Background Children born with gastroschisis face multiple challenges when newborn which may increase the risk of mental health issues. This study assessed the prevalence of mental health difficulties in children with gastroschisis and associated clinical factors. Method Parents of 57 children with gastroschisis aged 3–17 years and 23 children aged 11–17 years from a tertiary pediatric surgical center completed the Strength and Difficulties Questionnaire (SDQ), a screening instrument for mental health difficulties with four scales focusing on difficulties (Hyperactivity/inattention; Conduct problems; Emotional Symptoms; Peer relationships) and one focusing on strengths (Prosocial behavior). Clinical data were retrieved from medical records. Data was analyzed descriptively and using univariable association analysis. Significance level was considered p < 0.05. Result On child-report, 17.4% and on parent-report, 22.8%, of children with GS had elevated scores on the total difficulties scale of the SDQ. The prevalence of elevated scores on SDQ subscales varied between 13.0 and 30.4% on child-report and 10.5–33.3% on parent-report, with greatest difficulties on the Hyperactivity/Inattention subscale (child-report) and Emotional Symptoms subscale (parent-report). A more complicated postoperative period with infection and bowel ischemia were significantly associated with more difficulties on the Emotional (p = 0.047), Conduct (p = 0.0074), and Hyperactivity/Inattention (p = 0.036) subscales. Children with reports of stomach pain also had more mental health difficulties (p = 0.013). Conclusion Some children born with GS experience mental health difficulties, particularly following a complicated neonatal period, suggesting a need to screen for mental health issues in the follow-up. However, future multi-centre studies including self- and parent-reported assessments are needed to confirm these findings.
OBJECTIVE:Determine ROP overall incidence trends, stratified by gestational age (GA), throughout a 15-year period in the neonatal NEOCOSUR Network. Also, determine the main associated factors. DESIGN:Retrospective cohort study, employing prospectively collected data. Trends were analyzed with joinpoint regression. Multivariable logistic regression was performed to identify factors associated with ROP after adjusting for key perinatal confounders. SUBJECTS:VLBW infants between 24 and 31 weeks GA and BW 400 to 1500 g who survived to discharge, born between 2007 and 2021, across 21 centers were included. MAIN OUTCOME MEASURE:Trends in ROP incidence throughout a 15-year period in this Network and main associated factors. RESULTS:10,268 preterm infants were included. Baseline population differences with and without ROP were found. ROP incidence was higher in infants with lower gestational age. There was a significant decreasing trend in ROP incidence between 2007 and 2012 (30% to 18%); however, from 2012 to 2021, an increased incidence was observed, reaching 27% in 2021, although this change was not statistically significant. Moreover, a significant increasing trend occurred in severe ROP and/or plus disease in the 2013-2021 period. Female sex was protective for ROP (OR 0.84), whereas postnatal steroids nearly doubled the odds (OR 1.85). Each additional week of GA (OR 0.78) and every additional 100 g of BW (OR 0.79) were associated with lower odds of ROP. Cesarean section (OR 0.87) and every additional 100 g of weight gain at 28 days (OR 0.84) were also associated with reduced odds of ROP. CONCLUSIONS:ROP showed an initial decreasing trend followed by an increased incidence in more recent years. Possible causes for these variations are uncertain.
Introduction More active approach and increased survival rates of very preterm infants have raised concerns about their long-term neurodevelopment, especially regarding the cognitive outcome. Methods We included very preterm infants (gestational age <32 weeks and/or with birth weight ≤ 1500 g) born in 2001–2018 and attending clinical follow up at 2 years in Turku University Hospital, Finland. The prevalences of cognitive impairment (<−1 SD based on the Bayley scales) and cerebral palsy (CP) were described according to birth year: 2001–2006, 2007–2012, 2013–2018. Results We included 683 children (377 boys, 55.2%) born very preterm (mean gestational age 29.4 weeks, birth weight 1207 g). A total of 8.5% (53/623) of the children had cognitive impairment (−1 SD). Children born in 2007–2012 and in 2013–2018 had 30–50% lower odds for cognitive impairment at 2 years compared with children born in 2001–2006 (OR 0.7, CI95% 0.4–1.4, p = 0.3, and OR 0.5, CI95% 0.2–0.9, p = 0.03, respectively). CP was diagnosed in 4.7% (31/662). Children born in 2007–2012 and in 2013–2018 had 20–50% lower odds for CP compared with children born in 2001–2006 (OR 0.8, CI95% 0.4–1.7, p = 0.5, and OR 0.3, CI95% 0.1–0.8, p = 0.02, respectively). Conclusion The prevalence of cognitive impairment at 2 years has not increased during 18-year period from the early 2000s. It could be suggested that the long-term neurodevelopment of very preterm infants has not worsened despite increased survival rates.
