Preventing lung injuries in very premature babies: Current therapies less effective than expected

Main Category: Pediatrics / Children's Health
Also Included In: Respiratory / Asthma;  Pregnancy / Obstetrics
Article Date: 17 Aug 2013 - 0:00 PDT Current ratings for:
Preventing lung injuries in very premature babies: Current therapies less effective than expected

A neonatologist at The Children's Hospital of Philadelphia is the senior author of a large new study that found that current non-invasive techniques for respiratory support are less effective than widely assumed, in reducing the incidence of severe lung injury in very premature infants. Neonatologists commonly use non-invasive nasal ventilation instead of mechanical ventilation via a breathing tube, in hopes of avoiding bronchopulmonary dysplasia (BPD).

Frequently a by-product of intubation, BPD - scarring and inflammation of the lungs - is a leading cause of death or neurological injury in extremely-low-birth-weight infants.

Haresh Kirpalani, M.D., of the Division of Neonatology at Children's Hospital, is the senior author of a study published in the New England Journal of Medicine.

This multinational, randomized trial compared two common forms of non-invasive ventilation used in extremely-low-birth-weight premature infants. Both techniques make breathing easier for the infant by stopping the lungs from collapsing, which over time causes lung inflammation and injury.

The current standard of care, nasal continuous positive airway pressure (CPAP), delivers slightly pressurized air throughout the breathing cycle. In contrast, nasal intermittent positive-pressure ventilation (IPPV), which has become widespread, provides an additional spike of positive pressure when the infant inhales. While more complicated, the hope had been that it was more effective than standard CPAP. Researchers tested the hypothesis that this extra pressure delivered in IPPV would be more beneficial than CPAP in preventing BPD.

The study team randomly assigned 1009 infants with a birth weight under 1000 grams (2.2 pounds) and gestational age under 30 weeks to either nasal CPAP or nasal IPPV. The infants were from 34 neonatal intensive care units in 10 countries. The researchers found no significant difference in the primary outcome of either death or survival with BPD at 36 weeks. They also found no significant difference in rates of other neonatal complications between the two treatment groups.

"Although somewhat discouraging, this research is significant as it refutes the common assumption that the non-invasive therapies being used are reducing severe lung injury in these tiny babies," said Kirpalani. "The study alerts us that we still need to develop new therapies for babies to avoid lung injury and BPD."

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our pediatrics / children's health section for the latest news on this subject.

The Canadian Institutes of Health Research supported this study.

"A Trial Comparing Noninvasive Ventilation Strategies in Preterm Infants," New England Journal of Medicine, Aug. 15, 2013. doi.org/10.1056/NEJMoa1214533

Children's Hospital of Philadelphia

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Premature infants may have higher risk of heart disease

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Main Category: Pregnancy / Obstetrics
Also Included In: Heart Disease
Article Date: 14 Aug 2013 - 8:00 PDT Current ratings for:
Premature infants may have higher risk of heart disease

Babies who are born prematurely experience differences in how their heart forms and works as an adult, compared with babies who are born at full-term. According to a study published in the journal Circulation, this leads to a higher risk of cardiovascular disease later in life.

Researchers from the University of Oxford in England studied 102 premature infants from birth, alongside 132 infants who were born at full-term with no complications.

Of the premature infants, 14% were born at less than 28 weeks, 58% were born between 28 and 31 weeks, and 31% were born between 32 and 36 weeks.

All infants were born in the 1980s and tracked until they were between 23 and 28 years of age.

As well as standard heart health evaluations, which included measurements of blood pressure and cholesterol, the researchers used magnetic resonance imaging (MRI) techniques in order to measure the participants' hearts and blood vessels.

They used computer programs to create models of the hearts, enabling them to investigate their structure and see how much blood was being pumped around the body.

Results of the analysis revealed that the right ventricle - the part of the heart that receives deoxygenated blood from the right atrium and pumps it to the lungs - was significantly different in the adults who were premature babies, compared with the hearts of adults who were born at full-term.

The premature babies had hearts that were smaller, heavier and had thicker walls with reduced pumping activity.

Additionally, the scientists found that the earlier the former premature babies were born, the bigger the impact was on the size and function of the right ventricle.

