The purpose of this study was to compare growth following hospitalization in preterm, low birth weight infants fed their own mother's milk versus preterm, low birth weight infants of similar weight and gestational age given standard infant formula upon demand. Growth measurements were taken 40, 42, 48 and 56 weeks postconceptual age. A total of 28 healthy, preterm, low birth weight infants completed the study. Seventeen infants received standard infant formula (Similac) and 11 were breast-fed upon demand. Introduction of solid foods was delayed until the infant was greater than 56 weeks postconceptual age. Weight, length, occiptial frontal circumference, mid-upper arm circumference, triceps and subscapular skinfold measurements were obtained at 40, 42, 48 and 56 weeks postconceptual age in our nutrition follow-up clinic. Analysis of variance with feeding as well as age, sex, gestational age at birth, birth weight, birth length and birth head circumference as factors was performed utilizing Duncan's Multiple Range Test. Weight, mid-upper arm circumference, and triceps and subscapular skinfold measurements were shown to be significantly greater in infants fed formula versus human milk from birth to 40 weeks postconceptual age. Gestational age at birth and increasing chronological age was also shown to influence these measures. Statistical significance was less than the one percent level. However, no statistical or clinical differences were found in rates of growth preterm, low birth weight infants fed either human milk or standard infant formula from 40 to 56 weeks postconceptual age. Both feeding groups experienced growth within the 10 to 90th percentiles of accepted infant norms for all parameters. It was concluded that preterm, low birth weight infants allowed to be breast-fed upon demand post-hospitalization experienced acceptable rates of gains from 40 to 56 weeks postconceptual age. Use of commercial formula was not found to be more advantageous than breast feeding.

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Background: Periodontal disease has been associated with gestational complications and both conditions have a high prevalence in rural populations from developing regions. A cross-sectional study was carried out to explore the relationship between periodontal inflamed surface area (PISA), blood pressure (BP), and, serum uric acid levels (UA) in a group of rural North Chinese pregnant women in the third trimester of pregnancy. Methods: Three hundred and thirty-five rural women aged 20–34 years, with normal body mass index (BMI) were examined in a cross-sectional study during their third trimester of gestation. Exclusion criteria were history of pregnancy complications,multiple pregnancy, smoking habits, diabetes, hypertension or any known infectious disease. Socio-demographic variables, including age and socioeconomic status (SES), systolic blood pressure (SBP) and diastolic blood pressure (DBP) readings, serum UA levels, and PISA values were recorded. A structural equation model was implemented with two constructed latent variables including “Dem” (comprising of age and SES category to represent unobserved demographic variables) and, “BP” (comprising of SBP and DBP to account for measurement error and lack of multiple BP readings). The model accounted for co-variance of BP and UA, and implemented simultaneous regressions for BP and UA as outcomes, upon Dem and PISA values as exogenous variables. Results: The median PISA score was 1,081.7 (IQR = 835.01), reflecting high levels of periodontal inflammation in the sample. SEM showed a significant association of PISA with BP (estimate = 0.011, 95%CI = 0.009–0.012 p < 0.001) and UA (estimate = 0.001, 95% CI = 0.001–0.001, p < 0.001). Conclusion: Higher PISA values were significantly associated with higher blood pressure and uric acid levels among rural pregnant women in a cross-sectional sample from a center in North China after accounting for a latent demographic construct derived from age and SES.