BACKGROUND:Predicting and preventing metabolic bone disease (MBD) in preterm infants remains challenging. AIMS:To evaluate the associations of bone mineral density (BMD) with fortified breast milk intake, and biochemical markers, including intact parathyroid hormone (iPTH), and %tubular phosphate reabsorption (%TRP). STUDY DESIGN:A prospective observational study conducted at a single tertiary center in Japan. SUBJECTS:Infants born at ≤31 weeks of gestation and/or birth weight ≤ 1500 g from August 2018 to August 2020. OUTCOME MEASURES:Cord blood iPTH and 25-hydroxyvitamin D, weekly serum iPTH, alkaline phosphatase (ALP), and %TRP were measured until term-equivalent age (TEA). BMD at TEA was assessed using dual-energy X-ray absorptiometry. Associations between clinical and biochemical variables and BMD were analyzed. RESULTS:Of 137 infants screened, 105 were included in the analysis. Higher breast milk intake was positively correlated with BMD, whereas elevated iPTH levels and lower %TRP at 3-8 weeks were negatively correlated with BMD. In multivariable regression analysis, birth weight and breast milk intake were positively correlated with BMD, whereas iPTH levels at 4 weeks were negatively associated. A linear mixed-effects model confirmed this longitudinal association. Gestational age, ALP, and 25-hydroxyvitamin D levels were not associated with BMD. CONCLUSION:Lower breast milk intake and elevated iPTH levels are indicators of reduced BMD at TEA in very preterm and very-low-birth-weight infants. %TRP may serve as a practical alternative marker, when iPTH measurements are unavailable. Early monitoring of iPTH and/or %TRP, combined with optimized fortified breast milk intake, may support bone health in this high-risk population.
BACKGROUND:Hypoxic-ischemic encephalopathy (HIE) involves systemic inflammatory responses that may be reflected by routine blood-derived indices. OBJECTIVE:To evaluate the associations of systemic inflammatory indices and the hemoglobin-albumin-lymphocyte-platelet (HALP) score with HIE severity and short-term outcomes, and to characterize their temporal changes from the pre-hypothermia measurement to the post-treatment measurement at 72-96 postnatal hours. METHODS:This retrospective study included 555 neonates: 185 with mild HIE, 185 with moderate-to-severe HIE treated with therapeutic hypothermia, and 185 controls. Systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), pan-immune-inflammation value (PIV), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), and HALP were calculated at 0-6 h (T1); repeat measurements at 72-96 h (T2) were assessed in the hypothermia group. RESULTS:Systemic inflammatory indices showed limited discriminatory performance for distinguishing HIE from controls but showed stronger associations with HIE severity. For distinguishing moderate-to-severe HIE from mild HIE, SII showed the highest, although modest, discriminatory performance (AUC = 0.706), while lower hemoglobin, lower SII, and higher HALP remained associated with moderate-to-severe HIE in the adjusted analysis. In an exploratory analysis of the severe HIE subgroup (n = 18), SII showed the highest discriminatory performance (AUC = 0.770); however, these findings should be interpreted cautiously because of the limited subgroup size. Between T1 and T2, SII, SIRI, PIV, HALP score, and NLR significantly decreased (all p < 0.001), whereas PLR increased (p = 0.005). These findings should be interpreted as temporal biomarker changes across the treatment period; in the absence of a comparable non-cooled moderate-to-severe HIE group, they cannot be attributed specifically to therapeutic hypothermia. In an exploratory mortality analysis based on seven deaths, baseline albumin showed significant discrimination (AUC = 0.863); however, this estimate should be interpreted cautiously because of the small number of events. CONCLUSION:Routine blood-derived indices, particularly SII and HALP, were associated with HIE severity and may complement established clinical and neurological assessment. Prospective multicenter validation is required.
