Die Frühgeborenenretinopathie (Retinopathia praematurorum (RPM)) ist eine Erkrankung der Netzhaut, die vor allem sehr unreife Frühgeborene betrifft und in ihrem Endstadium zur Erblindung führen kann. Ein gesicherter Risikofaktor für die Entwicklung einer RPM ist die Gabe von hohen Konzentrationen an Sauerstoff nach der Geburt. Gegenstand dieser Arbeit war die Frage, ob nach der Einführung eines Sauerstoffprotokolls 2007 das Auftreten höherer Stadien der RPM reduziert werden konnte. Das Sauerstoffprotokoll hatte zum Ziel die Gabe von inspiratorischem Sauerstoff nach Möglichkeit zu senken und übermäßige Fluktuationen zu vermeiden. Hierfür wurden 268 Frühgeborene mit einem Gestationsalter < 32Wochen bei Geburt, welche in den Jahren von 2005 bis 2006 (pre-Gruppe) und 2008 bis 2009 (post-Gruppe) in der Universitätsklinik Leipzig geboren und einem RPM-Screening unterzogen wurden, verglichen. Es konnte gezeigt werden, dass die Inzidenz der RPM nach 2007 signifikant niedriger war. So erkrankten in der pre-Gruppe 12 von 102 Kinder an einer höhergradigen RPM (>Stadium 3), wohingegen diese Stadien in der post-Gruppe nicht mehr beobachtet wurden. Demzufolge reduzierte sich auch die Notwendigkeit einer Therapie von 7,4 % auf 0 % (jeweils p = 0.0005). In Hinblick auf die Kerndaten wie Gestationsalter, Geburtsgewicht, Körpergröße, sowie dem Auftreten schwerer Begleiterkrankungen wie u.a. der nekrotisierenden Enterokolitis oder der bronchopulmonalen Dysplasie fanden sich keine Unterschiede zwischen den Gruppen. Allerdings wies die post-Gruppe eine höheren Anteil an männlichen Frühgeborenen auf. Die Mortalität zeigte keine signifikante Veränderung nach der Intervention und lag bei 7.8 % in der pre- bzw. 6.6 % in der post-Gruppe (p = 0.81). Die Auswertung der pulsoximetrisch gemessenen Sauerstoffsättigung (SpO2) und der inspiratorischen Sauerstofffraktion (FiO2) zeigte, dass der SpO2 leicht und der FiO2 deutlich reduziert werden konnte. Ein signifikanter Unterschied ergab sich hier jedoch lediglich für den FiO2, insbesondere in den ersten 14 Lebenstagen. Die logistische Regressionsanalyse legt nahe, dass hohe SpO2- und FiO2-Werte sowie das Auftreten von intrakraniellen Blutungen mit schwerwiegenden ROP-Stadien korrelieren. Ein bedachter Umgang in der Sauerstofftherapie Frühgeborenen könnte in der Lage sein das Auftreten der Frühgeborenenretinopathie zu reduzieren ohne eine Erhöhung der Mortalitätsrate zu riskieren.

Since fetal alcohol syndrome was first reported, studies have demonstrated a range of perinatal/developmental abnormalities that fall under the umbrella term fetal alcohol spectrum disorders. Of these, low birth weight in exposed children is among the most commonly observed and widely accepted. However, in the past, assertion of an association between prenatal alcohol exposure and preterm birth was controversial. Methodological difficulties may have contributed to failure to consistently detect such a relationship. However, new evidence suggests that pregnancy drinking may be a major contributor to extreme, but not mild prematurity. Extreme prematurity is a major cause of severe perinatal morbidity and mortality. If recent findings are confirmed, it suggests that extreme prematurity might be reduced by eliminating prenatal alcohol exposure.

