Helena Lapinleimu

Prospective randomised trial in 1062 infants of diet low in saturated fat and cholesterol

Interventions to avoid atherosclerosis might be more successful if launched early in life when eating and life-style patterns are formed, but dietary interventions have been limited by fears of diet-induced growth failure. We investigated the effects of a diet low in saturated fat and cholesterol on serum lipid concentrations and growth in 1062 healthy 7-month-old infants in a randomised study. Every 1-3 months, families in the intervention group received dietary advice aimed at adequate energy supply, with low fat intake (30-35% energy, polyunsaturated/monounsaturated/saturated fatty acid ratio 1/1/1, and cholesterol intake < 200 mg daily). Infants in control families consumed an unrestricted diet. 3-day food records were collected at ages 8 and 13 months. Growth was carefully monitored. Between 7 and 13 months serum cholesterol and non-high-density-lipoprotein cholesterol concentrations did not change significantly in the intervention group (mean change -0.03 [SD 0.72] mmol/L and 0.01 [0.67] mmol/L) but increased substantially in the control group (0.24 [0.64] mmol/L and 0.23 [0.60] mmol/L; p for difference in mean changes between groups < 0.001). Daily intakes of energy and saturated fat were lower in the intervention than in the control group at 13 months (4065 [796] vs 4370 [748] kJ, p = 0.033, and 9.3 [3.5] vs 14.5 [4.8] g, p < 0.001, respectively), and intake of polyunsaturated fat was higher (5.8 [2.2] vs 4.4 [1.4] g, p < 0.001). Growth did not differ between the groups and was as expected for children at this age. Serum cholesterol concentrations fell significantly in parents of intervention-group infants. The increases in serum cholesterol and non-high-density-lipoprotein cholesterol concentration that occur in infants between the ages of 7 and 13 months can be avoided by individualised diets, with no effect on the childrens growth.

Cerebral magnetic resonance imaging and ultrasonography findings after neonatal hypoglycemia.

Objective. The aim of this study was to investigate sequential neuroradiologic changes in the brains of infants after transient neonatal hypoglycemia. We used magnetic resonance imaging (MRI) and ultrasonography (US) head scans. Methods. Eighteen symptomatic full-term infants whose serum glucose concentrations were ≤45 mg/dL (2.5 mmol/L) without any other diseases were included in the hypoglycemic group. MRI and US head scans were performed at full-term age and at the age of 2 months. The imaging results were compared with the findings of MRI and US scans in 19 healthy normoglycemic term newborn infants at the respective ages. The neurologic outcome was followed in the both groups. Results. MRI or US showed evidence of abnormality in 39% the hypoglycemic infants. MRI detected more abnormalities in the brains than US. Four infants showed patchy hyperintensity lesions either in the occipital periventicular white matter or the thalamus on T1-weighted images. These lesions had a good tendency to recover and only 1 of these infants appeared to be neurologically affected. Of the 19 controls, 10% (2 of 19) had caudothalamic cysts, which were detected both with MRI and US. The relative risk of the hypoglycemic child compared with nonhypoglycemic child, to have any abnormality detected in the brain, was 3.7, with a 90% confidence interval from 1.11 to 12.28. Conclusions. Postnatal full-term MRI and US scans showed abnormalities four times more often after transient neonatal hypoglycemia than in the healthy control group. However, most often lesions were absent 2 months later. The clinical relevance of these abnormal findings remains to be clarified with detailed neurologic examinations and follow-up.

Maternal depression is associated with mother-infant interaction in preterm infants.

Aim: The purpose of this study was to assess the prevalence and the background factors of maternal depressive symptoms and their relation to the quality of mother–infant interaction in a group of preterm infants and their mothers.

A prospective study on sucrose consumption, visible plaque and caries in children from 3 to 6 years of age

OBJECTIVES As data on the association of sugar consumption and dental caries in the industrialized countries give mixed results, we prospectively studied this association in 135 healthy Finnish children (71 boys, 64 girls). METHODS The dental health and oral hygiene of the children was first examined at the mean age (+/-SD) of 37.4 (+/-2.1) months and again at 73.7 (+/-2.6) months. On both occasions the parents were interviewed about the childs sweet intake and toothbrushing habits, and sucrose consumption was analyzed using 4-day food diaries. RESULTS The proportion of children with caries experience, enamel and dentin lesions combined, increased from 16% to 40%. Daily sucrose intake of children who developed caries by 6 years of age, whether expressed as absolute (g) or as relative (E%) amounts, was already higher at 3 years of age than that of children who stayed caries-free (P<0.05 and P<0.03, respectively). Furthermore, children who used sweets more than once a week at 3 years of age, consumed more sucrose 3 years later (P<0.01) than those who used sweets once a week or less. The proportion of children with a combination of a sweet intake more than once a week and visible plaque, increased (P<0.05) during the follow-up. The risk ratio of children with the combined risk habit at 3 years of age to develop carious lesions by 6 years of age was 1.7 compared to the rest of the children (95% confidence interval 0.9-3.0). CONCLUSIONS We conclude that the manifestation of dental caries at 6 years of age seemed to be associated with a higher daily sucrose intake that had started already at 3 years of age. Moreover, a combination of sweet intake more than once a week and visible plaque at 3 years of age may be predictive of dental health 3 years later.

