Early human development最新文献

{"title":"Contributions of music therapy and of prenatal singing to maternal mental health, maternal attachment, and neonatal behavior","authors":"E. Carvalho ,&nbsp;J. Justo ,&nbsp;F.M.B. Lã ,&nbsp;A. Queirós ,&nbsp;R. Panela ,&nbsp;M. Botelho ,&nbsp;M.S. Roberto","doi":"10.1016/j.earlhumdev.2025.106265","DOIUrl":"10.1016/j.earlhumdev.2025.106265","url":null,"abstract":"<div><h3>Background</h3><div>Listening to music during pregnancy is associated with better neonatal behavior; however, contributions of prenatal singing to neonatal behavior are still unknown. Also, contributions of acoustic propagation of maternal humming inside the womb on fetal and neonatal behavior are still not understood.</div></div><div><h3>Methods</h3><div>Low obstetric risk pregnant women (<em>N</em> = 24) were sequentially allocated into three groups: 1) control group (CG) without prenatal singing; 2) music therapy group (MTG); and 3) vocal training group (VTG). Depression, Anxiety and Stress Scales (DASS) and Antenatal Maternal Attachment Scales were applied at 32 GW and also at 37 GW. DASS, Postnatal Maternal Attachment Scales, and Neonatal Behavioral Assessment Scale (NBAS) were applied between one week and one month after birth.</div></div><div><h3>Results</h3><div>For MTG: prenatal attachment was improved at 37 GW; newborns range of state was higher when compared with CG newborns; lower scores of anxiety and of stress assessed at 37 GW were associated with higher neonatal autonomic regulation; after birth, lower maternal levels of depression were associated with newborns' higher social orientation. For VTG: anxiety assessed at 37 GW associated negatively with social orientation; after birth, DASS total score associated negatively with autonomic regulation.</div></div><div><h3>Conclusion</h3><div>MTG seems to favor prenatal attachment, and neonatal range of state. Apparently prenatal singing (present at both MTG and VTG) improves the association between maternal mental health and newborns' social and self-regulatory competencies.</div></div>","PeriodicalId":11435,"journal":{"name":"Early human development","volume":"205 ","pages":"Article 106265"},"PeriodicalIF":2.2,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143879252","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Iron deficiency in pregnancy and its association with blood lead and manganese levels in offspring in Benin, Sub-Saharan Africa","authors":"Shukrullah Ahmadi ,&nbsp;Raymond Van Huizen ,&nbsp;Romeo Zoumenou ,&nbsp;Barbara Le Bot ,&nbsp;Pierre Ayotte ,&nbsp;Pierre Dumas ,&nbsp;Achille Massougbodji ,&nbsp;Philippe Glorennec ,&nbsp;Florence Bodeau-Livinec","doi":"10.1016/j.earlhumdev.2025.106255","DOIUrl":"10.1016/j.earlhumdev.2025.106255","url":null,"abstract":"<div><h3>Introduction</h3><div>The impact of prenatal iron deficiency (ID) on offspring's blood lead level (BLL) and blood manganese level (BML) in infancy remains poorly understood. This study aimed to assess associations between prenatal ID and BLL/BML in offspring in Benin. We also investigated associations between infant ID and corresponding BLL and BML in infants.</div></div><div><h3>Materials and methods</h3><div>Data on hematological parameters, metal blood concentrations, and socioeconomic status were obtained from a prospective mother-child cohort study in Allada, Benin. Blood samples were collected during pregnancy (<em>n</em> = 501), at delivery (n = 501), and from 12-month-old infants (n = 501) to assess iron deficiency and haemoglobin concentration. Additionally, BML was analyzed for a subset of 12-month-old infants (<em>n</em> = 271), and BLL was determined for the full cohort of 12-month-old infants (n = 501). Associations between ID and metal concentrations were examined using logistic regressions.</div></div><div><h3>Results</h3><div>Prenatal ID and IDA at the first and third antenatal care visit (ANC) were positively associated with infant BLL above 50 μg/L. Infants of mothers with prenatal ID and IDA had higher BLL. Moreover, prenatal ID and IDA at first and second ANC visits were positively associated with higher infant BML. In infancy, infants with ID and IDA had significantly higher BLL as compared to those without ID and IDA. Infant ID and IDA were positively associated with elevated BLL.