Background Evidence on neonatal manifestations following prenatal substance exposure outside opioid-dominant settings is limited, and Türkiye lacks national multicenter data on exposure patterns and neonatal care. Objective To characterize opioid and non-opioid prenatal substance exposures, neonatal manifestations, management, short-term outcomes, and factors associated with pharmacological treatment and prolonged hospitalization in Türkiye. Methods This prospective observational study enrolled infants aged 0–28 days who were clinically diagnosed with NAS following documented prenatal opioid or non-opioid substance exposure at 32 neonatal intensive care units between September 2, 2024, and September 2, 2025. Exposure classification relied predominantly on self-report, with limited toxicological confirmation. Multivariable logistic regression evaluated factors associated with pharmacological treatment and hospitalization lasting >18 days. Results Among 137 infants from 17 provinces, stimulant-only exposure was the most common single-group pattern (51/137, 37.2%), and methamphetamine was the most frequently identified substance (57/137, 41.6%). Pharmacological treatment was given to 50 infants (36.5%), most commonly phenobarbital; morphine-containing regimens were used in four. Maximum Finnegan score independently predicted pharmacological treatment (adjusted OR 1.53 per point, 95% CI 1.30–1.80). Prolonged hospitalization was associated with maximum Finnegan score, gestational age, 1-minute Apgar score, and abandoned-infant status, with the latter showing the strongest association (adjusted OR 6.00, 95% CI 2.38–15.10). Conclusion This prospective multicenter cohort from Türkiye demonstrated a stimulant-predominant exposure pattern distinct from opioid-dominant cohorts. Clinical severity, rather than exposure group, independently predicted pharmacological treatment, while abandoned infant status was the strongest determinant of prolonged hospitalization. National pathways should address diagnostic heterogeneity, treatment resources, and social-care barriers.
BACKGROUND:Very low birth weight (VLBW) infants are at risk for adverse neurodevelopment. Although parental involvement during neonatal intensive care unit (NICU) hospitalization might influence development, parental visitation patterns have rarely been quantified. METHODS:This retrospective cohort study included infants born at <30 weeks' gestation (birth weight < 1500 g). Data on parental visitation patterns, specifically frequency (days/week) and visitation time (hours/week), were collected from electronic entry/exit card records throughout hospitalization and calculated as weekly indices using median values across the entire period. Neurodevelopment was assessed by the developmental quotient (DQ) of the Kyoto Scale of Psychological Development at 18 months' corrected age. RESULTS:Fifty-seven infants were included (median gestational age, 27.1 weeks; median birth weight, 934 g). The median weekly visitation frequencies for fathers and mothers were 3 (interquartile range [IQR], 2-4) and 6 (IQR, 4-7) days/week, respectively. The median weekly visitation times were 6.0 (IQR, 2.9-8.7) and 12.9 (IQR, 10.1-20.0) hours/week, respectively. The presence of siblings was associated with shorter parental visitation time. In multivariable analyses, the DQ was positively associated with maternal visitation time (adjusted β, 0.47; 95% confidence interval, 0.07-0.88). CONCLUSIONS:Maternal presence during NICU hospitalization, quantified by visitation time, was associated with a higher developmental quotient at 18 months' corrected age.
