This study investigated executive function and sustained attention in preterm and full-term infants at 8 months after expected date of delivery and at 10-11 months chronological age. Executive function and sustained attention emerge in infancy and continues to develop throughout childhood. Executive function and sustained attention is believed to underlie some learning problems in children at school age. Although numerous studies have reported that the overall development of preterm infants is comparable to that of full-term infants at the same corrected age, it is unclear to what extent the development of specific cognitive abilities is affected by prematurity and/or other factors such as medical complications. As preterm infants have a high rate of learning difficulties, it is possible that factors associated with prematurity specifically affect the development of some regions of the brain associated with the regulation of executive function and sustained attention. Thirty-seven preterm infants without identified disabilities, and 74 due date and gender matched healthy bull-term infants, participated in the present study. The preterm infants were all less that 32 weeks gestation and less that 1500 grams birth weight. The current study aimed to examine the effects of maturation and length of exposure to extrauterine environmental stimuli on the development of executive function and sustained attention, by comparing the development of preterm infants with that of full-term infants at both the same corrected age and the same chronological age. All infants were therefore assessed on executive function and sustained attention tasks at 8 months after the expected date of delivery (when preterm infants were actually 10-11 months chronological age). The full-term infants in the study were then reassessed at an age equivalent to the chronological age of their matched preterm infants at the time of the first assessment. The findings of the study showed that preterm infants performed significantly more poorly than full-term infants at both 8 months after the expected date of delivery and 10-11 months chronological age on all measures of executive function and sustained attention. However the difference between preterm and full-term infants at 8 months after expected date of delivery was much less that at 10-11 months chronological age. The results suggested that the effects of maturation are greater that the effects of exposure to extrauterine environmental stimuli on the development of executive function and sustained attention. However, as the performance of the preterm infants was below that of the term infants at the same corrected age, it was necessary to consider whether other factors associated with preterm birth were contributing to this difference. Confounding factors including cognitive abilities and psychomotor skills on the Bayley Scales of Infant Development, infant temperament, maternal education, family socioeconomic status and maternal psychological wellbeing were examined. Statistical analysis of the effects of these factors on the difference between preterm ad full-term infants found that only psychomotor sills significantly affected the differences between preterm and full-term infants of the same corrected age on executive function measures, although not on sustained attention measures. The differences between preterm and full-term infants of the same corrected age remained even when psychomotor skills were taken into consideration; therefore psychomotor skills were not sufficient to fully explain the differences between preterm and full-term infants in the performance of executive function. Consequently, the preterm infants were divided into two subgroups on the basis of (a) low or high medical risk factors, (b) birth weight of less that 1000g versus 1000-1500g, and (c) gestation age of less that 28 weeks versus 28-32 weeks, in order to assess the effects of these variables on the performance of executive function and sustained attention. Medical risk, lower birth weight and lower gestation age were all found to adversely affect performance on executive function, but did not affect the performance on sustained attention tasks. It is argued that these factors may influence the development of specific areas of the brain which govern executive function, and that as the prefrontal regions are particularly immature they may be especially vulnerable to damage or disruption. The fact that these perinatal factors did not contribute to the difference between preterm and full-term infants' performance on sustained attention tasks. This suggests that the deficits of sustained attention in preterm infants may be associated with birth prematurity per se, and that additional complications may not have any further detrimental effect. The three components of executive function (i.e., working memory, inhibition, and planning) did not correlate with each other when only infants with Bayley psychomotor ability scores greater that 85 were included, suggesting that the components of executive function may be discrete abilities which are governed by different parts of the prefrontal cortex. Sustained attention correlated with planning, supporting the suggestion that it may be a cognitive dimension which overlaps with executive function, depending upon the task requirement. Neither executive functio nor sustained attention correlated with the Bayley mental ability and Bayley psychomotor ability scores when infants with scores of less than 85 were excluded. This suggests that executive function and sustained attention measures are independent of general development.

