Paternal symptoms of anxiety and depression in the first month after childbirth: A comparison between fathers of full term and preterm infants.

BACKGROUND: Although men have a higher risk of developing a mental disorder during the perinatal period, few studies have focused on new fathers' mental health screening. This study compares anxiety and depression symptoms between fathers with newborn infants in the neonatal intensive care unit (NICU) and fathers of healthy full-term infants, assessing the impact of stress caused by the NICU.. METHODS: A longitudinal and prospective study with control (n= 33) and study groups (n=51) was designed. The dependent variables assessed were post-natal depression and anxiety-state while the social and demographic information, health background and the parental stress in the neonatal unit were the independent variables. The fathers were assessed twice during the first month after birth. RESULTS: Significant differences in the EPDS scores were found between both groups in the first assessment (p = .006) but not in the second assessment (p = .60). Significant differences in STAI scores were found between the groups for both assessments (p = .003 and p = .002). The stress caused by the infant's appearance and behavior was predictive of depression and anxiety in the study group. LIMITATIONS: The sample was collected at one hospital, immigrants were underrepresented, and no prenatal assessment of paternal mental health is available. CONCLUSIONS: Our results suggest that the hospitalization of newborn infants increases the risk of developing anxiety or depression disorder in fathers. Health providers should be aware of the emotional changes in men shortly after childbirth and include them in the screening of and support for mental health disorders.

Extrauterine growth restriction in very preterm infant: etiology, diagnosis, and 2-year follow-up.

In very-preterm small-for-gestational-age (SGA) infants, long-term postnatal growth is confused with extrauterine growth restriction (EUGR). We aimed to document EUGR in SGA infants and in non-SGA infants ("true-EUGR") and its relationship with fetal, maternal, and neonatal etiological factors. Four hundred seventy-nine very-preterm infants (< 32 weeks) born between 2003 and 2014 and attending the follow-up clinic were included. INTERGROWTH-21st preterm postnatal growth standards in conjunction with WHO Child Growth Standards were used to judge the postnatal growth patterns. EUGR was defined as weight < 10th percentile according to the sex at 36-34 weeks postmenstrual age, usually at discharge. Catch-up was evaluated at 2-2.5 years. Low-weight-for-age (wasting), low-length-for-age (stunting), and low-head-circumference-for-age were diagnosed if the z-scores were below - 2 SD. Logistic regression analysis estimated the association between the risk factors and EUGR, according to the SGA status at birth. Overall, EUGR occurred in 51% at 36-34 postmenstrual weeks and 21% at 2-2.5 years. However, among 411 non-SGA infants, "true-EUGR" rates were 43% and 15%, respectively.Conclusion: By 2-2.5 years of age, a "true-EUGR" of 15% can be expected and only the head circumference normalizes in SGA infants. Low birth weight, hyaline membrane disease, bronchopulmonary dysplasia, and male sex were associated with "true-EUGR." What is Known: • Fetal, neonatal, or postnatal charts have been considered to monitor the postnatal growth of preterm infants. • This selection influences the diagnosis of "extrauterine growth restriction" (EUGR) and the clinical strategies used. What is New: • Extrauterine growth restriction (EUGR) in small-for-gestational-age (SGA) infants can not be considered a true EUGR but a postnatal evolution of fetal growth restriction. • Preeclampsia, low gestational age, severe neonatal morbidity and male sex are independently associated with EUGR in non-SGA infants (named "true-EUGR"), which can be expected in 15% of very preterm infants by 2-2.5 years of age.

Adherence to the neonatal resuscitation algorithm for preterm infants in a tertiary hospital in Spain.