</div></div><div><h3>Conclusion</h3><div>Elevated BLL and BML in infants were positively associated with ID and/or IDA prenatally during at least one ANC visit, while in infancy, infant ID and IDA were positively associated with elevated BLL only. Infants with ID and IDA showed higher BLL but not BML. This suggests that ID prenatally and during infancy may contribute to high blood lead concentrations in infants, which can lead to neurotoxicity. Treating ID and IDA is critical to prevent toxicity caused by high BLL in infants.</div></div>","PeriodicalId":11435,"journal":{"name":"Early human development","volume":"205 ","pages":"Article 106255"},"PeriodicalIF":2.2,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143829117","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A study of the infant's lived experience of neonatal intensive care","authors":"Natalie Duffy ,&nbsp;Leah Hickey ,&nbsp;Karli Treyvaud ,&nbsp;Clare Delany","doi":"10.1016/j.earlhumdev.2025.106254","DOIUrl":"10.1016/j.earlhumdev.2025.106254","url":null,"abstract":"<div><h3>Background</h3><div>Neonatal care is essential for survival. However, advancements in medical care may come at a cost to the infant's experience of living. Research has traditionally focused on the effectiveness of the medical aspects of neonatal intensive care. Less attention has been paid to the subjective experience of infants hospitalised in NICU.</div></div><div><h3>Aim</h3><div>To provide an infant-centred, rich understanding and comprehensive analysis of the lived experience of infants hospitalised in NICU.</div></div><div><h3>Methods</h3><div>To explore the infant experience, we designed a novel approach, termed 360-degree phenomenology. We utilised observational fieldnotes, bedside diaries, Newborn Behavioural Observation recording forms and verbatim transcripts from individual interviews. Thematic analysis was used to analyse these data sources.</div></div><div><h3>Results</h3><div>This paper uses the whole data set (comprising a series of 7 case studies) to describe 4 overarching themes: (1) scary and safe; (2) all these hard things; (3) an emotional challenge; and (4) moments of meeting.</div></div><div><h3>Conclusion</h3><div>Hospitalisation in the newborn period poses a significant challenge to the developing infant by virtue of the complex and confronting early life experiences they endure, both physically and emotionally. This research illuminates these challenges but also shows moments of powerful meeting and connection, that serve to protect and nurture the developing infant. By listening to and valuing the infant's unique perspective and placing the infant as a person central to their own care, our research highlights strategies for immediate actionable change and future areas of research to better their early life experiences and improve long-term health outcomes.</div></div>","PeriodicalId":11435,"journal":{"name":"Early human development","volume":"205 ","pages":"Article 106254"},"PeriodicalIF":2.2,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143783673","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sleep and emotional functioning in premature children: A systematic literature review","authors":"Annemarie Kim Kozole Smid ,&nbsp;Vita Štukovnik ,&nbsp;Karin Bakracevic","doi":"10.1016/j.earlhumdev.2025.106251","DOIUrl":"10.1016/j.earlhumdev.2025.106251","url":null,"abstract":"<div><div>Sleep, as the predominant behavioral state in newborns, especially in preterm infants, represents a key component for development. It is suggested that preterm children exhibit greater sleep difficulties compared to full-term children, as well as a disproportionately higher prevalence of emotional deficits. Due to the limited research on sleep and emotional functioning in the population of preterm children, particularly their interconnections, the primary aim of this systematic literature review was to explore existing scientific research on sleep and emotional functioning in preterm children, with