Browsing by Subject "infant"

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  • Hannula, Leena; Puukka, Pauli; Asunmaa, Marjut; Mäkijärvi, Markku (2020)
    Background Many infants under 4 months suffer from infantile colic. Infants with colic cry a lot, appear to be in pain, and it is difficult to sooth them. Colic is a painful condition for the infant and very stressful to parents. Parents in Finland get advice to try reflexology treatment for their infant, but there are no studies in Finland to support this advice. Aim The aim of the pilot study was to treat infants with reflexology and find out parents' experiences of the effects of the treatment on colic symptoms and parental stress. Method A total of 33 parents of 35 infants diagnosed with colic participated to the pilot study. Three certified reflexologists with health care education background and extensive experience in infant reflexology were trained to give the reflexology treatment in a standardised manner. They treated each infant 3-4 times. The whole body reflexology treatment session consisted of gentle pressure treatment of soles and feet, hands, head, face, ears, back, neck and whole stomach area. One treatment session lasted about 20-30 minutes, and treatments were delivered within 8-12 days. The data were collected from the parents with semi-structured questionnaires. Results The series of the treatments helped reduce the suffering of all the babies with infant colic. The colic symptoms disappeared on 43% of infants and decreased on the remaining 57%. The parents reported having pleasant experiences with the treatment, regardless whether the colic symptoms disappeared or continued. Parents stated that the treatment reduced the most typical colic symptoms; infants' body tension, colic crying and restless movements, poor sleep quality and irregular bowel movements. Conclusions Reflexology treatment seems to be a safe and effective way to treat infants with colic when conducted by a health care professional with reflexology training and experience.
  • Kolho, Kaija-Leena; Alfthan, Henrik (2020)
    Objectives Fecal calprotectin is a valued surrogate marker for intestinal inflammation. It has been argued that calprotectin levels are higher in early age than in later life hampering the use of calprotectin in young children. Subjects and methods To study age-related variation, we used data from our laboratory information system on consecutive, unselected fecal calprotectin measurements from 2014 to 2017 in all children aged 0 to 18 years. From each individual, the first measurement was included and repeated measurements were excluded. Fecal calprotectin was quantitated in the major clinical laboratory in southern Finland, HUSLAB with an ELISA kit from Calpro AS (Calpro/Calprolab, Oslo, Norway). Currently, the assay is performed on two automatic pipetting analysers (Dynex DS2, Chantilly, USA) according to the instructions of the manufacturer. Results There were altogether 11,255 fecal calprotectin results from as many children. The median level of fecal calprotectin was 51 mg/kg in infants <1 year of age (95(th)percentile 648 mg/kg;n = 239). This was 3-4-fold higher when compared to yearly age groups from 1 to 10 years (total number of children included 5,691). Across yearly age groups from 11 to 18, the median values varied from 11 to 19 mg/kg (total number of included children 5,325). The proportion of samples above the routine cut-off for an elevated concentration >100 mg/kg increased with increasing age. Conclusions Fecal calprotectin values in children beyond the first year of life are in general low and comparable in children and adolescents.