BACKGROUND:Clinical early-onset sepsis (EOS) is associated with death and major morbidity in very preterm and/or very low birth weight infants. We aimed to develop and externally validate a model for a composite adverse outcome before discharge. METHODS:This retrospective multicenter study included infants with gestational age < 32 weeks and/or birth weight < 1500 g who met operational criteria for clinical EOS. Infants from two hospitals formed the development cohort (n = 249), and infants from a third hospital formed the external validation cohort (n = 84). The outcome comprised death, grade 3 bronchopulmonary dysplasia, severe intraventricular hemorrhage, cystic periventricular leukomalacia, or Bell stage II or higher necrotizing enterocolitis. Predictors were selected using least absolute shrinkage and selection operator and multivariable logistic regression. Internal validation used 500 bootstrap resamples. RESULTS:The composite outcome occurred in 98 of 333 infants (29.4%). The final model included birth weight, blood lactate, and base excess. In the development cohort, the C-index was 0.8309, the Brier score was 0.1468, and the optimism-corrected C-index was 0.8270. The optimism-corrected calibration intercept and slope were - 0.011 and 0.968, respectively. In external validation, the AUC was 0.7819 (95% CI, 0.6602-0.9036), the Brier score was 0.1540, the calibration-in-the-large intercept was -0.254, and the calibration slope was 0.753, indicating overprediction and overly extreme predictions. CONCLUSIONS:This three-variable model showed acceptable external discrimination, but calibration drift indicates that local recalibration and prospective multicenter validation are required before clinical use.
OBJECTIVE:Cerebral palsy (CP) is an etiologically heterogeneous neurodevelopmental condition arising from disturbances of the developing brain during prenatal, perinatal, or early postnatal life. The second-to-fourth digit ratio (2D:4D) has been proposed as an imperfect indirect correlate of first-trimester prenatal sex-steroid exposure. This study aimed to compare 2D:4D ratios between children with CP and healthy controls and to examine whether digit ratio was associated with functional and clinical severity in children with CP. METHODS:This case-control, cross-sectional study included 75 children with CP aged 4-12 years and 75 age- and sex-matched healthy controls. Second and fourth digit lengths were measured on both hands using a digital caliper, and right and left 2D:4D ratios were calculated. Gross motor function, manual ability, and spasticity were evaluated using the Gross Motor Function Classification System, Manual Ability Classification System, and Modified Ashworth Scale, respectively. Group comparisons, sex-stratified analyses, two-way analysis of variance, and correlation analyses were performed. RESULTS:The CP and control groups were comparable in age and sex distribution. Children with CP had significantly lower right and left 2D:4D ratios than controls. Females showed higher 2D:4D ratios than males, independent of group. No significant group × sex interaction was observed. The 2D:4D ratio was not significantly correlated with GMFCS, MACS, or MAS scores. Clinical severity measures were significantly interrelated. CONCLUSION:Children with CP showed lower 2D:4D ratios in both hands than healthy controls, whereas digit ratio was not associated with functional severity or spasticity. These exploratory findings suggest that 2D:4D variation may be associated with heterogeneity in the timing of prenatal influences related to CP. However, because neither prenatal sex-steroid concentrations nor the timing of prenatal perturbations was directly measured, no specific hormonal or temporal mechanism can be inferred.
BACKGROUND:Molar incisor hypomineralization (MIH) has a multifactorial, incompletely understood etiology, with prenatal factors increasingly implicated. The second-to-fourth digit length ratio (2D:4D ratio) is an indirect marker of prenatal sex hormone exposure. AIM:To determine whether children with MIH differ from controls in right- and left-hand 2D:4D ratios and whether differences vary by sex. METHODS:This case-control study included 60 children with MIH and 60 age- and sex-matched healthy controls aged 7-12 years. Groups were compared using Welch-corrected and paired-samples t-tests. Binary logistic regression assessed associations between the 2D:4D ratio and MIH, with continuous predictors z-transformed. Sex-stratified comparisons and sex × 2D:4D interaction models were performed as exploratory analyses. RESULTS:Right and left 2D:4D ratios were higher in the MIH group than controls (right: 0.977 ± 0.044 vs. 0.961 ± 0.014, p = 0.006; left: 0.978 ± 0.030 vs. 0.961 ± 0.015, p < 0.001). In logistic regression, each one-standard-deviation increase in the left 2D:4D ratio was associated with higher odds of MIH (OR = 2.29, 95% CI 1.46-3.62, p < 0.001), independently of age and sex. Exploratory sex-stratified analysis indicated that this association was confined to boys (OR = 4.02, 95% CI 1.81-8.92), with no comparable effect in girls (OR = 1.33, 95% CI 0.72-2.46); sex × 2D:4D interactions were significant for both hands. CONCLUSION:Higher 2D:4D ratios, particularly for the left hand, were associated with MIH. The association was concentrated in boys, a pattern compatible with a role for prenatal androgen signaling in enamel maturation. The 2D:4D ratio may be a candidate biomarker, although this sex-specific finding requires confirmation in larger samples.