Background: Rates of preterm delivery, a major proximate cause of perinatal morbidity and mortality, have been increasing. Prenatal alcohol exposure has been implicated in preterm delivery, although results have been inconsistent due to inadequate control for confounding factors, insufficient power, unreliable and inaccurate assessment of both exposure and gestational age, and lack of stratification of prematurity into severity levels. The purpose of this study was to examine the relation between maternal alcohol, cocaine and cigarette use during pregnancy, and extreme and mild preterm birth. Methods: Three thousand one hundred thirty consecutive gravidas were followed prospectively for antenatal substance use and had ultrasound confirmed pregnancy dating. Results: Alcohol and cocaine, but not cigarette use, were associated with increased risk of extreme preterm delivery after control for potential confounders. For every unit increase in alcohol exposure, risk of extreme preterm delivery increased significantly [odds ratio (OR) 34.8]. Furthermore, in women aged 30+, alcohol exposure was associated with mild prematurity. Abstention from alcohol while continuing to use cocaine and tobacco was related to a decrease in extreme prematurity of 41%. Conclusions: The risk of extreme preterm delivery associated with alcohol use is substantial and similar in magnitude to other well-recognized risks. Increased accuracy in identifying exposure and the use of ultrasound to confirm gestational age dating likely contributed to the findings of the current study. These findings suggest that eliminating pregnancy alcohol use might substantially reduce the risk of preterm delivery.

Premature children are at greater risk for developing communication delays than full-term children, although it is not inevitable. Recent research links specific temperament characteristics to early language development. Thus, temperament may provide a way to identify premature children who are at increased risk. The first purpose of this study was to determine if temperament characteristics of premature children are the same as full-term children when measured by the Infant Behavior Questionnaire-Revised. The second purpose was to determine if temperament and language acquisition, as measured by the MacArthur Communicative Development Inventory: Words and Gestures, are linked in premature infants and, if so, are the relationships similar to those of full-term populations. Participants included 19 children 8-12 months, chronological age. Results indicated that they exhibited similar temperament characteristics to full-term children. Additionally, temperament was linked to vocabulary comprehension and, unlike findings for full-term children, to expressive communication as well .

Introduction Although studies have examined the association between childhood asthma and parental smoking and secondhand smoke, little research has explored the moderating role of birth weight and prematurity (BWP) status on this association. We examined the association between secondhand smoke exposure, asthma, and asthma severity in children aged six to 17 as well as the modifying effect of BWP on parental smoking and asthma. Methods We used data from 36,954 children from the National Survey of Children's Health 2017-2018. In addition to univariate analysis, adjusted and unadjusted logistic regression models were used to estimate the effect of secondhand smoke on asthma. The interaction term between parental smoking and BWP was tested. Multinomial regression was used to evaluate the association between secondhand smoke on asthma severity. Results About 15.1 % of children had asthma and 15.4% of parents reported smoking. Odds of asthma were higher in children living with an outdoor (AOR, 1.27; 95% CI, 1.06-1.52) and indoor (AOR, 1.46; 95% CI, 1.01-2.11) smoker in the adjusted model. The association of parental smoking with asthma differed by birth weight and premature status. Normal weight children who are premature had the highest odds ratio (AOR, 2.15; 95% CI, 1.2-3.86). In the multinomial model, low birth weight and premature children had higher odds of mild (AOR, 1.90; 95% CI, 1.40-2.56) and moderate/severe (AOR, 1.81; 95% CI, 1.16-2.84) asthma compared to the no asthma group. Conclusion The Association of parental smoking on asthma was modified by BWP. Focused asthma interventions in children should inquire about BWP status as well as parental smoking and household smoke exposure to reduce asthma morbidity and mortality.

