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Ogata Y, Matsugaki R, Zaizen M, Kuhara S, Muramatsu K, Matsuda S, Suga S, Ito H, Saeki S. Implementation Rate of Physical Rehabilitation in Neonatal Intensive Care Units in Japan: A Retrospective Observational Study. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1075. [PMID: 39064504 PMCID: PMC11279125 DOI: 10.3390/medicina60071075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Revised: 06/25/2024] [Accepted: 06/28/2024] [Indexed: 07/28/2024]
Abstract
Background and Objective: The benefits of physical rehabilitation for very-low-birth-weight infants (VLBWI) have been reported in previous studies; however, the implementation rate of physical rehabilitation in this population remains to be clarified. This study aimed to examine the implementation rate of physical rehabilitation among VLBWI admitted to the neonatal intensive care unit (NICU) using real-world data. Material and Methods: This observational study obtained data from a nationwide administrative database associated with the diagnostic procedure combination (DPC) system in Japan (2014-2019). The participants were 30,464 infants admitted to the NICU between 2014 and 2019. The overall NICU physical rehabilitation rates and background factors of the participants were examined. Results: The overall physical rehabilitation rate in NICUs was 18%. Infants born at <28 weeks of age and extremely low birth weight infants (ELBWI) were more likely to receive physical rehabilitation interventions. The length of stay at the NICU and hospital, as well as the rate of discharge, were higher in patients who received physical rehabilitation than those in infants who did not. Conclusions: One-fifth of all patients admitted to the NICU received physical rehabilitation interventions. Extremely preterm infants and ELBWI were more likely to receive physical rehabilitation interventions. We need to consider ways to increase physical rehabilitation intervention rates in the NICU.
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Affiliation(s)
- Yuto Ogata
- Department of Rehabilitation, University Hospital of Occupational and Environmental Health, Yahatanishi-ku, Kitakyushu 807-8556, Japan
| | - Ryutaro Matsugaki
- Department of Work Systems and Health, Institute of Industry Ecological Sciences, University of Occupational and Environmental Health, Yahatanishi-ku, Kitakyushu 807-8556, Japan
| | - Manami Zaizen
- Department of Rehabilitation, University Hospital of Occupational and Environmental Health, Yahatanishi-ku, Kitakyushu 807-8556, Japan
| | - Satoshi Kuhara
- Department of Rehabilitation, University Hospital of Occupational and Environmental Health, Yahatanishi-ku, Kitakyushu 807-8556, Japan
| | - Keiji Muramatsu
- Department of Preventive Medicine and Community Health, School of Medicine, University of Occupational and Environmental Health, Yahatanishi-ku, Kitakyushu 807-8556, Japan; (K.M.)
| | - Shinya Matsuda
- Department of Preventive Medicine and Community Health, School of Medicine, University of Occupational and Environmental Health, Yahatanishi-ku, Kitakyushu 807-8556, Japan; (K.M.)
| | - Shutaro Suga
- Department of Pediatrics, University of Occupational and Environmental Health, Yahatanishi-ku, Kitakyushu 807-8556, Japan
| | - Hideaki Ito
- Department of Rehabilitation Medicine, University of Occupational and Environmental Health, Yahatanishi-ku, Kitakyushu 807-8556, Japan (S.S.)
| | - Satoru Saeki
- Department of Rehabilitation Medicine, University of Occupational and Environmental Health, Yahatanishi-ku, Kitakyushu 807-8556, Japan (S.S.)
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Grover M, Ashraf AP, Bowden SA, Calabria A, Diaz-Thomas A, Krishnan S, Miller JL, Robinson ME, DiMeglio LA. Invited Mini Review Metabolic Bone Disease of Prematurity: Overview and Practice Recommendations. Horm Res Paediatr 2024; 98:40-50. [PMID: 38211570 PMCID: PMC11854976 DOI: 10.1159/000536228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 12/27/2023] [Indexed: 01/13/2024] Open
Abstract
Metabolic bone disease of prematurity (MBDP) is defined by undermineralization of the preterm infant skeleton arising from inadequate prenatal and postnatal calcium (Ca) and phosphate (PO4) accretion. Severe MBDP can be associated with rickets and fractures. Despite advances in neonatal nutrition, MBDP remains prevalent in premature infants due to inadequate mineral accretion ex utero. There also remain significant knowledge gaps regarding best practices for monitoring and treatment of MBDP among neonatologists and pediatric endocrinologists. Preventing and treating MBDP can prevent serious consequences including rickets or pathologic fractures. Postnatal monitoring to facilitate early recognition of MBDP is best done by first-tier laboratory screening by measuring serum Ca, phosphorus, and alkaline phosphatase to identify infants at risk. If these laboratories are abnormal, further studies including assessing parathyroid hormone and/or tubular resorption of PO4 can help differentiate between Ca and PO4 deficiency as primary etiologies to guide appropriate treatment with mineral supplements. Additional research into optimal mineral supplementation for the prevention and treatment of MBDP is needed to improve long-term bone health outcomes and provide a fuller evidence base for future treatment guidelines. Metabolic bone disease of prematurity (MBDP) is defined by undermineralization of the preterm infant skeleton arising from inadequate prenatal and postnatal calcium (Ca) and phosphate (PO4) accretion. Severe MBDP can be associated with rickets and fractures. Despite advances in neonatal nutrition, MBDP remains prevalent in premature infants due to inadequate mineral accretion ex utero. There also remain significant knowledge gaps regarding best practices for monitoring and treatment of MBDP among neonatologists and pediatric endocrinologists. Preventing and treating MBDP can prevent serious consequences including rickets or pathologic fractures. Postnatal monitoring to facilitate early recognition of MBDP is best done by first-tier laboratory screening by measuring serum Ca, phosphorus, and alkaline phosphatase to identify infants at risk. If these laboratories are abnormal, further studies including assessing parathyroid hormone and/or tubular resorption of PO4 can help differentiate between Ca and PO4 deficiency as primary etiologies to guide appropriate treatment with mineral supplements. Additional research into optimal mineral supplementation for the prevention and treatment of MBDP is needed to improve long-term bone health outcomes and provide a fuller evidence base for future treatment guidelines.
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Affiliation(s)
- Monica Grover
- Division of Pediatric Endocrinology, Department of Pediatrics, Stanford School of Medicine, Stanford, CA, USA
| | - Ambika P. Ashraf
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sasigarn A. Bowden
- Division of Pediatric Endocrinology, Department of Pediatrics, Nationwide Children’s Hospital/The Ohio State University, Columbus, OH, USA
| | - Andrew Calabria
- Division of Endocrinology and Diabetes, Department of Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Alicia Diaz-Thomas
- Division of Pediatric Endocrinology, Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Sowmya Krishnan
- Section of Diabetes and Endocrinology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jennifer L. Miller
- Division of Pediatric Endocrinology, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Marie-Eve Robinson
- Division of Pediatric Endocrinology, Department of Pediatrics, University of Ottawa, and The Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Linda A. DiMeglio
- Division of Pediatric Endocrinology/Diabetology, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
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Schwartz BN, Pearson GD, Burns KM. Multicenter Clinical Research in Congenital Heart Disease: Leveraging Research Networks to Investigate Important Unanswered Questions. Neoreviews 2023; 24:e504-e510. [PMID: 37525311 PMCID: PMC10615178 DOI: 10.1542/neo.24-8-e504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
Congenital heart disease (CHD) is the most common birth defect in the United States. Neonates with CHD are often cared for by neonatologists in addition to cardiologists. However, there is a paucity of rigorous evidence and limited clinical trials regarding the management of neonates with CHD. In this review, we will describe some of the challenges of research in this field. The Pediatric Heart Network serves as an example of how a research network can effectively overcome barriers to conduct and execute well-designed multicenter studies.
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Affiliation(s)
- Bryanna N Schwartz
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
- Division of Cardiology, Children's National Hospital, Washington, DC
| | - Gail D Pearson
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Kristin M Burns
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
- Division of Cardiology, Children's National Hospital, Washington, DC
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Mollà-Casanova S, Sempere-Rubio N, Muñoz-Gómez E, Aguilar-Rodríguez M, Serra-Añó P, Inglés M. Effects of massage therapy alone or together with passive mobilisations on weight gain and length of hospitalisation in preterm infants: Systematic review and meta-analysis. Early Hum Dev 2023; 182:105790. [PMID: 37224588 DOI: 10.1016/j.earlhumdev.2023.105790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 04/06/2023] [Accepted: 05/05/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND The effect of massage therapy alone or together with passive mobilisations on weight gain and length of hospitalisation in very preterm and moderate-to-late preterm infants remains to be elucidated. AIM To compare massage therapy alone or combined with passive mobilisations with a control group in preterm infants. STUDY DESIGN A systematic review and meta-analysis according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement was conducted. Randomised controlled trials comparing massage therapy alone or combined with passive mobilisations with a control group in preterm infants were included. MEDLINE, EMBASE, ENFISPO, PEDro and Cochrane databases were searched up to March 2022. SUBJECTS Preterm infants. OUTCOME MEASURES Weight gain and time of hospitalisation. RESULTS Compared to usual care, massage therapy combined with passive mobilisations was demonstrated to be more effective in improving weight gain (standardized mean difference [95%CI] 0.67 [0.31, 1.02]) and reducing length of hospitalisation (0.53 [0.10, 0.97]) outcomes. However, massage therapy alone was not effective in improving weight gain (1.14 [-0.22, 2.49]). No differences in the effectiveness of these therapies between groups according to gestational age were found (p > 0.05). CONCLUSIONS Based on fair-to-high quality evidence, massage therapy combined with passive mobilisations significantly improves weight gain and reduces length of hospitalisation in premature infants. However, massage therapy alone does not achieve these improvements.
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Affiliation(s)
- Sara Mollà-Casanova
- UBIC Research Group, Department of Physiotherapy, Faculty of Physiotherapy, Universitat de València, València, Spain
| | - Núria Sempere-Rubio
- UBIC Research Group, Department of Physiotherapy, Faculty of Physiotherapy, Universitat de València, València, Spain
| | - Elena Muñoz-Gómez
- UBIC Research Group, Department of Physiotherapy, Faculty of Physiotherapy, Universitat de València, València, Spain
| | - Marta Aguilar-Rodríguez
- UBIC Research Group, Department of Physiotherapy, Faculty of Physiotherapy, Universitat de València, València, Spain
| | - Pilar Serra-Añó
- UBIC Research Group, Department of Physiotherapy, Faculty of Physiotherapy, Universitat de València, València, Spain.
| | - Marta Inglés
- UBIC Research Group, Department of Physiotherapy, Faculty of Physiotherapy, Universitat de València, València, Spain
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Pighini MJ, Guhn M, Zumbo BD. Over-reaching with causality language in neurodevelopmental infant research: A methodological literature review. Early Hum Dev 2023; 182:105781. [PMID: 37257252 DOI: 10.1016/j.earlhumdev.2023.105781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 04/25/2023] [Indexed: 06/02/2023]
Abstract
BACKGROUND A methodological review of 78 empirical articles focusing on the neurodevelopmental outcomes of at-risk infants was conducted. AIMS To examine ways language and terminology are used to describe methods, present results, and/or state conclusions in studies published during 1994-2005, a decade reflecting major advances in neurodevelopmental research and in medical intervention. More specifically, to investigate to what extent the design of the study and the language in the results section aligned in regard to causality. METHODS A process of search and selection of studies published in pediatric journals was conducted through Google Scholar. Criteria of inclusion and exclusion, following PRISMA, were used. Selected studies reported neurodevelopmental outcomes of infants and young children considered at-risk, and were further categorized accordingly to their study designs. Language use in regard to whether the presentation and interpretation of results may convey causal relationships between birth risk factors and neurodevelopmental outcomes was examined following two analytical steps. RESULTS Forty out of 78 studies, (51.28 %) used causality-implying language (e.g., effect, predict, influence) notwithstanding that the study design was non-causal. CONCLUSIONS Anticipating the next generation of neurodevelopmental-outcomes research, a framework that aims to raise awareness of the importance of language use and the impact of causality-related terms often used in longitudinal studies is proposed. The objective is to avoid ambiguities and misunderstandings around causal or non-causal connections between birth risk factors and developmental outcomes across diverse audiences, including early intervention practitioners working directly with infants and their families.
