Preterm delivery (PTD) is a leading cause of infant death, and surviving infants are at risk for poor health. Data from the Iowa Health in Pregnancy Study, a case-control study of maternal stress on risk of PTD and small for gestational age (SGA) deliveries were used to address three aims: 1) develop a method to correct for error in ultrasound measurement among suspected SGA infants, 2) estimate the association of occupational stress on risk of PTD, and 3) examine injury-related risk factors for PTD. Estimates of gestational age using ultrasound can be biased if the fetus is growth-restricted, yielding underestimates due to the small stature of the fetus. Multivariate linear regression modeling was used to estimate and correct for this bias among subjects with a suspected SGA infant who 1) began prenatal care in the first trimester, 2) reported a last menstrual period and 3) had an ultrasound examination between 7-21 weeks. To correct for this bias, an average of 1.5 weeks was added to the ultrasound gestational age. Following the correction, the proportion of PTD cases decreased from 29.1% to 26.5% while SGA cases increased from 23.7% to 31.3%. Using this PTD classification, occupational physical and psychosocial stressors were studied. Continuous employment over the first 20 weeks of pregnancy was associated with a 30% increased risk of PTD versus not working. Working women reporting highly repetitive tasks (aOR=1.47(1.10-1.98)) or inadequate breaks (aOR=1.67(1.03-2.73)) were at increased risk of PTD. Working women who reported high lifting in the home had double the risk of PTD. Over 5% of control subjects reported an injury during pregnancy, and injured women tended to be younger, unmarried, less educated, and have lower incomes. Women with injuries involving >1 body part (aOR=2.50(1.14-5.49)), or injuries to the abdomen and other regions of the body (OR=1.75(0.59-5.23)) were at increased risk of PTD. Our findings provide a statistical approach to assess and correct for underestimates of ultrasound gestational age in case-control studies of PTD and SGA. The analyses of occupational exposures and injury during pregnancy indicate the need for studies that incorporate specific and standardized assessments of these exposures.

Aim: The aim of the study was to compare knowledge and attitudes towards Kangaroo Mother Care (KMC) among neonatal unit staff at two neonatal units 2008 and 2010. Method: Members of staff from two neonatal units completed a questionnaire with 22 statements and an open-ended question in 2008 and 2010. The data were analysed with Mann-Whitney U test and content analysis. Results: There were significant differences between unit A and unit B in both the 2008 survey and the 2010 survey, showing better knowledge of KMC and a more positive attitude to KMC in unit A. Content analysis of responses to the open-ended question revealed concerns in unit B that its care environment was not suitable for KMC. Conclusions: Hypothetically, the fact that staff in unit A work in facilities designed to facilitate KMC, receive training in KMC and practice continuous KMC in intensive care as well as in intermediate care, has resulted in good knowledge of KMC and a general improvement of staff attitudes to KMC.

Background: Breastfeeding frequency decrease in Sweden and infants born preterm is a particularly vulnerable group to not be breastfed according to current recommendations. Mothers of preterm infants have an extra need of support from the health care system. Mothers' self-efficacy in breastfeeding affects the outcome of breastfeeding. Health professionals' attitudes to breastfeeding have an impact on the breast feeding support they provide to the mothers.Aim: To investigate whether an intervention could strengthen self-efficacy in breastfeeding among mothers of premature babies. A further aim was to investigate whether the intervention influenced health professionals' attitudes to breastfeeding.Method/Design: An experimental study with quantitative approach in the form of questionnaire survey was conducted. The selection consisted of 14 mothers who were divided into control group and intervention group, in the health professional group the selection was 20 respondents.Results: Health professionals ' attitudes to breastfeeding was significantly more positive after the intervention. Also two statements on the survey demonstrated significantly more positive attitudes to breastfeeding among health professionals. Regarding mothers' breastfeeding self-efficacy no significant difference was detected between the control group and the intervention group.Conclusion: An evidence based intervention influenced the health professionals´ attitudes to breastfeeding. Further research is needed to demonstrate the connection between the intervention and mothers´ self-efficacy to breastfeed premature babies. / Bakgrund: Amningsfrekvensen sjunker i Sverige och prematurfödda barn är en extra sårbar grupp för att inte bli ammade efter rådande rekommendationer och mammor till prematurfödda barn har ett extra stort behov av stöd från hälso- och sjukvården. Mammors tillit till sin förmåga att amma påverkar utfallet av amningen och vårdpersonalens attityder till amning påverkar amningsstödet de ger. Syfte: Att undersöka om en intervention kunde stärka tilliten till att amma hos mammor till prematurfödda barn. Ett ytterligare syfte var att undersöka om interventionen påverkade vårdpersonals attityder till amning. Metod/design: En experimentell studie med kvantitativ ansats i form av enkätundersökning genomfördes. Urvalet bestod av 14 mammor som fördelades i jämförelsegrupp och interventionsgrupp, i vårdpersonalgruppen bestod urvalet av 20 personer. Resultat: Vårdpersonalens attityder till amning var signifikant mer positiva efter interventionen. Även på två påståenden på attitydformuläret visades en signifikant mer positiv attityd till amning hos vårdpersonalen. Gällande mammors tillit till sin förmåga att amma kunde ingen signifikant skillnad påvisas mellan jämförelsegrupp och interventionsgrupp. Slutsats: En evidensbaserad intervention förbättrade vårdpersonalens attityder till amning. Ytterligare forskning krävs för att undersöka om interventionen kan påverka mammors till att amma prematurfödda barn.