Objectives: The purpose of this thesis is to explore the associations between childhood cognitive abilities assessed at age 8 and health and socioeconomic outcomes at age 29-36 in extremely low birth weight survivors (ELBW, <1000g). Methods: Using data from the McMaster Extremely Low Birth Weight Cohort Study, Study 1 explores the influence of overall intelligence, fluid intelligence, and language abilities on the prevalence of lifetime major depressive disorder in ELBW survivors and normal birth weight comparison subjects. Study 2 examines the mediating role of overall intelligence, fluid intelligence, language abilities, quantitative reasoning, and academic achievement on the association between being born at ELBW and socioeconomic outcomes at age 29-36. The final study examines the moderating role of childhood cognitive functioning on links between postnatal psychosocial adversity and adult personal earnings in ELBW survivors. Results: Results from Study 1 suggest that childhood cognitive abilities do not influence the onset of major depressive disorder in ELBW survivors, but are protective against depression in normal birth weight individuals. Study 2 suggests that childhood cognitive abilities partially mediate the association between being born at ELBW and income attainment in adulthood, but not full time employment. Further, Study 2 suggests that this association is stronger in ELBW survivors who have neurosensory impairments. Results of Study 3 suggest that enhanced childhood cognitive functioning is not protective against postnatal psychological adversity in influencing income attainment, as those ELBW survivors with higher childhood intelligence and who suffered psychological adversity reported lower annual income at age 30. Conclusions: This thesis suggests that overall and specific cognitive abilities significantly influence adult outcomes in ELBW survivors and normal birth weight individuals. However, while cognitive reserve may not be protective against psychological adversity in ELBW survivors, early cognitive abilities are a critical indicator of socioeconomic attainment in this vulnerable population. / Thesis / Master of Science (MSc) / The following thesis explores the predictive role of childhood cognitive abilities on adult health and socioeconomic outcomes in extremely low birth weight survivors at age 29-36. Study 1 explores the influence of overall intelligence, fluid intelligence, and language abilities assessed at age 8 on the prevalence of lifetime major depressive disorder in extremely low birth weight survivors and normal birth weight comparison participants. Study 2 examines the mediating role of overall intelligence, fluid intelligence, language abilities, quantitative reasoning, and academic achievement on the association between being born at extremely low birth weight and socioeconomic outcomes at age 29-36. The final study examines the moderating role of childhood cognition on the association between postnatal psychosocial adversity and personal income attainment at age 30 in extremely low birth weight survivors. Overall, this body of work suggests that childhood cognitive abilities are an important contributor to adult outcomes in preterm survivors.

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<p>Salivary cortisol and electrocardiogram data was collected at baseline and after a stress-anticipation task in extremely low birth weight (ELBW; < 1000 grams) survivors and normal birth weight (NBW) controls, in order to examine the moderating influence of emotion regulation on the relationship between being born at ELBW and internalizing problems in adulthood. The stress manipulation was an adapted Trier Social Stress Task. The participants were told they would have three minutes to create a speech on one of three predetermined topics (i.e., gun control, same sex marriage, or abortion). After three minutes passed, the particpants were told that there would be no speech. All participants showed a decrease in salivary cortisol levels throughout the day, and an increase in heart rate during the stress anticipation task. When a median split was used to create high and low stress reactive cortisol and heart rate groups, an interaction was found between birth status (ELBW vs. NBW) and group (High vs. Low Stress Reactive Cortisol) on self-reported internalizing problems (anxiety, depression, withdrawal). Those born at ELBW who had high stress reactive cortisol self-reported significantly higher levels of internalizing problems compared to ELBWs with low stress reactive cortisol. Those born at NBW did not differ on self-reported internalizing problems based on their stress reactive cortisol levels. When the moderating effect was probed with a linear regression analysis, the ELBW group was driving the relation between stress reactive cortisol levels and internalizing problems. Taken together, the results suggest that emotion regulation, as indexed by the neuroendocrine system, is moderating the relation between being born at ELBW and internalizing problems in adulthood. This is indicative of a differential susceptibility of risk and resilency in ELBW survivors depending on their ability to regulate their emotions, specifically during periods of stress.</p> / Master of Science (MSc)