particular focus on emotional regulation. Additionally, we aimed to examine potential links between these two constructs in this population. As a secondary objective, the review also considered studies addressing any interventions related to sleep or emotional functioning in preterm children. The results of the systematic literature review did not allow for definite conclusions regarding sleep in preterm compared to full-term children from a qualitative perspective. On the other hand, an increased presence of emotional and behavioral difficulties in this population was clearly identified. An effective intervention for regulating emotions and sleep was found to be the kangaroo care, as well when combined with music intervention. Breastfeeding also demonstrated positive effects on behavioral and emotional functioning. There appears to be a tendency for sleep problems to manifest more noticeably in late compared to early childhood. This finding highlighted the importance of long-term monitoring of this population through later childhood, adolescence, and even adulthood to better understand the long-term consequences of preterm birth on sleep and emotional functioning. Further research is essential for developing interventions that could mitigate or prevent long-term negative effects on sleep and emotional well-being associated with preterm birth.</div></div>","PeriodicalId":11435,"journal":{"name":"Early human development","volume":"205 ","pages":"Article 106251"},"PeriodicalIF":2.2,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143791103","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Breech presentation at birth has short-term but no long-term effect on neurodevelopmental outcome in moderate and late preterm infants","authors":"Anna Scheuchenegger ,&nbsp;Christa Einspieler ,&nbsp;Peter B. Marschik ,&nbsp;Jasmin Pansy ,&nbsp;Constanze Sommer ,&nbsp;Bernhard Resch","doi":"10.1016/j.earlhumdev.2025.106253","DOIUrl":"10.1016/j.earlhumdev.2025.106253","url":null,"abstract":"<div><h3>Aim</h3><div>To investigate the effects of fetal presentation at birth on spontaneous postnatal movements, postures and neurodevelopmental outcome in moderate and late preterm (MLPT) infants.</div></div><div><h3>Methods</h3><div>The study population comprised 154 infants (55 % male, 55 % singletons) of whom 33 (21 %) were born in breech presentation. During the neonatal period and at 3–4 months post-term age, categorical Prechtl general movements assessment (GMA) and detailed scoring of motor functions was performed by means of the General Movement Optimality Score (GMOS) neonatally and Motor Optimality Score-Revised (MOS-R) later. Neurodevelopment was assessed at one year using Bayley-III.</div></div><div><h3>Results</h3><div>Infants born in breech presentation more frequently exhibited pathological GMs (<em>p</em> = 0.05) with increased stiffness in the lower extremities (<em>p</em> &lt; 0.01) at neonatal age. Detailed motor assessments at 3–4 months post-term age (MOS-R) showed lower scores in infants born in breech compared to those with cephalic presentation at birth. Fetal presentation at the time of delivery did not impact neurodevelopmental outcomes at 12 months.</div></div><div><h3>Conclusion</h3><div>Breech presentation at birth affected GMs and movement assessments in the early postnatal period but had no persistent impact on neurodevelopmental outcomes at one year, suggesting a transient effect on lower extremity movements. Given stiffness in the extremities in neonates is an alarm sign and might relate to cramped synchronized GMs indicating an increased risk for cerebral palsy, fetal presentation at birth should be taken into consideration in neonatal neuromotor assessments.</div></div>","PeriodicalId":11435,"journal":{"name":"Early human development","volume":"205 ","pages":"Article 106253"},"PeriodicalIF":2.