Neonatal abstinence syndrome in neonates born of mothers in drug-assisted rehabilitation. / Neonatalt abstinenssyndrom blant nyfødte barn av mødre i legemiddelassistert rehabilitering.

BACKGROUND: In recent years, the use of opioid maintenance treatment (OMT) during pregnancy has been a topic of much debate among clinicians. A frequent consequence of such therapy is neonatal abstinence syndrome in the newborn infant. This study aimed to investigate whether follow-up of these neonates was in line with national recommendations. MATERIAL AND METHOD: All maternity units in Norway were asked whether they treated neonates born to mothers in opioid maintenance treatment (OMT). 14 out of 42 maternity units treated these patients in collaboration with neonatal units, while 28 units referred the patients onward. Altogether 13 of the 14 treatment units answered a questionnaire on the nature of the care received by neonates. RESULTS: None of the hospitals treated more than ten neonates at risk of neonatal abstinence syndrome each year. All neonatal units used a standardised scoring form to assess the development of abstinence. When there was a need for pharmacological treatment, morphine was the first-line choice for all the units. All of them used non-pharmacological interventions. Observation time, procedures for dose reduction of pharmacological treatment and use of supplementary medication varied considerably between the units. INTERPRETATION: Key aspects of the management of neonates born to mothers in opioid maintenance treatment (OMT) were practised in the same manner and in line with national recommendations. However, our study revealed differences between the hospitals, which overall represent a potential for improvement in the treatment of a vulnerable patient group.

Association between brain activation (fMRI), cognition and school performance in extremely preterm and term born children.

The purpose of the study was to investigate a possible association between brain activation in functional magnetic resonance imaging scans, cognition and school performance in extremely preterm children and term born controls. Twenty eight preterm and 28 term born children were scanned while performing a working memory/selective attention task, and school results from national standardized tests were collected. Brain activation maps reflected difference in cognitive skills but not in school performance. Differences in brain activation were found between children born preterm and at term, and between high and low performers in cognitive tests. However, the differences were located in different brain areas. The implication may be that lack of cognitive skills does not alone explain low performance due to prematurity.

fMRI: blood oxygen level-dependent activation during a working memory-selective attention task in children born extremely preterm.

BACKGROUND: Extremely preterm (EPT)/extremely low-birth-weight (ELBW) children attaining school age and adolescence often have problems with executive functions such as working memory and selective attention. Our aim was to investigate a hypothesized difference in blood oxygen level-dependent (BOLD) activation during a selective attention-working memory task in EPT/ELBW children as compared with term-born controls. METHODS: A regional cohort of 28 EPT/ELBW children and 28 term-born controls underwent functional magnetic resonance imaging (fMRI) scanning at 11 y of age while performing a combined Stroop n-back task. Group differences in BOLD activation were analyzed with Statistical Parametric Mapping 8 analysis software package, and reaction times (RTs) and response accuracy (RA) were compared in a multifactorial ANOVA test. RESULTS: The BOLD activation pattern in the preterm group involved the same areas (cingulate, prefrontal, and parietal cortexes), but all areas displayed significantly less activation than those in the control group, particularly when the cognitive load was increased. The RA results corresponded with the activation data in that the preterm group had significantly fewer correct responses. No group difference was found regarding RTs. CONCLUSION: Children born EPT/ELBW displayed reduced working memory and selective attention capacity as compared with term-born controls. These impairments had neuronal correlates with reduced BOLD activation in areas responsible for online stimulus monitoring, working memory, and cognitive control.