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Affiliation(s)
- Maria J Pighini
- Faculty of Education, The University of British Columbia, Canada.
| | - Martin Guhn
- Human Early Learning Partnership, School of Population and Public Health, The University of British Columbia, Canada
| | - Bruno D Zumbo
- Faculty of Education, The University of British Columbia, Canada
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Shayani LA, Marães VRFDS. Manual and alternative therapies as non-pharmacological interventions for pain and stress control in newborns: a systematic review. World J Pediatr 2023; 19:35-47. [PMID: 36100797 DOI: 10.1007/s12519-022-00601-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 07/25/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND Supporting therapies that provide stress and pain control of preterm and term newborns infants contribute positively to the neuropsychomotor development. Non-pharmacological interventions that involve manual techniques are described, considering protocols that can be reproduced by physical therapists, with positive and negative outcomes reports. DATA SOURCES Systematic review follows PRISMA 2020 statements guidelines. Primary and specific health sciences databases (Science Direct, Pubmed, Scielo, Embase and Scopus) were consulted between October 2021 and May 2022. Articles considered were clinical trials, randomized or not, that included descriptions of the type of intervention as non-pharmacological and that studied the following outcomes: "pain" and "stress". RESULTS Fifteen articles were selected for analysis, reaching a methodological quality of at least 3 on the Jadad Scale for the Quality of Researched Sources. The non-pharmacological therapies most applied in isolation were massage, swaddling or wrapping, gentle touch and kinesthetic stimulation, and the combined therapies were non-nutritive sucking and swaddling, oral sucrose and swaddling, sensory stimulation and familiar odors, and sensory saturation. The outcomes found were relaxation, pain, and stress reduction after the application of painful procedures. The behavioral changes included crying, grimacing, yawning, sneezing, jerky arm or leg movements, startles, and finger flaring. The vital signs included heart rate, blood oxygen saturation level, and pulse respiration. CONCLUSIONS Combined techniques lead to better results in controlling neonatal pain when compared to isolated techniques. They can be applied both in preterm and term infants in a safe way and are reproducible in any health unit in a simple and economical way.
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Torró-Ferrero G, Fernández-Rego FJ, Agüera-Arenas JJ, Gomez-Conesa A. Effect of physiotherapy on the promotion of bone mineralization in preterm infants: a randomized controlled trial. Sci Rep 2022; 12:11680. [PMID: 35804078 PMCID: PMC9270394 DOI: 10.1038/s41598-022-15810-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 06/29/2022] [Indexed: 11/21/2022] Open
Abstract
Preterm infants have a low level of bone mineralization compared to those born at term. The purpose of the present study was to investigate the effect of reflex locomotion therapy (RLT) on bone mineralization and growth in preterm infants and compare its effect to other physiotherapy procedures. Forty-six preterm infants born at 29–34 weeks were randomized into three groups: one group received RLT (n = 17); the other group received passive movements with gentle joint compression (n = 14); and the control group received massages (n = 15). All the treatments were performed at the neonatal unit for one month. The main outcome measure was bone mineralization, which was measured using the tibial speed of sound (Tibial-SOS). All the groups were similar in terms of gestational age (31.8 ± 1.18), birth weight (1,583.41 ± 311.9), and Tibia-SOS (1,604.7 ± 27.9) at the beginning of the intervention. At the end of the study, significant differences were found among the groups in the Tibial-SOS [F(4,86) = 2.77, p = 0.049, ηp2 = 0.114] in terms of the benefit to the RLT group. In conclusion, RLT has been effective at improving Tibial-SOS levels and has been more effective than other physical therapy modalities; therefore, it could be considered an effective physiotherapeutic modality for the prevention and treatment of osteopenia from prematurity.
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Affiliation(s)
- Galaad Torró-Ferrero
- International School of Doctorate of the University of Murcia (EIDUM), University of Murcia, Murcia, Spain.
| | | | - Juan José Agüera-Arenas
- Neonatal Intensive Care Unit, Clinic Hospital University Virgen de La Arrixaca, Murcia, Spain
| | - Antonia Gomez-Conesa
- Research Group Research Methods and Evaluation in Social Sciences, Mare Nostrum Campus of International Excellence, University of Murcia, Murcia, Spain
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Torró-Ferrero G, Fernández-Rego FJ, Jiménez-Liria MR, Agüera-Arenas JJ, Piñero-Peñalver J, Sánchez-Joya MDM, Fernández-Berenguer MJ, Rodríguez-Pérez M, Gomez-Conesa A. Effect of physical therapy on bone remodelling in preterm infants: a multicenter randomized controlled clinical trial. BMC Pediatr 2022; 22:362. [PMID: 35739544 PMCID: PMC9229521 DOI: 10.1186/s12887-022-03402-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 06/07/2022] [Indexed: 12/02/2022] Open
Abstract
Background Preterm infants have a low level of bone mineralization compared to those born at term, since 80% of calcium incorporation occurs at the end of pregnancy. The purpose of the present study was to investigate the effect of reflex locomotion therapy on bone modeling and growth in preterm infants and to compare its effect with those of other Physiotherapy modalities. Methods A multicentre randomized controlled clinical trial was conducted (02/2016 – 07/2020). 106 preterm infants born at the Virgen de la Arrixaca University Clinical Hospital, the General University Hospital of Elche and the Torrecárdenas University Hospital of Almería, between 26 and 34 weeks with hemodynamic stability, complete enteral nutrition and without any metabolic, congenital, genetic, neurological or respiratory disorders were evaluated for inclusion. Infants were randomly assigned to three groups: one group received reflex locomotion therapy (EGrlt); another group received passive mobilizations with gentle joint compression (EGpmc); and the control group received massage (CG). All treatments were carried out in the neonatal units lasting one month. The main outcome measure was bone formation and resorption measured with bone biomarkers. A mixed ANOVA was used to compare the results of bone biomarkers, and anthropometric measurements. Results Infants were randomized to EGrlt (n = 38), EGpmc (n = 32), and CG (n = 36). All groups were similar in terms of gender (p = 0.891 female 47.2%), gestational age (M = 30.753, SD = 1.878, p = 0.39) and birth weight (M = 1413.45, SD = 347.36, p = 0.157). At the end of the study, significant differences were found between the groups in their interaction in bone formation, measured with osteocalcin [F (2,35) = 4.92, p = 0.013, ηp2 = 0.043], in benefit of the EGrlt. Conclusions Reflex locomotion therapy has been effective in improving bone formation, more so than other Physiotherapy modalities. Therefore, reflex locomotion therapy could be considered one of the most effective physiotherapeutic modalities for the prevention and treatment of osteopenia of prematurity. Trial registrstion Trial retrospectively registered at ClinicalTrials.gov. First posted on 22/04/2020. Registration number: NCT04356807. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-022-03402-2.
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Affiliation(s)
- Galaad Torró-Ferrero
- International School of Doctorate of the University of Murcia (EIDUM), University of Murcia, 30100, Murcia, Spain.
| | - Francisco Javier Fernández-Rego
- Department of Physical Therapy, Faculty of Medicine University of Murcia, Espinardo, 30100, Murcia, Spain.,Early Intervention Center of Lorca City Council, Lorca, 30800, Murcia, Spain
| | | | | | - Jessica Piñero-Peñalver
- Department of Developmental and Educational Psychology, University of Murcia, Murcia, Spain.,Faculty of Psicology, University of Murcia, Espinardo, 30100, Murcia, Spain
| | | | | | | | - Antonia Gomez-Conesa
- Research Group Research Methods and Evaluation in Social Sciences. Mare Nostrum Campus of International Excellence, University of Murcia, Murcia, Spain
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Ntiloudi D, Rammos S, Giannakoulas G. Growth failure in patients with hypoplastic left heart syndrome: An ongoing challenge. Int J Cardiol 2022; 364:50-51. [PMID: 35690152 DOI: 10.1016/j.ijcard.2022.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 06/07/2022] [Indexed: 11/05/2022]
Affiliation(s)
- Despoina Ntiloudi
- Department of Cardiology, Tzaneio General Hospital of Piraeus, Piraeus, Greece
| | - Spyridon Rammos
- Department of Pediatric Cardiology and Adult Congenital Heart Disease, "Onassis" Cardiac Surgery Center, Athens, Greece
| | - George Giannakoulas
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
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Lambert LM, Pemberton VL, Trachtenberg FL, Uzark K, Woodard F, Teng JE, Bainton J, Clarke S, Justice L, Meador MR, Riggins J, Suhre M, Sylvester D, Butler S, Miller TA. Design and methods for the training in exercise activities and motion for growth (TEAM 4 growth) trial: A randomized controlled trial. Int J Cardiol 2022; 359:28-34. [PMID: 35447274 DOI: 10.1016/j.ijcard.2022.04.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 04/07/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Growth is often impaired in infants with congenital heart disease. Poor growth has been associated with worse neurodevelopment, abnormal behavioral state, and longer time to hospital discharge. Nutritional interventions, drug therapy, and surgical palliation have varying degrees of success enhancing growth. Passive range of motion (PROM) improves somatic growth in preterm infants and is safe and feasible in infants with hypoplastic left heart syndrome (HLHS), after their first palliative surgery (Norwood procedure). METHODS This multicenter, Phase III randomized control trial of a 21-day PROM exercise or standard of care evaluates growth in infants with HLHS after the Norwood procedure. Growth (weight-, height- and head circumference-for-age z-scores) will be compared at 4 months of age or at the pre-superior cavopulmonary connection evaluation visit, whichever comes first. Secondary outcomes include neonatal neurobehavioral patterns, neurodevelopmental assessment, and bone mineral density. Eligibility include diagnosis of HLHS or other single right ventricle anomaly, birth at ≥37 weeks gestation and Norwood procedure at <30 days of age, and family consent. Infants with known chromosomal or recognizable phenotypic syndromes associated with growth failure, listed for transplant, or expected to be discharged within 14 days of screening are excluded. CONCLUSIONS The TEAM 4 Growth trial will make an important contribution to understanding the role of PROM on growth, neurobehavior, neurodevelopment, and BMD in infants with complex cardiac anomalies, who are at high risk for growth failure and developmental concerns.