BACKGROUND:Fetal overgrowth can occur without pregestational diabetes or GDM, indicating a potential role of non-glucose metabolic factors. This study examined first-trimester TG status and AIP in relation to LGA and macrosomia among non-diabetic pregnant women. METHODS:This single-center retrospective cohort study included women with singleton term live births and fasting lipid profiles obtained at 10 + 0 to 14 + 0 gestational weeks between January 2023 and December 2025. Women who had pregestational diabetes, GDM, multiple gestation, significant maternal disease based on lipids, fetal anomalies, stillbirth or lack of essential data were excluded. High TG was defined as TG >1.72 mmol/L, corresponding to the 75th percentile of the cohort-specific distribution. LGA was defined as birth weight ≥90th percentile for gestational age and neonatal sex, and macrosomia was defined as birth weight ≥4000 g. Propensity score matching was performed at a 1:1 ratio, and logistic regression was used to estimate associations with LGA and macrosomia. AIP was estimated to be log10 (TG/HDL-C) and examined using quartiles and restricted cubic splines. RESULTS:There were 3433 women, 858 with high TG and 2575 with normal TG; 831 pairs were matched. High TG was associated with higher odds of LGA (15.2% vs. 9.9%; OR = 1.55, 95% CI: 1.15-2.09) and macrosomia (9.3% vs. 5.8%; OR = 1.58, 95% CI: 1.07-2.32). Similar associations were observed when TG was analyzed as a continuous variable. Compared with the lowest AIP quartile, the highest quartile was associated with LGA (OR = 1.73, 95% CI: 1.25-2.40) and macrosomia (OR = 1.68, 95% CI: 1.12-2.53). The primary LGA findings were confirmed by sensitivity and subgroup analyses. CONCLUSIONS:Higher first-trimester TG levels and AIP were associated with greater odds of LGA and macrosomia among non-diabetic pregnant women. These lipid-related markers warrant further evaluation as potential components of future fetal-overgrowth prediction models, but the present study did not assess clinical prediction or screening performance.
BACKGROUND AND AIM:Preterm birth and subsequent NICU hospitalization poses major challenges on maternal-infant bond and expose neonates to environmental stressors. Auditory stimulation with maternal singing has shown potential benefits on infants' development and physiological stability. We aimed to evaluate the effects of two different maternal singing modalities-spontaneous and expressive-on physiological parameters and regional tissue oxygenation in stable preterm infants. METHODS:Twenty mother-infant dyads were enrolled. Heart rate (HR), peripheral oxygen saturation (SpO2), cerebral (CrSO2) and splanchnic oxygenation (SrSO2), as well as cerebral (cFTOE) and splanchnic fractional tissue oxygen extraction (sFTOE), were continuously monitored using pulse oximetry combined with near-infrared spectroscopy (NIRS) during a 40-min period (10 min baseline, 20 min auditory stimulation, 10 min post-stimulation), during which both spontaneous and expressive maternal singing were administered. Variations from baseline in the study parameters during each maternal singing modality and in the post-stimulation phase were analysed using repeated-measures linear mixed-effects models. RESULTS:Expressive maternal singing induced a significant CrSO2 increase (p = 0.031) and a corresponding cFTOE reduction (p = 0.032) compared to baseline, while no significant difference in HR, SpO2, SrSO2 and sFTOE was observed. These effects persisted in the post-administration phase (CrSO2, p = 0.028; cFTOE p = 0.005). No significant changes were observed during the administration of spontaneous maternal singing. CONCLUSION:Expressive maternal singing promotes cerebral metabolic well-being in preterm infants, independently of systemic hemodynamic changes. These preliminary findings may support the integration of structured music therapy interventions with maternal involvement in neonatal developmental care.