  • ALBINO Study Group; Maiwald, C.A.; Annink, K.V.; Rüdiger, M.; Benders, M.J.N.L.; Van Bel, F.; Allegaert, K.; Naulaers, G.; Bassler, D.; Klebermaß-Schrehof, K.; Vento, M.; Guimarães, H.; Stiris, T.; Cattarossi, L.; Metsäranta, M.; Vanhatalo, S.; Mazela, J.; Metsvaht, T.; Jacobs, Y. (2019)
    Background: Perinatal asphyxia and resulting hypoxic-ischemic encephalopathy is a major cause of death and long-term disability in term born neonates. Up to 20,000 infants each year are affected by HIE in Europe and even more in regions with lower level of perinatal care. The only established therapy to improve outcome in these infants is therapeutic hypothermia. Allopurinol is a xanthine oxidase inhibitor that reduces the production of oxygen radicals as superoxide, which contributes to secondary energy failure and apoptosis in neurons and glial cells after reperfusion of hypoxic brain tissue and may further improve outcome if administered in addition to therapeutic hypothermia. Methods: This study on the effects of ALlopurinol in addition to hypothermia treatment for hypoxic-ischemic Brain Injury on Neurocognitive Outcome (ALBINO), is a European double-blinded randomized placebo-controlled parallel group multicenter trial (Phase III) to evaluate the effect of postnatal allopurinol administered in addition to standard of care (including therapeutic hypothermia if indicated) on the incidence of death and severe neurodevelopmental impairment at 24 months of age in newborns with perinatal hypoxic-ischemic insult and signs of potentially evolving encephalopathy. Allopurinol or placebo will be given in addition to therapeutic hypothermia (where indicated) to infants with a gestational age ≥ 36 weeks and a birth weight ≥ 2500 g, with severe perinatal asphyxia and potentially evolving encephalopathy. The primary endpoint of this study will be death or severe neurodevelopmental impairment versus survival without severe neurodevelopmental impairment at the age of two years. Effects on brain injury by magnetic resonance imaging and cerebral ultrasound, electric brain activity, concentrations of peroxidation products and S100B, will also be studied along with effects on heart function and pharmacokinetics of allopurinol after iv-infusion. Discussion: This trial will provide data to assess the efficacy and safety of early postnatal allopurinol in term infants with evolving hypoxic-ischemic encephalopathy. If proven efficacious and safe, allopurinol could become part of a neuroprotective pharmacological treatment strategy in addition to therapeutic hypothermia in children with perinatal asphyxia. Trial registration: NCT03162653, www.ClinicalTrials.gov, May 22, 2017. © 2019 The Author(s).
  • Hokkanen, Marie-Estelle (Helsingin yliopisto, 2020)
    Objectives: Early recognition of developmental challenges in infancy is central for being able to start interventions earlier with possible better outcomes. The aim of this study was to investigate the potential of using eye-tracking at seven months to predict adaptive behavior outcomes at two years. Adaptive behavior implies the child's adaptation to their specific living environment and it includes aspects of conceptual, social and practical adaptation. Here, I studied several eye-tracking based markers of visual attention in infancy for their possible association with adaptive behavior at two years, such as saccadic reaction time (SRT) and measures of attentional preference for faces and emotional facial expressions. SRT has been shown to be a general attentional marker in infancy associated with many developmental and clinical aspects while attentional preference for faces and emotional facial expressions are pronounced at seven months and have been hypothesized to play a role in socio-emotional development. Infants were also studied with respect to attentional behavioral tendencies based on their SRT measures. Methods: This study employed material from the Toibilas-study at BABA center at Helsinki University Hospital. The study consisted of 45 children of either typical development (n=26) or children of high developmental risk (n=19) due to their prior treatment at the neonatal intensive care unit. The high-risk group was assumed to increase variability of the sample. Infants participated in eye-tracking measurements at seven months old using two different eye-tracking paradigms; a SRT task and a task measuring attentional bias for facial vs. non-facial as well as emotional facial expressions vs. neutral facial expressions. The same children were assessed for adaptive behavior at two years of age by a parent filled-questionnaire. Associations between attentional behavioral markers at seven months and adaptive behavior at two years were analyzed using linear models. The models also accounted for behavioral attentional tendency as identified from a set of SRT measures. Results and conclusions: A bigger attentional preference for faces compared to non-faces was associated with better overall adaptive behavior score as well as adaptive behavior composites for conceptual and practical adaptive behavior. This is in line with the hypothesis that attentional bias for faces is important for socio-emotional development. A significant association between identified behavioral attentional tendencies and the conceptual composite score of adaptive behavior was found. This finding suggests that recognizing attentional tendency may be useful for predicting later developmental trajectories. The present work provides preliminary evidence for the proof of principle that eye-tracking based metrics may provide clinically relevant predictions in infants, however novel prospective datasets are needed for clinical validation.