Kinder, welche nach 34 (+0) bis 36 (+6) Gestationswochen geboren werden, bezeichnet man als späte Frühgeborene. Genau wie Kinder eines jüngeren Gestationsalters sind diese von einer höheren postnatalen Morbidität und Mortalität betroffen als reif geborene Kinder. Diese Studie betrachtet die pulmonale Funktionsleistung dieser Kinder weit über die Neonatalperiode hinaus. Ehemals späte Frühgeborene wurden im Alter von 6 Jahren untersucht. Eine gleichaltrige Kontrollgruppe, bestehend aus ehemals reifen Neugeborenen, diente dem Vergleich. Vor allem Parameter der Spirometrie sowie Peak-Flow- und Atemwegswiderstandsmessungen ermöglichten dabei die Objektivierung der pulmonalen Funktion. Statistisch signifikante Unterschiede ließen sich in der mittleren FVC (forcierte Vitalkapazität) sowie dem FEV1 (forciertes exspiratorisches Volumen in einer Sekunde) feststellen, wobei Kinder der Indexgruppe jeweils im Mittel nur geringere Werte erreichten als Kinder der Kontrollgruppe. Der mittlere Atemwegswiderstand unterschied sich in Index-und Kontrollgruppe ebenso signifikant, wobei bei ehemals späten Frühgeborenen der Atemwegswiderstand im Mittel höher war als bei ehemals reifen Neugeborenen.

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Very preterm birth is an important developmental and public health concern, with clear evidence to suggest that very preterm children may be at long term risk of neurodevelopmental impairment and educational difficulties. Although a great deal is known about the neurodevelopmental outcomes associated with very preterm birth,comparatively little is known about the social competence of children born very preterm during the important early childhood period. Therefore, as part of a prospective, longitudinal study, this research examined the social competence of 105 children born very preterm (birth weight <1,500 g and/or gestational age ≤33 weeks) and 108 full term comparison children (gestational age 37-40 weeks) at age 4 years (corrected for extent of prematurity at birth). The aims of this study were 1) to examine the social competence of a regional cohort of children born very preterm and full term comparison children at age four years, 2) to identify infant clinical factors and socio-familial characteristics associated with poor social competence amongst children born very preterm, and 3) to examine the predictive validity of social competence problems amongst both very preterm and full term preschoolers in relation to school academic functioning and behavioural adjustment at age 6 years. At age 4, children were assessed using a range of parent and/or teacher completed questionnaires, spanning emotional regulation, behavioural adjustment and interpersonal social behaviour. Measures included the Emotion Regulation Checklist, the Infant-Toddler Symptoms Checklist, the Strengths and Difficulties Questionnaire, the Behaviour Rating Inventory of Executive Functioning “ Preschool version and the Penn Interactive Peer Play Scale. In addition, as part of a structured research assessment, children completed a battery of false belief tasks and a short form version of the Weschler Preschool and Primary Scales of Intelligence. Two years later at age 6, school teachers qualitatively rated children's behavioural adjustment and academic achievement in math, reading, spelling and language comprehension compared to their classroom peers. Results showed that relative to their full term peers, some children born very preterm tended to score less well across several areas of social competence. Specifically, parent report showed that children born very preterm were more likely to be characterised by higher levels of emotional dysregulation (p=.002) as well as a range of behavioural adjustment problems, spanning inhibitory control problems (p=.03), hyperactivity/inattention (p=.01), conduct problems (p=.01) and emotional symptoms (p=.008). While elevated rates of behavioural adjustment difficulties were also evident amongst very preterm children within the preschool environment, group differences were not statistically significant. However, a statistical trend towards elevated risk of inhibitory control problems amongst very preterm children in the preschool environment was noted (p=.09). Further, children born very preterm were at around a four-fold risk of emotional regulation difficulties of clinical significance,as well as being around 1.5 times more likely to exhibit clinically significant externalising and internalising behavioural difficulties and interpersonal social problems at age 4 years. In contrast, the interpersonal social behaviours and the extent of social cognitive understanding were largely similar across both groups. This pattern of findings remained largely unchanged following statistical control for the selection effects of family socio-economic status. Amongst children born very preterm, significant infant clinical and sociofamilial predictors of both emotional dysregulation and externalizing behaviour were male gender (p=.008/p=.006), neonatal indomethacin (p=.002/p=.005) and elevated maternal anxiety (p=.009/p=.002). Emotional dysregulation was also predicted by low socio-economic status (p=.002). In contrast, internalising behaviour was predicted only by low birth weight (p=.03). Finally, across both groups significant associations were found between overall social competence problems at age 4 years and later school adjustment with those very preterm and full term preschoolers characterised by poor social competence being at elevated risk of a range of behavioural adjustment difficulties and poor academic functioning in reading, spelling and math at age 6 years (corrected). Links between poor social competence and later behavioural adjustment remained across both groups following statistical control for child IQ, while associations with academic functioning were largely attenuated. By age 4 years a number of very preterm children are beginning to display elevated levels of emotional dysregulation, hyperactivity/inattention, conduct problems and emotional symptoms. Further, a substantial proportion of very preterm children may be at risk of developing clinically significant difficulties with these most pronounced in terms of emotional regulation abilities. Children's abilities to regulate their emotions and behaviour represent important building blocks for their later social and emotional functioning. Further, these abilities will likely influence the extent to which children are able to successfully transition to school. Therefore,alongside other important aspects of development, these findings highlight the importance of monitoring the social abilities of preschoolers who were born very preterm across a range of developmental domains and contexts. Preschoolers characterised by emotional, behavioural and/or interpersonal difficulties could then receive targeted intervention aimed at facilitating their social competence prior to school entry.