BACKGROUND: There is evidence that delivery room resuscitation of very preterm infants often deviates from internationally recommended guidelines. There were no published data in Spain regarding the quality of neonatal resuscitation. Therefore, we decided to evaluate resuscitation team adherence to neonatal resuscitation guidelines after birth in very preterm infants. METHODS: We conducted an observational study. We video recorded resuscitations of preterm infants < 32 weeks' gestational age and evaluated every step during resuscitation according to a score-sheet specifically designed for this purpose, following Carbine's method, where higher scores indicated that more intense resuscitation maneuvers were required. We divided the score achieved by the total possible points per patient to obtain the percentage of adherence to the algorithm. We also compared resuscitations performed by staff neonatologists to those performed by pediatricians on-call. We compared percentages of adherence to the algorithm with the Chi-square test for large groups and Fisher's exact test for smaller groups. We compared assigned Apgar scores with those given after analyzing the recordings and described them by their median and interquartile range. We measured the interrater agreement between Apgar scores with Cohen's kappa coefficient. Linear and logarithmic regressions were drawn to characterize the pattern of algorithm adherence. Statistical analysis was performed using SPSS V.20. A p-value < 0.05 was considered significant. Our Hospital Ethics Committee approved this project, and we obtained parental written consent beforehand. RESULTS: Sixteen percent of our resuscitations followed the algorithm. The number of mistakes per resuscitation was low. Global adherence to the algorithm was 80.9%. Ventilation and surfactant administration were performed best, whereas preparation and initial steps were done with worse adherence to the algorithm. Intubation required, on average, 2.2 attempts; success on the first attempt happened in 33.3% of cases. Only 12.5% of intubations were achieved within the allotted 30 s. Many errors were attributable to timing. Resuscitations led by pediatricians on-call were performed as correctly as those by staff neonatologists. CONCLUSIONS: Resuscitation often deviates from the internationally recognized algorithm. Perfectly performed resuscitations are infrequent, although global adherence to the algorithm is high. Neonatologists and pediatricians need intubation training.

La influencia del estrés o ansiedad de la gestante en el peso fetal o neonatal: revisión bibliográfica / Impact of maternal stress or anxiety on the fetal or neonatal weight: a literature review

Objetivo: Examinar si la presencia de ansiedad o estrés materno durante el embarazo influye en el peso del feto o el neonato y cómo cambian las variables asociadas. Metodología: Se llevó a cabo una revisión bibliográfica de artículos indexados en las bases de datos PubMed, CINHAL, Cuiden, Scielo, Lilacs, Dialnet, Latindex, Cuidatge y WorldCat, publicados entre 2001 y 2016. Resultados: A pesar de que la metodología de los estudios es muy variada, 9 de los 22 artículos seleccionados para la revisión concluyeron que existe una relación entre la presencia de estrés o ansiedad y el menor peso del bebé al nacer. No hay consenso sobre en qué trimestre de gestación afecta más el estrés, aunque sí se destaca la importancia del segundo trimestre. Conclusión: La evidencia indica que la presencia de estrés o ansiedad durante el embarazo afecta negativamente al peso fetal o del recién nacido, reduciéndolo o impidiendo que se desarrolle el potencial de éste. La disparidad de herramientas y momento de medida del estrés o la ansiedad, entre otras variables, puede influir en la lectura de los resultados (AU)

Objective: To clarify through a review of the evidence whether the presence of stress or anxiety during pregnancy influence fetal weight and how change the associated variables. Methods: A literature search was conducted on PubMed, CINHAL, Cuiden, Scielo, Lilacs, Dialnet, Latindex, Cuidatge and Worldcat databases for articles published between 2001 and 2016 in peer-reviewed journals. Results: A total of 9 articles conclude that the babies of anxious and stressed women born weighing less despite there are multiples differences on the methodology of each article. There is no consensus about which trimester of pregnancy is more critical nor the mechanisms involved on the weight although emphasize the second trimester of pregnancy. Conclusions: The evidence shows that the presence of stress during pregnancy is related to a reduction on the birthweight. The disparity measurement tools and time stress, among other variables, may affect the reading of the results (AU)

Neurobehavioral conditions and effects of gender, weight and severity in preterm infants according to the Neonatal Behavioral Assessment Scale / Efecto del sexo, peso y gravedad de la prematuridad en el neurocomportamiento de recién nacidos prematuros a través de la Neonatal Behavioral Assessment Scale

El aumento de los recién nacidos prematuros en los últimos años hace que se incremente el interés por estudiar las consecuencias de este factor de riesgo. En este trabajo se evalúan 30 prematuros (a las 40 semanas de edad gestacional) con la Escala para la Evaluación del Comportamiento Neonatal de Brazelton y se comparan sus resultados con los de un grupo control formado por 28 neonatos a término. Así mismo se comparan dentro del grupo de prematuros el efecto del peso, el sexo y la gravedad de la prematuridad. Los controles muestran superioridad en 9 de los 28 ítems comportamentales de la Escala y en dos de las 5 categorías. Los prematuros muestran superioridad en Habituación. Las niñas muestran mejor ejecución en la categoría Social-Interactiva. Los prematuros se ven afectados por la abrupta interrupción de su maduración intrauterina. Aunque podría haber un efecto de aprendizaje debido a la exposición extrauterina