  • Thorlacius, Elin M.; Wåhlander, Håkan; Ojala, Tiina; Ylänen, Kaisa; Keski-Nisula, Juho; Synnergren, Mats; Romlin, Birgitta S.; Ricksten, Sven-Erik; Castellheim, Albert (2020)
    Objective : We aimed to determine the differential effects of intra-operative administration of milrinone versus levosimendan on myocardial function after pediatric cardiac surgery. Transthoracic echocardiography was employed for myocardial function evaluation, utilizing biventricular longitudinal strain with two-dimensional speckle tracking echocardiography in addition to conventional echocardiographic variables. Design : A secondary analysis of a randomized, prospective, double-blinded clinical drug trial Setting : Two pediatric tertiary university hospitals Participants : Infants between 1-12 months of age diagnosed with ventricular septal defect, complete atrioventricular septal defect, or tetralogy of Fallot who were scheduled for corrective surgery with cardiopulmonary bypass. Interventions : The patients were randomized to receive an infusion of milrinone or levosimendan at the start of cardiopulmonary bypass and for 26 consecutive hours. Measurements and main results : Biventricular longitudinal strain and conventional echocardiographic variables were measured preoperatively, on the first postoperative morning and prior to hospital discharge. The association between perioperative parameters and postoperative myocardial function was also investigated. Images were analyzed for left ventricular (n=67) and right ventricular (n=44) function. The day after surgery, left ventricular longitudinal strain was deteriorated in both the milrinone and levosimendan groups; 33% and 39%, respectively. The difference was not significant. The corresponding deterioration in right ventricular longitudinal strain was 42% and 50% (non-significant difference). For both groups, biventricular longitudinal strain approached their preoperative values at hospital discharge. Preoperative N-terminal pro-brain natriuretic peptide could predict the left ventricular strain on postoperative day one (p=0.014). Conclusions : Levosimendan was comparable to milrinone for left and right ventricular inotropic support in pediatric cardiac surgery.
  • Kaskinen, Anu K.; Keski-Nisula, Juho; Martelius, Laura; Moilanen, Eeva; Hämäläinen, Mari; Rautiainen, Paula; Andersson, Sture; Pitkänen-Argillander, Olli M. (2021)
    Objectives: The present study was performed to determine whether lung injury manifests as lung edema in neonates after congenital cardiac surgery and whether a stress-dose corticosteroid (SDC) regimen attenuates postoperative lung injury in neonates after congenital cardiac surgery. Design: A supplementary report of a randomized, double-blinded, placebo-controlled clinical trial. Setting: A pediatric tertiary university hospital. Participants: Forty neonates (age Measurements and Main Results: The chest radiography lung edema score was lower in the SDC than in the placebo group on the first postoperative day (POD one) (p = 0.03) and on PODs two and three (p = 0.03). Furthermore, a modest increase in the edema score of 0.9 was noted in the placebo group, whereas the edema score remained at the preoperative level in the SDC group. Postoperative dynamic respiratory system compliance was higher in the SDC group until POD three (p < 0.01). However, postoperative oxygenation; length of mechanical ventilation; and tracheal aspirate biomarkers of inflammation and oxidative stress, namely interleukin-6, interleukin-8, resistin, and 8-isoprostane, showed no differences between the groups. Conclusions: The SDC regimen reduced the development of mild and likely clinically insignificant radiographic lung edema and improved postoperative dynamic respiratory system compliance without adverse events, but it failed to improve postoperative oxygenation and length of mechanical ventilation. (C) 2021 The Authors. Published by Elsevier Inc.
