Research has shown that children born low birth weight (i.e., ≤2500 grams) and/or premature (i.e., birth prior to 37 weeks gestation) are at increased risk of experiencing developmental delays, as well as long-standing executive functioning and academic challenges. Despite these well-known risks, children born low birth weight are under-enrolled nationally in Part C Early Intervention (EI) services intended to support developmentally vulnerable children. Little is known regarding why EI enrollment is low in this high risk population, especially given children born LBW are readily identifiable as at increased risk of delays at birth. This study explored EI referral outcomes from a high risk infant follow up program serving children with complex early medical histories that place them at increased risk of experiencing developmental delays to determine how many children referred to EI were ultimately evaluated and enrolled in the program. This explanatory sequential mixed methods study included a quantitative phase characterizing the EI referral outcome and a qualitative phase consisting of interviews with families to explore the parent/caregiver's experience of the EI referral process. Data analysis included descriptive statistics to characterize the sample and Pearson Chi Square and independent samples t-tests to investigate child characteristics associated with successful referral. Qualitative interviews were transcribed and coded for themes in an iterative and cyclical fashion. Results indicate that only 62% of the children who were referred for EI services were evaluated by the program, with about the same percentage of those evaluated being found eligible (67%). Of those who were not found eligible, about a third of children should have qualified based on previous testing and/or medical conditions. However, these qualifying medical conditions were often not clearly documented on the referral form, and not all forms included documentation of the scores from developmental testing. There were also a significant number (71%) of Oregon children referred to EI but never evaluated who were likely to have qualified based on medical history and/or results from developmental testing. There were several key themes identified following analysis of the qualitative interviews. Most critically, the parent/caregiver's perception of the need for the EI referral was identified as an essential factor in facilitating a successful connection to EI. Other key themes included the need to honor the many different demands placed on the caregivers of these high risk children, as well as the necessity of providing clear explanation of the purpose of both the visit to the high risk infant follow up program and the EI referral. The Chronic Care Model is used as a framework for discussing implications for practice.

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Propõe uma intervenção após uma longa observação neonatal de risco, de um hospital escola na cidade de São Paulo, verificando se as modificações efetuadas na sala de pré-termo, tiveram influência em relação ao neonato, à equipe da unidade neonatal e no retorno dos pais ao ambulatório após a alta. Os Ss do estudo são 59 neonatos pré-termo, sendo 32 do grupo controle e 27 do grupo experimental. Realiza a intervenção através de um conjunto sitemático de medidas ao ambiente, às manipulações no neonato (dentro do conceito neuro-evolutivo Bobath) e à orientação aos pais. Faz a avaliação através de: tempo de permanência na unidade, de uso de sonda e de permanência na incubadora; escala de Brazelton; questionário de avaliação respondido pela equipe neonatal e frequência de retorno ambulatórial. Conclui pela validação das medidas propostas, dado que os neonatos do grupo experimental permaneceram menos tempo internados, com menos permanência na incubadora e no uso da sonda. Também mostraram um controle significativamente maior dos estados e da estabilidade autonôma, indicando prontidão para um amadurecimento mais uniforme, decorrente de uma maior estabilidade fisiológica e comportamental. O estudo indica a validade do uso de técnicas de baixo custo, adaptavéis ao meio brasileiro, facilitando a integração do bebê em seu meio / This study aimed to observe whether changes made in the premature roam of a special care neonatal unit could have influence on the baby, on the neonatal unit\'s staff and on the return of the parents to the ambulatory, after discharge. 59 premature babies, 32 of the control group and 27 of the experimental group, from a neonatal unit of a school hospital in the city of São Paulo were involved in this study. lt was done in two steps: observation and intervention with subsequent assessment. The intervention was done through a systematic set of measurements in relation to the environment, to the baby\'s handling (in the neuro-developmental Bobath concept)) and to the parents\' guidance. The survey was made by assessing the number of days the baby stayed in the unit and in the incubator, as well as the number of days he/she was tube fed; by assessing the babies with Brazelton\'s scale; by the survey of a questionnaire answered by the neonatal unit\'s staff and finally by assessing the frequency of the ambulatory return. The validity of the proposed means were confirmed due to the fact that the babies from the experimental group stayed significantly less time in the hospital as well as in the incubator and were tube fed for less time. They also showed a significantly better state controle as well as autonomic stability, showing readiness towards a more steady maturation due to a larger physiological and behavioral stability. This study shows the validity of using low cost techniques, adaptable to the Brazilian surrounding, enabling the baby\'s integration in his/her environment

