebral no Brasil que fazem uso de toxina botulínica. A análise das unidades de toxina botulínica utilizadas em diferentes subcategorias ressaltou a importância de adaptações personalizadas no tratamento, considerando as necessidades específicas de cada perfil de paciente, especialmente na faixa etária de 5 a 9 anos.
This article presents a revision of the literature regarding the influence of sex differences on the recovery and long‐term behavioral and cognitive outcomes of preterm children. After initial discussion of some methodological concerns, the literature regarding the concept of “male disadvantage,” which is often used when talking about early neurological and psychomotor outcomes in preterm children, is presented. Subsequently, the literature data on sex‐related differences in preterm children are discussed, focusing on their influence on the developmental pathways of cognition, language, executive function, behavior and affect, and response to rehabilitation therapies. Finally, evidence about brain structural and connectivity correlates of sex differences in the brain of preterm survivors is taken into account. Although visuo‐spatial and visuo‐perceptual functioning is widely studied in the preterm child and is strongly sex specific, little to no data are available regarding male–female differences in preterm children and the interaction effect between sex and preterm birth. For this reason, original data analyses of male–female differences in visuo‐spatial performance from a small sample of preterm children are also presented. The study reviews research regarding sex differences in the long‐term behavioral and cognitive outcomes of preterm children, discussing the role of several potential mediators. Original data on healthy preterm adolescents who were administered visuo‐spatial tasks support female disadvantage in the visuo‐cognitive domain.
