Lauritz Bredrup Dahl

A Randomized, Controlled Trial of the Effectiveness of an Early-Intervention Program in Reducing Parenting Stress After Preterm Birth

BACKGROUND. Preterm birth has been associated with increased parenting stress in early infancy, and some reports have found this to be a risk factor for later behavioral problems. There are, however, few studies and conflicting results. Information about the fathers is scarce. OBJECTIVES. Our goal was to study the effects of an early-intervention program on parenting stress after a preterm birth until 1 year corrected age. METHODS. A randomized, controlled trial was conducted including infants with a birth weight <2000 g treated at the University Hospital of North Norway Trust, which serves the 2 northern-most counties in Norway, to examine the effects of a modified version of the Mother-Infant Transaction Program on parenting stress measured by the Parenting Stress Index. A term control group was also recruited. The Parenting Stress Index was administered to the mothers at 6 and 12 months’ corrected age and to the fathers at 12 months’ corrected age. The intervention consisted of 8 sessions shortly before discharge and 4 home visits by specially trained nurses focusing on the infant’s unique characteristics, temperament, and developmental potential and the interaction between the infant and the parents. RESULTS. Seventy-one infants were included in the preterm intervention group, and 69 were included in the preterm control group. The preterm groups were well balanced. Seventy-four infants were included in the term control group. Compared with the preterm controls, both the mothers and fathers in the preterm intervention group reported significant lower scores in child domain, parent domain, and total stress on all occasions except the mother-reported child domain at 12 months. These differences were not related to birth weight or gestational age. The level of stress among the preterm intervention group was comparable to their term peers. Both parents in the intervention group reported consistently lower scores within the distractibility/hyperactivity, reinforces parents, competence, and attachment subscales compared with the preterm control group. There were no differences in mean summary stress scores between the mothers and fathers in the 2 preterm groups at 12 months, but the intraclass correlation coefficient was higher in the intervention group. CONCLUSIONS. This early-intervention program reduces parenting stress among both mothers and fathers of preterm infants to a level comparable to their term peers. We are now studying whether this will result in long-term beneficial effects.

Early Intervention Improves Behavioral Outcomes for Preterm Infants: Randomized Controlled Trial

Objective: The aim of this study was to examine the effectiveness of an early intervention program on behavioral outcomes at corrected age of 5 years for children with birth weights (BWs) of <2000 g. Methods: A randomized controlled trial of a modified version of the Mother-Infant Transaction Program was performed. Outcomes were measured by the Child Behavior Check List report (parents) and Strengths and Difficulties Questionnaire at 5 years (parents and preschool teachers). Results: A total of 146 infants were assigned randomly (intervention group: 72 infants; reference group: 74 infants). A term group was recruited (75 infants). The mean BWs were 1396 ± 429 g for the intervention group, 1381 ± 436 g for the control group, and 3619 ± 490 g for the term reference group. Parents in the intervention group reported significantly fewer behavioral problems measured by both instruments at 5 years. There were no differences in behavior problems reported by preschool teachers. Significantly more children in the preterm control group scored within the clinical area of both instruments. Conclusions: This modified version of the Mother-Infant Transaction Program led to fewer behavioral problems reported by parents at corrected age of 5 years for children with BWs of <2000 g.

Major congenital heart disease in Northern Norway: shortcomings of pre- and postnatal diagnosis.

Background.  Congenital heart disease (CHD) is a significant cause of perinatal mortality and morbidity worldwide. Prenatal detection rate of CHD remains low in most European countries and a substantial proportion of infants with serious heart disease are diagnosed only after discharge from hospital after birth. Earlier recognition of treatable abnormalities may improve the perinatal outcome. The purpose of this study was to evaluate the incidence, pre‐ and postnatal diagnosis and outcome of major CHD in two northern‐most counties of Norway.

Acute osteomyelitis in children: a population-based retrospective study 1965 to 1994.

OBJECTIVES To investigate changes in occurrence, clinical features, laboratory and other investigations, aetiology and use of antibiotics, and to calculate the incidence of acute hematogenous osteomyelitis (AHO) in children up to 12 y of age in the county of Troms in the northern part of Norway. METHODS Retrospective chart review of 86 children, newborn to 11 y old. with AHO between 1965 and 1994. RESULTS A constant yearly incidence (95% CI) of 0.1 (0.08-0.12) per 1000 children could be calculated (X2 for trend 0.51;p = 0.48). The female proportion (95% CI) was 0.6 (0.48-0.72). The median duration of complaints prior to admission was 4 days. Erythrocyte sedimentation rate (ESR; mean (95% CI)= 59 mm/h (52-66)) and C-reactive protein concentration (CRP; mean (95% CI)= 63 mg/l (36-90)) were elevated in 96% and 89%, respectively. Local and/or blood cultures were taken in 97%. In 55% an agent was found. Staphylococcus aureus (S. aureus) was responsible in 76%. The proportion of betalactamase-producing strains tended to increase (49%; X2 for trend 3.72; p = 0.054). In 78% the long bones of the upper or lower extremities were affected. Penicillin or ampicillin combined with cloxacillin or dicloxacillin was the preferred therapy. The median duration of antibiotic treatment was 7 weeks. The use of penicillin declined (p = 0.008), whereas that of cloxacillin/dicloxacillin increased (p < 0.001). The use of ampicillin was unchanged (p = 0.79). CONCLUSION The study confirms reports from various epochs and remote regions concerning the unchanged characteristics of AHO in children, except for the high proportion of females in the present study. An incidence for childhood AHO in a defined geographical region is given.

The concentration of hyaluronate in amniotic fluid.