Preterm birth is a public health problem affecting almost 15 million newborns each year, with almost one million cases annually being fatal. Despite many decades of research, identifying high-risk pregnancies remains difficult. Even with the therapies currently available to clinicians, 95% of preterm births are seemingly intractable. We see a great opportunity for engineers to collaborate with clinicians to help reduce the adverse health impact of this phenomenon. This work is a multi-faceted contribution to the study of the biomechanical problem of preterm birth. We portray the successful, full-term, pregnancy as a delicate balance of organ geometry, tissue deformation behavior, and the physical interaction between the uterus, cervix, and fetal membranes. The cervix is our focus, as its preterm ripening and dilation are the final pathway to premature delivery. We consider a selection of geometric and material factors, studying their impact on the loading that occurs in the cervix. We also study the mechanical implications of the use of a cervical pessary on the mechanical environment of pregnancy. Our mechanical analyses use a custom parameterized model of the pregnant anatomy, coupled with Finite Element Analysis techniques, to allow for rapid model development. In addition, we present a push towards the in-vivo measurement of cervical material properties by way of a phantom study using modern MRI techniques.

Background: Maternal sensitivity, or high quality maternal caregiving, in which the mother leads and structures the infant’s early experiences in a responsive way, is associated with improved child development outcomes and health, both in the immediate and long term, and thus an important area of public health research. Although previous research has established that exposure to high maternal sensitivity advances the outcome of infant cognitive development, factors such as breastfeeding, which is hypothesized to confound the association, or depression, which is negatively associated with sensitivity, have not yet been examined together in a single study. Maternal alcohol use, associated with both breastfeeding and depression, has not been examined in any study investigating the sensitivity-cognitive development association. The majority of infant studies examining the maternal sensitivity-infant cognition association include either normal birth weight infants or LBW infant samples. Using the LBW category may result in potential misclassification since this group combines at least two different phenomena and includes infants who have had either compromised gestational time as in the case of small for gestational age (SGA), or insufficient gestational time, as in the case of premature birth, or both. In studies using comparison groups, normal birth weight infants are sometimes compared to LBW infants or infants born prematurely. However, none of these studies examine the association between sensitivity and cognitive outcome in infants exclusively premature or SGA. Aim: This study investigates the association of several factors: (1) maternal depressive symptomology, (2) breastfeeding, (3) concurrent maternal alcohol intake and (4) infant biological vulnerability upon outcomes of (1) Maternal Sensitivity and (2) Infant Cognitive Development, as well as their effect on the association between senstivity and cognitive development. Methods: Using data from the Early Childhood Longitudinal Study-Birth (ECLS-B) Cohort, a nationally representative sample of U.S. born children, depressive symptomology was evaluated as an effect-modifier, and breastfeeding was evaluated as a confounder of the sensitivity-cognitive development association. Maternal alcohol use and biological vulnerability were also hypothesized to be confounders of the sensitivity-cognitive association. Univariate and multi-variable regression analyses were used to examine whether the four maternal factors were associated with Maternal Sensitivity, measured by the Nursing Child Assessment Teaching Scale (NCATS), and with Cognitive Development, measured by the Bayley Scale of Infant Development, Research Edition (BSF-R). Results: In univariate analyses, breastfeeding, depressive symptomology and alcohol use were associated with maternal sensitivity but only breastfeeding and depressive symptomology were associated with Cognitive Development In a final model examining the effect of sensitivity, depressive symptomology and breastfeeding upon the outcome of Cognitive Development, sensitivity (β =.375, p<.001) remained significantly associated with cognitive development after adjusting for breastfeeding (β =1.592, p<.001), depressive symptomology (β =-.061), p<.05), demographic factors and birthweight (R2=.053, p<.001). Depressive symptomology was not an effect modifier of the sensitivity-cognitive developmental association. Univariate regression analyses showed that of the measures of biological vulnerability, premature birth had the greatest association with both sensitivity and cognitive development in comparison to the LBW or SGA. In a multivariate regression model in which maternal sensitivity as an outcome, premature birth (β= -.524***) was associated with maternal sensitivity (R2=.100, p<.001), after adjusting for maternal depression and breastfeeding. In a multivariate regression model analysing the effect premature birth and maternal factors, including sensitivity in which cognitive development was the outcome, maternal sensitivity (β=.369, p<.001) and breastfeeding (β=1.567, p<.001) were positively associated with infant cognitive development, while premature birth (β= -2.949, p<.001) was negatively associated (R2=.049, p<.001). Conclusion: This research demonstrates that an independent association between maternal sensitivity and infant cognitive development remains even after adjusting for breastfeeding, and that breastfeeding is a separate means to advancing infant cognitive development. Premature birth, rather than SGA drove the negative association between low birth weight and cognitive development. Future research should look at the effects of premature birth separately from SGA when examining developmental outcomes. Keywords: Maternal Sensitivity, Parenting, Cognitive Development, Breastfeeding, Maternal Depression, Premature Birth, Small for Gestational Age, Low Birth Weight

