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Biomedical subjects

B M Lester

Publications and source records attributed to B M Lester.

At least 37 records · Page 2Linked to original sources
PubMed1996

Effects of in utero substance exposure on infant neurobehavior.

OBJECTIVE: This study had two objectives: (1) to assess infant behavior by using the NICU Network Neurobehavioral Scale (NNNS), an assessment designed specifically for prenatally drug-exposed infants; and (2) to control for the effects of polydrug use involving alcohol, marijuana, and cigarettes on the neurobehavioral status of the newborn infant. METHODS: The subjects and controls in this study were full-term infants of appropriate gestational age with no medical problems. At 1 to 2 days of age, 20 infants exposed to cocaine, alcohol, marijuana, and cigarettes; 17 infants exposed to alcohol and/or marijuana and cigarettes; and 20 drug-free infants were evaluated by using the Neonatal Intensive Care Unit Network Neurobehavioral Scale. The data were reduced to reflect clinically defined categories of neurobehavioral function and were analyzed by using analysis of variance and chi 2 statistics. RESULTS: Cocaine-exposed infants showed increased tone and motor activity, more jerky movements, startles, tremors, back arching, and signs of central nervous system and visual stress than unexposed infants. They also showed poorer visual and auditory following. There were no differences in how the examination was administered to cocaine-exposed and nonexposed infants. Reduced birth weight and length were also observed in cocaine-exposed infants. CONCLUSION: Differences attributable to cocaine-exposed infants were related to muscle tone and motor performance, following during orientation, and signs of stress. However, cocaine-exposed infants were not more difficult to test, nor did they require an alteration in the examination. Both neurobehavioral patterns of excitability and lethargy were observed. Findings may have been due to the synergistic effects of cocaine with alcohol and marijuana.

Cannabis↗
PubMed1996

The effects of maternal alcohol consumption and cigarette smoking during pregnancy on acoustic cry analysis.

During the last trimester of pregnancy, 127 primiparous Irish mothers were interviewed to ascertain their history of alcohol and tobacco use. Confounding effects due to other drugs were not a factor in this sample. Mothers consumed an average of .21 ounces absolute alcohol (AA) per day, with 62% classified as moderate drinkers, 10.6% as heavy drinkers, and 26% as nondrinkers. Neurobehavioral status was measured using acoustic characteristics of the infant's cry, collected on the third day of life. Multiple regression analysis showed that more ounces AA per day was related to more dysphonation and higher first formant, while more cigarette smoking was related to higher pitch, higher second formant, and more variability in the second formant. Analysis of variance comparisons of these 3 alcohol groups demonstrated significant cry effects on infants of heavy drinking mothers.

Adolescent↗
PubMed1995

Newborn acoustic cry characteristics of infants subsequently dying of sudden infant death syndrome.

OBJECTIVE: To test the hypothesis that the occurrence of a neonatal cry exhibiting a high first formant is a risk factor for sudden infant death syndrome (SIDS) and to evaluate the association between SIDS and other acoustic cry variables. METHOD: We recorded cries and obtained medical and demographic data for 21,880 apparently healthy term newborns. Two cries were recorded between days 2 and 7 of life, after a painful stimulus at the time of routine blood drawing. Acoustic variables were measured with an automated computer-based analysis system. Twelve infants died of SIDS. Age at death ranged from 19 days to 6.5 months. Autopsies were performed in all cases. At least one cry was analyzed for all 12 infants who died of SIDS and 20,167 infants without SIDS. Two cries were analyzed for 9 infants who died of SIDS and 14,235 infants without SIDS. RESULTS: Newborns whose first cries exhibited a high first formant were more likely to die of SIDS than infants whose first cries did not have this characteristic (relative risk, 3.5; 95% confidence interval [CI], 1.1 to 12). The relative risk for SIDS increased to 8.8 (95% CI, 2.2 to 35) for newborns whose second cries showed that this characteristic persisted. Newborns with the combination of both a high first formant and a high number of mode changes on both of two cries had a relative risk of 32 (95% CI, 8.7 to 120). CONCLUSIONS: We have shown an association between alterations in neonatal cry acoustics and SIDS. Cry analysis represents a potentially important research tool that, when studied in relation to other physiologic measures, may lead to an improved understanding of SIDS.

Acoustics↗
PubMed1995

Developmental outcome as a function of the goodness of fit between the infant's cry characteristics and the mother's perception of her infant's cry.