A neutropenia é um achado freqüente em recém-nascidos de mães com pré-eclampsia. Estudos avaliando a ativação leucocitária nestes recém-nascidos são escassos. No entanto, as principais citocinas pró-inflamatórias envolvidas são a IL-8 e o GRO-α. O objetivo deste estudo foi avaliar os níveis plasmáticos de IL-8 e GRO-α em recémnascidos prematuros de mães com pré-eclampsia. Metodologia: Foram incluídos recém-nascidos com idade gestacional menor de 36 semanas e peso de nascimento inferior a 2000 gramas, sendo divididos em dois grupos de acordo com a presença ou ausência de pré-eclampsia materna. Os critérios de exclusão foram: malformações congênitas, erro inato de metabolismo ou anormalidades cromossômicas, infecções do grupo STORCH, óbito na sala de parto e recém-nascidos nos quais as mães possuíam hipertensão crônica sem a presença de pré-eclampsia. Nas primeiras 48 horas de vida, no momento de coleta assistencial, uma pequena amostra adicional de sangue foi obtida para dosagem de IL-8 e GRO-α pelo método de enzimoimunoensaio. Foram usados os testes qui-quadrado, T student, Mann-Whitney, Kruskal-Wallis e regressão logística múltipla. Resultados: 119 recém-prematuros (64 sem pré-eclampsia e 55 com pré-eclampsia). Os grupos foram similares quanto ao peso de nascimento, idade gestacional, escore de Apgar no 5’minuto, sepse, doença de membrana hialina , ventilação mecânica, nutrição parenteral total, enterocolite necrosante, hemorragia periventricular. O grupo com préeclampsia apresentou mais neutropenia, foi mais PIG, parto cesariano e menos bolsa rota superior a 18 horas. Os níveis de IL-8 foram maiores no grupo sem pré-eclampsia materna [157.1 pg/ml (86.4-261.3) e 26.54 pg/ml (3.6-87.2) p<0.001 para não préeclampticos e pré-eclampticos, respectivamente]. Após análise por regressão múltipla apenas a ausência de pré-eclampsia foi associada com níveis elevados de IL-8. Conclusão: O prematuro de mãe com pré-eclampsia apresenta níveis reduzidos de IL-8, sugerindo que a ativação leucocitária possa estar prejudicada nestes recém-nascidos. / Neutropenia is frequent in newborn infants of preeclamptic mothers.Information on leukocyte activation in those newborns is scarce, but IL-8 and GRO- are the main proinflammatory cytokines involved. The aim was to study IL-8 and GRO- plasma levels in preterm newborn infants of preeclamptic mothers. Methods: Newborn infants with gestational age < 36 weeks and birth weight < 2000 grams were included and divided: non-preeclamptic and preeclamptic groups. Exclusion criteria: major congenital malformations, inborn errors of metabolism or chromosomal anomalies,STORCH infections, inborn preterm that died in the delivery room, and those whose mothers had chronic hypertension without preeclampsia. During the regular blood sample collection in the first 48 hours, a small amount was used for IL-8 and GRO- measurement by enzyme immunoassay. Chi-square, Student s t test, Mann Whitney test, Kruskal-Wallis and multiple logistic regression model were employed. Results: 119 preterm infants (64 non-preeclamptic and 55 preeclamptic). They were similar in birth weight, gestational age, Apgar scores at 5 minutes, sepsis, SDR, mechanical ventilation, TPN, NEC, intraventricular hemorrhage and death. The preeclamptic group had more neutropenia, SGA, C Section, and less rupture of membranes for > 18 hours. IL-8 was higher in the non-preeclamptic [157.1 pg/ml (86.4-261.3) e 26.54 pg/ml (3.6-87.2) p<0.001 non-preeclamptic and preeclamptic groups, respectively]. GRO-α was similar [229.5 pg/ml (116.6-321.3) and 185.5 pg/ml (63.9-306.7) p=0.236 in non-preeclamptic and preeclamptic groups, respectively]. After multiple regression analysis only absence of preeclampsia was associated with high IL-8 levels. Conclusions: Preterm newborn infants of preeclamptic mothers have a decreased plasma level of IL-8, suggesting that the leukocyte activation may be impaired in infants of preeclamptic mothers.

