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Background Family-centered intervention for preterm infants has shown short- to medium-term developmental benefits; however, the neurological effects of intervention have rarely been explored. Objective The objectives of this study were to examine the effect of a family-centered intervention program (FCIP) on neurophysiological functions in preterm infants with very low birth weight (VLBW; birth weight of < 1500 g) in Taiwan, to compare the effect of the FCIP with that of a usual-care program (UCP), and to explore the FCIP-induced changes in neurobehavioral and neurophysiological functions. Design This was a multicenter, single-blind randomized controlled trial. Setting The study took place in 3 medical centers in northern and southern Taiwan. Participants Two hundred fifty-one preterm infants with VLBW were included. Intervention The FCIP group received a family-centered intervention and the UCP group received standard care during hospitalization. Measurements Infants were assessed in terms of neurobehavioral performance using the Neonatal Neurobehavioral Examination–Chinese version, and their neurophysiological function was assessed using electroencephalography/event-related potentials during sleep and during an auditory oddball task during the neonatal period. Results The FCIP promoted more mature neurophysiological function than the UCP, including greater negative mean amplitudes of mismatch negativities in the left frontal region in the oddball task in all infants, lower intrahemispheric prefrontal-central coherence during sleep in infants who were small for gestational age, and higher interhemispheric frontal coherence during sleep in those who were appropriate for gestational age. Furthermore, interhemispheric coherence was positively associated with the total neurobehavioral score in preterm infants who were appropriate for gestational age (r  = 0.20). Limitations The fact that more parental adherence strategies were used in the FCIP group than in the UCP group might have favored the intervention effect in this study. Conclusions Family-centered intervention facilitates short-term neurophysiological maturation in preterm infants with VLBW in Taiwan. [ABSTRACT FROM AUTHOR]

Background There are limited nationwide data relating to neonatal mortality rate in Taiwan. This study aims to provide updated national birth weight/gestational age-specific neonatal mortality reference rates. Methods We abstracted the birth registration database from the Ministry of Interior in Taiwan from 1998 to 2002 and linked the data to the death registration database from the Ministry of Health and Welfare in Taiwan between 1998 and 2003. We included 1,331,785 infants born between 20 weeks and 44 weeks of gestation and weighing within the median ± 2 interquartile ranges in their age group in this study. We calculated the birth weight/gestational age-specific neonatal mortality rates of different genders by birth weight increments of 250 g and at gestational age intervals of 1 week. A Poisson regression model was used in modeling the mortality data. Results A total of 4,169 deaths occurred within 28 days of life out of a total of 1,331,785 live births between 20 weeks and 44 weeks of gestation, giving a neonatal mortality rate (0–27 days) of 3.39 per 1000 live births for males and 2.80 per 1000 for females. The infant mortality rate remained higher in the male (5.91 per 1000) than the female (5.10 per 1000) population within the 1 st year of life. Birth weight/gestational age-specific neonatal mortality rates were plotted with curves representing the 10 th and 90 th birth weight percentiles. The risk of an early neonatal death (0–6 days) does not exceed 50% except for female neonates < 500 g and ≤ 23 weeks, which implies that the limit of viability is now at 23 weeks for females. Conclusion We have provided an easy-to-use birth weight/gestational age-specific neonatal mortality rate chart as a reference document that physicians and parents can use to make decisions based on ethical considerations relating to whether to give palliative care or further invasive management. The normative data are crucial for public health policies on neonatal care in Taiwan. [ABSTRACT FROM AUTHOR]

ABSTRACT This study investigated the effect of still-face interaction on the affect, behavior, and perception in mothers of term and low-birth-weight preterm (gestational age <37 weeks and birth weight < 2,500g) infants. Thirty-five Taiwanese mothers and their healthy 2-month-old term and low-birth-weight preterm (corrected age) infants participated in the maternal still-face procedure. Mothers' perceptions of infant affect, their own affective experience, and parenting efficacy were obtained via video-playback interviews. Infant affect, maternal affect, and maternal behavior were also coded from videos using fine-grained behavioral coding strategies. Overall, the results showed that the perturbation of still-face interaction differentially affected the affect, behavior, and perception of mothers of term and preterm infants. Mothers of term, not preterm, infants accurately reported the still-face effect on their infants' affect. Although both groups of mothers reported similar changes in their affective experience that resembled the classic still-face effect on infants, mothers of term, not preterm, infants were observed to decrease their positive affect from before to after the still-face interaction. Furthermore, although neither groups of mothers did change their perceived and observed parenting efficacy from before to after the still-face interaction, mothers of term infants demonstrated greater responsive engagement than mothers of preterm infants. Finally, mothers' perceived affective positivity predicted perceived parenting efficacy both before and after the still-face interaction, after controlling for infant birth status and infant affective positivity perceived by mothers. The differential response in mothers of preterm infants indicated the needs for intervention. [ABSTRACT FROM AUTHOR]