The increasing number of preterm babies in recent years has raised interest in studying the consequences of prematurity as a risk factor. In the present paper, 30 preterm babies (at 40 weeks of gestational age) were assessed using the Neonatal Behavioral Assessment Scale and the results were compared with those of a control group of 28 full term babies. Moreover, the influence of weight, sex and gestational age was analyzed considering the Brazelton results in the preterm group. The preterm group showed significantly lower scores than the control group for 9 of the 28 behavioral items in the Scale and for 2 of the 5 clusters. However, preterm babies performed better in habituation to disturbing stimuli (light and noise) during sleep. In relation to the influence of sex, premature girls performed better in the Social-Interactive cluster. The preterm group has lower neurobehavioral conditions than the full term group, probably due to the abrupt interruption of their intrauterine maturation. In contrast, they showed a better ability of habituation, maybe as a consequence of a learning effect due to earlier additional extrauterine exposition

Metabolic bone disease and bone mineral density in very preterm infants.

OBJECTIVES: To evaluate bone mineral density (BMD) in preterm neonates at discharge and identify the optimum cutoff values for serum alkaline phosphatase (ALP) and phosphorus (P) concentrations to diagnose the severity of metabolic bone disease of prematurity. STUDY DESIGN: A total of 336 preterm neonates (≤ 31 weeks' gestation and birth weight ≤ 1500 g) were prospectively evaluated for BMD before discharge using dual-energy X-ray absorptiometry. RESULTS: BMD reference values (at ALP ≤ 500 IU/L) were measured in 279 patients. BMD was classified as poor (<10th percentile) at <0.068 g/cm(2), fair (10th-25th percentile) at 0.068-0.081 g/cm(2), good (25th-75th percentile) at 0.081-0.112 g/cm(2), and very good (>75th percentile) at >0.112 g/cm(2). Increased BMD was associated with a higher birth weight, short duration of parenteral nutrition, and the absence of small for gestational age status, patent ductus arteriosus, intraventricular hemorrhage, and other clinical variables. Metabolic bone disease of prematurity was absent (ALP ≤ 500 IU/L) in 279 cases (83.0%), mild (ALP >500 IU/L and P ≥ 4.5 mg/dL) in 46 cases (13.7%), and severe (ALP >500 IU/L and P <4.5 mg/dL) in 11 cases (3.3%). CONCLUSIONS: A BMD >0.068 g/cm(2) at discharge indicated a 90.3% probability of not developing metabolic bone disease of prematurity. The factors independently associated with increased BMD included higher birth weight, short duration of parenteral nutrition, absence of intraventricular hemorrhage, exclusive feeding of fortified breast milk, and older age at discharge.

Impact of chorioamnionitis on exhaled nitric oxide and endotracheal aspirate levels of nitrites-nitrates and interleukin-8 in mechanically ventilated preterm neonates.

OBJECTIVES: To assess the influence of maternal chorioamnionitis on early exhaled nitric oxide (NO) and levels of nitrites-nitrates and interleukin (IL)-8 in endotracheal aspirate fluid in mechanically ventilated preterm neonates. STUDY DESIGN: Cross-sectional study. PATIENT-SUBJECT SELECTION: Between September 2007 and August 2009, 54 mechanically ventilated preterm neonates were included. Patients were divided into two groups according to the presence or absence of maternal chorioamnionitis, and those without chorioamnionitis (controls) were further stratified into two subgroups by birth weight < or ≥ 2,000 g. METHODOLOGY: The ventilator used was a Babylog 8000. The NO level assessed was the plateau value given by the software of the Sievers NOA apparatus. Collection of endotracheal aspirate fluid samples was performed coinciding with routine aspirations and using the dry technique. RESULTS: The two groups of control neonates showed statistically significant differences in exhaled NO expressed as nl/min and normalized exhaled NO expressed as either nl/min or nl/min/kg, so they are not homogeneous and cannot be used in clinical practice. Serum C-reactive protein and endotracheal aspirate levels of nitrites-nitrates were significantly higher in the chorioamnionitis group than in controls (3.6 vs. 1.07 µmol/L; P = 0.035). Nitrites-nitrates levels were positively correlated with exhaled NO in ppb (ρ = 0.367; P = 0.006). Minute exhaled endogenous NO was significantly higher in the chorioamnionitis group (0.48 vs. 0.27 nl/min/kg; P = 0.021). CONCLUSIONS: In mechanically ventilated preterm infants weighing <2,000 g, maternal chorioamnionitis was associated with an increase of early exhaled NO (nl/min/kg) and serum levels of C-reactive protein and levels of nitrites-nitrates in endotracheal aspirate fluid.