A neutropenia é um achado freqüente em recém-nascidos de mães com pré-eclampsia. Estudos avaliando a ativação leucocitária nestes recém-nascidos são escassos. No entanto, as principais citocinas pró-inflamatórias envolvidas são a IL-8 e o GRO-α. O objetivo deste estudo foi avaliar os níveis plasmáticos de IL-8 e GRO-α em recémnascidos prematuros de mães com pré-eclampsia. Metodologia: Foram incluídos recém-nascidos com idade gestacional menor de 36 semanas e peso de nascimento inferior a 2000 gramas, sendo divididos em dois grupos de acordo com a presença ou ausência de pré-eclampsia materna. Os critérios de exclusão foram: malformações congênitas, erro inato de metabolismo ou anormalidades cromossômicas, infecções do grupo STORCH, óbito na sala de parto e recém-nascidos nos quais as mães possuíam hipertensão crônica sem a presença de pré-eclampsia. Nas primeiras 48 horas de vida, no momento de coleta assistencial, uma pequena amostra adicional de sangue foi obtida para dosagem de IL-8 e GRO-α pelo método de enzimoimunoensaio. Foram usados os testes qui-quadrado, T student, Mann-Whitney, Kruskal-Wallis e regressão logística múltipla. Resultados: 119 recém-prematuros (64 sem pré-eclampsia e 55 com pré-eclampsia). Os grupos foram similares quanto ao peso de nascimento, idade gestacional, escore de Apgar no 5’minuto, sepse, doença de membrana hialina , ventilação mecânica, nutrição parenteral total, enterocolite necrosante, hemorragia periventricular. O grupo com préeclampsia apresentou mais neutropenia, foi mais PIG, parto cesariano e menos bolsa rota superior a 18 horas. Os níveis de IL-8 foram maiores no grupo sem pré-eclampsia materna [157.1 pg/ml (86.4-261.3) e 26.54 pg/ml (3.6-87.2) p<0.001 para não préeclampticos e pré-eclampticos, respectivamente]. Após análise por regressão múltipla apenas a ausência de pré-eclampsia foi associada com níveis elevados de IL-8. Conclusão: O prematuro de mãe com pré-eclampsia apresenta níveis reduzidos de IL-8, sugerindo que a ativação leucocitária possa estar prejudicada nestes recém-nascidos. / Neutropenia is frequent in newborn infants of preeclamptic mothers.Information on leukocyte activation in those newborns is scarce, but IL-8 and GRO- are the main proinflammatory cytokines involved. The aim was to study IL-8 and GRO- plasma levels in preterm newborn infants of preeclamptic mothers. Methods: Newborn infants with gestational age < 36 weeks and birth weight < 2000 grams were included and divided: non-preeclamptic and preeclamptic groups. Exclusion criteria: major congenital malformations, inborn errors of metabolism or chromosomal anomalies,STORCH infections, inborn preterm that died in the delivery room, and those whose mothers had chronic hypertension without preeclampsia. During the regular blood sample collection in the first 48 hours, a small amount was used for IL-8 and GRO- measurement by enzyme immunoassay. Chi-square, Student s t test, Mann Whitney test, Kruskal-Wallis and multiple logistic regression model were employed. Results: 119 preterm infants (64 non-preeclamptic and 55 preeclamptic). They were similar in birth weight, gestational age, Apgar scores at 5 minutes, sepsis, SDR, mechanical ventilation, TPN, NEC, intraventricular hemorrhage and death. The preeclamptic group had more neutropenia, SGA, C Section, and less rupture of membranes for > 18 hours. IL-8 was higher in the non-preeclamptic [157.1 pg/ml (86.4-261.3) e 26.54 pg/ml (3.6-87.2) p<0.001 non-preeclamptic and preeclamptic groups, respectively]. GRO-α was similar [229.5 pg/ml (116.6-321.3) and 185.5 pg/ml (63.9-306.7) p=0.236 in non-preeclamptic and preeclamptic groups, respectively]. After multiple regression analysis only absence of preeclampsia was associated with high IL-8 levels. Conclusions: Preterm newborn infants of preeclamptic mothers have a decreased plasma level of IL-8, suggesting that the leukocyte activation may be impaired in infants of preeclamptic mothers.