Background: Although racial/ethnic disparities in neonatal and infant health are well known, positive associations between migration and perinatal health exist among immigrant mothers in western countries. There are unique marriage migration, East Asia culture, universal national health insurance system, and adequate social support in Taiwan that may differ from the situation in western countries. We aimed to assess the neonatal outcomes among live births to married immigrant mothers in recent years in Taiwan. Methods: We conducted a population-based analysis among all the live births in Taiwan during the period 1998-2003 to assess neonatal outcomes, including incidence of low birth weight and preterm birth and of early and late neonatal mortality, according to maternal nationality. Logistic regression was used to estimate the odds ratios (ORs) associated with low birth weight and preterm birth, and Cox proportional hazards were used to estimate the relative risks (RRs) associated with mortality in the neonatal period. Results: There were a total of 1,405,931 single live births, including 6.6% born to immigrant mothers and 93.4% born to Taiwanese mothers. Disparities existed among the intercultural couples, including paternal age, parental educational level, and residential distribution. Fewer low birth weight and fewer preterm babies were born to immigrant mothers than to Taiwanese mothers. In addition, babies born to immigrant mothers had lower early neonatal and neonatal mortalities than those born to Taiwanese mothers. There were lower risks of having a low birth weight (adjusted OR [AOR] 0.73, 95% confidence interval [CI] 0.70-0.75) or preterm (AOR 0.72, 95% CI 0.69-0.74) baby and lower hazard ratios (HRs) of having an early neonatal death (adjusted HR [AHR] 0.68, 95% CI 0.56-0.82) or neonatal death (AHR 0.74, 95% CI 0.64-0.87) in babies born to immigrant mothers. There is a gradual increase in the risks of adverse neonatal outcomes associated with increases in length of residence. Conclusions: Evidence of a healthy immigrant mother effect on neonatal health is clear. Despite lower parental education, advancing paternal age, and spatial distribution disparity, babies born to married immigrant mothers in Taiwan had favorable neonatal outcomes. [ABSTRACT FROM AUTHOR]

Background/Purpose: All children should have some developmental screening periodically throughout childhood, especially those who were born prematurely. There is limited information about the development of children with very low birth weight (VLBW; birth weight < 1500 g) beyond the preschool age in Taiwan. We evaluated intelligence quotient (IQ) and cognitive ability of prematurely born school-aged children in Taiwan. Methods: This was a multicenter study of VLBW and full-term children born between 1995 and 1997 at four hospitals in northern Taiwan. We used the Wechsler Intelligence Scale for Children, 3rd Edition (WISC-III), to assess these children. Demographic data were recorded including maternal and paternal age, education, birth weight, gestational age, and gender. Results: A total of 189 children (130 with VLBW born prematurely and 59 born at full term) were recruited. There were significant differences in performance IQ (PIQ; 90.16 ± 17.05 vs. 108.51 ± 15.65, p < 0.001), verbal IQ (VIQ; 97.43 ± 15.62 vs. 111.78 ± 13.65, p < 0.001), full-scale IQ (FSIQ; 93.14 ± 16.33 vs. 111.05 ± 14.81, p < 0.001), verbal comprehension index score (VCIS; 98.06 ± 15.53 vs. 112.47 ± 13.74, p < 0.001), perceptional organization index score (POIS; 92.39 ± 17.13 vs. 109.42 ± 14.87, p < 0.001) and freedom from distractibility index score (FDIS; 98.34 ± 17.71 vs. 110.53 ± 10.94, p = 0.008). There was no correlation between perinatal outcomes and FSIQ. Conclusion: Our results suggest that VLBW children have significantly lower PIQ, VIQ, FSIQ, VCIS, POIS and FDIS at primary school compared with full-term children. [Copyright &y& Elsevier]