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143791104","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors affecting the incidence of congenital anomaly of the kidney and urinary tract: A systematic review and meta-analysis","authors":"Gusti Ngurah P. Pradnya Wisnu ,&nbsp;Gerhard Reinaldi Situmorang ,&nbsp;Irfan Wahyudi ,&nbsp;Arry Rodjani ,&nbsp;Reza Fahlevi ,&nbsp;Putu Angga Risky Raharja","doi":"10.1016/j.earlhumdev.2025.106252","DOIUrl":"10.1016/j.earlhumdev.2025.106252","url":null,"abstract":"<div><h3>Introduction</h3><div>Congenital anomaly of kidney and urinary tract (CAKUT) is one of the most common congenital anomalies, occurring in over 1 % of live births and accounting for 40–50 % of chronic kidney failure cases in children. The prevalence of CAKUT was multifaceted and varies widely. This study aimed to report the latest evidence of incidence, trends, and risk factors associated with the incidence of CAKUT.</div></div><div><h3>Evidence acquisition</h3><div>We conducted a systematic search of PubMed, ScienceDirect, Scopus, and Proquest databases. The included studies were then assessed using Newcastle-Ottawa (NOS) risk of bias tools. Meta-analysis was performed using Review Manager version 5.4.1 software and presented as pooled incidence and Odds Ratio (OR) with a 95 % confidence interval.</div></div><div><h3>Evidence synthesis</h3><div>Eight studies in total were included from 2004 to 2022 (12.838 infants of all ages). NOS risk of bias tools indicated all studies had low risk of bias. The overall pooled incidence of CAKUT was 13,6 per 1000 births (95 % CI: 4 to 45,7 per 1000 births) in all infants and 4,9 per 1000 births (95 % CI: 1,1 to 21,3 per 1000 births) in term infants without congenital anomalies, with an increasing trend over the years. Factors, such as sex (boys) (OR = 1,53; 95 % CI 1,26-1,86), prematurity (OR = 1,46; 95 % CI 1,27-1,67), low birth weight (OR = 1,28; 95 % CI 1,10-1,48), maternal diabetes (OR = 1,81; 95 % CI 1,43-2,28), maternal obesity (OR = 1,45; 95 % CI 1,23-1,70), and maternal age (&gt;40 years) were also found to be risk factors of CAKUT incidence. Furthermore, one study reported race (black people [OR = 0,89; 95 % CI 0,87-0,91] and Hispanics [OR = 1,22; 95 % CI 1,18-1,25]) to be a risk factor of CAKUT.</div></div><div><h3>Conclusions</h3><div>The incidence of CAKUT was high and showed an increasing trend over the years. Several risk factors, such as sex, prematurity, low birth weight, maternal diabetes, maternal obesity, maternal age and race were also found to be associated with CAKUT incidence. These findings should increase awareness regarding CAKUT incidence in at-risk populations.</div></div>","PeriodicalId":11435,"journal":{"name":"Early human development","volume":"205 ","pages":"Article 106252"},"PeriodicalIF":2.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143783672","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Timing of initiation of therapeutic hypothermia in neonates with hypoxic ischemic encephalopathy born at a high-volume urban safety net hospital","authors":"Christine C. Pazandak ,&nbsp;Maria Grajeda Martinez ,&nbsp;Megan E. Whiting ,&nbsp;Srinivas Kota ,&nbsp;L. Steven Brown ,&nbsp;Lina F. Chalak ,&nbsp;Rachel L. Leon","doi":"10.1016/j.earlhumdev.2025.106249","DOIUrl":"10.1016/j.earlhumdev.2025.106249","url":null,"abstract":"<div><h3>Background</h3><div>Ethnic and racial disparities in neonatal outcomes have been well-documented, including higher risk of hypoxic-ischemic encephalopathy (HIE). Therapeutic hypothermia (TH) is the only approved treatment for infants with moderate to severe HIE and previous studies have shown mixed results regarding the impact of timing of initiation of TH on outcomes. These studies often include both inborn and outborn neonates and few minority patients.</div></div><div><h3>Study design</h3><div>This retrospective cohort study of exclusively inborn neonates from a high-volume, urban, safety net hospital (SNH) serving primarily racial/ethnic minority patients assessed the impact of timing of initiation of TH on short-term outcomes.