A neutropenia é um achado freqüente em recém-nascidos de mães com pré-eclampsia. Estudos avaliando a ativação leucocitária nestes recém-nascidos são escassos. No entanto, as principais citocinas pró-inflamatórias envolvidas são a IL-8 e o GRO-α. O objetivo deste estudo foi avaliar os níveis plasmáticos de IL-8 e GRO-α em recémnascidos prematuros de mães com pré-eclampsia. Metodologia: Foram incluídos recém-nascidos com idade gestacional menor de 36 semanas e peso de nascimento inferior a 2000 gramas, sendo divididos em dois grupos de acordo com a presença ou ausência de pré-eclampsia materna. Os critérios de exclusão foram: malformações congênitas, erro inato de metabolismo ou anormalidades cromossômicas, infecções do grupo STORCH, óbito na sala de parto e recém-nascidos nos quais as mães possuíam hipertensão crônica sem a presença de pré-eclampsia. Nas primeiras 48 horas de vida, no momento de coleta assistencial, uma pequena amostra adicional de sangue foi obtida para dosagem de IL-8 e GRO-α pelo método de enzimoimunoensaio. Foram usados os testes qui-quadrado, T student, Mann-Whitney, Kruskal-Wallis e regressão logística múltipla. Resultados: 119 recém-prematuros (64 sem pré-eclampsia e 55 com pré-eclampsia). Os grupos foram similares quanto ao peso de nascimento, idade gestacional, escore de Apgar no 5’minuto, sepse, doença de membrana hialina , ventilação mecânica, nutrição parenteral total, enterocolite necrosante, hemorragia periventricular. O grupo com préeclampsia apresentou mais neutropenia, foi mais PIG, parto cesariano e menos bolsa rota superior a 18 horas. Os níveis de IL-8 foram maiores no grupo sem pré-eclampsia materna [157.1 pg/ml (86.4-261.3) e 26.54 pg/ml (3.6-87.2) p<0.001 para não préeclampticos e pré-eclampticos, respectivamente]. Após análise por regressão múltipla apenas a ausência de pré-eclampsia foi associada com níveis elevados de IL-8. Conclusão: O prematuro de mãe com pré-eclampsia apresenta níveis reduzidos de IL-8, sugerindo que a ativação leucocitária possa estar prejudicada nestes recém-nascidos. / Neutropenia is frequent in newborn infants of preeclamptic mothers.Information on leukocyte activation in those newborns is scarce, but IL-8 and GRO- are the main proinflammatory cytokines involved. The aim was to study IL-8 and GRO- plasma levels in preterm newborn infants of preeclamptic mothers. Methods: Newborn infants with gestational age < 36 weeks and birth weight < 2000 grams were included and divided: non-preeclamptic and preeclamptic groups. Exclusion criteria: major congenital malformations, inborn errors of metabolism or chromosomal anomalies,STORCH infections, inborn preterm that died in the delivery room, and those whose mothers had chronic hypertension without preeclampsia. During the regular blood sample collection in the first 48 hours, a small amount was used for IL-8 and GRO- measurement by enzyme immunoassay. Chi-square, Student s t test, Mann Whitney test, Kruskal-Wallis and multiple logistic regression model were employed. Results: 119 preterm infants (64 non-preeclamptic and 55 preeclamptic). They were similar in birth weight, gestational age, Apgar scores at 5 minutes, sepsis, SDR, mechanical ventilation, TPN, NEC, intraventricular hemorrhage and death. The preeclamptic group had more neutropenia, SGA, C Section, and less rupture of membranes for > 18 hours. IL-8 was higher in the non-preeclamptic [157.1 pg/ml (86.4-261.3) e 26.54 pg/ml (3.6-87.2) p<0.001 non-preeclamptic and preeclamptic groups, respectively]. GRO-α was similar [229.5 pg/ml (116.6-321.3) and 185.5 pg/ml (63.9-306.7) p=0.236 in non-preeclamptic and preeclamptic groups, respectively]. After multiple regression analysis only absence of preeclampsia was associated with high IL-8 levels. Conclusions: Preterm newborn infants of preeclamptic mothers have a decreased plasma level of IL-8, suggesting that the leukocyte activation may be impaired in infants of preeclamptic mothers.