Abstract: An increasing number of studies have examined the development of walking in preterm infants; however, the results concerning those who had no major neonatal disease were inconclusive. This study was therefore aimed to examine the age of onset, the quality of early walking movement, and the sensitivity to resonant period of the force-driven harmonic oscillator (FDHO) model in preterm infants who had no major neonatal disease and normal term infants. Twenty-nine preterm infants and 29 term infants were prospectively examined for their age of onset of independent walking and were subsequently assessed the qualitative features of walking at 18 months of corrected age using kinematic analysis. Kinematic variables examined included spatio-temporal organization, inter-joint coordination, and inter-limb coordination. The anthropometric data were used to calculate the resonant period. The results demonstrated that the preterm infants attained independent walking at significantly older ages than the term infants when corrected for prematurity. The preterm infants manifested similar walking characteristics, except for shorter stride lengths, at 18 months of corrected age compared with the term infants. Furthermore, the stride periods of both groups were accurately predicted by the resonant period of the FDHO model. We conclude that preterm birth without accompanied major neonatal disease may affect infants’ age of onset and spatial organization but not their sensitivity to resonance during the early stage of walking development. [Copyright &y& Elsevier]

This study examined the developmental and clinical outcomes in very-low-birthweight (VLBW; ≤1500g) infants with and without bronchopulmonary dysplasia (BPD) throughout infancy, and assessed if BPD predicted poor developmental outcome beyond the effects of other risk factors. One hundred and three VLBW infants (53 males, 50 females; mean gestational age 28wks [SD 2] birthweight 1041g [SD 261]) were graded for severity of BPD according to the American National Institutes of Health (NIH) consensus definition. Neuro-development was assessed using the Neonatal Neurobehavioral Examination-Chinese version, at 36 and 39 weeks' postmenstrual age, and the 2nd edition of the Bayley Scales of Infant Development at 6 and 12 months' corrected age. Clinical outcome was measured by means of rehospitalization for pulmonary causes and treatment with pulmonary medications. Compared with infants without BPD, infants with BPD had higher rates of clinical morbidity, and those with severe BPD further exhibited higher incidences of developmental delay throughout infancy. BPD predicts poor 1-year developmental and clinical outcomes in VLBW infants for which effects are well correlated to the NIH consensus definition. [ABSTRACT FROM AUTHOR]

Discussion and Conclusion. The findings indicate that infants with VLBW, particularly those with a low gestational age, have age-related differences in movement organization and coordination of kicking compared with full-term infants. [Jeng SF, Chen LC, Yau KIT. Kinematic analysis of kicking movements in preterm infants with very low birth weight and full-term infants. Phys Ther. 2002;82:148 -159.] [ABSTRACT FROM AUTHOR]

Preterm infants are at risk for emotional difficulties and behavioral problems. This study was aimed to investigate the effects of a clinic-based intervention program (CBIP) and a home-based intervention program (HBIP) compared with a usual care program (UCP) on emotion regulation to stress in preterm infants with very low birth weight (VLBW, birth weight <1500 g). A total of 178 VLBW preterm infants had been previously randomly assigned to receive one of three interventions (57 in CBIP, 63 in HBIP and 58 in UCP). The CBIP and HBIP contained identical child-, parent- and dyad-focused interventions that were provided to infants during hospitalization and were respectively delivered at clinics and at home at PMA 36-38 and 40 weeks, and 1, 2, 4, 6, 9, 12 months of corrected age. All infants were prospectively observed for behavioral reactivity and regulation in response to experimentally evoke stress evoked by a toy-behind-barrier procedure at 12, 18, and 24 months of corrected age. Their cognitive and language abilities, and mothers' responsiveness were also assessed at 12 months as potential covariates. Compared to the UCP-group infants, the HBIP-group infants exhibited shorter durations of visual orientation to a toy (adjusted difference [95% CI]=-1.60 [-3.07 to -0.13], p=0.03), and the CBIP-group infants exhibited shorter durations of avoidance (adjusted difference [95% CI]=-0.84 [-1.57 to -0.10], p=0.03) from 12 to 24 months of corrected age. The CBIP and HBIP showed no difference in the stress reactivity from the UCP, however. These results suggest that comprehensive interventions incorporating child-, parent- and dyad-focused services enhanced VLBW preterm infants' emotion regulation in response to stress at toddler age. [ABSTRACT FROM AUTHOR]