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Affiliation(s)
- Linda M Lambert
- Division of Pediatric Cardiothoracic Surgery, University of Utah, Salt Lake City, UT, United States of America.
| | - Victoria L Pemberton
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, NIH, Bethesda, MD, United States of America
| | | | - Karen Uzark
- Division of Cardiology, C.S. Mott Children's Hospital, Ann Arbor, MI, United States of America
| | - Frances Woodard
- Division of Pediatric Cardiology, Medical University of South Carolina, Charleston, SC, United States of America
| | - Jessica E Teng
- HealthCore Inc., Watertown, MA, United States of America
| | - Jessica Bainton
- Division of Cardiology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Shanelle Clarke
- Division of Cardiology, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, United States of America
| | - Lindsey Justice
- Division of Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States of America
| | - Marcie R Meador
- Division of Cardiology Pediatric Anesthesiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, United States of America
| | - Jessica Riggins
- Division of Cardiovascular Surgery, Riley Hospital for Children at IU Health, Indianapolis, IN, United States of America
| | - Mary Suhre
- Division of Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States of America
| | - Donna Sylvester
- Division of Cardiology, The Children's Hospital of Philadelphia, Perelman School of Medicine, Philadelphia, PA, United States of America
| | - Samantha Butler
- Department of Psychiatry, Children's Hospital Boston, Boston, MA, United States of America
| | - Thomas A Miller
- Division of Cardiology, Maine Medical Center, Portland, ME, United States of America
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Leone M, Alsofrom J, Kane M, Laryea S, Abdelatif D, Mohamed MA. Length of Neuromuscular Re-education Therapy and Growth Parameters in Premature Infants. Am J Perinatol 2022; 39:429-435. [PMID: 32916750 DOI: 10.1055/s-0040-1716492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Neuromuscular re-education (NMRE) therapy including bracing, containment, facilitation techniques, joint compression, weight (WT) bearing, and myofascial release has been shown to improve neurodevelopmental maturation in premature infants. This study aimed to examine the association of NMRE with growth parameters including WT and length (L) at 36 weeks postmenstrual age (PMA) and at discharge. STUDY DESIGN We analyzed data of infants <34 weeks gestational age (GA) or <1,800 g birth weight (BW) to examine the association of NMRE with growth parameters using correlation coefficient analysis. The effect of potential confounders was examined using multilinear regression models. RESULTS Study includes 253 premature infants. Average GA was 300/7 weeks (±23/7) and BW was 1,315 g (±416), 49.8% were females and 65% were African Americans. NMRE has inverse correlation with WT at birth and at 36 weeks PMA, -0.66 (<0.001) and -0.21 (<0.001), respectively, but not at the time of discharge. NMRE has direct correlation with change in WT from birth to 36 weeks PMA and time of discharge, 0.50 (<0.001) and 0.62 (<0.001), respectively, and from the time of starting therapy to 36 weeks PMA or discharge, 0.25 (<0.001) and 0.51 (<0.001), respectively. There was no negative correlation between NMRE with daily WT gain from birth to 36 weeks PMA or to discharge, -0.05 (0.43) and -0.07 (0.23), respectively, or from the time of starting therapy to 36 weeks PMA, -0.09 (0.14). There was an inverse correlation between NMRE with average WT gain per day from the time of starting therapy to discharge, -0.26 (<0.001), Similar findings were found examining the correlation between NMRE and changes in L. Multilinear regression analysis examining the relationship while controlling for GA, BW, sex, and race; socioeconomic variables; and concurrent massage therapy and sensory integration revealed similar results. CONCLUSION NMRE, aimed to enhance neurodevelopmental outcomes of premature infants, may not have a negative impact on their physical growth. KEY POINTS · NMRE has been introduced in the care of premature infants to improve neurodevelopmental outcomes.. · It was hypothesized that NMRE may cause stress and lead to failure to thrive or suboptimal growth.. · The association of the duration of NMRE with length and weight gain in very low birth weight infants was examined, and there was no negative correlation..
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Affiliation(s)
- Mariana Leone
- Department of Maternal and Child Health, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia
| | - Jessica Alsofrom
- Department of Pediatrics, University of California at San Francisco, San Francisco, California
| | - Megan Kane
- Department of Rehabilitation Services and Occupational Therapy, The George Washington University Hospital, Washington, District of Columbia
| | - Sarah Laryea
- Department of Rehabilitation Services and Occupational Therapy, The George Washington University Hospital, Washington, District of Columbia
| | - Dinan Abdelatif
- Department of Obstetrics and Gynecology, The George Washington University Medical Faculty Associates, Washington, District of Columbia
| | - Mohamed A Mohamed
- Department of Neonatology, Pediatrics Institute, Cleveland Clinic Children's Hospital, Cleveland, Ohio
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Kozol B, Jett P. Effects of Self-Regulated Physical Activity in Premature Infants on Bone Density and Length of Stay: A Pilot Study. Am J Occup Ther 2021; 75:14122. [PMID: 34780639 DOI: 10.5014/ajot.2021.039487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Premature infants are not prepared developmentally, physically, or cognitively with the multiple survival skills of the typical newborn. OBJECTIVE To determine whether physical activity generated spontaneously by premature infants stretching against the resistance of "prepod" garments is as effective as exercises provided by therapists in slowing bone density loss. DESIGN Preterm very low birth weight infants were placed in two nonrandomized parallel groups according to birth age. SETTING Infants routinely started in a traditional intense intervention setting and graduated to a special care section with private rooms that allowed parents to remain with their child. PARTICIPANTS Healthy infants without medical complications, born between 28 and 32 wk postmenstrual age. INTERVENTION The control group received traditional exercises. The experimental group wore a prepod almost 24 hr a day. Outcomes and Measures: An ultrasound of the tibia was obtained at 31 to 32 wk and 4 wk later. Weight gain, head circumference growth, and length of stay (LOS) were also measured. RESULTS Although not statistically significant, the ultrasound results showed that the prepod group had less loss of bone density than the traditional therapy exercise group. The desired outcome was for pods to be as effective at reducing bone loss as traditional exercise, so the results exceeded expectations. The unexpected, and more notable, finding was a striking drop in LOS for the prepod group. CONCLUSIONS AND RELEVANCE Spontaneous exercise by premature infants decreases bone loss and LOS. Better bone health and increased developmental maturity increase the chances of a positive developmental outcome and save the hospital significant expense. What This Article Adds: The prepod is a simple, cost-effective, noninvasive treatment tool occupational therapy practitioners can use to support a premature infant's development. This study has considerable potential to affect how infants are served, both developmentally and financially.
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Affiliation(s)
- Barbara Kozol
- Barbara Kozol, MS, OTL, is Occupational Therapist, Rogue Regional Medical Center, Medford, OR;
| | - Patricia Jett
- Patricia Jett, MD, is Neonatologist, Rogue Regional Medical Center, Medford, OR
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13
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常 艳, 林 新, 张 蓉, 刘 喜, 童 笑, 陈 平, 封 志. Expert consensus on clinical management of metabolic bone disease of prematurity (2021). ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2021; 23:761-772. [PMID: 34511163 PMCID: PMC8428920 DOI: 10.7499/j.issn.1008-8830.2105152] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 06/29/2021] [Indexed: 11/21/2022]
Abstract
Metabolic bone disease of prematurity (MBDP) is a systemic bone disease with a reduction in bone mineral content due to disorder of calcium and phosphorus metabolism. There is still a lack of in-depth research and systematic understanding of MBDP in China, and there are many irregularities in clinical management of this disease. Based on relevant studies in China and overseas, Grading of Recommendations Assessment, Development and Evaluation was used to develop the expert consensus on the clinical management of MBDP, which provides recommendations from the following five aspects: high-risk factors, screening/diagnosis, prevention, treatment, and post-discharge follow-up of MBDP, so as to provide relevant practitioners with recommendations on the clinical management of MBDP to reduce the incidence rate of MBDP and improve its short- and long-term prognosis.
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Affiliation(s)
| | - 新祝 林
- 厦门大学附属妇女儿童医院/厦门市妇幼保健院新生儿科， 福建厦门 361003
| | | | - 喜红 刘
- 广州市妇女儿童医疗中心 临床营养科，广东广州 510623
| | | | - 平洋 陈
- 中南大学湘雅二医院儿童医学中心新生儿专科，湖南长沙410011
| | - 志纯 封
- 解放军总医院第七医学中心八一儿童医院新生儿科北京100700
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14
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Torró-Ferrero G, Fernández-Rego FJ, Gómez-Conesa A. Physical Therapy to Prevent Osteopenia in Preterm Infants: A Systematic Review. CHILDREN (BASEL, SWITZERLAND) 2021; 8:664. [PMID: 34438555 PMCID: PMC8391284 DOI: 10.3390/children8080664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 07/16/2021] [Accepted: 07/28/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND During the last trimester of pregnancy, about 80% of the infant's calcium is incorporated, and for this reason, preterm infants have less bone mineralization compared to those born at term. The aim of the present systematic review was to identify, evaluate and summarize the studies that deal with the effect of physiotherapy modalities in the prevention and treatment of osteopenia in preterm infants. METHODS A comprehensive search (09/2019-02/2021) using PubMed, Web of Science, SCOPUS, ProQuest, SciELO, Latindex, ScienceDirect, PEDro and ClinicalTrials.gov was carried out. The following data were extracted: The number of participants, characteristics of the participants, design, characteristics of the intervention, outcome measures, time of evaluation and results. A non-quantitative synthesis of the extracted data was performed. The methodological quality and risk of bias were assessed using a PEDro scale and ROB-2 scale, respectively. RESULTS A total of 16 studies were analyzed, presenting a methodological quality that ranged from 3 to 8 points, and all showed some concerns regarding their risk of bias. Almost all studies (15/16) used passive mobilizations with joint pressure to prevent osteopenia, but they differed in the intensity and frequency of application. CONCLUSIONS A daily exercise program of passive mobilizations with joint pressure, improves bone mineralization in preterm infants admitted to neonatal units.
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Affiliation(s)
- Galaad Torró-Ferrero
- International School of Doctorate of the Univesity of Murcia (EIDUM), University of Murcia, 30100 Murcia, Spain
| | | | - Antonia Gómez-Conesa
- Research Group Research Methods and Evaluation in Social Sciences, Mare Nostrum Campus of International Excellence, University of Murcia, 30100 Murcia, Spain;
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15
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Sezer Efe Y, Erdem E, Güneş T. The Effect of Daily Exercise Program on Bone Mineral Density and Cortisol Level in Preterm Infants with Very Low Birth Weight: A Randomized Controlled Trial. J Pediatr Nurs 2020; 51:e6-e12. [PMID: 31285069 DOI: 10.1016/j.pedn.2019.05.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 05/15/2019] [Accepted: 05/30/2019] [Indexed: 12/29/2022]
Abstract
PURPOSE This randomized controlled double-blinded experimental study was carried out to determine the effects of the daily exercise program on bone mineral density and cortisol level in preterm infants with VLBW matched for birth weight, gestation week, and gender. DESIGN AND METHODS The study was carried out with preterm infants (n = 24) hospitalized in the NICU of a tertiary hospital. Ethical committee approval, institutional permission, parental written consent were obtained. A daily exercise program was implemented in preterm infants in the exercise group for 30 days, once a day, and continuing for 7-10 min. Before and after the study the following were evaluated in preterm infants in the exercise and control group: anthropometric measurements, tibia speed of sound (SOS) for bone mineral density, serum cortisol levels. RESULTS Serum cortisol levels (p = 0.05) were decreased, bone SOS values in the exercise group were increased (p = 0.009), after the study. The difference between pre-, post-study bone SOS and serum cortisol values of infants in the exercise group were high (p > 0.05). Percentage increases in anthropometric values in the exercise group were higher than the control group after the study (for all; p > 0.05). CONCLUSIONS The daily exercise program has positive effect on bone SOS and serum cortisol values in preterm infants. Neonatal nurses can implement the daily exercise program in clinical practice. Trial registration numberClinicaltrials.govNCT03773679.