The concentration of sodium hyaluronate has been determined in amniotic fluid by a specific radioassay. It shows a large individual variation. The mean concentration is approximately 20 micrograms/ml at Weeks 16-20 of the gestational period. It drops to approximately 1 micrograms/ml at Week 30 and is then constant until the end of the pregnancy.

The Catabolic Fate of Hyaluronic Acid

Part of the hyaluronic acid (HA) synthesized in peripheral tissues enters the blood circulation through the lymph. It is rapidly taken up by the endothelial cells in the liver (half-life in blood is 2.5-5.5 minutes) and degraded. Pure primary cultures of liver endothelial cells were obtained by a newly developed technique and used to follow the metabolism of the polysaccharide on the cell surface. At 37 degrees C the HA is effectively endocytosed and degraded to acetate and lactate. A radioassay specific for HA and sensitive in the nanogram range has been developed to follow the concentration of HA in serum. The normal level in man is 10 to 100 micrograms/l. Elevated serum levels of HA are seen in liver cirrhosis, rheumatoid arthritis and scleroderma indicating that both an impaired catabolism in the liver and an increased synthesis in the peripheral tissues can modify the HA level.

Antenatal, neonatal and post neonatal deaths evaluated by medical audit : A population-based study in northern Norway - 1976 to 1997

BACKGROUND Perinatal committees evaluate deaths by medical audit to improve antenatal and neonatal care. We report data from Troms County from 1976 to 1997. SUBJECTS AND METHODS Antenatal, neonatal and post neonatal deaths (n=472) at > or = 20 weeks of gestation have been evaluated. Data were collected from the Medical Birth Registry of Norway and from medical records. Pregnancy risk factors, mortality rates, causes of deaths, non-optimal care and avoidable deaths were recorded. RESULTS The death rate (all deaths per thousand total births) declined from 13.8 (1976-80) to 7.7 (1992-97), (p<0.001), due to a reduced death rate in preterms > or = 24 weeks (p<0.001) and in those between 500 and 1995 g (p<0.001). Antenatal deaths decreased (p<0.001) due to reduced intrapartum deaths (p<0.001). Prelabor deaths, unexpected intrauterine pre-hospitalization deaths included, did not change. Postnatal deaths declined (p=0.01) due to reduced early neonatal mortality (p=0.002). Deaths from malformations (p<0.001), fetal and neonatal infections (p=0.03) and placental disorders (p<0.001) declined. Non-optimal care (22.5% of deaths, 2.3%o of total births), avoidable deaths (13.1% of deaths, 1.3% of total births), and maternal neglect (7.5% of cases with non-optimal care, 0.6% of total births) did not change. Death during transport was rare (n=5), and no deaths occurred at maternity homes. Non-cohabitance, smoking and undiagnosed SGA new borns declined, and the level of education increased in the study population. CONCLUSION The improvement is due to a reduction in intrapartum deaths and early neonatal mortality in preterms. A constant high rate of unexpected intrauterine deaths in non-hospitalized patients is a challenge for antenatal health care providers.

ROLE OF ENDOCARDIAL ENDOTHELIAL CELLS IN THE TURNOVER OF HYALURONAN IN ATLANTIC COD (GADUS MORHUA)

Abstract.The fate of the major connective tissue polysaccharide hyaluronan, as it appears after release from the matrix, was studied in the Atlantic cod by use of subcutaneous administration of hyaluronan conjugated with fluorescein isothiocyanate (FITC) and labelled with 125I. After administration, the ligand was transported to the heart, which contained 58% of the recovered label after 22 h, whereas 36% remained at the injection site. Uptake in other organs was low. Results from intravenous co-injection studies showed that 125I-FITC-hyaluronan and native hyaluronan were in competition for uptake by the same receptor in cod heart. Fluorescence microscopy revealed that FITC-hyaluronan accumulated in spherical structures and discrete vesicles in endocardial endothelial cells lining the muscular trabeculae of both heart chambers. Immunoelectron microscopy showed that, in these cells, the ligand lined the limiting membrane of endosomes and filled the lumen of late endosomes or lysosomes. We conclude that, in the cod, heart endothelial cells are essential for the turnover of hyaluronan. Atrial endothelial cells were also able to ingest 2-μm latex beads, although these were far more effectively phagocytosed by head kidney macrophages. The present results strengthen the notion that the cod endocardium consists of specialized scavenger endothelial cells, resembling sinusoidal endothelial cells of salmonid kidney and mammalian liver. These cells should therefore be regarded as an important part of the cod reticulo-endothelial system.

Antenatal, neonatal and post neonatal deaths evaluated by medical audit

Background. Perinatal committees evaluate deaths by medical audit to improve antenatal and neonatal care. We report data from Troms County from 1976 to 1997.

A randomized study of the impact of a sensitizing intervention on the child-rearing attitudes of parents of low birth weight preterm infants

The background for this study was that nurturant child-rearing attitudes are associated with positive development in low birth weight (LBW) infants. The objective was to study child-rearing attitudes and early intervention (EI) in parents of LBW infants from 12-36 months corrected age. LBW infants (BW< 2000 g) were randomized to an intervention (IG) or a control group (CG). The EI consisted of seven in-hospital sessions prior to discharge, then four home visits. A Child Rearing Practices Report was administered at 12 (mothers only), 24 and 36 months. A total of 146 infants were randomized. The mean BW in IG was 1396 (SD 429) g and 1381 (436) g in CG. The mean GA was 30.2 (3.1) weeks in IG and 29.9 (3.5) weeks in CG. Mothers in IG reported significantly more nurturant child-rearing attitudes at 12 and 24 months. There was a significant change in restrictive and nurturant attitudes over time. It was concluded that EI may lead to more nurturant child-rearing attitudes in mothers of preterms.