</div></div><div><h3>Results</h3><div>There were 268 infants diagnosed with moderate or severe HIE from 2009 to 2023. After excluding patients for late cooling (<em>n</em> = 32), participation in a clinical trial (<em>n</em> = 41), and major comorbidities (<em>n</em> = 8), there were 187 patients for analysis. Similar to our neonatal population, this study cohort consisted of 94 % racial/ethnic minority patients. The average time to initiate TH was 4.4 ± 1.1 h of life (HOL) and 88 % of qualifying neonates received TH by 6 HOL. Those initiating TH at &lt;4 HOL compared to 4–6 HOL were more likely to have severe HIE (<em>p</em> = 0.01). The adjusted OR for the primary outcome of in-hospital death was not associated with timing of initiation of TH [aOR = 0.75 (95 % CI 0.40–1.33); <em>p</em> = 0.33], nor were secondary outcomes of abnormal brain MRI or length of stay.</div></div><div><h3>Conclusion</h3><div>In a vulnerable population from a high-volume SNH, timing of initiation of TH was not associated with short-term outcomes.</div></div>","PeriodicalId":11435,"journal":{"name":"Early human development","volume":"204 ","pages":"Article 106249"},"PeriodicalIF":2.2,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143714670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of prenatal testosterone-estrogen balance in the development of Os trigonum: A comparative matched-pair analysis","authors":"Mehmet Ali Tokgoz ,&nbsp;Asim Ahmadov ,&nbsp;Ethem Burak Oklaz ,&nbsp;Haluk Yaka ,&nbsp;Ramazan Duzgun ,&nbsp;Cagatay Delice ,&nbsp;Ulunay Kanatli","doi":"10.1016/j.earlhumdev.2025.106250","DOIUrl":"10.1016/j.earlhumdev.2025.106250","url":null,"abstract":"<div><h3>Background</h3><div>The 2D:4D ratio, a marker of the prenatal testosterone-estrogen balance, is defined as the proportion of the second to fourth finger lengths, with lower values indicating greater testosterone exposure. Studies demonstrated that this exposure affects chondrocyte activity and function during secondary ossification. Considering that the os trigonum is an unfused secondary ossification center, investigating the relationship between hormonal balance and os trigonum could provide valuable insights as etiopathogenesis.</div></div><div><h3>Aim</h3><div>To investigate the relationship between the presence of os trigonum and the 2D:4D ratio.</div></div><div><h3>Methods</h3><div>A matched-pair cohort study was conducted to compare patients with and without an os trigonum among those undergoing ankle arthroscopy between 2019 and 2024. 34 patients in each group were matched 1:1 by age, sex, body mass index, and history of ankle overuse before age 14. Finger lengths were measured with a caliper and 2D:4D ratios were determined.</div></div><div><h3>Results</h3><div>The analysis revealed that patients with os trigonum had significantly lower 2D:4D ratios in the right hand (<em>p</em> &lt; 0.001), left hand (p &lt; 0.001), and average of both (p &lt; 0.001) compared to those without. The average 2D:4D ratio had the highest predictive ability (AUC = 0.867), with a cut-off of 0.997 predicting the presence of os trigonum with 91.2 % sensitivity and 70.6 % specificity.</div></div><div><h3>Conclusion</h3><div>A low 2D:4D ratio, indicative of high intrauterine testosterone exposure, is associated with the presence of an os trigonum. Therefore, this research contributes to the growing evidence that prenatal testosterone exposure, may influence specific skeletal characteristics, such as the formation of accessory bones.</div></div>","PeriodicalId":11435,"journal":{"name":"Early human development","volume":"204 ","pages":"Article 106250"},"PeriodicalIF":2.2,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143714729","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Forever premature: Adults born preterm and their life challenges","authors":"Gaby Stegmann-Woessner ,&nbsp;Peter Bartmann ,&nbsp;Barbara Mitschdoerfer ,&nbsp;Dieter Wolke","doi":"10.1016/j.earlhumdev.2025.106248","DOIUrl":"10.1016/j.earlhumdev.2025.106248","url":null,"abstract":"<div><h3>Background</h3><div>Adults born preterm face greater social, cognitive, mental and physical challenges in adulthood than their full term born peers according to longitudinal studies. In contrast, little is known about the lived experiences of adults born preterm.</div></div><div><h3>Objective</h3><div>The study investigates the lived experiences of adults born preterm across the life course and their views on health care support.