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Affiliation(s)
- Yağmur Sezer Efe
- Department of Nursing, Faculty of Health Sciences, Erciyes University, Kayseri, Turkey.
| | - Emine Erdem
- Department of Nursing, Faculty of Health Sciences, Erciyes University, Kayseri, Turkey.
| | - Tamer Güneş
- Department of Pediatrics, Faculty of Medicine, Erciyes University, Kayseri, Turkey.
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16
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Tobias JH, Sayers A, Deere KC, Heazell AEP, Lawlor DA, Ireland A. Breech presentation is associated with lower adolescent tibial bone strength. Osteoporos Int 2019; 30:1423-1432. [PMID: 31020365 DOI: 10.1007/s00198-019-04945-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 03/18/2019] [Indexed: 12/28/2022]
Abstract
We compared bone outcomes in adolescents with breech and cephalic presentation. Tibia bone mineral content, density, periosteal circumference, and cross-sectional moment of inertia were lower in breech presentation, and females with breech presentation had lower hip CSA. These findings suggest that prenatal loading may exert long-lasting influences on skeletal development. INTRODUCTION Breech position during pregnancy is associated with reduced range of fetal movement, and with lower limb joint stresses. Breech presentation at birth is associated with lower neonatal bone mineral content (BMC) and area, but it is unknown whether these associations persist into later life. METHODS We examined associations between presentation at onset of labor, and tibia and hip bone outcomes at age 17 years in 1971 participants (1062 females) from a UK prospective birth cohort that recruited > 15,000 pregnant women in 1991-1992. Cortical BMC, cross-sectional area (CSA) and bone mineral density (BMD), periosteal circumference, and cross-sectional moment of inertia (CSMI) were measured by peripheral quantitative computed tomography (pQCT) at 50% tibia length. Total hip BMC, bone area, BMD, and CSMI were measured by dual-energy X-ray absorptiometry (DXA). RESULTS In models adjusted for sex, age, maternal education, smoking, parity, and age, singleton/multiple births, breech presentation (n = 102) was associated with lower tibial cortical BMC (- 0.14SD, 95% CI - 0.29 to 0.00), CSA (- 0.12SD, - 0.26 to 0.02), BMD (- 0.16SD, - 0.31 to - 0.01), periosteal circumference (- 0.14SD, - 0.27 to - 0.01), and CSMI (- 0.11SD, - 0.24 to 0.01). In females only, breech presentation was associated with lower hip CSA (- 0.24SD, - 0.43 to 0.00) but not with other hip outcomes. Additional adjustment for potential mediators (delivery method, birthweight, gestational age, childhood motor competence and adolescent height and body composition) did not substantially affect associations with either tibia or hip outcomes. CONCLUSIONS These findings suggest that prenatal skeletal loading may exert long-lasting influences on skeletal size and strength but require replication.
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Affiliation(s)
- J H Tobias
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - A Sayers
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - K C Deere
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - A E P Heazell
- Division of Developmental Biology and Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - D A Lawlor
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Science, Bristol Medical School, Bristol University, Bristol, UK
- Bristol NIHR Biomedical Research Centre, Bristol, UK
| | - A Ireland
- School of Healthcare Science, Manchester Metropolitan University, John Dalton Building, Chester Street, Manchester, M1 5GD, UK.
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17
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Effects of physical activity on children's growth. J Pediatr (Rio J) 2019; 95 Suppl 1:72-78. [PMID: 30593790 DOI: 10.1016/j.jped.2018.11.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 11/09/2018] [Accepted: 11/19/2018] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To describe the current scientific knowledge on the effects of physical exercise on the growth of children and adolescents since intrauterine life. SOURCE OF DATA A search was carried out in the Medline, Embase, Scielo, and Cochrane databases of studies published from 1990 to 2018. The authors included studies with different designs: clinical trials, cohort, cross-sectional and review studies. SYNTHESIS OF DATA Studies that addressed the subject of physical exercise or physical activity, and weight-height growth or bone or muscle tissue growth were identified. These studies were analyzed, classified, and presented by age group: fetuses, preterm newborns, preschoolers, schoolchildren, and adolescents. It was observed that almost all studies indicated the safety of physical exercises, of mild to moderate intensity, for pregnant women, as well as children and adolescents, including both aerobic and anaerobic exercises. The retrieve studies did not demonstrate that the practice of physical exercises or certain sports, especially basketball and floor gymnastics, influenced the linear growth of children or adolescents. Some studies showed an increase in bone and muscle tissue growth in child and adolescent athletes. CONCLUSIONS Despite the small number of studies with adequate methodology, especially randomized clinical trials, evidence appears to indicate that physical exercise is safe for both the pregnant woman and the child, from fetal life to adolescence. Physical exercise does not appear to impair the child's linear growth and contributes to the ideal shaping of bone and muscle tissues, ensuring possible beneficial effects throughout life.
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18
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Alves JGB, Alves GV. Effects of physical activity on children's growth. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2019. [DOI: 10.1016/j.jpedp.2019.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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19
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Xie LF, Alos N, Cloutier A, Béland C, Dubois J, Nuyt AM, Luu TM. The long-term impact of very preterm birth on adult bone mineral density. Bone Rep 2018; 10:100189. [PMID: 30627597 PMCID: PMC6319299 DOI: 10.1016/j.bonr.2018.100189] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 12/05/2018] [Accepted: 12/11/2018] [Indexed: 12/31/2022] Open
Abstract
Introduction Preterm infants are at increased risk of osteopenia of prematurity due to insufficient bone mineral accretion. Data on long term effects of prematurity on bone health are conflicting. This study aimed to compare bone mineral density (BMD) in young adults born very preterm and full-term controls and to examine factors associated with long-term bone health. Methods This observational cross-sectional study enrolled 101 young adults (18–29 years) born <29 weeks of gestation and 95 sex- and age-matched full-term controls. Participants underwent dual-energy X-ray absorptiometry to measure areal BMD and body composition. Generalized estimated equations were used to compare groups adjusting for height Z-score, lean body mass and fat mass. Results Adults born preterm were shorter and lighter than full-term controls. Areal BMD was reduced at the lumbar spine, the femoral neck and whole body in the preterm versus full-term group, but after adjustment, areal BMD Z-score was only significantly lower at the femoral neck by −0.3 unit (95% confidence interval −0.6 to −0.0). Low BMD (Z-score ≤ −1 standard deviation) at any site was observed in 53% of adults born preterm versus 28% of full-term controls, but this was not statistically significantly different. We did not identify any neonatal factors associated with lower BMD within the preterm group. Conclusions Very preterm birth is associated with lower areal BMD at the femoral neck in young adulthood, even after accounting for body size. Whether this will translate into higher risk of osteoporotic fractures later in life remains unknown.
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Affiliation(s)
- Li Feng Xie
- Research Center, Centre Hospitalier Universitaire Sainte-Justine, 3175 Chemin de la Côte-Ste-Catherine, Montreal, Quebec H3T 1C5, Canada
| | - Nathalie Alos
- Research Center, Centre Hospitalier Universitaire Sainte-Justine, 3175 Chemin de la Côte-Ste-Catherine, Montreal, Quebec H3T 1C5, Canada.,Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, 3175 Chemin de la Côte-Ste-Catherine, Montreal, Quebec H3T 1C5, Canada
| | - Anik Cloutier
- Research Center, Centre Hospitalier Universitaire Sainte-Justine, 3175 Chemin de la Côte-Ste-Catherine, Montreal, Quebec H3T 1C5, Canada
| | - Chanel Béland
- Research Center, Centre Hospitalier Universitaire Sainte-Justine, 3175 Chemin de la Côte-Ste-Catherine, Montreal, Quebec H3T 1C5, Canada
| | - Josée Dubois
- Research Center, Centre Hospitalier Universitaire Sainte-Justine, 3175 Chemin de la Côte-Ste-Catherine, Montreal, Quebec H3T 1C5, Canada.,Department of Radiology, Centre Hospitalier Universitaire Sainte-Justine, 3175 Chemin de la Côte-Ste-Catherine, Montreal, Quebec H3T 1C5, Canada
| | - Anne Monique Nuyt
- Research Center, Centre Hospitalier Universitaire Sainte-Justine, 3175 Chemin de la Côte-Ste-Catherine, Montreal, Quebec H3T 1C5, Canada.,Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, 3175 Chemin de la Côte-Ste-Catherine, Montreal, Quebec H3T 1C5, Canada
| | - Thuy Mai Luu
- Research Center, Centre Hospitalier Universitaire Sainte-Justine, 3175 Chemin de la Côte-Ste-Catherine, Montreal, Quebec H3T 1C5, Canada.,Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, 3175 Chemin de la Côte-Ste-Catherine, Montreal, Quebec H3T 1C5, Canada
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20
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Hayat TTA, Rutherford MA. Neuroimaging perspectives on fetal motor behavior. Neurosci Biobehav Rev 2018; 92:390-401. [PMID: 29886176 DOI: 10.1016/j.neubiorev.2018.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 05/22/2018] [Accepted: 06/01/2018] [Indexed: 12/19/2022]
Abstract
We are entering a new era of understanding human development with the ability to perform studies at the earliest time points possible. There is a substantial body of evidence to support the concept that early motor behaviour originates from supraspinal motor centres, reflects neurological integrity, and that altered patterns of behaviour precede clinical manifestation of disease. Cine Magnetic Resonance Imaging (cineMRI) has established its value as a novel method to visualise motor behaviour in the human fetus, building on the wealth of knowledge gleaned from ultrasound based studies. This paper presents a state of the art review incorporating findings from human and preclinical models, the insights from which, we propose, can proceed a reconceptualisation of fetal motor behaviour using advanced imaging techniques. Foremost is the need to better understand the role of the intrauterine environment, and its inherent unique set of stimuli that activate sensorimotor pathways and shape early brain development. Finally, an improved model of early motor development, combined with multimodal imaging, will provide a novel source of in utero biomarkers predictive of neurodevelopmental disorders.
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Affiliation(s)
- Tayyib T A Hayat
- Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, United Kingdom.
| | - Mary A Rutherford
- Centre for the Developing Brain, Perinatal Imaging & Health, Imaging Sciences & Biomedical Engineering Division, King's College London, London, United Kingdom
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Assisted Physical Exercise for Improving Bone Strength in Preterm Infants Less than 35 Weeks Gestation: A Randomized Controlled Trial. Indian Pediatr 2017. [DOI: 10.1007/s13312-018-1242-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Abstract
Objective
To compare the efficacy of daily assisted physical exercise (starting from one week of postnatal age) on bone strength at 40 weeks of post menstrual age to no intervention in infants born between 27 and 34 weeks of gestation.
Design
Open-label randomized controlled trial.
Setting
Tertiary-care teaching hospital in northern India from 16 May, 2013 to 21 November, 2013.
Participants
50 preterm neonates randomized to Exercise group (n=26) or Control group (n=24).
Intervention
Neonates in Exercise group underwent one session of physical exercise daily from one week of age, which included range-of-motion exercises with gentle compression, flexion and extension of all the extremities with movements at each joint done five times, for a total of 10-15 min. Infants in Control group underwent routine care and were not subjected to any massage or exercise.