Professor Paul Leeson, a cardiologist at the Cardiovascular Clinical Research Facility of the University of Oxford, says that around 10% of today's adults are born prematurely and appear to be at higher risk of cardiovascular problems in adulthood.

He says:

"We wanted to understand why this occurs so that we can identify the small group of patients born premature who may need advice from their healthcare provider about this cardiovascular risk.

The changes we have found in the right ventricle are quite distinct and intriguing."

The scientists say that in older adults, changes in the structure of the right ventricle may lead to increased risk of heart failure and cardiovascular death.

But they add that there was no evidence of such problems in the young people who participated in the study.

The study authors conclude that further analysis is needed to enhance understanding of the structure of the hearts in premature babies, and how their risk of cardiovascular can increase in adulthood.

"We are trying to dig deeper into what's different about the hearts of those born preterm," says Adam Lewandowski, first author of the study.

"The potential scientific explanations for why their hearts are different are fascinating and our study adds to the growing understanding of how premature birth shapes future heart health."

Written by Honor Whiteman

Copyright: Medical News Today
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Right ventricular systolic dysfunction in young adults born preterm doi: 10.1161/ CIRCULATIONAHA.113.002583, published in the journal Circulation, 12 August 2013.

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Sensitive parenting can boost premature children's school performance

Main Category: Pediatrics / Children's Health
Also Included In: Psychology / Psychiatry
Article Date: 02 Aug 2013 - 1:00 PDT Current ratings for:
Sensitive parenting can boost premature children's school performance

Sensitive parenting helps protect against the negative effects of being born prematurely on children's school success, a new study has found.

Children born prematurely are at risk of a variety of neurological impairments which can mean they are more likely to need special educational support when they reach school age.

But a new study led by the University of Warwick shows that parents of very preterm and very low birthweight (VP/VLBW) children can increase their child's academic achievement through sensitive and cognitively stimulating parenting.

Researchers looked at parenting styles of parents of children aged 6 to see what effect they had on those children's school success when they reached the age of 13.

The study found that highly sensitive parenting at age 6 boosted the academic performance of VP/VLBW children when they reached 13 to levels similar to full-term children. A parallel increase was not seen for full-term children.

However, the results also showed that more cognitively stimulating early home environments benefit all children's long-term school success, regardless of whether they were premature or not.

Professor Dieter Wolke of University of Warwick said: "By sensitive parenting, we mean adapting one's parenting to the individual child's behaviour and responses, while clearly remaining the more competent partner and setting age appropriate limits."

"So for example providing gentle feedback and suggesting potential solutions rather than taking over and solving the tasks for the child.

"Cognitively stimulating parenting is where parents include activities designed to get children thinking such as reading to them or doing puzzles together.

"We found that both these styles of parenting have a positive effect in increasing school performance, with sensitive parenting particularly effective at closing the gap in achievement between preterm and low birth-weight children and their full-term counterparts."

The study, Effects of Sensitive Parenting on the Academic Resilience of Very Preterm and Very Low Birth Weight Adolescents was published in the Journal of Adolescent Health.

The researchers sought to clear up uncertainty among the scientific community about whether parenting has an influence on academic achievement of preterm children.

They looked at two groups of German children - 314 very preterm/very low birth weight children and a control group of 338 full-term children.

They were studied from birth to age 13, with the researchers analysing socioeconomic status, neurological and physical impairment at age 20 months and levels of parental sensitive and cognitive stimulation at age 6 years. School success was measured from six to 13 years of age.

The study defined very preterm as babies born at less than 32 weeks gestation or weighing less than 1500g (3lb 5 oz).

The researchers found that the 15 per cent of highly sensitive parents within the VP/VLBW group had children whose academic performance at 13 years was similar to the full-term children.

In contrast, parents of VP/VLBW children who showed low sensitivity had children who required more special educational help and had more schooling problems.

Maternal sensitivity made little difference to the grades or academic performance of full-term children, who were much less susceptible to parenting differences.

The research found that cognitively stimulating parenting raised academic performance across both groups of children.

Professor Wolke said: "The results suggest that sensitive parenting boosts children's self-control and attention regulation, which are important for school success.

