Linda Johnston

Autism in toddlers born very preterm

OBJECTIVE: This study aimed to determine the prevalence of autism spectrum disorder (ASD) by using the Autism Diagnostic Observation Schedule-Generic (ADOS-G) classifications in children born very preterm during their toddler years. METHODS: Two birth cohorts of toddlers (2 and 4 years old) each recruited over 12 months and born at <29 weeks’ gestation were administered the Modified Checklist of Autism in Toddlers–Follow-up Interview (M-CHAT-FI) screen, the ADOS-G, and developmental assessments. The ADOS-G was conducted on toddlers with M-CHAT-FI–positive screens. RESULTS: Data were available on 88% (169/192) of children. In total, 22 (13%) toddlers screened positive and 3 (1.8%) were confirmed diagnostically with ASD. These 3 cases reached the highest ADOS-G threshold classification of autism. All but 1 child who scored below the ADOS-G thresholds (11/12) demonstrated some difficulty with social communication. Risk was significantly increased for co-occurring neurodevelopmental problems in 21 of the 22 positive-screen ASD cases. Adaptive behavior (P < .001) was the only co-occurring factor independently predictive of ASD in toddlers. CONCLUSIONS: Children born very preterm are at increased risk of ASD. By using the ADOS-G, we found a lower incidence of ASD in children born at <29 weeks’ gestation compared with previous studies. Children who screened positive for ASD on the M-CHAT-FI had developmental delays consistent with subthreshold communication impairment.

Dipyridamole reduced myocardial platelet and leukocyte deposition following ischemia and cardioplegia

Urgent coronary revascularization for acute myocardial ischemia results in an increased mortality and morbidity. Deposition of activated platelets and leukocytes into the ischemic myocardium during reperfusion may augment perioperative ischemic injury. Dipyridamole reduces platelet activation and may reduce myocardial deposition and prevent ischemic injury during reperfusion. The effects of dipyridamole on myocardial platelet and leukocyte deposition were evaluated in a canine model of acute regional myocardial ischemia with reperfusion during cardioplegia on cardiopulmonary bypass. Eight dogs underwent left anterior descending (LAD) coronary artery ligation for 45 min followed by cardiopulmonary bypass and release of the ligature during 60 min of cold crystalloid cardioplegic arrest to simulate urgent revascularization. Four dogs were randomized to receive an infusion of dipyridamole perioperatively (50 mg/hr) and 4 dogs served as controls. Autologous platelets were labeled with 111In, leukocytes with 99mTc, and erythrocytes with 51Cr. The labeled cells were infused immediately after cross-clamp release and myocardial biopsies were obtained at 10, 20, 30, and 60 min of reperfusion. Platelets were deposited in the myocardium during reperfusion and four times more platelets were found in the LAD region than the circumflex region. Leukocyte deposition was similar in the LAD and circumflex regions. Dipyridamole reduced both platelet and leukocyte deposition and the reduction was greater in the LAD than in the circumflex region. Myocardial platelet and leukocyte deposition was found after regional ischemia, cardioplegia, and cardiopulmonary bypass. Dipyridamole reduced myocardial platelet and leukocyte deposition and may reduce perioperative ischemic injury.

Stress and distress in parents of neonates admitted to the neonatal intensive care unit for cardiac surgery.

BACKGROUND Parents of infants admitted to the Neonatal Intensive Care Unit (NICU) are at risk of psychological distress and NICU-related stress. However, parents of infants admitted to NICU for cardiac surgery are an under-researched population. AIMS Identify levels of NICU-related stress, and levels of psychological distress, reported by parents of infants admitted to the NICU for cardiac surgery. STUDY DESIGN Observational study. SUBJECTS 69 parents of infants admitted to the NICU for cardiac surgery (cardiac group) and 142 parents of healthy infants (control group). OUTCOME MEASURES Questionnaire packs provided to parents prior to discharge (time-point 1), and at six and 12months corrected age included: Hospital Anxiety and Depression Scale, Coping Inventory for Stressful Situations, and Family Support Scale. The Parental Stressor Scale:NICU was administered to the cardiac group at time-point 1. RESULTS The cardiac group reported (i) that parental role alteration was the most stressful aspect of the NICU and (ii) higher scores for anxiety and depression than the control group at all three time-points, with the highest levels reported during the NICU stay. Correlation analyses indicated (i) stress associated with the sights and sounds of the NICU, and the appearance and behaviour of the infant in the NICU, had a significant positive association with anxiety and depression, and (ii) a significant negative relationship between anxiety and task-focused coping. CONCLUSIONS An individualised parent-targeted intervention aimed at reducing stress associated with the NICU and enhancing task-focused coping style may help to reduce levels of anxiety and depression within this group of parents.