Outcome measures
Primary: Bone speed of sound of left tibia measured by quantitative ultrasound at 40 weeks post menstrual age. Secondary: Anthropometry (weight length and head circumference) and biochemical parameters (calcium, phosphorus, alkaline phosphatase) at 40 weeks post menstrual age.
Results
The tibial bone speed of sound was comparable between the two groups [2858 (142) m/s vs. 2791 (122) m/s; mean difference 67.6 m/s; 95% CI -11 to 146 m/s; P=0.38]. There was no difference in anthropometry or biochemical parameters.
Conclusion
Daily assisted physical exercise does not affect the bone strength, anthropometry or biochemical parameters in preterm (27 to 34 weeks) infants.
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Abstract
Premature infants have an increased risk of osteopenia due to limited bone mass accretion in utero and a greater need for bone nutrients. Until recently, most efforts to prevent osteopenia of prematurity focused on nutritional changes. Recent studies indicate that passive range-of-motion exercise of the extremities may lead to beneficial effects on body weight, increased bone mineralization, increased bone formation markers and leptin levels, and attenuation of the natural postnatal decline in bone speed of sound. These results suggest that exercise may play an important role in the prevention and treatment of osteopenia of prematurity. This review summarizes our current knowledge on the role of exercise in the prevention and treatment of osteopenia of prematurity.
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Passive range of motion exercise to enhance growth in infants following the Norwood procedure: a safety and feasibility trial. Cardiol Young 2017; 27:1361-1368. [PMID: 28330522 PMCID: PMC5712224 DOI: 10.1017/s1047951117000427] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the safety and feasibility of a passive range of motion exercise programme for infants with CHD. Study design This non-randomised pilot study enrolled 20 neonates following Stage I palliation for single-ventricle physiology. Trained physical therapists administered standardised 15-20-minute passive range of motion protocol, for up to 21 days or until hospital discharge. Safety assessments included vital signs measured before, during, and after the exercise as well as adverse events recorded through the pre-Stage II follow-up. Feasibility was determined by the percent of days that >75% of the passive range of motion protocol was completed. RESULTS A total of 20 infants were enrolled (70% males) for the present study. The median age at enrolment was 8 days (with a range from 5 to 23), with a median start of intervention at postoperative day 4 (with a range from 2 to 12). The median hospital length of stay following surgery was 15 days (with a range from 9 to 131), with an average of 13.4 (with a range from 3 to 21) in-hospital days per patient. Completion of >75% of the protocol was achieved on 88% of eligible days. Of 11 adverse events reported in six patients, 10 were expected with one determined to be possibly related to the study intervention. There were no clinically significant changes in vital signs. At pre-Stage II follow-up, weight-for-age z-score (-0.84±1.20) and length-for-age z-score (-0.83±1.31) were higher compared with historical controls from two earlier trials. CONCLUSION A passive range of motion exercise programme is safe and feasible in infants with single-ventricle physiology. Larger studies are needed to determine the optimal duration of passive range of motion and its effect on somatic growth.
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Stalnaker KA, Poskey GA. Osteopenia of Prematurity: Does Physical Activity Improve Bone Mineralization in Preterm Infants? Neonatal Netw 2017; 35:95-104. [PMID: 27052984 DOI: 10.1891/0730-0832.35.2.95] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Bone mineralization of preterm infants is significantly less than full-term infants at birth, placing preterm infants at risk for osteopenia of prematurity and other metabolic bone diseases. Advances in nutritional supplementation and standard nursing care alone have been unsuccessful in improving bone mineralization postnatally. Research supports a daily physical activity protocol of passive range of motion and gentle joint compression when combined with adequate nutritional supplementation reduces osteopenia of prematurity. This article provides a systematic review of the current evidence surrounding early physical activity and neonatal massage for the treatment of osteopenia and indicates the need for universal handling protocols in caring for this unique population.
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Affiliation(s)
- Kelsey A Stalnaker
- CHI Baylor St. Luke' s Medical Center, Physical Medicine and Rehabilitation Department, 6720 Bertner Avenue, Houston, TX 77030, USA
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The Clinical and Biochemical Predictors of Bone Mass in Preterm Infants. PLoS One 2016; 11:e0165727. [PMID: 27806112 PMCID: PMC5091911 DOI: 10.1371/journal.pone.0165727] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 10/17/2016] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Metabolic bone disease of prematurity still occurs in preterm infants, although a significant improvement in neonatal care has been observed in recent decades. Dual-energy X-ray absorptiometry (DXA) is the precise technique for assessing bone mineral content (BMC) in preterm infants, but is not widely available. AIM To investigate the clinical and biochemical parameters, including bone metabolism markers as potential predictors of BMC, in preterm infants up to 3 months corrected age (CA). MATERIALS AND METHODS Ca-P homeostasis, iPTH, 25-hydroxyvitamin D, osteocalcin, N-terminal propeptide, cross-linked C-telopeptide and amino-terminal pro C-type natriuretic peptide and the DXA scans were prospectively performed in 184 preterm infants (≤ 34 weeks' gestation) between term age and 3 mo CA. Lower bone mass was defined as BMC below or equal to respective median value for the whole study group, rounded to the nearest whole number. RESULTS The appropriate quality DXA scans were available for 160 infants (87%) examined at term and for 130 (71%) tested at 3 mo CA. Higher iPTH level was the only independent predictor of lower BMC at term, whereas lower BMC at 3 mo CA was associated both with lower urinary phosphate excretion and higher serum osteocalcin level. ROC analysis showed that iPTH >43.6 pg/mL provided 40% sensitivity and 88% specificity in identification of preterm infants with lower BMC at term. In turn, urinary phosphate excretion (TRP>97% or UP/Cr ≤0.74 mg/mg) and serum osteocalcin >172 ng/mL provided 40% sensitivity and 93% specificity in identification of infants with decreased BMC at 3 mo CA. CONCLUSION Serum iPTH might to be a simple predictor of reduced BMC in preterm infants at term age, but urinary phosphate excretion and serum osteocalcin might predict reduced BMC at 3 mo CA. These results represent a promising diagnostic tool based on simple, widely available biochemical measurements for bone mass assessment in preterm infants.
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Miranda DL, Putman M, Kandah R, Cubria M, Suarez S, Nazarian A, Snyder B. A pediatric animal model to evaluate the effects of disuse on musculoskeletal growth and development. J Biomech 2016; 49:3549-3554. [PMID: 27623705 DOI: 10.1016/j.jbiomech.2016.08.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 06/15/2016] [Accepted: 08/16/2016] [Indexed: 12/12/2022]
Abstract
Prolonged immobilization in hospitalized children can lead to fragility fractures and muscle contractures and atrophy. The purpose of this study was to develop a lower-extremity disuse rabbit model with musculoskeletal changes similar to those observed in children subjected to prolonged immobilization. Six-week-old rabbits were randomly assigned to control (CTRL, n=4) or bilateral sciatic and femoral neurectomy (bSFN, n=4) groups. Trans-axial helical CT scans of each rabbit׳s hind limbs were acquired after eight weeks. The rabbits were then euthanized and the tibiae and calcanea were harvested from each rabbit. μCT imaging was performed on the tibiae and calcanea mid-diaphysis. Four-point bending, gas pycnometry, and ashing were then performed on each tibia. All comparisons reflect the differences between the bSFN and CTRL rabbits. Significant decreases in tibiae bone mineral density (≥9.41%, p≤0.006), axial rigidity (≥50.47%, p≤0.02), and soft tissue mass (55.25%, p=0.006) were observed from the trans-axial helical CT scans. The μCT results indicated significant detriments in tibia and calcaneus cortical thickness and bone volume fraction (p≤0.011). Significant changes in stiffness, yield load, ultimate load, and ultimate displacement (≥30.05%, p≤0.025) were observed from mechanical testing. These data indicate that limb disuse at a time of rapid musculoskeletal growth severely impairs muscle and bone development, reflecting the musculoskeletal complications observed in children with chronic medical conditions causing immobilization. Interventions to reduce these musculoskeletal complications in children are urgently needed. This disuse rabbit model will be useful in pre-clinical studies evaluating novel interventions for improving pediatric musculoskeletal health.
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Affiliation(s)
- Daniel L Miranda
- Wyss Institute for Biologically Inspired Engineering at Harvard University, Boston, MA, USA.
| | - Melissa Putman
- Division of Endocrinology, Boston Children׳s Hospital and Harvard Medical School, Boston, MA, USA
| | - Ruby Kandah
- Wyss Institute for Biologically Inspired Engineering at Harvard University, Boston, MA, USA
| | - Maria Cubria
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Sebastian Suarez
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Ara Nazarian
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Brian Snyder
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA; Department of Orthopedic Surgery, Boston Children׳s Hospital and Harvard Medical School, Boston, MA, USA
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Litmanovitz I, Erez H, Eliakim A, Bauer-Rusek S, Arnon S, Regev RH, Sirota G, Nemet D. The Effect of Assisted Exercise Frequency on Bone Strength in Very Low Birth Weight Preterm Infants: A Randomized Control Trial. Calcif Tissue Int 2016; 99:237-42. [PMID: 27142078 DOI: 10.1007/s00223-016-0145-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 04/21/2016] [Indexed: 10/21/2022]
Abstract
We aimed to assess whether a twice daily assisted exercise interventional program will have a greater effect on bone strength compared to a once daily intervention or no intervention in very low birth weight (VLBW) preterm infants. Thirty-four very VLBW preterm infants (mean BW 1217 ± 55 g and mean gestational age 28.6 ± 1.1 weeks) were randomly assigned into one of three study groups: twice daily interventions (n = 13), a once daily intervention (n = 11), and no intervention (control, n = 10). The intervention was initiated at a mean of 8 ± 2.4 days of life and continued for 4 weeks. It included passive extension and flexion range-of-motion exercise of the upper and lower extremities. Bone strength was measured at enrollment and after 2 and 4 weeks using quantitative ultrasound of tibial bone speed of sound (SOS, Sunlight Omnisense™). At enrollment, the mean bone SOS was comparable between the twice daily interventions, once daily intervention and control groups (2918 ± 78, 2943 ± 119, and 2910 ± 48 m/s, respectively). As expected, the bone SOS declined in all groups during the study period (-23.6 ± 24, -68.8 ± 28, and -115.8 ± 30 m/s, respectively, p < 0.05), with a significantly attenuated decrease in bone strength in the twice daily intervention group (p = 0.03). A twice daily intervention program of assisted range-of-motion exercise attenuates the decrease in bone strength and may decrease the risk of osteopenia and future fractures in VLBW preterm infants.
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Affiliation(s)
- Ita Litmanovitz
- Department of Neonatology, Meir Medical Center, 59 Tchernichovsky St., 44281, Kfar Saba, Israel.
