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Aim To measure the association between cerebral palsy (CP) and non-CP-related movement difficulties and health-related quality of life (HRQoL) among 5-year-old children born extremely preterm (<28 weeks gestational age). Method We included 5-year-old children from a multi-country, population-based cohort of children born extremely preterm in 2011 to 2012 in 11 European countries (n = 1021). Children without CP were classified using the Movement Assessment Battery for Children, Second Edition as having significant movement difficulties (<= 5th centile of standardized norms) or being at risk of movement difficulties (6th-15th centile). Parents reported on a clinical CP diagnosis and HRQoL using the Pediatric Quality of Life Inventory. Associations were assessed using linear and quantile regressions. Results Compared to children without movement difficulties, children at risk of movement difficulties, with significant movement difficulties, and CP had lower adjusted HRQoL total scores (beta [95% confidence interval] = -5.0 [-7.7 to -2.3], -9.1 [-12.0 to -6.1], and - 26.1 [-31.0 to -21.2]). Quantile regression analyses showed similar decreases in HRQoL for all children with CP, whereas for children with non-CP-related movement difficulties, reductions in HRQoL were more pronounced at lower centiles. Interpretation CP and non-CP-related movement difficulties were associated with lower HRQoL, even for children with less severe difficulties. Heterogeneous associations for non-CP-related movement difficulties raise questions for research about mitigating and protective factors., Funding Agencies|Faculdade de Ciencias e Tecnologia, Universidade Nova de Lisboa; Horizon 2020 Framework Programme; Seventh Framework Programme; [SFRH/BPD/117597/2016]; [633724]; [733280]; [259882]

Aim: Studies examining the long-term effects of neonatal music interventions on the cognition of children born preterm are scarce. We investigated whether a parental singing intervention before term age improves cognitive and language skills in preterm-born children.Methods: In this longitudinal, two-country Singing Kangaroo, randomised controlled trial, 74 preterm infants were allocated to a singing intervention or control group. A certified music therapist supported parents of 48 infants in the intervention group to sing or hum during daily skin-to-skin care (Kangaroo care) from neonatal care until term age. Parents of 26 infants in the control group conducted standard Kangaroo care. At 2-3 years of corrected age, the cognitive and language skills were assessed with the Bayley Scales of Infant and Toddler Development, Third Edition.Results: There were no significant differences in cognitive and language skills between the intervention and control groups at the follow-up. No associations between the amount of singing and the cognitive and language scores were found.Conclusion: Parental singing intervention during the neonatal period, previously shown to have some beneficial short-term effects on auditory cortical response in preterm infants at term age, showed no significant long-term effects on cognition or language at 2-3 years of corrected age., Funding Agencies|Alfred Kordelin Foundation; Queen Silvia Jubilee Foundation; Swedish Brain Foundation; Philipsson Foundation; Medicinska Understoedsfoereningen Livoch Haelsa; Signe and Ane Gyllenberg Foundation; Swedish Order of Freemasons; Finnish Cultural Foundation; Swedish Research Council

Introduction: The risk for brain injury manifested as cerebral palsy is higher in very preterm born children than in term. Prenatal administration of magnesium sulfate (MgSO4) has been shown to be neuroprotective and reduces the proportion of very preterm born children later diagnosed with cerebral palsy. A Swedish national clinical practice guideline was implemented in March 2020, stipulating the administration of a single intravenous dose of 6 g MgSO4 1-24 h prior to delivery before gestational age 32+ 0, aiming for 90% treatment coverage. The aim of this study was to evaluate the feasibility of this new clinical practice guideline in the first year of its implementation. Material and methods: Data on MgSO4 treatment were collected by reviewing the medical charts of women who gave birth to live born children in gestational age 22+ 0-31+ 6 during the period of March 1, 2020 to February 28, 2021, at five Swedish university hospitals. Women with pre-eclampsia, eclampsia, or high elevated liver enzymes low platelets (HELLP) were excluded. Results: A total of 388 women were eligible and 79% received treatment with MgSO4. Of the 21% not receiving treatment, 9% did not receive treatment due to lack of knowledge about the clinical practice guideline, 9% were not possible to treat and 3% had missing data. The proportion treated increased from 72% to 87% from the first to the last 3 months. Of those treated, 81% received the drug within the stipulated timeframe (mean 8.7 h, median 3.4 h). Conclusions: There was a positive trend over time in the proportion of women receiving MgSO4 treatment, but the a priori target of 90% was not reached during the first year of implementation. Our findings indicate that this target could be reached with additional information to clinicians., Funding Agencies|Frimurarfonden Barnhusdirektionen Foundation [GLS 7000991]; Linnea and Josef Carlsson Foundaton; Rune and Ulla Almloevs stiftelse SEB; Stiftelsen Mary von Sydows, foedd Wijk, donationsfond; Stiftelserna Wilhelm och Martina Lundgrens [GLS-964281]; ALF Agreement [2019- 2941, ALFGBG-77860, ALFGBG-75710]; Vetenskapsradet [ALFGBG-718591]; Swedish government; county councils; [2019-01320]

Aim: To assess the inter--assessor reliability of the Motor Optimality Score-Revised (MOS-R) when used in infants at elevated likelihood for adverse neurological outcome. Methods: MOS-R were assessed in three groups of infants by two assessors/cohort. Infants were recruited from longitudinal projects in Sweden (infants born extremely preterm), India (infants born in low-resource communities) and the USA (infants prenatally exposed to SARS-CoV-2). Intraclass correlation coefficients (ICC) and kappa (.w) were applied. ICC of MOS- -R subcategories and total scores were presented for cohorts together and separately and for age-spans: 9-12, 13--16 and 17-25-weeks post--term age. Results: 252 infants were included (born extremely preterm n = 97, born in low-resource communities n = 97, prenatally SARS-CoV-2 exposed n = 58). Reliability of the total MOS-R was almost perfect (ICC: 0.98-0.99) for all cohorts, together and separately. Similar result was found for age-spans (ICC: 0.98-0.99). Substantial to perfect reliability was shown for the MO-R subcategories (.w: 0.67--1.00), with postural patterns showing the lowest value 0.67. Conclusion: The MOS-R can be used in high-risk populations with substantial to perfect reliability, both in regards of total/subcategory scores as well as in different age groups. However, the subcategory postural patterns as well as the clinical applicability of the MOS-R needs further study., Funding Agencies|Jerring foundation; Kronprinsessan Lovisas foerening foer barnasjukvard/Stiftelsen Axel Tielmans minnesfond; Promobilia Foundation Sweden; Region Stockholm (clinical research appointment); Saellskapet Barnavard; Swedish governmental funding of clinical research; Swedish Medical Research Council; Austrian Science Fund [FWF -KLI811]; DFG -SFB [1528 (C03)]; BMBF (CP-Diadem project); Cocozza foundation; Laerdal Foundation; Leibniz Foundation (LSC Audacity Award); Philipson Foundation; Simons Foundation SFARI program; Swedish Brain Foundation; Swedish Medical Society; Swedish Order of Freemasons in Stockholm; Volkswagenfoundation