Magister Public Health - MPH / Background: Every year, about 20 million infants are born with low birth weight globally, putting a heavy burden on health care and social systems, especially in developing countries as they are often understaffed and/or lack optimally functional equipment. In 1978, Dr E. Rey proposed the Kangaroo Mother Care (KMC) programme which was further developed by coworkers at one of the largest obstetric facilities in Santa Fe de Bogotá, Colombia. KMC was introduced as an alternative to the expensive and seldom used traditional methods to care for low birth weight infants. KMC is currently not practised at Tsumeb district hospital despite many infants born with low weight in the district. Aim: The aim of the study was to explore perceptions regarding the implementation of Kangaroo Mother Care in the maternity ward of Tsumeb district hospital. Study design: This was a qualitative exploratory study. Study population and sampling: The study population are doctors and nurses working in Tsumeb district, the Chief Medical Officer (CMO) as well as the health programme administrators in the family health division of the Ministry of Health and Social Services (MOHSS), Oshikoto region. Purposive sampling was used to select participants. Results: Perceptions were grouped into three main themes namely the parent-related, health worker-related and baby-related. Parent-related perceptions include self-trust, increased competency, less frustration, and active involvement of parents in baby care, which are similar to the literature and regarded as benefits of KMC. Health worker-related perceptions included both reduced workload and an increased workload. Baby-related perceptions are reduced morbidity, increased bonding and improved care. The study also revealed the barriers to KMC implementation as well as factors that can make KMC implementation a success. Conclusions: Three broad themes emerged from the study, parent-related, health worker-related and baby-related. Most of the health workers’ perceptions are similar to the benefits of KMC found in the literature but, some health workers have negative perceptions regarding KMC.

In der Neonatologie ist die Verabreichung von Erythrozytenkonzentrat (EK) eine der häufigsten therapeutischen Maßnahmen. Ursachen dafür sind die Frühgeborenen-anämie und die iatrogen durch diagnostische Blutentnahmen hervorgerufene sekundäre Anämie. Obwohl ca. 80% der Frühgeborenen während des postnatalen stationären Aufenthaltes EK erhalten, gibt es noch immer keine einheitlichen Richtlinien zur Bluttransfusion bei Frühgeborenen. In der vorliegenden Studie sollte der Effekt einer EK-Gabe mit Hilfe der Messung der cerebralen und peripheren Gewebsoxygenierung (crSO2 und prSO2) erfasst werden. Und es wurde der Annahme nachgegangen, dass in der Neonatologie Subgruppen existieren, welche unterschiedlich von einer EK-Transfusion profitieren. Im Rahmen dieser Promotionsarbeit wurden Frühgeborene der neonatologischen Abteilung der Universitätsklinik und Poliklinik für Kinder- und Jugendmedizin Leipzig prospektiv analysiert. Es konnte gezeigt werden, dass bei allen untersuchten Patienten sowohl die cerebrale als auch die periphere Gewebsoxygenierung unter EK-Transfusion ansteigen und auch nach einem Intervall von 24 Stunden noch auf diesem gesteigerten Niveau konstant bleiben. Zudem konnte nachgewiesen werden, dass Kinder mit niedrigen crSO2-Ausgangswerten vor Transfusion mehr Sauerstoffsättigungsabfälle unter 80% (SaO2<80%) aufweisen. Nach Transfusion ist bei diesen Patienten zusätzlich ein stärkerer Rückgang der Anzahl der SaO2<80% zu beobachten. Somit ist die Gewebsoxygenierung möglicherweise ein sinnvoller Parameter für die Indikation zur EK-Transfusion, welcher bei der Erarbeitung neuer Transfusionsricht-linien in der Neonatologie mit einbezogen werden sollte.