Propõe uma intervenção após uma longa observação neonatal de risco, de um hospital escola na cidade de São Paulo, verificando se as modificações efetuadas na sala de pré-termo, tiveram influência em relação ao neonato, à equipe da unidade neonatal e no retorno dos pais ao ambulatório após a alta. Os Ss do estudo são 59 neonatos pré-termo, sendo 32 do grupo controle e 27 do grupo experimental. Realiza a intervenção através de um conjunto sitemático de medidas ao ambiente, às manipulações no neonato (dentro do conceito neuro-evolutivo Bobath) e à orientação aos pais. Faz a avaliação através de: tempo de permanência na unidade, de uso de sonda e de permanência na incubadora; escala de Brazelton; questionário de avaliação respondido pela equipe neonatal e frequência de retorno ambulatórial. Conclui pela validação das medidas propostas, dado que os neonatos do grupo experimental permaneceram menos tempo internados, com menos permanência na incubadora e no uso da sonda. Também mostraram um controle significativamente maior dos estados e da estabilidade autonôma, indicando prontidão para um amadurecimento mais uniforme, decorrente de uma maior estabilidade fisiológica e comportamental. O estudo indica a validade do uso de técnicas de baixo custo, adaptavéis ao meio brasileiro, facilitando a integração do bebê em seu meio / This study aimed to observe whether changes made in the premature roam of a special care neonatal unit could have influence on the baby, on the neonatal unit\'s staff and on the return of the parents to the ambulatory, after discharge. 59 premature babies, 32 of the control group and 27 of the experimental group, from a neonatal unit of a school hospital in the city of São Paulo were involved in this study. lt was done in two steps: observation and intervention with subsequent assessment. The intervention was done through a systematic set of measurements in relation to the environment, to the baby\'s handling (in the neuro-developmental Bobath concept)) and to the parents\' guidance. The survey was made by assessing the number of days the baby stayed in the unit and in the incubator, as well as the number of days he/she was tube fed; by assessing the babies with Brazelton\'s scale; by the survey of a questionnaire answered by the neonatal unit\'s staff and finally by assessing the frequency of the ambulatory return. The validity of the proposed means were confirmed due to the fact that the babies from the experimental group stayed significantly less time in the hospital as well as in the incubator and were tube fed for less time. They also showed a significantly better state controle as well as autonomic stability, showing readiness towards a more steady maturation due to a larger physiological and behavioral stability. This study shows the validity of using low cost techniques, adaptable to the Brazilian surrounding, enabling the baby\'s integration in his/her environment

