Background

A sensitive, well-functioning maternal interaction is vital for healthy infant development. For moderate to late preterm infants, this is even more important as this group of infants are at increased risk of facing neurodevelopmental disorders. The Early Collaborative Intervention supports parent-preterm infant interaction and includes three sessions, two in the hospital and one after discharge.

Objective

To investigate the impact of the Early Collaborative Intervention, compared with standard care, on mother-preterm infant interaction at one month corrected age.

Design

A longitudinal randomized controlled trial, reporting secondary outcomes from the first follow-up. SettingThe intervention was conducted at a pediatric center with two neonatal intensive care units with an infant and family centered approach. The intervention was evaluated in the homes of the families.

Participants

Families with preterm infants born in gestational week 30+0–35+6 (n = 143) were randomized. In this one-month follow up a total of 101 families participated, (standard care with the Early Collaborative Intervention, n = 60, standard care, n = 41).

Methods

The mother-infant interactive behavior was videotaped during a bath and later analyzed with Ainsworth’s Maternal Sensitivity Scales and the Emotional Availability Scales. The coder was masked to group randomization as well as to demographic data of the dyads.

Results

In the analysis the maternal mean scores were statistically significantly higher for the intervention-group versus the standard care group in the Availability subscale, 7.30 vs 6.29 (CI 0.01–0.86, p = 0.045, Cohen’s d 0.43), and Acceptance subscale, 8.00 vs 7.22 (CI 0.12–0.97, p = 0.012, Cohen’s d 0.55), in the Ainsworth’s Maternal Sensitivity Scales. Mean score were also statistically significantly higher for the intervention-group versus the standard care group in the Non-hostility subscale, 6.60 vs 6.12 (CI 0.11–0.97, p = 0.013, Cohen’s d 0.54), in the Emotional Availability Scales. The results suggest that these aspects of maternal interactive behavior towards her infant, are the ones most influenced by the Early Collaborative Intervention.

Conclusions

The Early Collaborative Intervention had beneficial impacts on maternal interactive behavior for those who took part in three sessions or more of the intervention program.

Registration

The project was registered in ClinicalTrials.gov with the number: NCT02034617, registered 19/12/2013, date of the first recruitment 15/01/2014.

AimThis study aimed to determine the longitudinal impact of the EArly Collaborative Intervention (EACI), a three-session early intervention designed to enhance parent-infant interaction, on the developmental outcomes of preterm infants born between 30 + 0 and 35 + 6 weeks of gestation.MethodsThis randomised controlled blinded study recruited families in two neonatal intensive care units in Sweden. In this one-year follow-up, 87 infants (standard care = 37, standard care with EACI = 50) were included in the intention-to-treat analysis. The primary study outcomes were cognition, receptive and expressive communication, and fine and gross motor development measured with the Bayley-III.ResultsAt one year of age (mean age 13.1 months SD = 0.64), there was a statistically significant effect in the intention-to-treat analysis on receptive communication F(1, 85) = 4.61, p = 0.035, eta 2 = 0.051. No statistically significant effects were found on the other Bayley-III outcome measures. There were no significant differences between the groups regarding gestational age, birth weight, gender, parents' education, or age at assessment.ConclusionThis new intervention indicates a small positive effect on moderate-to-late preterm infants' communication ability at one year of age. Though the attrition rate was relatively large, results are encouraging since clinical interventions supporting moderate-to-late preterm infants and parents are lacking.Trial Registration: NCT02034617

The overall aim of this scoping review was to map the existing literature on residual placental blood volume in cesarean sections as an indirect measure of placental transfusion. Multiple databases including Pubmed, Cochrane, Embase and Web of Science were searched for relevant studies published between 1972 and 2023. All studies on cesarean sections with term pregnancies and information on residual placental blood volume were included. The PRISMA checklist was used for guiding the writing of this report. The literature search resulted in 31 studies including 8337 neonates born by cesarean section. Only four studies specifically explored cord clamping time in cesarean section and following residual placental blood volume. All except one, showed a significant association between delayed cord clamping and decreased residual placental blood volume, indicating an increased placental transfusion to the infant. No difference was found between emergency and elective cesarean section. Inconclusive results appeared regarding association between placental weight, foetal weight, gravitation, uterotonics and residual placental blood volume. Delayed cord clamping time in cesarean section seems to be associated with a decreased residual placental blood volume indicating an increased transfusion to the infant. Due to the limited evidence revealing placental transfusion in cesarean section, further studies are needed to investigate the physiology of placental transfusion and to identify the optimal time of cord clamping at cesarean section.