Intravenous immunoglobulin and necrotizing enterocolitis in newborns with hemolytic disease.

OBJECTIVE: The objective of this study was to assess whether the use of high-dose intravenous immunoglobulin (IVIG) in late-preterm and term newborns with severe isoimmune hemolytic jaundice caused by Rh and ABO incompatibility was a risk factor for necrotizing enterocolitis (NEC). METHODS: An observational, retrospective study that encompassed 16 years was conducted. A total of 492 liveborn infants who were of >or=34 weeks' gestation and had severe isoimmune hemolytic jaundice caused by Rh (n = 91) and ABO (n = 401) incompatibility and were treated with phototherapy were included in the study. IVIG (500 mg/kg over 2-4 hours) was indicated when total serum bilirubin level plus 2 points reached 85% of the cutoff value for performing exchange transfusion. RESULTS: A total of 167 (34%) infants received IVIG. NEC was diagnosed in 11 (2.2%) patients: 10 (6%) in the IVIG-treated group and 1 (0.3%) in the non-IVIG-treated group. Five patients required urgent operation, and 1 of them died as a result of massive intestinal necrosis. Another patient died 2 years later as a result of short bowel syndrome. In the multivariate analysis, cesarean delivery (odds ratio [OR]: 3.76 [95% confidence interval (CI): 1.10-12.90), Apgar test at 5 minutes (OR: 0.50 [95% CI: 0.40-0.64), and IVIG (OR: 31.66 [95% CI: 3.25-308.57]) were independent factors significantly associated with NEC. CONCLUSIONS: The use of high-dose IVIG for severe isoimmune hemolytic jaundice in late-preterm and term infants was associated with a higher incidence of NEC.

[Psychometric evaluation of the Brazelton Scale in a sample of Spanish newborns]. / Evaluación psicométrica de la Escala de Brazelton en una muestra de recién nacidos españoles.

This study analyses the data obtained from a sample of 220 healthy full-term neonates evaluated with the Neonatal Behavioral Assessment Scale, NBAS, 3rd edition. Standard scores were obtained for each of the 35 behavioral items and analysis of the main components of all the clusters was performed. Similarly to the original scale, the five following factors were obtained: Autonomic and Motor Systems, Habituation, State Organization, State Regulation, and Social Interactive. The analysis of the reliability of these groupings reveals that it is between moderate and high (the average Cronbach's alpha coefficient was .78).

Evaluación psicométrica de la Escala de Brazelton en una muestra de recién nacidos españoles / Psychometric evaluation of the Brazelton Scale in a sample of Spanish newborns

En este trabajo se analizan las puntuaciones obtenidas por una muestra de 220 neonatos sanos, nacidos a término, evaluados con la Escala para la evaluación del comportamiento neonatal, 3ª edición. Se han obtenido puntuaciones típicas para cada uno de los 35 ítems conductuales y se ha realizado un análisis de componentes principales de las agrupaciones de ítems. Los factores obtenidos (muy similares a los de la escala original) son los cinco siguientes: Sistema nervioso autónomo-motor; Habituación; Organización del estado; Regulación del estado y Social interactivo. El análisis de la fiabilidad de estos factores (la media de los coeficientes alfa de Cronbach con ítems tipificados es 0,78) indica que la consistencia interna de las puntuaciones es entre moderada y alta