OBJECTIVE:To evaluate whether differences in neonatal size in adolescent pregnancy reflect prematurity or intrinsic fetal growth restriction using gestational age-adjusted growth metrics. STUDY DESIGN:This retrospective single-center study included 329 mother-infant dyads (111 adolescents ≤19 years; 218 adults aged 20-35 years). Neonatal anthropometric measurements were converted into sex- and gestational age-adjusted z-scores using INTERGROWTH-21st standards. Birth weight, length, and head circumference z-scores, along with ponderal index, and growth asymmetry (HC_z - BW_z) were compared between groups. Multivariable regression analyses adjusted for gestational age, maternal smoking, neonatal sex, and maternal hemoglobin level. RESULTS:In unadjusted analyses, infants born to adolescents had lower birth weight, length, and head circumference (all p < 0.001). After gestational age standardization, no statistically significant differences were detected in birth weight or length z-scores. A small nominal difference was observed in head-circumference z-score (Cohen's d = -0.25; nominal p = 0.031), which should be interpreted cautiously. Ponderal index and growth asymmetry did not differ. In multivariable analyses, adolescent pregnancy was not independently associated with birth weight or length z-scores but showed a modest association with lower head-circumference z-score (β = -0.35, 95% CI -0.61 to -0.08). Adolescent pregnancy remained independently associated with preterm birth (adjusted OR 2.39), while its association with low birth weight was attenuated. CONCLUSION:Adverse neonatal outcomes in adolescent pregnancy appear to be largely mediated through prematurity rather than generalized impairment in fetal growth. A modest difference in head-circumference z-score was observed, but its clinical relevance remains uncertain and requires confirmation in larger prospective studies. Gestational age-standardized assessment may improve the interpretation of neonatal growth patterns in adolescent pregnancy.
Background and objectives Sleep problems such as prolonged night waking and difficulty falling asleep are common in infants. Sleep problems can affect development and put parents at risk of sleep deprivation, potentially leading to stress and burnout. It is therefore important to identify sleep problems early to facilitate targeted intervention and support. The Brief Infant Sleep Questionnaire (BISQ) developed by Sadeh (2004) is a widely used tool to identify and describe sleep behavior. However, a validated German translation is still missing. The main aim was to validate the German version of the BISQ by evaluating whether it captures age-related changes in sleep behavior whether it can distinguish between infants with and without sleep problems similarly to the original version. Methods We validated the German version of the BISQ by secondary analyses including N = 562 infants aged 6 to 24 months from seven independent samples and examined relations to infant development. Caregivers completed the German version of the BISQ. Additionally, parents in a subset of samples completed the Ages and Stages Questionnaires to assess developmental progress. To validate the BISQ against an objective measure, infants in three of the samples wore an actiwatch for a single night. Results Results showed age-related changes in sleep measures as assessed by the BISQ. Significant moderate correlations emerged between caregiver-reported night sleep duration and night wakings and one night of actigraphy. Additionally, BISQ sleep measures differed between infants whose parents reported a sleep problem and those who did not. The infant's sleep location (in own vs. shared bed) was a significant predictor of BISQ measures. Infants who slept alone in a separate room had more favorable sleep measures than infants who slept in the parent's room or the parent's bed. Daytime sleep duration and the time taken to fall asleep at night were positively associated with gross motor development, whereas nocturnal sleep duration was negatively associated. Conclusion Our findings suggest that the German BISQ is a valid, quick-to-administer instrument for assessing infant sleep.