The aim of this study was to explore temperament, psychopathology and quality of life (QOL) in adolescents born at extremely low birth weight (ELBW), i.e., < 1000g. ELBW adolescents (N = 15) completed the Revised Cheek and Buss Scale and Mini International Neuropsychiatric Interview 5.0.0 (M.I.N.I.), while their legal guardians completed a biographical questionnaire and the Short Form 12 version 2. The median age of the sample was 13 SD = 2.526 years (60% male) and all participants spoke English. ELBW adolescents with social phobia (n = 6) were more shy (p = .041) and had poorer mental health-related QOL (p = .041) than those without such symptoms. The results suggest that ELBW could be a predisposing factor for increased shyness and psychological disorders including social phobia. Planning of interventions for ELBW individuals should therefore include strategies to prevent or mitigate the effects of these factors in adolescence / Psychology / M.A. (Clinical Psychology)

<p>Uvod: Bronhopulmonalna displazija (BPD) je najče&scaron;ća i najteža respiratorna posledica prematuriteta. Utvrđivanje najznačajnijih faktora rizika za nastanak BPD kod novorođenčadi porođajne mase (PM) ispod 1500g može omogućiti procenu rizika za&nbsp; nastanak bolesti i identifikaciju novorođenčadi u visokom riziku, &scaron;to je važno za pružanje informacija roditeljima o prognozi,&nbsp; planiranje preventivnih i terapijskih mera i stratifikovanje novorođenčadi koja su u riziku za sprovođenje budućih istraživanja. Cilj: Utvrđivanje incidencije, stepena težine BPD, smrtnosti, identifikacija najznačajnijih prenatalnih i postnatalnih faktora rizika za nastanak BPD, konstrukcije modela predikcije za nastanak BPD. Materijal i metode: Istraživanje je sprovedeno na 504&nbsp; prevremeno rođene novorođenčadi PM&lt;1500g koja su rođena u porodili&scaron;tima u AP Vojvodini i lečena u tercijarnom Centru za neonatologiju i intenzivnu negu i terapiju, na Institutu za zdravstvenu za&scaron;titu dece i omladine Vojvodine u periodu od&nbsp; 2006.-2011. godine. Retrospektivno je analizirano prisustvo BPD, prema stepenima težine, smrtnost. Podaci su izdvojeni iz&nbsp; istorija bolesti za svako novorođenče, 30 potencijalnih prenatalnih i postnatalnih faktora je opisano deskriptivnom i univarijantnom statistikom. Statstički najznačajniji faktori su uneti u multifaktorsku logističku regresionu analizu u cilju&nbsp; konstrukcije prediktivnih modela za nastanak BPD u 1.,14. i 21. danu neonatalnog života. Podaci su obrađeni u StatSoft-ovom&nbsp; programskom paketu Statistica 10.0.&nbsp; Validacija modela predikcije je sprovedena u prospektivnom delu istraživanja, na 100&nbsp;&nbsp;&nbsp; prevremeno rođene novorođenčadi&lt;1500g, u periodu od 2012-2013. godine. Rezultati: U retrospektivnom delu&nbsp; istraživanja,&nbsp; od 504&nbsp; novorođenčeta PM&lt;1500 grama, umrlo je 17.65%, BPD je imalo 45.43% (blagu BPD 19.44%, srednje te&scaron;ku 19.84%,&nbsp; te&scaron;ku&nbsp; 6.15%), srednje te&scaron;ku i&nbsp; te&scaron;ku 25.99%.Antenatalna primena kortikosteroida je zastupljena u 47.02%, surfaktant&nbsp;&nbsp; je&nbsp;&nbsp; primenjen kod 69.78% novorođenčadi. Najznačajniji prenatalni prediktivni faktor rizika za nastanak BPD/smrtnog ishoda je horioamnionitis (OR 5.72; 95% CI 3.42-9.62), dok su protektivni faktori: prenatalna primene kortikosteroida (OR&nbsp; 0.41;&nbsp; 95%CI&nbsp; 0.29-0.60), porođaj carskim rezom (OR&nbsp; 0.24; 95% CI 0.16-0.36). Najznačajniji&nbsp; postnatalni prediktivni faktori rizika su: GS&nbsp; (p&asymp;0.00), PM (p&asymp;0.00), reanimacija u porođajnoj sali (OR 7.01; 95% CI 4.12-12.01), rana&nbsp; neonatalna&nbsp; sepsa&nbsp; (OR&nbsp; 7.35;&nbsp; 95%CI&nbsp; 3.79-14.58), RDS&nbsp; (p&asymp;0.00), primena surfaktanta (OR13,3;95%CI 8,2 - 21,67), DAP (OR 4.12; 95%CI&nbsp; 2.47-6.89),&nbsp; dok&nbsp; je&nbsp; ženski&nbsp; pol&nbsp; protektivan (OR&nbsp; 0.61; 95% CI 0.42-0.89). FiO2 i IPPV su u svim posmatranim danima značajni faktori rizika. Primena IPPV u 1. danu (OR 10.71;&nbsp; 95% CI 6.67-17.26); u ostalim danima rizik od BPD raste prema rastućoj invazivnosti respiratorne&nbsp; potpore.&nbsp; Konstruisani su modeli&nbsp; predikcije za 1, 14 i 21. dan života, modeli imaju visoku prediktivnu vrednost: ukupan procenat uspe&scaron;nosti&nbsp; modela je 84.26%-90.80%, modeli sa ne&scaron;to većim uspehom predviđaju&nbsp;&nbsp; prisustvo (85.36%-94.12%), nego odusustvo BPD (81.72-86.56%). OR modela je 28.07-103.04. Modeli su uspe&scaron;no validirani&nbsp; na 102 pacijenta sa ukupnim procentom uspe&scaron;nosti (82-90%), PPV (0.86-0.94) i NPV (0.76-0.87). Zaključak:&nbsp; Kori&scaron;ćenjem&nbsp; prenatalnih i postnatalnih kliničkih podataka moguće je predvideti nastanak BPD ili smrtnog ishoda.