  • Acosta Leinonen, Johanna Natalia (Helsingin yliopisto, 2019)
    Sleep is one of the most vital functions of newborns and infants, and it is essential for neuronal network development. Therefore, long-term sleep disturbances have been associated with growth delays and behavioral disorders. Commonly reported infant sleep disturbances, such as night awakenings and difficulties falling asleep, cause distress to parents. Yet, the development of infant sleep in the home environment has not been fully elucidated due to lack of objective measurement parameters. In the current study, we assessed the feasibility of a motion sensor, attached to wearable pants, and ECG textile electrodes to monitor sleep-related respiration and heart rate of newborns and infants. First, we compared signals recorded by the motion sensor’s measurement channels to the standard respiratory piezo effort belt’s signal during daytime EEG recordings. According to our results, the motion sensor’s gyroscope proved to measure respiratory rate most accurately, while the ECG signal transmitted by the sensor was reliable in interpretable sections. We then provided wearable garments and smartphones to families with infants to assess overnight home-use. Our results indicate that different sleep states could likely be identified based on respiration fluctuation visible in the gyroscope’s signals. Moreover, the wearable system was considered practical and easy to use by the parents. Future studies should focus on validating the sensor with clinically approved measures, in order to train the algorithms to automatically identify different sleep-wake states. By doing so, the wearable sensor could provide information on natural infant sleep structure development over long time periods. Additionally, clinical validation of the sensor may result in the development of a companion diagnostic tool for infant cardiorespiratory and movement disorders.
  • Svedenkrans, Jenny; Ekblom, Örjan; Domellöf, Magnus; Fellman, Vineta; Norman, Mikael; Bohlin, Kajsa (2020)
    Physical activity (PA) can prevent cardiovascular diseases. Because of increased risks of impairments affecting motor activity, PA in children born preterm may differ from that in children born at term. In this prospective cohort study, we compared objectively measured PA in 71 children born extremely preterm (
  • Huotilainen, Minna; Tervaniemi, Mari (2018)
    Music-based amelioration and training of the developing auditory system has a long tradition, and recent neuroscientific evidence supports using music in this manner. Here, we present the available evidence showing that various music-related activities result in positive changes in brain structure and function, becoming helpful for auditory cognitive processes in everyday life situations for individuals with typical neural development and especially for individuals with hearing, learning, attention, or other deficits that may compromise auditory processing. We also compare different types of music-based training and show how their effects have been investigated with neural methods. Finally, we take a critical position on the multitude of error sources found in amelioration and training studies and on publication bias in the field. We discuss some future improvements of these issues in the field of music-based training and their potential results at the neural and behavioral levels in infants and children for the advancement of the field and for a more complete understanding of the possibilities and significance of the training.
  • Viitaharju, Janika (Helsingin yliopisto, 2020)
    OBJECTIVES. The association between prenatal maternal stress and adverse health and developmental offspring outcomes has been long known but explanations for this association remain insufficient. One of the most recent suggestions is gut microbiota. Only a few studies with many limitations have concentrated on the association between prenatal stress and offspring gut microbiota. The aim of this study is to conduct a large scale study with follow-up covering the whole infancy, and to test whether the association differs between girls and boys. METHODS. This study’s sample consists of 825 mothers and their infants from HELMi cohort. Prenatal maternal stress is measured with self-report questionnaire, and infant gut microbiota from fecal samples. 16S rRNA sequencing is used in analyzing the microbiota. RESULTS. High stress group had lower alpha-diversity than low stress group at 3 weeks. No differences were found in richness and beta-diversity. Several phylum, family, and genus level bacteria were associated with prenatal stress. Regarding sex differences, no differences were found in richness or in alpha- or beta-diversity. However, in phylum, family, and genus level bacterial relative abundances, more associations were found in boys than in girls. CONCLUSION. Overall the findings in this study were contradicting compared to previous findings. There was indication that there is no clear association between prenatal stress and infant overall microbiota composition. Also, the association regarding bacterial abundances could decline over age, and the association might be stronger in boys. However, not very consistent conclusions can be made based on research conducted so far.