"We would like to see increased investment in programmes that equip parents of VP/VLBW with the skills needed to provide appropriate and sensitive support to their children."

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Premature aging of immune cells present in joints of kids with chronic arthritis, Pitt/Children's Hospital team says

Main Category: Arthritis / Rheumatology
Also Included In: Immune System / Vaccines;  Pediatrics / Children's Health;  Seniors / Aging
Article Date: 31 Jul 2013 - 1:00 PDT Current ratings for:
Premature aging of immune cells present in joints of kids with chronic arthritis, Pitt/Children's Hospital team says

The joints of children with the most common form of chronic inflammatory arthritis contain immune cells that resemble those of 90-year-olds, according to a new study led by researchers at Children's Hospital of Pittsburgh of UPMC and the University of Pittsburgh School of Medicine. The findings, published in the August issue of Arthritis and Rheumatism, suggest that innovative treatment approaches could aim to prevent premature aging of immune cells.

Juvenile idiopathic arthritis, or JIA, is the most prevalent rheumatic condition in the world and affects one of every 1,000 children in the U.S., said senior researcher Abbe de Vallejo, Ph.D., associate professor of pediatrics and immunology, Pitt School of Medicine. It usually starts with a swollen ankle, knee or wrist that parents often assume is due to a minor injury sustained while playing.

"Untreated JIA has devastating consequences," Dr. de Vallejo said. "It can slow growth and, in extreme cases, the child can be physically disfigured. It's a degenerative disease that eats up the joints."

Doctors have long thought of JIA as an autoimmune disease, meaning the body attacks itself. But previous studies by Dr. de Vallejo of young adults with rheumatoid arthritis indicated that a certain population of cells present in the joint synovial fluid and blood displayed telltale signs of abnormal cell division and premature aging. His current team at Children's wanted to see if that was true in pediatric arthritis.

They examined immune cells called T-cells in the synovial fluid and blood from 98 children ages 1 to 17 and known to have JIA, as well as 46 blood samples from children who didn't have the disease. T-cells are the army of immune cells that eradicate infection, tumors and other dangerous agents to which people may be exposed.

The research team found about one-third of the T-cells of children with JIA had shortened telomeres and had reduced, or in some cases lost, the capacity to proliferate. Telomeres are the ends of chromosomes that don't code for proteins and, because they are not fully copied by enzyme mechanisms, are trimmed slightly during each DNA replication cycle. It is thought that aging occurs when the telomeres become too short for DNA replication and cell division to proceed normally.

"The T-cells of the children with JIA had very short telomeres, about the length we see in a 90-year-old or a young adult with rheumatoid arthritis. Those same T-cells express unusually high levels of several classic protein markers of cell aging and exhaustion," Dr. de Vallejo said. "These kids haven't lived long enough to have cells that look that old. This is the first indication that premature aging in occurring in this childhood condition."

In addition, the T-cells had become dysregulated, and their immune activity could be stimulated through atypical cell surface receptors. Much more must be learned about the unusual cells and about genetic mechanisms that might contribute to the development of JIA, Dr. de Vallejo said, but these findings could point the way to new therapies.

"JIA is typically treated with broad-spectrum drugs such as steroids and biologics that essentially paralyze the entire immune system, but only a third of the cells are affected and their abnormality seems to be premature aging, rather than autoimmune activity," he noted. "This study suggests cell-targeted treatments could be developed to prevent this premature immune aging."

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our arthritis / rheumatology section for the latest news on this subject.

Co-authors of the paper include other researchers from Children’s Hospital of Pittsburgh of UPMC; Pitt School of Medicine; and the Mayo Clinic. The project was funded by the Nancy E. Taylor Foundation for Chronic Diseases, the Arthritis Foundation, and National Institutes of Health grant AR052282.