ObjectiveTo explore associations between perinatal activity and survival in infants born at 22 and 23 weeks of gestation in Sweden. Design/SettingData on all births at 22 and 23 weeks gestational age (GA) were prospectively collected in 2004-2007 (T1) or obtained from national registers in 2014-2016 (T2) and 2017-2019 (T3). Infants were assigned perinatal activity scores based on 3 key obstetric and 4 neonatal interventions. Main outcomeOne-year survival and survival without major neonatal morbidities (MNM): intraventricular haemorrhage grade 3-4, cystic periventricular leucomalacia, surgical necrotising enterocolitis, retinopathy of prematurity stage 3-5 or severe bronchopulmonary dysplasia. The association of GA-specific perinatal activity score and 1-year survival was also determined. Results977 infants (567 live births and 410 stillbirths) were included: 323 born in T1, 347 in T2 and 307 in T3. Among live-born infants, survival at 22 weeks was 5/49 (10%) in T1 and rose significantly to 29/74 (39%) in T2 and 31/80 (39%) in T3. Survival was not significantly different between epochs at 23 weeks (53%, 61% and 67%). Among survivors, the proportions without MNM in T1, T2 and T3 were 20%, 17% and 19% for 22 weeks and 17%, 25% and 25% for 23 weeks infants (p>0.05 for all comparisons). Each 5-point increment in GA-specific perinatal activity score increased the odds for survival in first 12 hours of life (adjusted OR (aOR) 1.4; 95% CI 1.3 to 1.6) in addition to 1-year survival (aOR 1.2; 95% CI 1.1 to 1.3), and among live-born infants it was associated with increased survival without MNM (aOR 1.3; 95% CI 1.1 to 1.4). ConclusionIncreased perinatal activity was associated with reduced mortality and increased chances of survival without MNM in infants born at 22 and 23 weeks of GA.

Aim To explore mothers experiences of the EArly Collaborative Intervention. Background Preterm birth puts a considerable emotional and psychological burden on parents and families. Parents to moderate and late premature infants have shorter stays at the neonatal intensive care unit and have described a need for support. The EArly Collaborative Intervention was developed to support parents with preterm infants born between gestational Weeks 30 to 36. In this study, mothers experiences of the new intervention were explored. Design A qualitative design guided by a reflexive thematic analysis according to Braun and Clarke. Interviews were individually performed with 23 mothers experienced with the EArly Collaborative Intervention. Data were identified, analysed and reported using reflexive thematic analysis. The COREQ checklist was used preparing the manuscript. Results Two main overarching themes were constructed. The first theme, mothers feelings evoked from the EArly Collaborative Intervention describes the emotions raised by the intervention and how the intervention affected their parental role. Their awareness of the preterm babys behaviour increased, and the intervention helped the parents to communicate around their babys needs. The second theme, based on the preterm babys behavior, describes experiences of the provision and the learning process about their preterm babys needs and communication. The intervention was experienced as helpful both immediately and for future interaction with the baby. Conclusions Mothers found the intervention to be supportive and encouraging. They came to look upon their baby as an individual, and the new knowledge on how to care and interact with their baby affected both their own and their babys well-being. Furthermore, the intervention felt strengthening for their relationship with the other parent. Relevance to Clinical Practice The EArly Collaborative Intervention can support parents abilities as well as their relation to their baby and may thereby contribute to infant development, cognition and well-being.

16S rRNA gene sequencing enables microbial community profiling, but recovering fecal DNA from extremely premature infants is challenging. Here, we describe an optimized protocol for fecal DNA isolation, library preparation for 16S rRNA gene sequencing, taxonomy assignation, and statistical analyses. The protocol is complemented with a quantitative PCR for probiotic L. reuteri identification. This protocol describes how to characterize preterm infant gut microbiota and relate it to probiotic supplementation and clinical outcomes. It is customizable for other clinical trials. For complete details on the use and execution of this protocol, please refer to Martí et al. (2021) and Spreckels et al. (2021).

Background Early colonization with a diverse microbiota seems to play a crucial role for appropriate immune maturation during childhood. Breastmilk microbiota is one important source of microbes for the infant, transferred together with maternal IgA antibodies. We previously observed that allergy development during childhood was associated with aberrant IgA responses to the gut microbiota already at 1 month of age, when the IgA antibodies are predominantly maternally derived in breastfed infants. Objective To determine the microbial composition and IgA-coated bacteria in breastmilk in relation to allergy development in children participating in an intervention trial with pre- and post-natal Lactobacillus reuteri supplementation. Methods A combination of flow cytometric cell sorting and 16S rRNA gene sequencing was used to characterize the bacterial recognition patterns by IgA in breastmilk samples collected one month post-partum from 40 mothers whose children did or did not develop allergic and asthmatic symptoms during the first 7 years of age. Results The milk fed to children developing allergic manifestations had significantly lower bacterial richness, when compared to the milk given to children that remained healthy. Probiotic treatment influenced the breastmilk microbiota composition. However, the proportions of IgA-coated bacteria, the total bacterial load and the patterns of IgA-coating were similar in breastmilk between mothers of healthy children and those developing allergies. Conclusion Consumption of breastmilk with a reduced microbial richness in the first month of life may play an important role in allergy development during childhood.