  • Keski-Nisula, Juho; Arvola, Oiva; Jahnukainen, Timo; Andersson, Sture; Pesonen, Eero (2020)
    Objective Corticosteroids attenuate inflammatory reaction in pediatric heart surgery. Inflammation is a source of free oxygen radicals. Children with a cyanotic heart defect are prone to increased radical stress during heart surgery. We hypothesized that high-dose methylprednisolone reduces inflammatory reaction and thereby also oxidative stress in infants with a univentricular heart defect undergoing bidirectional Glenn procedure. Design A double-blind, placebo-controlled, randomized clinical trial. Setting Operation theatre and pediatric intensive care unit of a university hospital. Participants Twenty-nine infants undergoing bidirectional Glenn procedure with or without aortic arch or pulmonary arterial repair. Interventions After anesthesia induction, the patients received intravenously either 30 mg/kg of methylprednisolone (n=15) or the same volume of saline as placebo (n=14). Measurements and Main Results Plasma interleukin-6, interleukin-8 and interleukin-10 (biomarkers of inflammation) as well as 8-hydroxydeoxyguanosine concentrations (a biomarker of oxidative stress) were measured at four different time points: preoperatively, during CPB, after protamine administration, and six hours postoperatively. The study parameters did not differ between the study groups preoperatively. Methylprednisolone reduced the pro-inflammatory cytokines interleukin-6 and interleukin-8 and increased the anti-inflammatory cytokine interleukin-10 postoperatively. Despite reduced inflammation, there were no differences in 8-hydroxydeoxyguanosine between the methylprednisolone and placebo groups. Conclusions Pro-inflammatory reaction and increase in free radical stress were not interrelated during congenital heart surgery in cyanotic infants with a univentricular heart defect undergoing bidirectional Glenn procedure. High-dose methylprednisolone was ineffective in attenuating free radical stress.
  • Kohva, Ella; Huopio, Hanna; Hietamäki, Johanna; Hero, Matti; Miettinen, Päivi J.; Raivio, Taneli (2019)
    What is the peripubertal outcome of recombinant human FSH (r-hFSH) treatment during minipuberty in boys with congenital hypogonadotropic hypogonadism (CHH)?Sertoli-cell response to r-hFSH, given during the minipuberty of infancy, appears insufficient to maintain Sertoli cell function throughout childhood, as evaluated by inhibin B measurements.Severe CHH in boys can be diagnosed during the minipuberty of infancy. Combined gonadotropin treatment at that age is suggested to improve testicular endocrine function and future fertility, yet long-term evidence is lacking.In this retrospective cohort study, we describe five CHH boys treated with r-hFSH in Helsinki University Hospital or Kuopio University Hospital between 2004 and 2018. Immediate follow-up data (0.1–1.4 months after cessation of the gonadotropin therapy) was available for four boys and long-term observations (at the age of 10.0–12.8 years) was available for three boys. As a retrospective control cohort, we provide inhibin B values of eight untreated CHH boys at the age of 12.7–17.8 years.Four patients had combined pituitary hormone deficiency, and one had CHARGE syndrome due to a CHD7 mutation. The patients were treated at the age of 0.7–4.2 months with r-hFSH (3.4 IU/kg–7.5 IU/kg per week in 2 or 3 s.c. doses for 3–4.5 months) combined with T (25 mg i.m. monthly for three months for the treatment of micropenis). Inhibin B was chosen as the primary outcome measure.During the r-hFSH + T treatment, inhibin B increased from 76 ± 18 ng/l to 176 ± 80 ng/l (P = 0.04) and penile length increased by 81 ± 50% (P = 0.04). Unexpectedly, two boys with robust inhibin B responses in infancy demonstrated low inhibin B values in peripuberty: declining from 290 ng/l (4 months) to 16 ng/l (12.4 years), and from 207 ng/l (6 months) to 21 ng/l (12.8 years). All boys underwent orchiopexy at 2.0 ± 0.7 years of age. Inhibin B values in long-term follow-up, available for the three boys, did not significantly differ from the untreated CHH controls.Limitations of this retrospective study are the small number and heterogeneity of the patients and their treatment schemes.We describe the first long-term follow-up data on CHH boys treated with r-hFSH and T as infants. The results from this small patient series suggest that the effects of infant r-hFSH treatment may be transient, and further longitudinal studies are required to determine the efficacy of this treatment approach to optimise the fertility potential in this patient population.This work was supported by the Finnish foundation for Pediatric Research, the Academy of Finland and the Emil Aaltonen Foundation. The authors have no competing interests.Non-applicable.