Ms. Hester is Content Specialist with Contemporary OB/GYN and Contemporary Pediatrics.

Miranda Hester

Medical advancements in perinatal and neonatal care have led to greater survival for extremely preterm infants. A 

 examined whether these advances had also led improvements in the neurodevelopmental outcomes in children who were born <28 weeks’ gestation.1

The investigators used 4 prospective longitudinal cohort studies that included all live extremely preterm births 22 to 27 weeks’ gestation in the state of Victoria, Australia in 1991-1992, 1997, 2005, and 2016-2017. The main outcomes looked at were survival, blindness, cerebral palsy, developmental delay, deafness, and neurodevelopmental disability at 2 years’ corrected age. Delays in development included a developmental quotient that was less than -1 SD relative to the control group averages on the Bayley Scales. A major neurodevelopmental disability involved moderate to severe cerebral palsy, blindness, deafness, or a developmental quotient less than −2 SDs.

Data were available for 1152 children across the 4 studies. The investigators found that survival to 2 years of age was highest in the 2016-2017 cohort (73% [215 of 293]) in comparison with the other cohorts: 1991-1992: 53% (225 of 428); 1997: 70% (151 of 217); 2005: 63% (170 of 270). Additionally, cerebral palsy was not as common in 2016-2017 (6%) than the other 3 time periods (1991-1992: 11%; 1997: 12%; 2005: 10%). No notable changes in the rates of developmental quotient less than -2 SDs (1991-1992: 18%; 1997: 22%; 2005: 7%; 2016-2017: 15%) or rates of major neurodevelopmental disability (1991-1992: 20%; 1997: 26%; 2005: 15%; 2016-2017: 15%) were found across the eras. Across all 4 cohorts, both blindness and deafness were not common. Furthermore, the rate of survival that was also free from major neurodevelopmental disability went up steadily over time 42% (1991-1992), 51% (1997), 53% (2005), and 62% (2016-2017) (odds ratio, 1.30; 95% CI, 1.15-1.48 per decade; 

The investigators concluded that children who are born extremely preterm are increasingly surviving to age 2 years without a major disability. Furthermore, this increased rate of survival was not linked to an increase in neurodevelopmental disability.

1. Cheong J, Olsen J, Lee K, et al. Temporal trends in neurodevelopmental outcomes to 2 years after extremely preterm birth. 

. July 19, 2021. Epub ahead of print. doi:10.1001/jamapediatrics.2021.2052

This article was originally published on Contemporary Pediatrics®. 

Articles

As more extremely preterm infants survive delivery, a study examines whether the advances that allowed for that survival also improve neurodevelopmental outcomes.

Neurodevelopment outcomes of extremely preterm births

Many parents and teenagers think that it’s important to have discussions about sexual and reproductive health with their clinicians. However, these discussions aren’t always happening at preventive care visits. A 

 in Pediatrics assessed how often those visits were occurring and what was being missed when they didn’t occur.

The investigators ran an internet survey of a national sample of adolescents and their parents. The teenagers had a preventive visits in the past 2 years. Both parents and adolescents were asked about a variety of sexual and reproductive health topics, including puberty, sexual orientation, methods of birth control, and where to obtain sexual reproductive health services and rate how important it was to discuss. Both groups were also asked about whether their clinician had discussed confidentiality. The teenagers were asked about what was discussed during their most recent preventive care visits as well as whether they had time alone with the clinician.

In the sample, slightly more than half of the teenagers were non-Hispanic White. Nearly all of them identified as heterosexual. A majority of the parents were either the stepmother or mother and nearly all of them were married or living with a partner. When asked about which topics were important to discuss, teenagers said that they believed puberty, sexually transmitted infections including HIV, birth control methods, and where to access sexual and reproductive health services, with older adolescents, those aged 15 to 17 years, saying they were important more often than the younger ones, those 11 to 14 years. 

The parents were more likely than their children to say that it was important to discuss these topics at preventive visits. Confidentiality appeared to not be commonly discussed, with only 42.3% of older adolescents reporting that their provider had ever discussed confidentiality with them. When discussing their most recent visit, 14.0% of younger teenagers and 38.7% of older teenagers said that they had been asked about their sexual activity. Among younger adolescents, younger girls were twice as likely to be asked about their sexual activity than their male peers. 

Puberty was the mostly likely sexual and reproductive health topic discussed at the visit with less than a third of teenagers reporting a discussion of any other topic. Not including puberty, the other topics were more likely to occur with older adolescents than the younger group.

The investigators determined that both teenagers and parents think that having discussions about sexual and reproductive health topics like puberty and birth control are very important, but many of those topics did not occur during many of the recent preventive visits. The lack of discussion was particularly common during visits with younger adolescents.

1. Sieving R, McRee A, Mehus C, et al. Sexual and Reproductive health discussions during preventive visits. Pediatrics. July 12, 2021. Epub ahead of print. doi:10.1542/peds.2020-049411

This article was originally posted on Contemporary Pediatrics®. 