gamma delta T cells are unconventional T cells that function on the border of innate and adaptive immunity. They are suggested to play important roles in neonatal and infant immunity, although their phenotype and function are not fully characterized in early childhood. We aimed to investigate gamma delta T cells in relation to age, prematurity and cytomegalovirus (CMV) infection. Therefore, we used flow cytometry to characterize the gamma delta T-cell compartment in cord blood and peripheral blood cells from 14-day-, 2-year- and 5-year-old children, as well as in peripheral blood samples collected at several time points during the first months of life from extremely premature neonates. gamma delta T cells were phenotypically similar at 2 and 5 years of age, whereas cord blood was divergent and showed close proximity to gamma delta T cells from 14-day-old neonates. Interestingly, 2-year-old children and adults showed comparable V delta 2(+) gamma delta T-cell functionality toward both microbial and polyclonal stimulations. Importantly, extreme preterm birth compromised the frequencies of V delta 1(+) cells and affected the functionality of V delta 2(+) gamma delta T cells shortly after birth. In addition, CMV infection was associated with terminal differentiation of the V delta 1(+) compartment at 2 years of age. Our results show an adult-like functionality of the gamma delta T-cell compartment already at 2 years of age. In addition, we demonstrate an altered gamma delta T-cell phenotype early after birth in extremely premature neonates, something which could possible contribute to the enhanced risk for infections in this vulnerable group of children.

The recently documented high survival of extremely preterm infants in Sweden is related to a high degree of centralization of pre- and postnatal care and to recently issued national consensus guidelines providing recommendations for perinatal care at 22-24 gestational weeks. The prevalence of major neonatal morbidity remains high and exceeded 60 % in a recent study of extremely preterm infants born at < 27 gestational weeks delivered in Sweden in 2014-2016 and surviving to 1 year of age. Damage to immature organ systems inflicted during the neonatal period causes varying degrees of functional impairment with lasting effects in the growing child. There is an urgent need for evidence-based novel interventions aiming to prevent neonatal morbidity with a subsequent improvement of long-term outcome.

Överlevnaden till 1 års ålder är hög hos extremt för tidigt födda barn (<28 graviditetsveckor) i Sverige, vilket är kopplat till en höggradigt genomförd centralisering av prenatal och neonatal vård.

Förekomsten av neonatal sjuklighet efter extremt förtidig födelse är i hög grad kopplad till framtida funktionsnedsättning hos det växande barnet och utgör en stor kvarstående utmaning.

Det finns ett tydligt behov av nya evidensbaserade preventiva interventioner liksom validering av existerande kliniska behandlingar. 

Preterm delivery in Sweden constitutes 5.7 % of all deliveries, which is among the lowest rates in the world. There has not been any increase in the proportion of iatrogenic preterm deliveries during the last decades.The main hypothesis concerning the causality of preterm delivery is still that of the ascending infection from the vagina to the uterus and inflammation resulting in contractions, rupture of membranes and delivery. The mechanisms behind parturition at term are still elusive and this is also true for preterm delivery. The genetic contribution to preterm delivery is about 25-30 %. The first genes that are associated with preterm delivery and gestational duration have recently been published. Huge progress has been made in care of preterm born infants. Sweden has among the lowest rates of mortality and morbidity in the world, especially in the lowest gestational weeks. New modes of care, family-centered care and hospital-assisted home care, have empowered the parents and reduced the cost for care.

Förtidsbörd utgör 5,7 procent av alla förlossningar i Sverige. Internationellt rapporteras från vissa länder upp till 18 procent. 

Den biologiska förståelsen av de mekanismer som resulterar i förtidsbörd är fortfarande mycket begränsad. 

Neonatalvården av för tidigt födda barn har gjort mycket stora framsteg under de senaste decennierna. Nya vårdformer har etablerats, t ex familjecentrerad vård och sjukhusassisterad hemvård i slutet av vårdtiden.

Cirka 15 miljoner barn föds för tidigt i världen varje år. De flesta av dem är födda under graviditetsvecka 32–36 och svarar för huvuddelen av mortalitet och neurologiska funktionshinder bland för tidigt födda.