Данная работа посвящена исследованию особенностей сенсомоторного и когнитивного развития недоношенных младенцев. Недоношенность рассматривается как симптомокомплекс, который реализуется за счет многих разнообразных механизмов. На основе работ отечественных и зарубежных авторов проведен анализ наиболее часто встречающихся форм неинфекционных перинатальных патологий, в частности недоношенности. В эмпирическом исследовании с помощью однофакторного дисперсионного анализа было проведено сравнение показателей уровня развития сенсомоторных и когнитивных функций у доношенных и недоношенных младенцев в возрасте от 6 до 13 месяцев. Для реализации исследования были сформированы три группы: экспериментальная (недоношенные дети) и 2 контрольных группы (соответствующие по хронологическому и гестационному возрасту). На основе полученных данных делается вывод, что недоношенные дети демонстрируют отставание в развитии моторики при типичном развитии когнитивных функций. / This work is devoted to research of sensorimotor and cognitive development in premature infants. Prematurity is considered as a set of symptoms, which is being implemented by many mechanisms. It was analyzed the most common forms of non-infectious perinatal pathology, particularly prematurity using the works of Russian and foreign researchers. It was conducted comparison of the level of development of sensorimotor and cognitive functions in term and preterm infants aged 6 to 13 months using one-way ANOVA. Three groups were formed: experimental (premature babies), and two control groups (corresponding to chronological and gestational age). It was shown that preterm infants have delay in motor development and typical development of cognitive functions.

Le troisième trimestre de grossesse est une période-clé du développement cérébelleux. L’extrême prématurité et les lésions cérébelleuses (LCb) associées prédisposent ces enfants à des déficits moteurs, sociaux, comportementaux et cognitifs. Nos objectifs étaient de décrire les déficits neurocomportementaux associés à long-terme aux LCb, et d’explorer le rôle des microglies cérébelleuses dans leur survenue. À 3 jours de vie, des LCb ont expérimentalement et aléatoirement été induites chez des souriceaux transgéniques (B6.129P2(Cg)-Cx3Cr1 CreERT2-EYFP/iDTR), présentant ou non, une déplétion microgliale cérébelleuse transitoire : contrôle, hémorragies cérébelleuses, état inflammatoire systémique précoce et association des deux lésions. Une évaluation neurocomportementale a été réalisée à l’aveugle en période juvénile et à l’âge adulte. En présence de microglies cérébelleuses, les souris mâles adultes ayant souffert de LCb présentaient une diminution des comportements liés à l’anxiété (test du labyrinthe en croix surélevé) et les souris femelles juvéniles ayant souffert de LCb une augmentation des comportements d’investigation sociale (test de reconnaissance sociale) en comparaison des groupes contrôles. Vis-à-vis d’un état inflammatoire systémique précoce, la déplétion microgliale cérébelleuse assurait une récupération fonctionnelle du phénotype anxieux masculin et social féminin. Ce constat suggérait l’implication d’une activation microgliale délétère à la suite de LCb. Des études complémentaires permettront de préciser les sous-domaines neurocomportementaux affectés et d’investiguer les conséquences d’une activation microgliale (altération de l’élagage synaptique et/ou de la myélinogénèse cérébelleuse). / The third trimester of pregnancy is a key period for cerebellar development. Extreme prematurity and cerebellar injuries (CBI) predispose ex-preterm infants to long-term motor, social, behavioral, and cognitive deficits. Our objectives were to describe the long-term neurobehavioral deficits associated with CBI, and to determine if cerebellar microglia play a pathological role in these induced neurobehavioral deficits. At 3 days of life, CBI were experimentally and randomly induced in transgenic mice (B6.129P2(Cg)-Cx3Cr1 CreERT2-EYFP/iDTR), with or without transient cerebellar microglial depletion: control, cerebellar hemorrhages, early systemic inflammatory state, and association of these 2 injuries. A blinded neurobehavioral assessment was performed in juvenile and adult age. In the presence of cerebellar microglial cells, CBI adult male mice exposed to CBI showed a decrease in anxiety-related behaviors (elevated plus maze test), and CBI juvenile female mice exposed to CBI showed an increase in social investigation behaviors (social recognition test) compared to control groups. Cerebellar microglial depletion ensured a functional recovery of these anxiety-related and social investigation behaviors in mice exposed to an early systemic inflammatory state. This finding was consistent with a deleterious role of microglial activation. Further studies will precise the neurobehavioral subdomains affected and investigate the consequences of microglial activation (alteration of synaptic pruning and/or cerebellar myelinogenesis).

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