</p> / <p>Introduction: Bronchopulmonary dysplasia (BPD) is the most common serious pulmonary morbidity in very low birth weight (VLBW) infants. It is of clinical importance to determine clinical variables that are associated with BPD in order to identify infants who are at risk of developing BPD; it contributes to BPD prevention, may enable prognostic information for parents and future studies design. Objective: The aim of this study was to determine the incidence and severity of BPD, mortality rate in VLBW infants, to identify prenatal and postnatal predictive risk factors for bronchopulmonary dysplasia and competing outcome of death and to develop predictive models. Materials and Methods: Study was conducted in 504 VLBW infants born in the maternity hospitals in Vojvodina and admitted to tertiary Center for newborn and neonatal intensive care at the Institute for Child and Youth Health Care of Vojvodina, from January 2006. to December 2011. Data were retrospectively collected from clinical records for outcomes BPD or death; prenatal and postnatal factors associated with BPD were collected at three postnatal ages and examined by descriptive and univariate statistics; factors that were significantly associated with BPD and/or death were entered into a multivariate logistic regression analysis for develop predictive models. Data were analyzed using StatSoft&#39;s software package Statistica 10.0. Validation of the models were conducted in a prospective study in 102 VLBW infants born from January 2012. to December 2013. Results: There were 504 very low birth weight infants who were eligible for this study, 17.65% died, 45.43% developed BPD (mild BPD 19.44%, moderate 19.84%, severe 6.15%), moderate and severe 25.99%. The mean birth weight for the cohort was 1125.6&plusmn;280.9g, the mean gestation age was GS 28,78&plusmn;3,01, 49.21% were male. Surfactant received 69.78%, antenatal steroids 47.02% newborns. Key risk factors for BPD and/or death were: chorioamnionitis and maternal infections at delivery (OR 5.72; 95% CI 3.42-9.62); protective prenatal factors were: antenatal corticosteroid therapy (OR 0.41; 95%CI 0.29-0.60), cesarean delivery (OR 0.24; 95% CI 0.16-0.36). Postnatal rick factors were: GS (p&asymp;0.00), birth weight (p&asymp;0.00), delivery room resuscitation (OR 7.01; 95% CI 4.12-12.01), early neonatal sepsis (OR 7.35; 95%CI 3.79-14.58), RDS (p&asymp;0.00), surfactant (OR13,3;95%CI 8,2 - 21,67), DAP (OR4.12; 95% CI 2.47-6.89), while female gender was protective (OR 0.61; 95% CI 0.42-0.89). At each time point studied, FiO2 was significantly higher in BPD/death, as well as respiratory support; on the first day invasive respiratory support was significantly associated with BPD/death (IPPV and HFOV) (OR 10.71; 95% CI 6.67-17.26), in other days BPD was associated with increasing invasiveness of respiratory support. In multifactorial logistic regression analysis separately predictive models were developed at three postnatal ages, at 1st, 14th and 21st day. Models had high predictive performance: total success of the models were 84.26% - 90.80%, models successfully predicted the presence of BPD in 85.36% -94.12%, absence of the BPD in 81.72 - 86.56% cases. OR of models were 28.07-103.04. The models were successfully validated on 102 patients with a total percentage of success 82 - 90%, with PPV 0.86-0.94 and NPV 0.76-0.87. Conclusion: Using prenatal and postnatal clinical data it is possible to predict the development of BPD and/or death in very low birth weight infants. It is very important to identify risk factors for BPD development in order to decrease the incidence of BPD and mortality rate.</p>

This diploma thesis deals with very low birth weight children in relation to the occurrence of motor problems. The theoretical part provides an overview of knowledge about the low birth children's problems, early postnatal problems and problems from childhood to adulthood in the physical, psychological and pedagogic field. The main part of the theoretical information concerns the occurrence of motor disorders, particularly the developmental dyspraxia and motor disorders about very low birth children. The aim of the practical part of the work was to determine whether low birth weight infants have higher incidence of developmental dyspraxia in comparison with term infants. The research group consisted of 25 low birth weight children, they were examined by Movement Assessment Battery for Children 2 (MABC-2). Children were examinate for posture and postural functions compiled using our protocol. The another aim of the practical part of the work was to determine whether low birht weight children have higher incidence of physical activity in steps by week in comparison with normal birth weight infants. There was significant difference in the incidence of motor disorders between the research group and the control group of 73 normal birth weight children and standard population and the group of late...