O diálogo entre mãe e filho é uma questão primordial no desenvolvimento da linguagem. A mãe é considerada coautora no desenvolvimento comunicativo-linguístico de seu filho. Este trabalho caracterizou o desenvolvimento da linguagem oral de crianças pré-termo em idade pré-escolar e verificou o impacto da interação mãe-criança neste processo. Participaram da pesquisa 20 díades de mães e filhos de 5-6 anos com diagnóstico de prematuridade ao nascimento que são acompanhadas pelo Ambulatório de Alto Risco de um Hospital no interior do Estado de São Paulo. Realizou-se uma anamnese com a mãe para verificar a interação mãe-criança desde o nascimento e uma avaliação da linguagem oral das crianças, verificando os aspectos de vocabulário, fonologia, pragmática, fluência e discurso. Observou-se que as crianças, em sua maioria, foram prematuras extremas e de muito baixo peso e, que durante o período de internação, houve uma expectativa pessimista da maioria das mães com relação à melhora da criança. Apesar da maioria das mães relatarem que as crianças não apresentaram comprometimento no desenvolvimento e a metade destas considerarem-se as principais cuidadoras, observou-se que as crianças apresentaram desempenho abaixo do esperado para os testes de fonologia, vocabulário, pragmática e fluência e desempenho esperado para o discurso oral. Este resultado deve-se, além dos fatores biológicos e socioeconômicos, que podem influenciar o desenvolvimento, à qualidade da interação materno-infantil, à estimulação materna, uma vez que a mãe é considerada o modelo e a provedora de conhecimento e desenvolvimento para seu filho. Porém, o estímulo à leitura e à brincadeira conjunta da mãe com a criança podem também ser realizados por profissionais de diversas áreas e serão uma forte referência para o desenvolvimento da linguagem, do discurso e, futuramente, para o aprendizado da linguagem escrita. / The dialogue between mother and child is a important aspect of language development and mother is considered a model of linguistical-communicative development for her sun. The aim of this research was to describe the oral language development of preschoolar children who were pretern and verify the impact of mother-child interaction in this process. The subjects of this research were 20 mother and child who were 5 and 6 years old and had preterm diagnosis when they were born. They´ve been followed by professionals of High Risk Ambulatory of a Hospital in countryside of São Paulo. First there was an interview with the mother to knew the mother-child interaction since the child was born until now and then it were made four tests-vocabulary, phonology, fluency, pragmacy and discourse to verify the development of oral language of the children. It was observed that a great number of children were extreme preterm and born with very low weight and, during the hospitalized period, mothers had a negative reaction of survival of their sons. The most part of the mothers related that children didn´t have problems in development and they considered themselves the main person who took care of their son. All children obtained low scores in four testes performed (vocabulary, fluency, phonoloy and pragmacy). Only in oral discourse, the children had an expected performance to chronological age. It was explained to biological, economical and social factors but the quality of mother-child interaction, the mother stimulation was a important fact to influence these results, because the mother is considered a provider of knowledge and behavior to the son. The mother stimulus for reading and play may be also performed by several professionals and will be a important indicator for a language development, discourse and, in the future, the learning of reading and writing.

Thesis (Ph. D.)--Ohio State University, 2006. / Title from first page of PDF file. Includes bibliographical references (p. 223-241).

Although very low birth weight preterm (VLBW) infants with grade 3,4 retinopathy of prematurity (ROP) are at high risk for unfavorable visual outcomes, the middle school vision motor integration (VMI) skills and cognitive outcome scores of these children remain largely unknown. Data for 323 very VLBW survivors of the Multicenter Randomized Indomethacin IVH Prevention Trial (BW 600 1250 g) were analyzed to test the hypothesis that grades 3, 4 ROP would be an important predictor of cognitive and VMI skills. 3 subgroups were evaluated: ROP negative (N = 163), ROP grades 1,2 (N = 137) and ROP grades 3,4 (N = 23) were evaluated prospectively at 12 years of age with a neurocognitive battery. High-resolution volumetric MRI scans were quantified for 40 of the study subjects, and occipital brain volumes were correlated with Beery VMI scores. Children with ROP 3-4 had [arrow up - increased] vision impairment and lower test scores. Whole brain volumes were significantly less for children with any grade of ROP (p = 0.02), occipital white matter volumes tended to be less for the same study subjects (p = 0.08) and both total occipital brain volumes and occipital white matter volumes were significantly correlated with Beery VMI scores (r=0.610, p = 0.009 and r = 0.652, p =0.005, respectively). Prematurely-born children with a history of grade 3-4 ROP continue to have [arrow up - increased] vision impairment, special needs and lower performance on cognitive, language and visual motor integration scores at age 12 years. Both whole occipital brain volumes and occipital white matter volumes were predictive of VMI scores for children with ROP. (supp by NS 27116)