</div></div><div><h3>Methods</h3><div>A qualitative study of 21 participants completing semi structured interviews analyzed through content analysis.</div></div><div><h3>Results</h3><div>Over half of adults born preterm report trauma and feeling of otherness since early childhood, high sensitivity to the environment, higher introversion/shyness and social or performance related anxiety. Over half reported that their parents were traumatized by the preterm birth and tried to compensate by overprotective parenting that, however, stifled them becoming independent. Over half experienced bullying victimization and many have continuing mental health problems. Overload by demands in school or work is a consistent theme that makes it hard to have the energy to socialize. Many received physical therapy in childhood and most had psychotherapy in adulthood. Many feel that health professionals trivialize the long-term effects of prematurity and most find support from their parents or peer network.</div></div><div><h3>Conclusions</h3><div>Prematurity has significantly shaped the life of adults born preterm. Greater awareness and recognition of the unique needs of this group are essential to provide adequate support. Existing services fail to address these needs highlighting an urgent demand for enhanced social and psychological services for educational and workplace settings.</div></div>","PeriodicalId":11435,"journal":{"name":"Early human development","volume":"204 ","pages":"Article 106248"},"PeriodicalIF":2.2,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143642519","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical and echocardiographic predictors of medical therapy failure for patent ductus arteriosus closure in preterm infants: Insights from a risk-based treatment approach","authors":"Rachel Mullaly ,&nbsp;Aisling Smith ,&nbsp;Orla Franklin ,&nbsp;Naomi McCallion ,&nbsp;Afif EL-Khuffash","doi":"10.1016/j.earlhumdev.2025.106238","DOIUrl":"10.1016/j.earlhumdev.2025.106238","url":null,"abstract":"<div><h3>Objective</h3><div>This study aims to identify initial clinical and echocardiographic markers in preterm infants which may predict failure of medical therapy to close a high-risk patent ductus arteriosus (PDA).</div></div><div><h3>Study design</h3><div>This was an observational cohort study conducted in a level III NICU. Infants born &lt;29 weeks gestation were treated with medical therapy if they were deemed high-risk as per the EL-Khuffash PDA Severity Score (PDAsc). Treatment-failure infants were compared to treatment-success infants.</div></div><div><h3>Results</h3><div>110 infants were high-risk (58 responders, 52 non-responders). Initial differences in clinical and echocardiographic characteristics between infants in the treatment-failure and treatment-success groups, respectively, included a lower gestational age (25.2 ± 1.3 vs 25.9 ± 1.4; <em>p</em> &lt; 0.01), higher PDAsc (7.8 ± 1.9 vs 7.0 ± 1.5; p &lt; 0.01), lower incidence of pre-eclampsia (3 (6 %) vs 12 (21 %); <em>p</em> = 0.02), lower mitral E:A ratio (0.78 ± 0.13 vs 0.90 ± 0.27; p = 0.02), higher LA:Ao ratio (1.7 ± 0.6 vs 1.4 ± 0.5; <em>p</em> = 0.02), lower celiac artery systolic velocity(m/s) (0.36 ± 0.12 vs 0.46 ± 0.20; p = 0.02) and higher global longitudinal strain (GLS) (%) (20.8 ± 3.1 vs 18.1 ± 4.4; <em>p</em> &lt; 0.01). In a multivariate logistic regression model, GLS remained the only independent predictor of medical therapy failure (OR 0.83, 95 % CI 0.70–0.98, <em>p</em> = 0.03).</div></div><div><h3>Conclusion</h3><div>These findings highlight a distinct subgroup of high-risk preterm infants who are unlikely to respond to medical therapy, emphasising the need for an individualised approach to PDA management. Integrating clinical and echocardiographic markers with risk-based scoring systems may improve early identification of treatment non-responders and guide alternative therapeutic strategies.</div></div>","PeriodicalId":11435,"journal":{"name":"Early human development","volume":"204 ","pages":"Article 106238"},"PeriodicalIF":2.2,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143578680","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}