Family factors have been gaining increased attention in understanding adverse neurodevelopmental and psychosocial outcomes for children with congenital heart disease (CHD). To clarify relevance, we undertook a systematic review of only longitudinal studies which assessed such associations. Comparisons with the contribution of disease/surgical factors were also made where included studies considered such. We included longitudinal studies which assessed dynamic family factors (e.g. parent mental health, attachment, family functioning) and later child outcomes. Searches were conducted across CINAHL, Medline-Pubmed, PsychInfo and SCOPUS Web of Science. The NIH Quality Assessment Tool was used to evaluate study quality and risk of bias. Eighteen studies, utilizing data from 11 study samples and 2109 participants, met inclusion criteria. These studies included samples from infancy, with follow-up periods stretching into young adulthood, and with various degrees of CHD severity. The quality of studies was “good” to “fair”, with key limitations of attrition and limited sociocultural diversity in samples. Findings suggested that family factors predicted later child psychosocial outcomes and more consistently than severity of disease indicators. This contrasted with a much smaller number of studies examining family factors and child neurodevelopmental outcomes, where no reliable conclusions could be reached. Findings highlight the importance of screening and family focused interventions for this population.
OBJECTIVE:To evaluate fetal growth patterns in spontaneous twin anemia-polycythemia sequence (TAPS) pregnancies treated with fetoscopic laser surgery. METHOD:This retrospective cohort study included all consecutive spontaneous TAPS pregnancies treated with laser surgery at the Leiden University Medical Center between 2002 and 2024. We evaluated the changes in estimated fetal weight (EFW) and presence of fetal growth restriction (FGR; EFW <10th centile) in TAPS donors and recipients after laser, and presence of small for gestational age (SGA; birth weight < 10th centile). RESULTS:Twenty-two spontaneous TAPS twin pairs were analyzed. At the time of laser surgery, FGR was more common in donors than in recipients (43% (9/21) vs. 5% (1/21), p = 0.023). Following laser treatment, growth centiles remained stable in most donors (77%, 17/22), improved in 5% (1/22), while declined in 18% (4/22). Among recipients, 64% (14/22) had stable growth, whereas 36% (8/22) experienced a decrease in growth centile and none showed improvement. At birth, SGA was observed in 55% (12/22) of donors and 36% (8/22) of recipients. CONCLUSION:Donor twins are frequently growth restricted prior to laser surgery but generally maintain or improve growth afterward. In contrast, one-third of recipients demonstrate post-laser growth decline, likely reflecting the cessation of intertwin transfusion.
BACKGROUND:Early developmental stages are critical for shaping later life personality traits, such as, temperament. Exposure to natural disasters, as an independent source of prenatal maternal stress, can influence child behavioural outcomes. The pioneering and the other studies on prenatal maternal stress from disasters were conducted in Western societies. Thus, the aim of this study was to assess the association of exposure to a severe ND, during prenatal and early postnatal stage, with temperament in preadolescent Indian children. METHOD:We assessed temperament using the EAS Temperament Survey in 867 Indian children aged 7-10 years, categorized by prenatal, early postnatal, or no exposure to cyclone Aila. RESULTS:Boys exposed to Aila showed reduced activity levels, while exposed girls exhibited lower emotionality and higher sociability compared to controls, indicating sex-specific effects. CONCLUSIONS:Early-life exposure to natural disasters is associated with distinct sex-specific temperament variations in Indian children, highlighting the role of environmental and cultural factors in developmental outcomes following prenatal and early postnatal stress.
OBJECTIVES:Early exposures are increasingly recognized as influential in shaping children's long-term development. This study examines how children's early screen time, outdoor play, and risky play experiences relate to developmental vulnerability in kindergarten. METHODS:This longitudinal study linked data from children (n = 4968; 51.1% male, 48.9% female) entering kindergarten in British Columbia in 2023 and 2024. Data from the Childhood Experiences Questionnaire (CHEQ) were linked with the Early Development Instrument (EDI). The CHEQ captured children's exposure to screen time, outdoor play and risky play in the six months prior to kindergarten entry as reported by caregivers, while the EDI assessed children's developmental health across five domains (physical, social, emotional, language and cognition, and communication skills) during kindergarten, as reported by teachers. Multivariate logistic regression was used to assess the relationship between exposure variables (outdoor play, risky play and screen time) and children's developmental vulnerability. RESULTS:In total, 32.9% (n = 1635) of children were vulnerable on one or more domains of the EDI. Increased opportunities for risky play were associated with reduced vulnerability (aOR: 0.92, 95% CI: 0.87-0.98), while more screen time in the early years was associated with increased vulnerability (aOR: 1.38, 95% CI: 1.26-1.50). Outdoor play was not associated with overall developmental vulnerability; however, it was associated with reduced vulnerability in the physical health and well-being, and communication skills and general knowledge domains. CONCLUSION:Collectively, these longitudinal results highlight the need to limit screen time and provide thrilling outdoor risky play opportunities in the early years to help reduce developmental vulnerability in kindergarten.
