Gestational Age, Health, and Educational Outcomes in Adolescents

Berry, Mary J.; Foster, Tim; Rowe, Kate; Robertson, Oliver; Robson, Bridget; Pierse, Nevil

doi:10.1097/01.ogx.0000554436.92583.c7

Cited by 7 publications

(12 citation statements)

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“…Because we wanted to restrict our analysis to variables available at birth, this study did not specifically include information about neonatal morbidities, such as intraventricular hemorrhage or necrotizing enterocolitis or on whether active resuscitation was offered at birth. 37 We did not have information on the use of antenatal steroids. 37,38 We believe that disability-free survival is an important concept.…”

Section: Discussionmentioning

confidence: 99%

“…37 We did not have information on the use of antenatal steroids. 37,38 We believe that disability-free survival is an important concept. At birth and even before to birth when clinicians and families are making decisions about the viability and appropriateness of active resuscitation, not only survival, but also the likelihood of long-term major disability, need to be considered.…”

Section: Discussionmentioning

confidence: 99%

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Predicting Long-Term Survival Without Major Disability for Infants Born Preterm

Bourke

Wong

Srinivasjois

et al. 2019

The Journal of Pediatrics

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Objective To describe the long-term neurodevelopmental and cognitive outcomes for children born preterm. Study design In this retrospective cohort study, information on children born in Western Australia between 1983 and 2010 was obtained through linkage to population databases on births, deaths, and disabilities. For the purpose of this study, disability was defined as a diagnosis of intellectual disability, autism, or cerebral palsy. The Kaplan-Meier method was used to estimate the probability of disability-free survival up to age 25 years by gestational age. The effect of covariates and predicted survival was examined using parametric survival models. Results Of the 720 901 recorded live births, 12 083 children were diagnosed with disability, and 5662 died without any disability diagnosis. The estimated probability of disability-free survival to 25 years was 4.1% for those born at gestational age 22 weeks, 19.7% for those born at 23 weeks, 42.4% for those born at 24 weeks, 53.0% for those born at 25 weeks, 78.3% for those born at 28 weeks, and 97.2% for those born full term (39-41 weeks). There was substantial disparity in the predicted probability of disability-free survival for children born at all gestational ages by birth profile, with 5-year estimates of 4.9% and 10.4% among Aboriginal and Caucasian populations, respectively, born at 24-27 weeks and considered at high risk (based on low Apgar score, male sex, low sociodemographic status, and remote region of residence) and 91.2% and 93.3%, respectively, for those at low risk (ie, high Apgar score, female sex, high sociodemographic status, residence in a major city). Conclusions Apgar score, birth weight, sex, socioeconomic status, and maternal ethnicity, in addition to gestational age, have pronounced impacts on disability-free survival.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Predicting Long-Term Survival Without Major Disability for Infants Born Preterm

Bourke

Wong

Srinivasjois

et al. 2019

The Journal of Pediatrics

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“…Evidence suggests that changes of GA at delivery could have a long-lasting influence on various health outcomes, including mortality, cognitive health, diabetes, respiratory health, and psychological and behavioral problems during all life stages. 2 – 8 …”

Section: Introductionmentioning

confidence: 99%

Prenatal exposure to particulate air pollution and gestational age at delivery in Massachusetts neonates 2001–2015

Qiu

Fong

Shi

et al. 2020

Environmental Epidemiology

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“…In utero , the fetal neurosteroid allopregnanolone is responsible for protection from neurological insults, modulating fetal behavior leading to the onset of a ‘sleep-like state,’ and promoting myelination through its action on the inhibitory GABA A receptors of the central nervous system (CNS) (Nicol et al, 1998; Nguyen et al, 2003; Herd et al, 2007). Importantly, recent studies suggest that behavioral and cognitive outcomes are tightly linked with gestational age (Berry et al, 2018). Any decrement in gestation, even across ‘early term’ (37/38 weeks’ gestation) is associated with, on a population basis, impaired cognitive and developmental outcomes compared to outcomes found in children born at full term (39–40 weeks gestational age) (Berry et al, 2018).…”

Section: Introductionmentioning

confidence: 99%

“…Importantly, recent studies suggest that behavioral and cognitive outcomes are tightly linked with gestational age (Berry et al, 2018). Any decrement in gestation, even across ‘early term’ (37/38 weeks’ gestation) is associated with, on a population basis, impaired cognitive and developmental outcomes compared to outcomes found in children born at full term (39–40 weeks gestational age) (Berry et al, 2018).…”

Section: Introductionmentioning

confidence: 99%

Reduced Neurosteroid Exposure Following Preterm Birth and Its’ Contribution to Neurological Impairment: A Novel Avenue for Preventative Therapies

et al. 2019

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Children born preterm are at an increased risk of developing cognitive problems and neuro-behavioral disorders such as attention deficit hyperactivity disorder (ADHD) and anxiety. Whilst neonates born at all gestational ages, even at term, can experience poor cognitive outcomes due to birth-complications such as birth asphyxia, it is becoming widely known that children born preterm in particular are at significant risk for learning difficulties with an increased utilization of special education resources, when compared to their healthy term-born peers. Additionally, those born preterm have evidence of altered cerebral myelination with reductions in white matter volumes of the frontal cortex, hippocampus and cerebellum evident on magnetic resonance imaging (MRI). This disruption to myelination may underlie some of the pathophysiology of preterm-associated brain injury. Compared to a fetus of the same post-conceptional age, the preterm newborn loses access to in utero factors that support and promote healthy brain development. Furthermore, the preterm ex utero environment is hostile to the developing brain with a myriad of environmental, biochemical and excitotoxic stressors. Allopregnanolone is a key neuroprotective fetal neurosteroid which has promyelinating effects in the developing brain. Preterm birth leads to an abrupt loss of the protective effects of allopregnanolone, with a dramatic drop in allopregnanolone concentrations in the preterm neonatal brain compared to the fetal brain. This occurs in conjunction with reduced myelination of the hippocampus, subcortical white matter and cerebellum; thus, damage to neurons, astrocytes and especially oligodendrocytes of the developing nervous system can occur in the vulnerable developmental window prior to term as a consequence reduced allopregnanolone. In an effort to prevent preterm-associated brain injury a number of therapies have been considered, but to date, other than antenatal magnesium sulfate and corticosteroid therapy, none have become part of standard clinical care for vulnerable infants. Therefore, there remains an urgent need for improved therapeutic options to prevent brain injury in preterm neonates. The actions of the placentally derived neurosteroid allopregnanolone on GABA A receptor signaling has a major role in late gestation neurodevelopment. The early loss of this intrauterine neurotrophic support following preterm birth may be pivotal to development of neurodevelopmental morbidity. Thus, restoring the in utero neurosteroid environment for preterm neonates may represent a new and clinically feasible treatment option for promoting better trajectories of myelination and brain development, and therefore reducing neurodevelopmental disorders in children born preterm.

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Gestational Age, Health, and Educational Outcomes in Adolescents

Cited by 7 publications

References 0 publications

Predicting Long-Term Survival Without Major Disability for Infants Born Preterm

Predicting Long-Term Survival Without Major Disability for Infants Born Preterm

Prenatal exposure to particulate air pollution and gestational age at delivery in Massachusetts neonates 2001–2015

Reduced Neurosteroid Exposure Following Preterm Birth and Its’ Contribution to Neurological Impairment: A Novel Avenue for Preventative Therapies

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