Fertility rates and perinatal outcomes of adolescent pregnancies: a retrospective population-based study

Objetivo: analizar as tendencias das taxas de fertilidade e associacoes com desfechos perinatais entre adolescentes em Santa Catarina, Brasil. Metodo: estudo populacional conduzido de 2016 a 2013. Associacoes entre desfechos perinatais e grupos por faixa etaria foram investigadas usando odds Ratio e teste Chi-quadrado. Resultados: as diferencas encontradas nas taxas de fertilidade entre maes adolescentes nas regioes e periodo observado variaram de 40,9-72,0 por 1.000 entre maes de 15 a 19 anos de idade. As adolescentes atenderam menos consultas pre-natais, quando comparadas as maes com 20 anos ou mais, e a maioria nao tinha parceiro. Maes entre 15 e 19 anos eram mais propensas a ter filhos prematuros (OR:1,1; IC:1,08-1,13; p<0,001), ter um filho com baixo peso ao nascer (OR:1,1; IC:1,10-1,15; p<0,001) , com baixo e Apgar no quinto minuto (OR:1,4; IC:1,34-1,45; p<0,001), do que maes com 20 anos ou mais; as chances de desfechos adversos tambem eram maiores entre maes de 10 a 14 anos. Conclusao: este estudo apresenta evidencia de que as taxas de fertilidade entre adolescentes continuam altas em regioes que enfrentam privacao social e economica. Adolescentes e seus filhos sao mais propensos a desfechos perinatais adversos. Enfermeiros(as), profissionais de saude publica, profissionais de saude e de assistencia social, assim como educadores precisam trabalhar em conjunto para direcionar estrategias as adolescentes com maior risco, para ajudar a melhorar as taxas de fertilidade e dos desfechos.Objetivo: analizar tendencias en las tasas de fertilidad y asociaciones con resultados perinatales para adolescentes en el Estado de Santa Catarina, Brasil. Metodos: estudio poblacional, considerando el periodo de 2006 a 2013. Para evaluar las asociaciones entre los resultados perinatales y los grupos de edad fueron aplicados los odds ratios y pruebas de ji-cuadrado. Resultados: fueron observadas diferencias en la tasa de fertilidad entre las adolescentes de acuerdo con las regiones y periodos, variando de 40,9 a 72,0 por 1.000 en madres entre 15 y 19 anos de edad. Las adolescentes tuvieron menos consultas prenatales en comparacion con madres ≥20 anos, con una mayor proporcion sin pareja. La probabilidad de parto prematuro (OR:1,1; IC:1,08-1,13; p<0,001), bebe con peso bajo al nacer (OR:1,1; IC:1,10-1,15; p<0,001) y puntuacion de Apgar baja a los 5 minutes (OR:1,4; IC:1,34-1,45; p<0,001) fue superior para madres entre 15 y 19 anos en comparacion con madres ≥20 anos, con mayores chances de resultados negativos para aquellas entre 10 y 14 anos de edad. Conclusion: este estudio evidencia que las tasas de fertilidad entre las adolescentes siguen superiores en regiones de pobreza social y economica. Madres adolescentes y sus bebes tienen mayor probabilidad de efectos perinatales adversos. Enfermeros, trabajadores de salud publica, profesionales de salud y asistencia social y educadores deben colaborar para mejor dirigir estrategias a adolescentes con riesgo superior; para fines de ayudar a reducir las tasas de fertilidad y mejorar los resultados.ABSTRACT Objective: analyze trends in fertility rates and associations with perinatal outcomes for adolescents in Santa Catarina, Brazil. Methods: a population-based study covering 2006 to 2013 was carried out to evaluate associations between perinatal outcomes and age groups, using odds ratios, and Chi-squared tests. Results: differences in the fertility rate among female adolescents across regions and time period were observed, ranging from 40.9 to 72.0 per 1,000 in mothers aged 15-19 years. Adolescents had fewer prenatal care appointments than mothers ≥20 years, and a higher proportion had no partner. Mothers aged 15-19 years were more likely to experience preterm birth (OR:1.1; CI:1.08-1.13; p<0.001), have an infant with low birthweight (OR:1.1; CI:1.10-1.15; p<0.001) and low Apgar score at 5 minutes (OR:1.4; CI:1.34-1.45; p<0.001) than mothers ≥20 years, with the odds for adverse outcomes greater for those aged 10-14 years. Conclusion: this study provides evidence of fertility rates among adolescents remaining higher in regions of social and economic deprivation. Adolescent mothers and their infants more likely to experience adverse perinatal outcomes. Nurses, public health practitioners, health and social care professionals and educators need to work collaboratively to better target strategies for adolescents at greater risk; to help reduce fertility rates and improve outcomes.