A report indicates that both parents and teenagers want to have discussions on sexual and reproductive health during preventive visits, but those discussions may not be happening as often as they should be.

The reproductive health discussion between parents and teens

In spite of the fact that the human papillomavirus (HPV) vaccine is highly effective in preventing a variety of squamous cell carcinomas, the uptake of the vaccine in the United States remains low. A 

 examines the concerns that may be contributing to nonvaccination.

The investigators used data from the National Immunization Survey-Teen from 2008 to 2019. The survey is a population-based survey of caregivers of adolescents aged 13 to 17 years and their primary care professionals. The primary outcome for the research was caregivers reporting safety concerns or adverse effects as the main reason behind the refusal for the HPV vaccine, using the survey question “What is the MAIN reason teen will not receive HPV shots in the next 12 months?” to find caregivers with those concerns.

During the studied period, self-reports of concerns about safety or adverse effects being the main reason for vaccine refusal increased in prevalence, from 5.3% (95% CI, 4.4-6.5) in 2008 to 12.9% (95% CI, 12.0-13.9) in 2015 and then a sharp increase between 2015 to 2019 with a 26.2% (95% CI, 24.3-28.2) increase. Higher rates of concern as the main reason for nonvaccination were seen by non-Hispanic White caregivers as well as by parents or guardians of teenaged girls. Mothers who had college degrees and mothers who had less than 12 years of completed education had roughly the same rates of reporting safety concerns between 2008 to 2013. However, there was a statistically significant increase in the college educated mothers reporting safety concerns or adverse effects as the main reason for nonvaccination when compared to mothers who had less than 12 years of completed education (eg, 28.3% [95% CI, 25.5-31.2] among mothers with college degrees vs 13.7% [95% CI, 9.5-19.4] among mothers with less than 12 years of education in 2019).

The investigators concluded that a concern about safety or adverse effects as the main cause for HPV vaccine refusal has increased over the years. This increase could have a negative effect on the already sluggish uptake of the vaccine. During parent-caregiver encounters, clinicians should prepare to address HPV vaccine hesitancy and particularly safety concerns when discussing the vaccine at age-appropriate appointments.

1. Chido-Amajuoyi O, Talluri R, Shete S, Shete S. Safety concerns or adverse effects as the main reason for human papillomavirus vaccine refusal. 

. June 28, 2021. Epub ahead of print. doi:10.1001/jamapediatrics.2021.1585

There are many reasons why a caregiver may refuse to have his or her child receive the human papillomavirus (HPV) vaccine, including safety concerns. A research letter examines whether those concerns have increased.

Safety concerns in HPV vaccine refusal

Neonatal hypoglycemia is a common occurrence in newborns and treatment can help reduce the risk of brain injury due to severe, prolonged, or recurrent hypoglycemia. A presentation at the 81st virtual Scientific Sessions for the American Diabetes Association examined the long-term outcomes of neonatal hypoglycemia. Raghavendra Rao, MD, a professor of pediatrics and director of the division of neonatology at the University of Minnesota in Minneapolis, discussed whether newborn brains were more vulnerable than adult brains during hypoglycemia as well as well the impact of rapid correction on brain injury.

In a study that used rats, investigators found that hypoglycemia led to injury in the areas of the brain that govern emotion, attention and learning as well as cognitive function. In the adult rats, it led to problems with the areas that involve visuospatial information processing and the ability to smell. In cases of acute hypoglycemia, the brain will initially use glucose and then move onto other substrates. If those substrates are exhausted, there is energy failure which can lead to brain injury. Although dextrose administration can lead to improved metabolite levels, some metabolites such as aspartate and glutamine do not easily recover after treatment. Another test in rhesus monkeys included monkeys that had different durations of hypoglycemia including 6 hours and 10 hours. In this study, the investigators found that both cognitive and behavioral performance were unaffected in those with 6 hours of hypoglycemia. However, there were training difficulties noted in 50% of the monkeys who had experienced 10 hours. No memory or personality differences were noted in either group.

The CHYLD study from New Zealand involved 604 preterm and term at-risk infants who received glucose monitoring for the first 7 days. The children were given a neurodevelopmental assessment at age 2 and 4.5 years. There was no link between neonatal hypoglycemia and neurosensory impairment at either assessment. However, infants with hypoglycemia were found to have more executive dysfunction, impaired visual-motor integration, and greater risk of severe and recurrent hypoglycemia at the 4.5 year assessment.

Rao also discussed a study in rats that compared using different doses of dextrose, 10% versus 50%, to end acute hypoglycemia. The investigators in this study found that the use of the 50% dextrose solution was linked to a higher risk of neuronal injury.

1. Rao R. Long-term outcomes of neonatal hypoglycemia-clinical lessons from the lab. American Diabetes Association Scientific Sessions 2021; June 28, 2021; virtual. Accessed June 28, 2021.

A session at the virtual Scientific Sessions for the American Diabetes Association examined the potential long-term outcomes for a child who experiences neonatal hypoglycemia.