BACKGROUND:A variant of spontaneous movements "fidgety-like movements" has been described, but its prevalence and clinical relevance remain unclear. AIM:To describe the prevalence of "fidgety-like movements" at 3-5 months corrected age (CA), its relation to major cerebral lesions, and neurodevelopmental outcome in children born extremely preterm (EPT; <28 weeks gestation). METHOD:A retrospective re-analysis was conducted using three General Movement Assessment datasets, including Motor Optimality Score-Revised (MOS-R) at 3-5 months CA, in 402 infants born EPT from cohorts in the Netherlands, Sweden and Australia. Follow-up age ranged 1-8 years. Neurodevelopmental outcomes were assessed using standardized assessments and ICD-10, and classified as typical or adverse. RESULTS:Twenty-six of 402 infants (7%; range 5-8%) (mean gestational age ± SD, 25.1 ± 1.4 weeks; birth weight 780.1 ± 202.1 g) showed "fidgety-like movements". Median (IQR) MOS-R was 22 (21-24). Eighteen (69%) were boys, 18 (69%) had bronchopulmonary dysplasia and two (8%) had severe brain lesions. Follow-up data were available for 25 children (96%): 12 (48%) had typical and 13 (52%) adverse outcomes. Of those with adverse outcomes, most were motor delay (n = 6, 24%), language delay (n = 5, 20%) and ADHD (n = 4, 16%) or combined, with only one case of CP (4%). Fifty-four percent of children had MOS-R < 23 (below cut-off for high risk of NDD). CONCLUSION:The rate of "fidgety-like movements" was 7% in infants born EPT. Only one infant developed CP; however, more than half of infants with "fidgety-like movements" had adverse outcomes and reduced MOS-R scores highlighting need for careful follow-up.
Background Infants born very preterm (VPT) or with very low birth weight (VLBW) are at increased risk of neurodevelopmental difficulties. While biomedical predictors have been extensively studied, less is known about early psychosocial factors, particularly parental mental health and postnatal bonding. Aim This study examined parental mental health, postnatal bonding, sociodemographic, and biomedical predictors of neurodevelopment during the first three years in VPT/VLBW infants. Methods This prospective longitudinal study included 114 VPT/VLBW infants and their parents. Predictors included neonatal, sociodemographic, and obstetric factors, as well as psychopathology, postpartum depression, anxiety, and postnatal bonding, assessed during the neonatal intensive care unit (NICU) stay. Neurodevelopment was assessed at 12, 24, and 36 months using the Bayley Scales of Infant and Toddler Development, Third Edition. Linear mixed-effects models were fitted for cognitive, receptive and expressive language, and fine and gross motor domains. Results Greater partner phobic anxiety and maternal postnatal bonding difficulties were associated with poorer cognitive and language outcomes. Maternal interpersonal sensitivity was negatively associated with expressive language, whereas maternal paranoid ideation was associated with poorer fine motor outcomes. Maternal foreign origin was associated with poorer language outcomes. Among biomedical factors, infant female sex was associated with better fine motor outcomes, longer NICU stay with poorer gross motor outcomes, and higher 5-min Apgar scores with better receptive language outcomes. Conclusions Neurodevelopment in VPT/VLBW infants was associated with both biomedical and psychosocial factors. Findings highlight the relevance of parental mental health and postnatal bonding, supporting an integrative approach to early monitoring and support.