Neonatal intensive care nurses’ knowledge and beliefs regarding kangaroo care in China: a national survey

Objective Kangaroo care (KC), a well-established parent-based intervention in neonatal intensive care units (NICUs), with documented benefits for infants and their parents. However, in China there remains a lack of knowledge and a reluctance to implement KC in hospitals. Therefore, our aim was to investigate the current knowledge, beliefs and practices regarding KC among NICU nurses in China using the ‘Kangaroo Care Questionnaire’. Methods A quantitative descriptive survey was designed. This questionnaire comprised 90 items classified according to four domains: knowledge, practice, barriers and perception. Data were analysed using SPSS V.20.0, and content analysis was used to summarise data derived from open-ended questions. Results The survey involved 861 neonatal nurses from maternity and general hospitals across China (response rate=95.7%). The findings showed that 47.7% (n=411) of the nurses had participated in the implementation of KC. Neonatal nurses in the ‘experienced in KC’ group showed an overall better understanding of KC and its benefits with a higher ‘correct response’ rate than those in the ‘not experienced in KC’ group. In the ‘experienced in KC’ group, over 90% considered KC beneficial to the parent-baby relationship and attachment, and over 80% believed that KC positively affected outcomes of preterm infants. The ‘not experienced in KC’ group perceived more barriers to KC implementation than did the ‘experienced in KC’ group. Conclusion Although most nurses working in NICUs in China were aware of the benefits of KC, there remain substantial barriers to its routine use in practice. Education for both staff and parents is necessary, as is the provision of appropriate facilities and policies to support parents in providing this evidence-based intervention.

Tasas de fertilidad y resultados perinatales de embarazos adolescentes: un estudio retrospectivo poblacional

