Apostolos Papageorgiou

Anxiety affects the relationship between parents and their very low birth weight infants

The goal of this study was to examine the medical and sociodemographic factors associated with parental anxiety following the birth of a very low birth weight infant (VLBW, below 1500 g), and to determine the impact of anxiety on the behavior of parents with their VLBW infants in the Neonatal Intensive Care Unit (NICU). The parents of 88 VLBW infants were recruited through the NICU of a tertiary-care hospital, approximately 2 weeks following delivery. Parents completed self-report questionnaires measuring anxiety, marital quality, and social support. Prior to discharge, each parent was observed twice during a feeding interaction with the infant. Maternal anxiety was greater when their infants were smaller in terms of birth weight and younger in gestational age. Maternal education, marital status, and country of origin, as well as social support and marital quality, were also associated with anxiety. Paternal anxiety was not related to socioeconomic status or infant medical risk, but was associated with country of origin, social support, and marital quality. For both mothers and fathers, anxiety was a better predictor of parental behavior than was infant medical risk. These findings suggest the need to intervene with anxious parents in order to promote satisfactory parent-infant relationships.

Adverse Effects of Fetal Cocaine Exposure on Neonatal Auditory Information Processing

Background. Studies with animals have shown that in utero exposure to cocaine interferes with fetal brain development by disrupting the processes of neuronal proliferation, differentiation, and migration, often leading to subsequent neurobehavioral deficits. However, studies with humans have produced inconsistent findings. Although neurobehavioral abnormalities have been observed among cocaine-exposed infants in several studies and in some cases dose-response effects have been found, the specific neurobehaviors affected vary from one study to the next. Researchers studying the effects of fetal cocaine-exposure are faced with many difficult challenges. For example, women who use cocaine typically use other substances in addition to cocaine, many of the methods available for identifying cocaine-exposed neonates are not reliable, and the available methods for assessing cocaine-exposed newborns may not be sufficiently sensitive to detect the subtle effects of cocaine on the developing central nervous system. Despite these difficulties, there is a growing body of research that suggests that fetal cocaine exposure is associated with subsequent language deficits among children exposed in utero. However, it is virtually impossible to disentangle the effects of the impoverished environments in which these children are often raised from the effect, if any, of fetal cocaine exposure. To determine the effects of fetal cocaine exposure independent of postnatal environmental effects, cocaine-exposed neonates would ideally be tested within the first few weeks of birth, and to identify early risks for subsequent language delay, well-researched auditory information processing measures could be used. Objective. The purpose of the present study was to assess the effects of fetal cocaine exposure on neonatal auditory information processing ability. To overcome limitations of some previous studies on the neuroteratogenic effects of cocaine, such as unreliable subject identification techniques, inadequate control over confounding variables, and questionable measures of central nervous system integrity, a valid measure of auditory information processing was used in a rigorous, case-control design. Method. Newborn information processing was assessed using habituation and recovery of head-turning toward an auditory stimulus across the 3 phases of the procedure: familiarization, novelty, and dishabituation. During the familiarization phase, the infant orients and habituates to a repeated word; during the novelty phase, the infant recovers head-turning to a novel word and subsequently habituates to this word; and during the dishabituation phase the infant displays renewed head-turning to the return of the original stimulus. Testing takes ∼20 minutes. This procedure has been shown previously to discriminate among infants at high-, moderate-, and low-risk for subsequent developmental delay. Twenty-five cocaine-exposed and 25 nonexposed control neonates, identified by meconium analysis, urine analysis, and/or maternal self-report, were tested on the auditory information processing procedure. The majority of infants were tested within the first few days of birth. Cocaine-exposed and control neonates were matched on birth weight, gestational age, Apgar scores, age at testing, and socioeconomic status as reflected by household income. Mothers were matched on age, weight gain, cigarette smoking, and alcohol consumption. Results. Fetal cocaine exposure was associated with impaired auditory information processing. Both cocaine-exposed and nonexposed control neonates oriented to the familiarization stimulus, but cocaine-exposed neonates displayed impaired habituation. Moreover, cocaine-exposed neonates did not recover or habituate to the novel stimulus or dishabituate to the return of the familiarization stimulus. Whereas nonexposed, control infants exhibited high levels of turning away from the familiarization stimulus during habituation (implying boredom), followed by high levels of turning toward the novel stimulus, indicating recovery of attention, the cocaine-exposed infants turned randomly. Clearly, auditory information processing of cocaine-exposed infants was impaired, despite the fact that they exhibited the same overall number of head-turns and the same high level of positive state as the nonexposed infants. Conclusions. The results imply that cocaine is a neuroteratogenic agent that impairs auditory information processing ability during the newborn period. Cocaine-exposed neonates exhibited a response pattern that is consistent with slower speed of auditory information processing. These deficits were observed within the first few days of birth, before adverse postnatal environmental influences could exert their effect. Moreover, the case-control design increased the probability that the observed information processing deficits were due primarily to the direct effects of fetal exposure to cocaine and not other prenatal factors. However, the long-term implications of these findings for the development of the infant/child are not known and must be addressed in follow-up studies.

A familial syndrome of cranial, facial, oral and limb anomalies.

A family is described in which two male infants have microcephaly, abnormal ears, anti‐mongoloid slant, small mouth, cleft palate, flexed overlapping fingers with syndactyly of digits three and four, syndactyly of the second to the fifth toes, and normal karyotype. This seems to be a new syndrome.

The ethics and practice of neonatal resuscitation at the limits of viability: an international perspective

Premature infants at the limits of viability raise difficult ethical, legal, social and economic questions. Neonatologists attending an international Collegium were surveyed about delivery room behaviour, and the approach taken by selected countries practicing ‘modern’ medicine was explored.

Recovery and Dishabituation of Sound Localization Among Normal-, Moderate-, and High-Risk Newborns: Discriminant Validity

Abstract The discriminant validity of newborn localized head-turning to speech sounds was assessed using a familiarization-recovery-dishabituation paradigm. Neonates (72 hours corrected age) born at normal, moderate, or high risk for delayed mental development were identified using independent pre- and perinatal criteria. An infant-controlled procedure was used to assess head-turning across three phases of the experiment: (1) familiarization to a repeated stimulus; (2) presentation of a novel stimulus; (3) the return of the original familiarized stimulus. Percentage of trial blocks with head-turns toward the sound source and the difference in number of turns toward and away served as principal dependent measures. Comparable percentages of head-turning and rates of orientation and habituation occurred during initial familiarization trials. However, degree of recovery to the novel word and return of the original word and habituation to the novel word discriminated among groups, particularly between normal neonates and those at high risk for subsequent mental delays.

Are antenatal steroids beneficial to severely growth restricted fetuses

Abstract Antenatal steroids (AS) have been shown to enhance fetal maturation in preterms and to improve outcome. The aim of this study was to evaluate the efficacy of AS in premature severely intrauterine growth restricted infants. The electronic data of 149 inborn, single infants born 24 to 31 6/7 weeks of GA and with a BW ≤ 3rd percentile were reviewed. Infants with congenital anomalies and syndromes were excluded. We compared the outcome of those who received 2 doses of AS (group A, 87 infants) with those who did not receive AS (group B, 62 infants). Sixty-eight infants in group A and 53 in group B were discharged home alive. AS did not improve the neonatal outcome, with the exception of a better cord pH and 5-min Apgar and we did not observe a significant difference in the Griffith’s test at 2 years of corrected age, although there was a trend to a higher incidence of severe global delay in the steroid group. In view of the potential cerebral and CVS risks associated with high circulating steroids, the indications for AS in such a population need to be re-evaluated.