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Hedva Erez
- Department of Physical Therapy, Meir Medical Center, Kfar Saba, Israel
| | - Alon Eliakim
- Department of Pediatrics, Meir Medical Center, Kfar Saba, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Sofia Bauer-Rusek
- Department of Neonatology, Meir Medical Center, 59 Tchernichovsky St., 44281, Kfar Saba, Israel
| | - Shmuel Arnon
- Department of Neonatology, Meir Medical Center, 59 Tchernichovsky St., 44281, Kfar Saba, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Rivka H Regev
- Department of Neonatology, Meir Medical Center, 59 Tchernichovsky St., 44281, Kfar Saba, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Gisela Sirota
- Department of Neonatology, Meir Medical Center, 59 Tchernichovsky St., 44281, Kfar Saba, Israel
| | - Dan Nemet
- Department of Pediatrics, Meir Medical Center, Kfar Saba, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Abstract
PURPOSE To study development of bone mineral content (BMC) in infants with myelomeningocele (MMC) who did or did not receive upright supported stepping practice (USSP) and in infants with typical development (TD). METHODS We tested 36 infants across the ages of 1 to 18 months. Dual-energy x-ray absorptiometry was used to collect raw BMC data for the whole body, legs, and arms, which were normalized using anthropometrics. RESULTS Whole-body BMC generally increased with age; values for infants with MMC were slightly lower than those for infants with TD. Bone mineral content for legs and arms was lower for infants with MMC than for infants with TD. Between MMC groups, the group receiving USSP showed increases in BMC with age. CONCLUSION Bone mineralization in infants with MMC begins to lag compared with infants with TD across infancy, and daily USSP can improve BMC as early as the first year of life.
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Rehman MU, Narchi H. Metabolic bone disease in the preterm infant: Current state and future directions. World J Methodol 2015; 5:115-121. [PMID: 26413483 PMCID: PMC4572023 DOI: 10.5662/wjm.v5.i3.115] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 07/01/2015] [Accepted: 08/04/2015] [Indexed: 02/06/2023] Open
Abstract
Neonatal osteopenia is an important area of interest for neonatologists due to continuing increased survival of preterm infants. It can occur in high-risk infants such as preterm infants, infants on long-term diuretics or corticosteroids, and those with neuromuscular disorders. Complications such as rickets, pathological fractures, impaired respiratory function and poor growth in childhood can develop and may be the first clinical evidence of the condition. It is important for neonatologists managing such high-risk patients to regularly monitor biochemical markers for evidence of abnormal bone turnover and inadequate mineral intake in order to detect the early phases of impaired bone mineralization. Dual-energy X-ray absorptiometry has become an increasingly used research tool for assessing bone mineral density in children and neonates, but more studies are still needed before it can be used as a useful clinical tool. Prevention and early detection of osteopenia are key to the successful management of this condition and oral phosphate supplements should be started as soon as is feasible.
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Cheng HH, Carmona F, McDavitt E, Wigmore D, Perez-Rossello JM, Gordon CM, Pigula FA, Laussen PC, Rajagopal SK. Fractures Related to Metabolic Bone Disease in Children with Congenital Heart Disease. CONGENIT HEART DIS 2015; 11:80-6. [PMID: 26302998 DOI: 10.1111/chd.12293] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/15/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Critically ill children with congenital heart disease (CHD) are at risk for metabolic bone disease (MBD) and bone fractures. Our objective was to characterize a cohort of CHD patients with fractures and describe a Fragile Bone Protocol (FBP) developed to reduce fractures. DESIGN/SETTING Patients who developed fractures in the Cardiac Intensive Care Unit (CICU) of Boston Children's Hospital from 3/2008 to 6/2014 were identified via quality improvement and radiology databases. The FBP (initiated July 2011) systematically identifies patients at risk for MBD and prescribes special handling precautions. RESULTS Twenty-three fractures were identified in 15 children. Median age at fracture identification was 6.2 months, with a median duration of hospitalization before fracture diagnosis of 2.7 months. Six patients (40%) had single ventricle CHD. Hyperparathyroidism and low 25-OH vitamin D levels were present in 77% and 40% of those tested, respectively. Compared with patients not diagnosed with fractures, fracture patients had increased exposure to possible risk factors for MBD and had elevated parathyroid and decreased calcitriol levels.Six patients (40%) did not survive to hospital discharge, compared with an overall CICU mortality rate of 2.6% (P < .01). The fracture case rate before implementation of the FBP was 2.6 cases/1000 admissions and was 0.7/1000 after implementation of the FBP (P = .04). CONCLUSIONS Critically ill CHD patients are at risk for fractures. They represent a complex group who frequently has hyperparathyroidism and decreased calcitriol levels, and each may predispose to fractures. FBPs consisting of identification and careful patient handling should be considered in at-risk patients.
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Affiliation(s)
- Henry H Cheng
- Department of Cardiology, Boston Children's Hospital, Boston, Mass, USA
| | - Fabio Carmona
- Department of Pediatric Intensive Care, Hospital das Clinicas of Ribeirao Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Erica McDavitt
- Department of Cardiology, Boston Children's Hospital, Boston, Mass, USA
| | - Daniel Wigmore
- Department of Cardiology, Boston Children's Hospital, Boston, Mass, USA
| | - Jeannette M Perez-Rossello
- Department of Radiology, Boston Children's Hospital, Boston, Mass, USA.,Department of Radiology, Harvard Medical School, Boston, Mass, USA
| | - Catherine M Gordon
- Department of Medicine, Boston Children's Hospital, Boston, Mass, USA.,Department of Pediatrics, Harvard Medical School, Boston, Mass, USA.,Department of Adolescent Medicine and Endocrinology, Hasbro Children's Hospital and Albert Medical School, Brown University, Providence, RI, USA
| | - Frank A Pigula
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, Mass, USA.,Department of Surgery, Harvard Medical School, Boston, Mass, USA
| | - Peter C Laussen
- Department of Critical Care Medicine, Hospital for Sick Children, Toronto, ON, Canada
| | - Satish K Rajagopal
- Department of Cardiology, Boston Children's Hospital, Boston, Mass, USA.,Department of Pediatrics, Harvard Medical School, Boston, Mass, USA
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Pepino VC, Mezzacappa MA. Application of tactile/kinesthetic stimulation in preterm infants: a systematic review. J Pediatr (Rio J) 2015; 91:213-33. [PMID: 25677214 DOI: 10.1016/j.jped.2014.10.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Revised: 10/03/2014] [Accepted: 10/06/2014] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE To verify the methods used by the clinical trials that assessed the effect of tactile/kinesthetic stimulation on weight gain in preterm infants and highlight the similarities and differences among such studies. SOURCES This review collected studies from two databases, PEDro and PubMed, in July of 2014, in addition to bibliographies. Two researchers assessed the relevant titles independently, and then chose which studies to read in full and include in this review by consensus. Clinical trials that studied tactile stimulation or massage therapy whether or not associated with kinesthetic stimulation of preterm infants; that assessed weight gain after the intervention; that had a control group and were composed in English, Portuguese, or Spanish were included. SUMMARY OF THE FINDINGS A total of 520 titles were found and 108 were selected for manuscript reading. Repeated studies were excluded, resulting in 40 different studies. Of these, 31 met all the inclusion criteria. There were many differences in the application of tactile/kinesthetic stimulation techniques among studies, which hindered the accurate reproduction of the procedure. Also, many studies did not describe the adverse events that occurred during stimulation, the course of action taken when such events occurred, and their effect on the outcome. CONCLUSIONS These studies made a relevant contribution towards indicating tactile/kinesthetic stimulation as a promising tool. Nevertheless, there was no standard for application among them. Future studies should raise the level of methodological rigor and describe the adverse events. This may permit other researchers to be more aware of expected outcomes, and a standard technique could be established.
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Affiliation(s)
- Vanessa C Pepino
- Program in Child and Adolescent Health Science, Universidade Estadual de Campinas (UNICAMP), São Paulo, SP, Brazil.
| | - Maria Aparecida Mezzacappa
- Division of Neonatology, Department of Pediatrics, Faculty of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), São Paulo, SP, Brazil
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Erdem E, Tosun Ö, Bayat M, Korkmaz Z, Halis H, Güneş T. Daily physical activity in low-risk extremely low birth weight preterm infants: positive impact on bone mineral density and anthropometric measurements. J Bone Miner Metab 2015; 33:329-34. [PMID: 24866926 DOI: 10.1007/s00774-014-0594-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Accepted: 04/09/2014] [Indexed: 11/24/2022]
Abstract
The aim of this study was to evaluate the changes in bone mineral density and anthropometric indices of extremely low birth weight (ELBW) preterm infants undergoing daily physical activity. Twenty-eight low-risk ELBW preterm infants (intervention group = 14, control group = 14) with a birth weight of under 1000 g and gestational age of 26-32 weeks were recruited. Preterm infants in the control group were provided with standard nursing care, whereas those in the intervention group received a daily physical activity programme in addition to standard nursing care during the study. Before and after the study, anthropometric indices and tibial speed of sound (SOS) values were measured. In this study, the tibial SOS values were found to be increased in the intervention group (+111.14 m/s) (p = 0.001) and decreased in the control group (-58.21 m/s) (p = 0.030). The increase in percentage of body weight, height, and tibial length of infants in the intervention group was significantly higher than in the control group (respectively; p = 0.002, p = 0,015, p < 0.001). A daily physical activity programme increased body weight, height, tibial length, and SOS values of the tibia in ELBW preterm infants.
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Affiliation(s)
- Emine Erdem
- Department of Nursing, Faculty of Health Sciences, Erciyes University, Kayseri, Turkey,
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33
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Pepino VC, Mezzacappa MA. Application of tactile/kinesthetic stimulation in preterm infants: a systematic review. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2015. [DOI: 10.1016/j.jpedp.2015.03.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Ireland A, Rittweger J, Schönau E, Lamberg-Allardt C, Viljakainen H. Time since onset of walking predicts tibial bone strength in early childhood. Bone 2014; 68:76-84. [PMID: 25132490 DOI: 10.1016/j.bone.2014.08.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 08/01/2014] [Accepted: 08/08/2014] [Indexed: 11/25/2022]
Abstract
Bone strength in adulthood is known to be affected by health at birth and early childhood. Habitual bone loading is a primary determinant of bone strength in later childhood and adulthood. However, the effects of physical activity in early childhood (e.g. crawling, standing and walking) on bone strength are unknown. Fifty-three children (twenty-seven males) were included in a longitudinal study in their early infancy. Shortly after birth (0.3±0.3months), details of mass and height were obtained along with a pQCT scan at 20% distal-proximal tibia length. At 14.8±0.5months of age the same data were collected, along with details of age at onset of standing, crawling, supported and unsupported walking. Time since onset of walking unsupported was associated with greater bone mass, cortical bone area, pericortical circumference and polar moment of inertia of both total and cortical bone (all P<0.05). There were no significant associations between other physical activity timepoints and bone measures. Age at onset of walking was not significantly related to mass, length or bone measures at birth. The results suggest that time since attainment of independent walking - representing exposure of the tibia to the large reaction and muscular forces associated with locomotion - is a primary determinant of bone strength in early childhood. This finding raises the possible opportunity of physical activity interventions at young age in paediatric populations associated with low childhood bone strength and late walking (e.g. low birth weight, cerebral palsy and Down's Syndrome, etc.).