Parental Psychological Well-Being and Behavioral Outcome of Very Low Birth Weight Infants at 3 Years

OBJECTIVE: The purpose was to explore whether poor parental psychological well-being is associated with behavioral problems of very low birth weight (VLBW, ≤1500 g) infants at 3 years of age. METHODS: In this prospective cohort study, 189 VLBW preterm infants born between January 2001 and December 2006 at the Turku University Hospital, Finland, were followed. Validated questionnaires (Beck Depression Inventory, Parenting Stress Index, and Sense of Coherence Scale) were mailed to the parents when their children were 2 years corrected age. A total of 140 parents evaluated the behavior of the child at 3 years by filling out the Child Behavior Checklist. RESULTS: There were significant associations between most of the measures of parental symptoms of depression, parenting stress, and sense of coherence and the behavioral outcome of the VLBW infants. The concomitant symptoms of both parents were associated with more problematic child behavior. CONCLUSIONS: Parents report more behavioral and emotional problems in VLBW children at age 3 if they themselves have had symptoms of depression, parenting stress, or weak sense of coherence 1 year earlier. The new finding of this study was to show the significance of the father’s psychological well-being on the behavioral development of a preterm child.

Maternal Smoking during Pregnancy and Regional Brain Volumes in Preterm Infants

OBJECTIVE To evaluate the association between maternal smoking during pregnancy and both brain volumes and head circumference in very-low-birth-weight/very-low-gestational-age infants. STUDY DESIGN The PIPARI Study is a prospective follow-up study of infants with a birth weight < or =1500 g or a gestational age <32 weeks born in 2001 to 2006 (n = 232) at Turku University Hospital. The brain was imaged by serial brain ultrasound examinations until discharge and magnetic resonance imaging at term age. The head circumference was measured at birth, term, and 2 years corrected age. These measures were correlated to maternal smoking during pregnancy as reported by the mothers. RESULTS The prevalence of maternal smoking was 18%. The frontal lobe (P = .01) and the cerebellar (P = .03) volumes were significantly smaller in the exposed than in the unexposed infants. The volumes of the other parts of the brain did not differ. There was no association between prenatal smoking exposure and head growth or structural brain disease. CONCLUSIONS Prenatal smoking exposure was associated with significantly smaller frontal lobe and cerebellar volumes in the brains of preterm infants. This is consistent with reports showing an association between prenatal smoking exposure and impairments in frontal lobe and cerebellar functions such as emotion, impulse control, and attention.

The early lexical development and its predictive value to language skills at 2 years in very-low-birth-weight children.

UNLABELLED The aim of this longitudinal study was to obtain information on the early lexical development and its predictive value to language skills in very-low-birth-weight (VLBW) children. The MacArthur Communicative Development Inventory was used to collect data of the early receptive and expressive lexicon of the 32 VLBW children. This information was compared to the data of 35 full-term controls. The childrens language skills were tested using Reynell Developmental Language Scales at 2 years. The growth of the receptive lexicon was slower, and the language skills poorer in VLBW children. The early receptive lexicon growth was strongly associated with the performance in Reynells test in VLBW children. The findings indicate that the small receptive lexicon size is an early predictor of delayed language development in VLBW children. The results also emphasise the need to assess the language development of the VLBW children in detail at an early age. LEARNING OUTCOMES The reader becomes aware of the receptive and expressive lexical development of the VLBW children, and learns about the predictive value of early vocabulary growth to the language skills at 2 years of corrected age in this group of children.

Cognitive outcome at 2 years of age in Finnish infants with very low birth weight born between 2001 and 2006.

Aim:  To study cognitive outcome of premature, very low birth weight (VLBW) infants in relation to parental education and neonatal data.

Cognitive and neuropsychological outcomes at 5 years of age in preterm children born in the 2000s

Aim  The aim of this study was to assess the cognitive level and neuropsychological performance at 5 years of age in children with a very low birthweight (VLBW; birthweight <1501g) born in 2001 to 2003.

Early lexical development of Finnish children: A longitudinal study

The growth rate and the development of the composition of the receptive and expressive lexicon were studied in a longitudinal sample of 35 Finnish children. The MacArthur Communicative Development Inventory was used to gather data of the receptive lexicon at 0;9, 1;0 and 1;3, and the expressive lexicon at 0;9, 1;0, 1;3, 1;6 and 2;0. The receptive lexicon was acquired earlier, at a faster rate and with higher individual variation than the expressive lexicon. A gender difference was found in expressive vocabulary, but not in receptive vocabulary. The growth trajectories of semantic lexical categories detected in both lexicons resembled each other. Verbs were acquired more readily in receptive lexicons. Results support a universal sequence in the development of the composition of the lexicon.