Objetivo: analizar as tendencias das taxas de fertilidade e associacoes com desfechos perinatais entre adolescentes em Santa Catarina, Brasil. Metodo: estudo populacional conduzido de 2016 a 2013. Associacoes entre desfechos perinatais e grupos por faixa etaria foram investigadas usando odds Ratio e teste Chi-quadrado. Resultados: as diferencas encontradas nas taxas de fertilidade entre maes adolescentes nas regioes e periodo observado variaram de 40,9-72,0 por 1.000 entre maes de 15 a 19 anos de idade. As adolescentes atenderam menos consultas pre-natais, quando comparadas as maes com 20 anos ou mais, e a maioria nao tinha parceiro. Maes entre 15 e 19 anos eram mais propensas a ter filhos prematuros (OR:1,1; IC:1,08-1,13; p<0,001), ter um filho com baixo peso ao nascer (OR:1,1; IC:1,10-1,15; p<0,001) , com baixo e Apgar no quinto minuto (OR:1,4; IC:1,34-1,45; p<0,001), do que maes com 20 anos ou mais; as chances de desfechos adversos tambem eram maiores entre maes de 10 a 14 anos. Conclusao: este estudo apresenta evidencia de que as taxas de fertilidade entre adolescentes continuam altas em regioes que enfrentam privacao social e economica. Adolescentes e seus filhos sao mais propensos a desfechos perinatais adversos. Enfermeiros(as), profissionais de saude publica, profissionais de saude e de assistencia social, assim como educadores precisam trabalhar em conjunto para direcionar estrategias as adolescentes com maior risco, para ajudar a melhorar as taxas de fertilidade e dos desfechos.Objetivo: analizar tendencias en las tasas de fertilidad y asociaciones con resultados perinatales para adolescentes en el Estado de Santa Catarina, Brasil. Metodos: estudio poblacional, considerando el periodo de 2006 a 2013. Para evaluar las asociaciones entre los resultados perinatales y los grupos de edad fueron aplicados los odds ratios y pruebas de ji-cuadrado. Resultados: fueron observadas diferencias en la tasa de fertilidad entre las adolescentes de acuerdo con las regiones y periodos, variando de 40,9 a 72,0 por 1.000 en madres entre 15 y 19 anos de edad. Las adolescentes tuvieron menos consultas prenatales en comparacion con madres ≥20 anos, con una mayor proporcion sin pareja. La probabilidad de parto prematuro (OR:1,1; IC:1,08-1,13; p<0,001), bebe con peso bajo al nacer (OR:1,1; IC:1,10-1,15; p<0,001) y puntuacion de Apgar baja a los 5 minutes (OR:1,4; IC:1,34-1,45; p<0,001) fue superior para madres entre 15 y 19 anos en comparacion con madres ≥20 anos, con mayores chances de resultados negativos para aquellas entre 10 y 14 anos de edad. Conclusion: este estudio evidencia que las tasas de fertilidad entre las adolescentes siguen superiores en regiones de pobreza social y economica. Madres adolescentes y sus bebes tienen mayor probabilidad de efectos perinatales adversos. Enfermeros, trabajadores de salud publica, profesionales de salud y asistencia social y educadores deben colaborar para mejor dirigir estrategias a adolescentes con riesgo superior; para fines de ayudar a reducir las tasas de fertilidad y mejorar los resultados.ABSTRACT Objective: analyze trends in fertility rates and associations with perinatal outcomes for adolescents in Santa Catarina, Brazil. Methods: a population-based study covering 2006 to 2013 was carried out to evaluate associations between perinatal outcomes and age groups, using odds ratios, and Chi-squared tests. Results: differences in the fertility rate among female adolescents across regions and time period were observed, ranging from 40.9 to 72.0 per 1,000 in mothers aged 15-19 years. Adolescents had fewer prenatal care appointments than mothers ≥20 years, and a higher proportion had no partner. Mothers aged 15-19 years were more likely to experience preterm birth (OR:1.1; CI:1.08-1.13; p<0.001), have an infant with low birthweight (OR:1.1; CI:1.10-1.15; p<0.001) and low Apgar score at 5 minutes (OR:1.4; CI:1.34-1.45; p<0.001) than mothers ≥20 years, with the odds for adverse outcomes greater for those aged 10-14 years. Conclusion: this study provides evidence of fertility rates among adolescents remaining higher in regions of social and economic deprivation. Adolescent mothers and their infants more likely to experience adverse perinatal outcomes. Nurses, public health practitioners, health and social care professionals and educators need to work collaboratively to better target strategies for adolescents at greater risk; to help reduce fertility rates and improve outcomes.

Taxa de fertilidade e desfecho perinatal em gravidez na adolescência: estudo retrospectivo populacional