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Affiliation(s)
- Alex Ireland
- Cognitive Motor Function Research Group, Manchester Metropolitan University, UK.
| | - Jörn Rittweger
- Institute of Aerospace Medicine, German Aerospace Centre, Germany
| | | | | | - Heli Viljakainen
- Department of Food and Environmental Sciences, University of Helsinki, Finland
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35
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Miller M, Ward T, Stolfi A, Ayoub D. Overrepresentation of multiple birth pregnancies in young infants with four metabolic bone disorders: further evidence that fetal bone loading is a critical determinant of fetal and young infant bone strength. Osteoporos Int 2014; 25:1861-73. [PMID: 24696017 DOI: 10.1007/s00198-014-2690-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Accepted: 03/12/2014] [Indexed: 11/29/2022]
Abstract
UNLABELLED The frequency of multiple birth pregnancies, mostly twin pregnancies, was overrepresented in four different groups of young infants with fractures and bone abnormalities. This finding suggests that fetal bone loading through fetal movement is an important determinant of fetal bone formation and its resultant bone strength. INTRODUCTION It has been suggested that intrauterine confinement related to the multiple birth pregnancy (MBP) may lead to an increased risk for fragility fractures in young infants as a result of decreased fetal bone loading. METHODS To objectively test this idea, the frequency of MBPs was evaluated in five groups of young infants with bone disorders: (1) infants exposed to prolonged in utero exposure to magnesium, (2) infants with dietary copper deficiency, (3) infants with rickets from vitamin D deficiency, (4) infants with temporary brittle bone disease, and (5) infants with multiple unexplained fractures in which child abuse was the most likely diagnosis. RESULTS Compared to a control group and controlled for preterm birth, there was a statistically greater frequency of MBPs in each group. CONCLUSIONS The results of this study suggest the following: (a) The overrepresentation of MBPs (95 % twins) in these five groups indicates that fetal bone loading is a critical determinant of fetal bone strength; (b) fetal and young infant bone strength is a multifactorial characteristic; and (c) infants from MBPs are at increased risk for fragility fractures during the first 12 months of life, and thus may be mistakenly diagnosed as victims of child abuse.
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Affiliation(s)
- M Miller
- Departments of Pediatrics, Ob/Gyn, and Biomedical Engineering, Wright State University Boonshoft School of Medicine, Dayton, OH, USA,
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36
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A risk of sensory deprivation in the neonatal intensive care unit. J Pediatr 2014; 164:1265-7. [PMID: 24661341 DOI: 10.1016/j.jpeds.2014.01.072] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Revised: 12/18/2013] [Accepted: 01/30/2014] [Indexed: 11/20/2022]
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Schulzke SM, Kaempfen S, Trachsel D, Patole SK, Cochrane Neonatal Group. Physical activity programs for promoting bone mineralization and growth in preterm infants. Cochrane Database Syst Rev 2014; 2014:CD005387. [PMID: 24752440 PMCID: PMC11008108 DOI: 10.1002/14651858.cd005387.pub3] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Lack of physical stimulation may contribute to metabolic bone disease of preterm infants, resulting in poor bone mineralization and growth. Physical activity programs combined with adequate nutrition might help to promote bone mineralization and growth. OBJECTIVES The primary objective was to assess whether physical activity programs in preterm infants improve bone mineralization and growth and reduce the risk of fracture.The secondary objectives included other potential benefits in terms of length of hospital stay, skeletal deformities and neurodevelopmental outcomes, and adverse events.Subgroup analysis:• Given that the smallest infants are most vulnerable for developing osteopenia (Bishop 1999), a subgroup analysis was planned for infants with birth weight < 1000 g.• Calcium and phosphorus intake may affect an infant's ability to increase bone mineral content (Kuschel 2004). Therefore, an additional subgroup analysis was planned for infants receiving different amounts of calcium and phosphorus, along with full enteral feeds as follows. ∘ Below 100 mg/60 mg calcium/phosphorus or equal to/above 100 mg/60 mg calcium/phosphorus per 100 mL milk. ∘ Supplementation of calcium without phosphorus. ∘ Supplementation of phosphorus without calcium. SEARCH METHODS The standard search strategy of the Cochrane Neonatal Review Group (CNRG) was used. The search included the Cochrane Central Register of Controlled Trials (CENTRAL) (2012, Issue 9), MEDLINE, EMBASE, CINAHL (1966 to March 2013), and cross-references, as well as handsearching of abstracts of the Society for Pediatric Research and the International Journal of Sports Medicine. SELECTION CRITERIA Randomized and quasi-randomized controlled trials comparing physical activity programs (extension and flexion, range-of-motion exercises) versus no organized physical activity programs in preterm infants. DATA COLLECTION AND ANALYSIS Data collection, study selection, and data analysis were performed according to the methods of the CNRG. MAIN RESULTS Eleven trials enrolling 324 preterm infants (gestational age 26 to 34 weeks) were included in this review. All were small (N = 16 to 50) single-center studies that evaluated daily physical activity for three and one-half to eight weeks during initial hospitalization. Methodological quality and reporting of included trials were variable.Four trials demonstrated moderate short-term benefits of physical activity for bone mineralization at completion of the physical activity program. The only trial assessing long-term effects on bone mineralization showed no effect of physical activity administered during initial hospitalization on bone mineralization at 12 months corrected age. Meta-analysis from four trials demonstrated a positive effect of physical activity on daily weight gain (weighted mean difference (WMD) 2.21 g/kg/d, 95% confidence interval (CI) 1.23 to 3.19). Data from four trials showed a positive effect on linear growth (WMD 0.12 cm/wk, 95% CI 0.01 to 0.24) but not on head growth (WMD -0.03 cm/wk, 95% CI -0.14 to 0.08) during the study period. Only one trial reported on fractures (this outcome did not occur in intervention and control groups) and complications of preterm birth (no significant differences between intervention and control groups). None of the trials assessed other outcomes relevant to this review. AUTHORS' CONCLUSIONS Some evidence suggests that physical activity programs might promote short-term weight gain and bone mineralization in preterm infants. Data are inadequate to allow assessment of harm or long-term effects. Current evidence does not support the routine use of physical activity programs in preterm infants. Further trials incorporating infants with a high baseline risk of osteopenia are required. These trials should address adverse events, long-term outcomes, and the effects of nutritional intake (calories, protein, calcium, phosphorus).
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Affiliation(s)
- Sven M Schulzke
- University of Basel Children's Hospital (UKBB)Department of NeonatologySpitalstrasse 21BaselSwitzerland4031
| | - Siree Kaempfen
- University of Basel Children's Hospital (UKBB)Department of NeonatologySpitalstrasse 21BaselSwitzerland4031
| | - Daniel Trachsel
- University Children's Hospital BaselDepartment of Pediatric Intensive Care/PulmonologyPO Box, CH‐4005BaselSwitzerland4005
| | - Sanjay K Patole
- King Edward Memorial HospitalSchool of Paediatrics and Child Health, School of Women's and Infant's Health, University of Western Australia374 Bagot RdSubiacoPerthWestern AustraliaAustralia6008
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Diego MA, Field T, Hernandez-Reif M. Preterm infant weight gain is increased by massage therapy and exercise via different underlying mechanisms. Early Hum Dev 2014; 90:137-40. [PMID: 24480603 PMCID: PMC3956039 DOI: 10.1016/j.earlhumdev.2014.01.009] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Revised: 12/23/2013] [Accepted: 01/07/2014] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To compare the effects of massage therapy (moderate pressure stroking) and exercise (flexion and extension of limbs) on preterm infants' weight gain and to explore potential underlying mechanisms for those effects. METHODS Weight gain and parasympathetic nervous system activity were assessed in 30 preterm infants randomly assigned to a massage therapy group or to an exercise group. Infants received 10min of moderate pressure massage or passive flexion and extension of the limbs 3 times per day for 5days, and EKGs were collected during the first session to assess vagal activity. RESULTS Both massage and exercise led to increased weight gain. However, while exercise was associated with increased calorie consumption, massage was related to increased vagal activity. CONCLUSION Taken together, these findings suggest that massage and exercise lead to increased preterm infant weight gain via different underlying mechanisms.
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Affiliation(s)
- Miguel A. Diego
- Touch Research Institute, Department of Pediatrics, University of Miami School of Medicine,Fielding Graduate University
| | - Tiffany Field
- Touch Research Institute, Department of Pediatrics, University of Miami School of Medicine,Fielding Graduate University
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Early developmental care interventions of preterm very low birth weight infants. Indian Pediatr 2013; 50:765-70. [DOI: 10.1007/s13312-013-0221-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Smith SL, Haley S, Slater H, Moyer-Mileur LJ. Heart rate variability during caregiving and sleep after massage therapy in preterm infants. Early Hum Dev 2013; 89:525-9. [PMID: 23361061 PMCID: PMC3647010 DOI: 10.1016/j.earlhumdev.2013.01.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Revised: 12/14/2012] [Accepted: 01/07/2013] [Indexed: 11/17/2022]
Abstract
BACKGROUND Preterm birth impairs the infant's stress response due to interruption of autonomic nervous system (ANS) development. Preterm infants demonstrate a prolonged and aberrant sympathetic response to stressors. ANS development may be promoted by massage therapy (MT), which has been shown to improve stress response in preterm infants. AIMS The aim of this study was to compare preterm infant ANS function and stress response during sleep and caregiving epochs, as measured by heart rate variability (HRV), after two weeks of twice-daily MT. STUDY DESIGN A subset of participants from a larger randomized, masked, controlled trial was used. SUBJECTS Twenty-one infants (8 males and 13 females) from a larger study of 37 medically stable preterm infants were studied. The infants were receiving full volume enteral feedings with a mean post-menstrual age of 31.4 (MT) and 30.9 (control) weeks. OUTCOME MEASURES Low to high frequency (LF:HF) ratio of HRV was the outcome of interest. RESULTS There was a significant group×time×sex interaction effect (p<.05). Male control infants demonstrated a significant decline in LF:HF ratio from baseline to the second caregiving epoch, suggesting decreased mobilization of sympathetic nervous system response when exposed to stressors. Male MT infants demonstrated increased LF:HF ratio during caregiving and decreased LF:HF ratio during sleep epochs, suggesting improved ANS function, although this was not statistically significant. LF:HF ratio was similar in female MT and female control infants during caregiving and sleep. CONCLUSIONS Control males had decreased HRV compared to MT males. There was no difference in HRV between MT and control females.
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Affiliation(s)
| | - Shannon Haley
- University of Utah Division of Neonatology, Department of Pediatrics, University of Utah, Salt Lake City, UT
| | - Hillarie Slater
- University of Utah Division of Neonatology, Department of Pediatrics, University of Utah, Salt Lake City, UT
| | - Laurie J. Moyer-Mileur
- University of Utah Division of Neonatology, Department of Pediatrics, University of Utah, Salt Lake City, UT
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Abstract
Mounting evidence shows that low-birth-weight and prematurity are related to serious health problems in adulthood, including increased body fat, decreased fitness, poor bone mineralization, pulmonary problems, and cardiovascular disease. There are data to suggest that increasing physical activity in preterm infants will have effects on short-term muscle mass and fat mass, but we also hypothesized that increasing physical activity early in life can lead to improved health outcomes in adulthood. Because few studies have addressed the augmentation of physical activity in premature babies, the objective of this study was to evaluate the feasibility of whether caregivers (mostly mothers) can learn from nurses and other healthcare providers to implement a program of assisted infant exercise following discharge. Ten caregivers of preterm infants were taught by nurses, along with occupational therapists and other healthcare providers, to perform assisted infant exercise and instructed to conduct the exercises daily for approximately 3 weeks. The researchers made home visits and conducted qualitative interviews to understand the caregivers' experiences with this exercise protocol. Quantitative data included a caregiver's daily log of the exercises completed to measure adherence as well as videotaped caregiver sessions, which were used to record errors as a measure of proficiency in the exercise technique. On average, the caregivers completed a daily log on 92% of the days enrolled in the study and reported performing the exercises on 93% of the days recorded. Caregivers made an average of 1.8 errors on 2 tests (with a maximum of 23 or 35 items on each, respectively) when demonstrating proficiency in the exercise techniques. All caregivers described the exercises as beneficial for their infants, and many reported that these interventions fostered increased bonding with their babies. Nearly all reported feeling "scared" of hurting their babies during the first few days of home exercise but stated that fears were alleviated by practice in the home and further teaching and learning. Caregivers were willing and able to do the exercises correctly, and they expressed a belief that the intervention had positive effects on their babies and on caregiver-infant interactions. These findings have important implications for nursing practice because nurses are in key positions to teach and encourage caregivers to practice these exercises with their newborn babies.