Hypoxia can result in brain injury. Hypoxic brain injury can also result in excess stress hormones and activated immune responses. In this study, we examined multiple spontaneous motor behaviors, concentrations of stress hormones, and gene expression of immune responses in rats after perinatal hypoxia. Hypoxic animals exhibited impaired spontaneous motor behaviors in several tests. Perinatal hypoxia also caused increased levels of stress hormones and altered expression of genes associated with adaptive and innate immunity at different time points after hypoxia exposure. Findings demonstrate stress hormones and immune responses are available to play an important role in perinatal brain injury and can impact delayed behavioral development.

The incidence of preterm labor has risen over recent decades and preventative antibiotic treatment is ineffective. Associated with a 40% increased risk of preterm birth, bacterial vaginosis is characterized by a decrease in lactobacilli and increase in pathogenic bacteria in the vaginal flora. Ascent of bacterial products to the intrauterine environment stimulates cytokine and prostaglandin secretion from invading immune cells and gestational tissues. Probiotic lactobacilli modulate the immune responses in mouse macrophages and human placental trophoblast cells. The focus of this thesis was to determine the influence of Lactobacillus rhamnosus GR-1 (GR-1) on cytokines and prostaglandins which are part of the activated pathway in infection and/or inflammation mediated preterm labour. GR-1 increased amnion chemokine and reduced pro-inflammatory cytokine release. GR-1 elevated prostaglandin E2 release that was paralleled by an increase in mPGES2 expression. It is possible that t that GR-1 may enhance the host defense barriers of the amnion to pathogenic bacteria.

The incidence of preterm labor has risen over recent decades and preventative antibiotic treatment is ineffective. Associated with a 40% increased risk of preterm birth, bacterial vaginosis is characterized by a decrease in lactobacilli and increase in pathogenic bacteria in the vaginal flora. Ascent of bacterial products to the intrauterine environment stimulates cytokine and prostaglandin secretion from invading immune cells and gestational tissues. Probiotic lactobacilli modulate the immune responses in mouse macrophages and human placental trophoblast cells. The focus of this thesis was to determine the influence of Lactobacillus rhamnosus GR-1 (GR-1) on cytokines and prostaglandins which are part of the activated pathway in infection and/or inflammation mediated preterm labour. GR-1 increased amnion chemokine and reduced pro-inflammatory cytokine release. GR-1 elevated prostaglandin E2 release that was paralleled by an increase in mPGES2 expression. It is possible that t that GR-1 may enhance the host defense barriers of the amnion to pathogenic bacteria.