This study analyses the data obtained from a sample of 220 healthy full-term neonates evaluated with the Neonatal Behavioral Assessment Scale, NBAS, 3rd edition. Standard scores were obtained for each of the 35 behavioral items and analysis of the main components of all the clusters was performed. Similarly to the original scale, the five following factors were obtained: Autonomic and Motor Systems, Habituation, State Organization, State Regulation, and Social Interactive. The analysis of the reliability of these groupings reveals that it is between moderate and high (the average Cronbachs alpha coefficient was .78)

Efectos de una intervención temprana basada en la escala de Brazelton sobre las percepciones maternas / Effects of an early intervention based on Brazelton's scale on the maternal perceptions

OBJETIVO: evaluar el efecto de una breve intervención temprana, basada en la administración de la NBAS en presencia de la madre, sobre las percepciones que ésta posee de su bebé y de sí misma como madre. METODOLOGÍA: 23 madres primíparas de bebés sanos (a 37 semanas) completaron la Escala sobre percepciones maternas Mother and Baby Scales (MABS) dos días después del parto. Antes del alta, las madres del grupo experimental (12) participaron activamente en una sesión con la NBAS, que consistió en evaluar la conducta de su hijo recién nacido. Al cabo de un mes, se realizó una segunda administración de la MBAS en toda la muestra. RESULTADOS: no se encontraron diferencias significativas entre los grupos en las percepciones maternas, aunque sí las hubo intra grupo experimental en las subescalas Alerta-interés e Inestable-irregular de la MABS. CONCLUSIONES: la intervención no tuvo el suficiente impacto, aunque posiblemente influyó en que las madres del grupo experimental percibiesen a su bebé como significativamente más alerta después de transcurrido un mes.

Efectos de una intervención temprana basada en la escala de Brazelton sobre las percepciones maternas / Effects of an early intervention based on Brazeltons scale on the maternal perceptions

OBJETIVO: evaluar el efecto de una breve intervención temprana, basada en la administración de la NBAS en presencia de la madre, sobre las percepciones que ésta posee de su bebé y de sí misma como madre. METODOLOGIA: 23 madres primíparas de bebés sanos (a 37 semanas) completaron la Escala sobre percepciones maternas Mother and Baby Scales (MABS) dos días después del parto. Antes del alta, las madres del grupo experimental (12) participaron activamente en una sesión con la NBAS, que consistió en evaluar la conducta de su hijo recién nacido. Al cabo de un mes, se realizó una segunda administración de la MBAS en toda la muestra. RESULTADOS: no se encontraron diferencias significativas entre los grupos en las percepciones maternas, aunque sí las hubo intra grupo experimental en las subescalas Alerta-interés e Inestable-irregular de la MABS. CONCLUSIONES: la intervención no tuvo el suficiente impacto, aunque posiblemente influyó en que las madres del grupo experimental percibiesen a su bebé como significativamente más alerta después de transcurrido un mes. (AU)

Residual hippocampal atrophy in asphyxiated term neonates.

BACKGROUND AND PURPOSE: Previous studies have shown the hippocampus and basal ganglia to be highly sensitive to hypoxic-ischemic insult. The authors' aim was to evaluate the long-term effects of perinatal asphyxia (PA) on the hippocampus and caudate nucleus in a group of participants born at term and who met the criteria for hypoxic-ischemic encephalopathy (HIE). Additionally, the authors looked for damage in other brain regions using voxel-based morphometry (VBM). METHODS: The sample consisted of 13 participants (8 boys and 5 girls) with a mean age at study of 16.23 years (+/- 2.89) with antecedents of perinatal asphyxia, diagnosed as moderate hypoxic-ischemic encephalopathy. A group of 13 healthy adolescents matched for age, sex, educational level, and social background were recruited as a comparison group. MR scans were acquired on a 1.5T Signa (General Electric, Milwaukee, WI) to evaluate hippocampal and caudate volumes and to perform VBM analysis. Finally, Rey's Auditory Verbal Learning Test was administered to evaluate verbal long-term memory. RESULTS: HIE participants were found to have bilateral hippocampal atrophy (P = .015) and gray matter damage in temporal and frontal lobes. The caudate nucleus showed no atrophic changes in PA participants, and VBM analysis did not reveal other consistent brain abnormalities. Verbal long-term memory was slightly worse in HIE participants. CONCLUSIONS: These findings indicate that PA produces hippocampal and other nonspecific long-term damage, which cannot be compensated for by plasticity mechanisms. However, this damage does not preclude normal development and scholarship.