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Huh SY, Gordon CM. Fractures in hospitalized children. Metabolism 2013; 62:315-25. [PMID: 22959479 DOI: 10.1016/j.metabol.2012.07.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Revised: 07/25/2012] [Accepted: 07/25/2012] [Indexed: 10/27/2022]
Abstract
Hospitalized children have multiple risk factors for fragility fractures, related to disease pathophysiology, treatments, nutritional status and immobilization. Recognition and treatment of these risk factors are important to prevent morbidity associated with fractures and to promote current and future bone health. Many knowledge gaps remain regarding the ideal nutrition, physical activity, and medication regimens needed to optimize bone health and reduce the risk of fractures over the life course. This article reviews the pathogenesis, risk factors, treatment and prevention strategies for fractures in hospitalized infants and children.
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Affiliation(s)
- Susanna Y Huh
- Harvard Medical School, and the Division of Gastroenterology and Nutrition, Boston Children's Hospital, Boston, MA 02115, USA.
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Abstract
This article presents the elements of the Intervention section of the Infant Care Path for Physical Therapy in the Neonatal Intensive Care Unit (NICU). The types of physical therapy interventions presented in this path are evidence-based and the suggested timing of these interventions is primarily based on practice knowledge from expert therapists, with supporting evidence cited. Physical therapy intervention in the NICU is infant-driven and focuses on providing family-centered care. In this context, interventions to facilitate a calm behavioral state and motor organization in the infant, address positioning and handling of the infant, and provide movement therapy are presented.
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Affiliation(s)
- Eilish Byrne
- Neonatal Intensive Care Unit, Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA 94304, USA.
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Smith SL, Lux R, Haley S, Slater H, Beechy J, Moyer-Mileur LJ, Moyer-Mileur LJ. The effect of massage on heart rate variability in preterm infants. J Perinatol 2013; 33:59-64. [PMID: 22538325 PMCID: PMC3531576 DOI: 10.1038/jp.2012.47] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To test the hypothesis that massage would improve autonomic nervous system (ANS) function as measured by heart rate variability (HRV) in preterm infants. STUDY DESIGN Medically stable, 29- to 32-week preterm infants (17 massage, 20 control) were enrolled in a masked, randomized longitudinal study. Licensed massage therapists provided the massage or control condition twice a day for 4 weeks. Weekly HRV, a measure of ANS development and function, was analyzed using SPSS generalized estimating equations. RESULTS Infant characteristics were similar between groups. HRV improved in massaged infants but not in the control infants (P<0.05). Massaged males had a greater improvement in HRV than females (P<0.05). HRV in massaged infants was on a trajectory comparable to term-born infants by study completion. CONCLUSION Massage-improved HRV in a homogeneous sample of hospitalized, medically stable, preterm male infants and may improve infant response to exogenous stressors. We speculate that massage improves ANS function in these infants.
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Affiliation(s)
- SL. Smith
- School of Nursing, University of Louisville, Louisville, KY, USA
| | - R. Lux
- Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, UT, USA
| | - S. Haley
- Division of Neonatology, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - H. Slater
- Division of Neonatology, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - J. Beechy
- Division of Neonatology, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - LJ. Moyer-Mileur
- Division of Neonatology, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
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Namgung R, Lee SM, Ehun HS, Park MS, Park KI, Lee C. Metabolic Bone Disease of Prematurity. NEONATAL MEDICINE 2013. [DOI: 10.5385/nm.2013.20.3.276] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Ran Namgung
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Soon Min Lee
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ho Sun Ehun
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Min Soo Park
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Kook In Park
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Chul Lee
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
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Haley S, Beachy J, Ivaska KK, Slater H, Smith S, Moyer-Mileur LJ. Tactile/kinesthetic stimulation (TKS) increases tibial speed of sound and urinary osteocalcin (U-MidOC and unOC) in premature infants (29-32weeks PMA). Bone 2012; 51:661-6. [PMID: 22846674 PMCID: PMC3434881 DOI: 10.1016/j.bone.2012.07.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Revised: 07/17/2012] [Accepted: 07/19/2012] [Indexed: 11/17/2022]
Abstract
Preterm delivery (<37 weeks post-menstrual age) is associated with suboptimal bone mass. We hypothesized that tactile/kinesthetic stimulation (TKS), a form of infant massage that incorporates kinesthetic movement, would increase bone strength and markers of bone accretion in preterm infants. Preterm, AGA infants (29-32 weeks) were randomly assigned to TKS (N=20) or Control (N=20). Twice daily TKS was provided 6 days per week for 2 weeks. Control infants received the same care without TKS treatment. Treatment was masked to parents, health care providers, and study personnel. Baseline and week two measures were collected for tibial speed of sound (tSOS, m/sec), a surrogate for bone strength, by quantitative ultrasound (Sunlight8000) and urine markers of bone metabolism, pyridinium crosslinks and osteocalcin (U-MidOC and unOC). Infant characteristics at birth and study entry as well as energy/nutrient intake were similar between TKS and Control. TKS intervention attenuated the decrease in tSOS observed in Control infants (p<0.05). Urinary pyridinium crosslinks decreased over time in both TKS and CTL (p<0.005). TKS infants experienced greater increases in urinary osteocalcin (U-MidOC, p<0.001 and unOC, p<0.05). We conclude that TKS improves bone strength in premature infants by attenuating the decrease that normally follows preterm birth. Further, biomarkers of bone metabolism suggest a modification in bone turnover in TKS infants in favor of bone accretion. Taken together, we speculate that TKS improves bone mineralization.
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Affiliation(s)
- S Haley
- Center for Pediatric Nutrition Research, University of Utah, 295 Chipeta Way Salt Lake City, 84108 Utah, USA.
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Identification of Fracture Risk and Strategies for Bone Health in the Neonatal Intensive Care Unit. TOP CLIN NUTR 2012. [DOI: 10.1097/tin.0b013e318262d434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Zhang Y, Xue C, Zhu T, Du X, Su N, Qi H, Yang J, Shi Y, Chen L. Serum bone alkaline phosphatase in assessing illness severity of infected neonates in the neonatal intensive care unit. Int J Biol Sci 2011; 8:30-8. [PMID: 22211102 PMCID: PMC3226030 DOI: 10.7150/ijbs.8.30] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2011] [Accepted: 09/23/2011] [Indexed: 12/18/2022] Open
Abstract
Background: Infections can influence bone metabolism of neonates, which may lead to changes in some bone metabolism biomarkers. The purpose of this study was to determine whether serum bone alkaline phosphatase (BALP), osteocalcin (OC) and beta carboxy-terminal peptide of type I collagen (CTX), as specific biomarkers of bone metabolism, can be used to assess the severity of neonatal infections. Methods: Sixty-three neonates in the NICU were enrolled in this study. The neonates were divided into infected group (n=33) and non-infected group (n=30). The scores for neonatal acute physiology-perinatal extension II (SNAPPE-II) were calculated and interleukin-6 (IL-6), procalcitonin (PCT), BALP, OC and CTX were measured among the neonates with or without infections, and among the infected neonates before and after treatment. Results: The serum BALP levels were lower in the infected group than that in the non-infected group (p<0.01). The serum BALP levels increased markedly in the infected neonates after treatment (p<0.01). The serum BALP levels were also inversely correlated with SNAPPE-II of infected neonates before and after treatment (r=-0.56, p<0.05; r=-0.37, p<0.05, respectively). In infected neonates, the differences between serum BALP levels before and after treatment were inversely correlated with those of IL-6 levels (p<0.05). There were no significant changes in the OC, CTX and PCT levels in the infected or non-infected group before and after treatment. Conclusion: Our data suggest that serum BALP level might be used as a marker for assessing the severity of illness in infected neonates.
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Affiliation(s)
- Yaozong Zhang
- State Key Laboratory of Trauma, Burns and Combined Injury, Center of Bone Metabolism and Repair, Trauma Center, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, China
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Abstract
AIM To illustrate, via case histories, the importance of laboratory investigations for the early diagnosis and management of metabolic bone disease (MBD). METHODS We report three cases of extreme premature infants with MBD. RESULTS These three infants had several risk factors for MBD of prematurity: very low birthweight, delayed enteral feeds, cholestatic liver disease, intolerance of fortification, the use of glucocorticoids and diuretics. Serum alkaline phosphatase and parathyroid hormone (PTH) were elevated despite relatively normal calcium and phosphate levels. These parameters were corrected with additional supplementation of calcium, phosphate and vitamin D. CONCLUSIONS Infants born extremely prematurely have significant calcium and phosphate depletion by the time they reach full term compared with the normal fetal accretion rate. This is exacerbated if there is poor tolerability to feeds where extra calcium and phosphate could not be added either by additives or via human milk fortifier. Serum calcium and phosphate levels may be normal despite inadequate intake or stores due to the counter-regulatory effect of PTH. In infants at risk of MBD, testing serum alkaline phosphatase, vitamin D and PTH with calcium and phosphate may assist in the monitoring and management of MBD.
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Affiliation(s)
- Ashish Lothe
- Department of Neonatology, Royal North Shore Hospital The University of Sydney, Sydney, New South Wales, Australia
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Tosun Ö, Bayat M, Güneş T, Erdem E. Daily physical activity in low-risk pre-term infants: positive impact on bone strength and mid-upper arm circumference. Ann Hum Biol 2011; 38:635-9. [PMID: 21745153 DOI: 10.3109/03014460.2011.598187] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Prevention of pre-term osteopenia is important because it results in ventilator dependency, fractures in long bones, softening of the ribs or respiratory failure due to bone breaks in newborns. AIM The aim of this study was to evaluate the changes in bone strength and anthropometric indices of very low birth-weight (VLBW) pre-term infants undergoing daily physical activity. SUBJECTS AND METHODS Forty VLBW and low-risk pre-term infants (n intervention group = 20, n control group = 20) with a birth weight of 800-1600 g and gestational age of 26-32 weeks were recruited. Pre-term infants in the control group were provided with standard nursing care whereas those in the intervention group received a daily physical activity programme in addition to standard nursing care during the study. Before and after the study, anthropometric indices and tibial speed of sound (SOS) values were measured. RESULTS In this study the tibial SOS values were found to be increased in the intervention group (p < 0.001) and decreased in the control group (p = 0.002). The increase in percentage of the mid-upper arm circumference of infants was significantly higher in the intervention group than in the control group (p < 0.001). CONCLUSION A daily physical activity programme increased SOS values of the tibia and mid-upper arm circumference in VLBW pre-term infants.
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Affiliation(s)
- Öznur Tosun
- Department of Nursing, Faculty of Health Sciences, ErciyesUniversity, Kayseri, Turkey.
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