Children’s Hospital of Pittsburgh of UPMC & University of Pittsburgh Schools of the Health Sciences

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Premature aging of immune cells present in joints of kids with chronic arthritis, Pitt/Children's Hospital team says

Main Category: Arthritis / Rheumatology
Also Included In: Immune System / Vaccines;  Pediatrics / Children's Health;  Seniors / Aging
Article Date: 31 Jul 2013 - 1:00 PDT Current ratings for:
Premature aging of immune cells present in joints of kids with chronic arthritis, Pitt/Children's Hospital team says

The joints of children with the most common form of chronic inflammatory arthritis contain immune cells that resemble those of 90-year-olds, according to a new study led by researchers at Children's Hospital of Pittsburgh of UPMC and the University of Pittsburgh School of Medicine. The findings, published in the August issue of Arthritis and Rheumatism, suggest that innovative treatment approaches could aim to prevent premature aging of immune cells.

Juvenile idiopathic arthritis, or JIA, is the most prevalent rheumatic condition in the world and affects one of every 1,000 children in the U.S., said senior researcher Abbe de Vallejo, Ph.D., associate professor of pediatrics and immunology, Pitt School of Medicine. It usually starts with a swollen ankle, knee or wrist that parents often assume is due to a minor injury sustained while playing.

"Untreated JIA has devastating consequences," Dr. de Vallejo said. "It can slow growth and, in extreme cases, the child can be physically disfigured. It's a degenerative disease that eats up the joints."

Doctors have long thought of JIA as an autoimmune disease, meaning the body attacks itself. But previous studies by Dr. de Vallejo of young adults with rheumatoid arthritis indicated that a certain population of cells present in the joint synovial fluid and blood displayed telltale signs of abnormal cell division and premature aging. His current team at Children's wanted to see if that was true in pediatric arthritis.

They examined immune cells called T-cells in the synovial fluid and blood from 98 children ages 1 to 17 and known to have JIA, as well as 46 blood samples from children who didn't have the disease. T-cells are the army of immune cells that eradicate infection, tumors and other dangerous agents to which people may be exposed.

The research team found about one-third of the T-cells of children with JIA had shortened telomeres and had reduced, or in some cases lost, the capacity to proliferate. Telomeres are the ends of chromosomes that don't code for proteins and, because they are not fully copied by enzyme mechanisms, are trimmed slightly during each DNA replication cycle. It is thought that aging occurs when the telomeres become too short for DNA replication and cell division to proceed normally.

"The T-cells of the children with JIA had very short telomeres, about the length we see in a 90-year-old or a young adult with rheumatoid arthritis. Those same T-cells express unusually high levels of several classic protein markers of cell aging and exhaustion," Dr. de Vallejo said. "These kids haven't lived long enough to have cells that look that old. This is the first indication that premature aging in occurring in this childhood condition."

In addition, the T-cells had become dysregulated, and their immune activity could be stimulated through atypical cell surface receptors. Much more must be learned about the unusual cells and about genetic mechanisms that might contribute to the development of JIA, Dr. de Vallejo said, but these findings could point the way to new therapies.

"JIA is typically treated with broad-spectrum drugs such as steroids and biologics that essentially paralyze the entire immune system, but only a third of the cells are affected and their abnormality seems to be premature aging, rather than autoimmune activity," he noted. "This study suggests cell-targeted treatments could be developed to prevent this premature immune aging."

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our arthritis / rheumatology section for the latest news on this subject.

Co-authors of the paper include other researchers from Children’s Hospital of Pittsburgh of UPMC; Pitt School of Medicine; and the Mayo Clinic. The project was funded by the Nancy E. Taylor Foundation for Chronic Diseases, the Arthritis Foundation, and National Institutes of Health grant AR052282.

Children’s Hospital of Pittsburgh of UPMC & University of Pittsburgh Schools of the Health Sciences

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University of Pittsburgh Medical Center. "Premature aging of immune cells present in joints of kids with chronic arthritis, Pitt/Children's Hospital team says." Medical News Today. MediLexicon, Intl., 31 Jul. 2013. Web.
31 Jul. 2013. APA
University of Pittsburgh Medical Center. (2013, July 31). "Premature aging of immune cells present in joints of kids with chronic arthritis, Pitt/Children's Hospital team says." Medical News Today. Retrieved from
http://www.medicalnewstoday.com/releases/264123.php.

Please note: If no author information is provided, the source is cited instead.

'Premature aging of immune cells present in joints of kids with chronic arthritis, Pitt/Children's Hospital team says'

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