Towards improving neurodevelopmental outcomes in preterm infants: efforts during NICU stay and beyond

    Research output: ThesisThesis fully internal (DIV)

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    Abstract

    Despite advances in neonatal care that have led to increased survival rates, adverse neurodevelopmental outcomes following preterm birth remain a significant problem. The overall aim of this thesis was to move towards improving neurodevelopmental outcomes in preterm infants. This thesis covers three parts. First, we provide insight into detection of adverse neurodevelopmental outcomes following preterm birth using developmental milestones in preventive child healthcare (PCHC), adding knowledge to the developmental trajectories of preterm infants and on how to assess their developmental milestones in a PCHC setting. Second, we aimed to increase our understanding of neonatal stress during Neonatal Intensive Care Unit (NICU) stay as pathophysiological mechanism leading to adverse neurodevelopment. For neonates, this entails exposure to skin-breaking procedures, other medical procedures, excessive noise and light, handling by nurses, and parental separation. We show that early life experiences and exposure to neonatal stress may alter developmentally sensitive processes, such as the functioning of the Hypothalamic-Pituitary-Adrenal axis or neuronal circuits in the brain. This may very well occur through DNA-methylation as a central pathophysiological mechanism in which neonatal stress is biologically embedded. The findings underline the importance of stress during NICU admission and beyond. Finally, we studied live-performed music therapy as a new and promising intervention to prevent adverse neurodevelopment, showing that live-performed music therapy interventions are safe and may improve neurodevelopment through direct effects on the brain, stress reduction, enhanced parent-infant interaction, and environmental enrichment. Music therapy is a great addition to neonatal care and quality of life of extremely preterm infants.
    Original languageEnglish
    QualificationDoctor of Philosophy
    Awarding Institution
    • University of Groningen
    Supervisors/Advisors
    • Reijneveld, Menno, Supervisor
    • Bos, Arie, Supervisor
    • de Kroon, Marlou, Co-supervisor
    Award date8-Feb-2023
    Place of Publication[Groningen]
    Publisher
    DOIs
    Publication statusPublished - 2023

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