The purpose of this study was to examine whether mother-administered moderate pressure massage intervention could improve self-regulation, which would result in improvements in play outcomes. It was posited that a child who is self-regulated may be more successful in his/her play and that moderate pressure massage could be an effective tool to improve self-regulation in preterm infants with decreased self-regulation. Participants in the study were five preterm children ranging from 12 to 18 months corrected age and their mothers. The study utilized an A-B nonconcurrent multiple baselines across subjects design in which each participant acted as his/her own control as well as a pretesting and posttesting component with objective measures. Baselines were of varying lengths, ranging from 3 to 7 weeks. Intervention of mother-administered massage was 6 weeks long for all participants. Three objective standardized measures were used in pretesting and posttesting. These measures included the Infant Toddler Social Emotional Assessment to measure self-regulation, the Revised Knox Preschool Play Scale to measure play age, and the Test of Playfulness to measure playfulness. Visual analogue scales, with mother generated behavioral goals related to the three standardized assessments, were scored weekly by the mothers. The results indicated that moderate pressure massage had a calming and regulating effect on the child and resulted in improvements in the child’s play skills and playfulness over the course of the 6 weeks of intervention. The important clinical implications are that this cost-effective, parent-administered technique can positively affect outcomes of improved self-regulation, playfulness, and play skills. In addition, the study contributes important information about the influence of self-regulation on the development of play and playfulness in preterm babies and on mothers’ participation in their baby’s intervention, which contributes to a family-centered approach.

No description available.

Preterm infants are not able to tolerate full enteral feeding of breast milk due to gut immaturity. To fill this nutritional gap, parenteral nutrition is introduced while enteral feeding is gradually increased. Of parenteral nutrition, lipid emulsions supply energy, essential and polyunsaturated fatty acids, which significantly affect short- and long-term health outcomes of growth, visual-and neuro-development for preterm infants. However, elevated plasma triglyceride (TG) levels in preterm infants receiving lipid emulsions have been observed despite less lipid intake compared to breast milk fed infants. We hypothesized that unbalanced fatty acid profiles in lipid emulsion was one factor to cause high plasma TGs for preterm infants. In the multi-center, observational, prospective study, the following samples were analyzed using GC-MS: (1) lipid emulsions (n=5) and breast milk (n=112), (2) plasma (n=294) including normal TG (n=116) and high TG (n=88). Lipoproteins in normal TG (n=18) and high TG (n=24) plasma were measured using gel electrophoresis. Fatty acid profiles in lipid emulsions differed from ones in breast milk. Plasma fatty acid profiles were related to dietary fatty acid intake. Accumulation of all fatty acids except C20:5n3 and relatively high (LDL+VLDL) levels (p<0.001) resulted in high TG plasma compared to normal TG plasma. Overall, this study supports the hypothesis that nutrition of lipid emulsions was associated high TG with differences in fatty acid uptake but it is still unclear if the imbalance of fatty acids directly causes high TG. More research is necessary to investigate other factors such as enzyme activity, lipid clearance rate, or different rate of fatty acid metabolism. / Thesis / Master of Science (MSc)

京都大学 / 新制・論文博士 / 博士(医学) / 乙第13580号 / 論医博第2302号 / 新制||医||1069(附属図書館) / (主査)教授 平井 豊博, 教授 江木 盛時, 教授 齋藤 潤 / 学位規則第4条第2項該当 / Doctor of Medical Science / Kyoto University / DFAM