Objetivo: analizar as tendencias das taxas de fertilidade e associacoes com desfechos perinatais entre adolescentes em Santa Catarina, Brasil. Metodo: estudo populacional conduzido de 2016 a 2013. Associacoes entre desfechos perinatais e grupos por faixa etaria foram investigadas usando odds Ratio e teste Chi-quadrado. Resultados: as diferencas encontradas nas taxas de fertilidade entre maes adolescentes nas regioes e periodo observado variaram de 40,9-72,0 por 1.000 entre maes de 15 a 19 anos de idade. As adolescentes atenderam menos consultas pre-natais, quando comparadas as maes com 20 anos ou mais, e a maioria nao tinha parceiro. Maes entre 15 e 19 anos eram mais propensas a ter filhos prematuros (OR:1,1; IC:1,08-1,13; p<0,001), ter um filho com baixo peso ao nascer (OR:1,1; IC:1,10-1,15; p<0,001) , com baixo e Apgar no quinto minuto (OR:1,4; IC:1,34-1,45; p<0,001), do que maes com 20 anos ou mais; as chances de desfechos adversos tambem eram maiores entre maes de 10 a 14 anos. Conclusao: este estudo apresenta evidencia de que as taxas de fertilidade entre adolescentes continuam altas em regioes que enfrentam privacao social e economica. Adolescentes e seus filhos sao mais propensos a desfechos perinatais adversos. Enfermeiros(as), profissionais de saude publica, profissionais de saude e de assistencia social, assim como educadores precisam trabalhar em conjunto para direcionar estrategias as adolescentes com maior risco, para ajudar a melhorar as taxas de fertilidade e dos desfechos.Objetivo: analizar tendencias en las tasas de fertilidad y asociaciones con resultados perinatales para adolescentes en el Estado de Santa Catarina, Brasil. Metodos: estudio poblacional, considerando el periodo de 2006 a 2013. Para evaluar las asociaciones entre los resultados perinatales y los grupos de edad fueron aplicados los odds ratios y pruebas de ji-cuadrado. Resultados: fueron observadas diferencias en la tasa de fertilidad entre las adolescentes de acuerdo con las regiones y periodos, variando de 40,9 a 72,0 por 1.000 en madres entre 15 y 19 anos de edad. Las adolescentes tuvieron menos consultas prenatales en comparacion con madres ≥20 anos, con una mayor proporcion sin pareja. La probabilidad de parto prematuro (OR:1,1; IC:1,08-1,13; p<0,001), bebe con peso bajo al nacer (OR:1,1; IC:1,10-1,15; p<0,001) y puntuacion de Apgar baja a los 5 minutes (OR:1,4; IC:1,34-1,45; p<0,001) fue superior para madres entre 15 y 19 anos en comparacion con madres ≥20 anos, con mayores chances de resultados negativos para aquellas entre 10 y 14 anos de edad. Conclusion: este estudio evidencia que las tasas de fertilidad entre las adolescentes siguen superiores en regiones de pobreza social y economica. Madres adolescentes y sus bebes tienen mayor probabilidad de efectos perinatales adversos. Enfermeros, trabajadores de salud publica, profesionales de salud y asistencia social y educadores deben colaborar para mejor dirigir estrategias a adolescentes con riesgo superior; para fines de ayudar a reducir las tasas de fertilidad y mejorar los resultados.ABSTRACT Objective: analyze trends in fertility rates and associations with perinatal outcomes for adolescents in Santa Catarina, Brazil. Methods: a population-based study covering 2006 to 2013 was carried out to evaluate associations between perinatal outcomes and age groups, using odds ratios, and Chi-squared tests. Results: differences in the fertility rate among female adolescents across regions and time period were observed, ranging from 40.9 to 72.0 per 1,000 in mothers aged 15-19 years. Adolescents had fewer prenatal care appointments than mothers ≥20 years, and a higher proportion had no partner. Mothers aged 15-19 years were more likely to experience preterm birth (OR:1.1; CI:1.08-1.13; p<0.001), have an infant with low birthweight (OR:1.1; CI:1.10-1.15; p<0.001) and low Apgar score at 5 minutes (OR:1.4; CI:1.34-1.45; p<0.001) than mothers ≥20 years, with the odds for adverse outcomes greater for those aged 10-14 years. Conclusion: this study provides evidence of fertility rates among adolescents remaining higher in regions of social and economic deprivation. Adolescent mothers and their infants more likely to experience adverse perinatal outcomes. Nurses, public health practitioners, health and social care professionals and educators need to work collaboratively to better target strategies for adolescents at greater risk; to help reduce fertility rates and improve outcomes.