OBJECTIVE: To determine whether the "goodness of fit" between infant cry characteristics and the mother's perception of the cry is related to developmental outcome at 18 months of age. DESIGN: This was a prospective, longitudinal study from birth to 18 months performed in a blinded manner. SETTING: The study was conducted in a maternity hospital, including normal and special care nurseries and a laboratory for developmental follow-up. PATIENTS: The 121 term and preterm infants and their mothers were selected to meet medical criteria. MEASUREMENT: Acoustic analysis of 1-month infant cry and the mother's perception of the same cry was used to divide subjects into four groups representing matches and mismatches between infant cry characteristics and maternal cry perception. Primary outcome measures of cognitive, language, motor, and neurologic outcome were administered at 18 months. Caretaking environment measures were also recorded. RESULTS: Statistically significant (P < .05) findings showed that matched groups scored higher on measures of language and cognitive performance than infants in the mismatch groups, with a particular advantage for infants in the matched group in which mothers accurately perceived the higher-pitched cries of their infants. There were no differences between the groups in biologic or sociodemographic factors. Group differences were observed in social support and maternal self-esteem. CONCLUSIONS: Matches and mismatches between infant cry characteristics at 1 month and the mother's perception of the cry are related to cognitive and language outcome at 18 months in term and preterm infants. This relation is probably due to transactional processes in which developmental outcome is affected by the clarity of the infants' signals and by the ability of the mother to accurately perceive her infant's signals. The mother's ability to read her infant's cues may be affected by factors such as social support and self-esteem.

Adult↗
PubMed1994

Family-based intervention improves maternal psychological well-being and feeding interaction of preterm infants.

OBJECTIVE: To determine the efficacy of an individualized, family-based intervention with preterm infants and their families. DESIGN: Randomized, repeated measures intervention outcome study. SETTING: Level III neonatal intensive care nursery. PATIENTS: Random sample of 34 preterm infants < or = 1500 g and their families. INTERVENTIONS: Individualized, family-based intervention during the hospitalization and transition to home addressed problems identified by parents in four domains including: infant behavior and characteristics, family organization and functioning, caregiving environment, and home discharge and community resources. MEASUREMENTS AND MAIN RESULTS: Standardized questionnaires were administered at baseline and discharge to mothers, and predischarge bottle-feeding interactions were videotaped and coded by two blinded observers. Results were in favor of intervention (Int) versus control (Con) mothers (baseline; discharge) (P < .05) on the Parental Stressor Scale Sights and Sounds subscale (Int 2.4 +/- 1.0; 2.0 +/- 0.8 vs Con 2.4 +/- 0.9; 2.6 +/- 0.8); Child's Appearance and Behavior subscale (Int 2.8 +/- 1.0; 2.5 +/- 1.1 vs Con 2.8 +/- 0.8; 3.1 +/- 0.6); and Total Stressor Score (Int 93.9 +/- 36.6; 72.3 +/- 41.8 vs Con 87.5 +/- 26.7; 87.8 +/- 26.2). On the Beck Depression Inventory, intervention mothers had significant decreases in depressive symptoms (39%; 11%) vs control mothers (31%; 44%). Maternal self-esteem in both groups improved over time. There were no significant group differences in family environment. During feeding interactions, intervention infants grimaced (P < .001) and gagged (P < .05) less than controls. Intervention mothers less frequently interrupted feedings (P < .001); less frequently stimulated infant sucking (P < .01); smiled more (P < .001); vocalized more (P < .01); demonstrated greater sensitivity to infant behavior (P < .001), better quality of physical contact (P < .001), and more positive affect (P < .01). CONCLUSIONS: Individualized, family-based intervention appears to reduce maternal stress and depression, and to enhance early mother-infant feeding interactions. Further research is needed to determine whether these short-term beneficial effects persist beyond the newborn period.

Adult↗
PubMed1993

Possible association between fluoxetine hydrochloride and colic in an infant.

This is a case study of a 6-week-old infant referred for colic whose mother was using fluoxetine hydrochloride and breast feeding the infant. The mother switched to a commercial formula and reported a dramatic decrease in the infant's crying. We asked the mother to feed the infant breast milk from a bottle and she agreed. Throughout the study the mother kept a daily diary of her infant's crying, sleeping, stooling patterns, and feeding problems. Analysis of the mother's breast milk showed concentrations of 69 ng/mL for fluoxetine and 90 ng/mL for norfluoxetine. Infant blood serum/plasma level was analyzed for fluoxetine hydrochloride following return to breast milk. The concentrations were 340 ng/mL for fluoxetine and 208 ng/mL for norfluoxetine. The diary records showed increased crying, decreased sleep, increased vomiting, and watery stools when fluoxetine hydrochloride was transmitted through breast feeding or breast milk in bottle. These symptoms were reduced when the infant was formula fed. We suggest a possible relationship between colic and associated symptoms and fluoxetine hydrochloride in maternal breast milk.

Adult↗
PubMed1992

The effects of maternal epidural anesthesia on neonatal behavior during the first month.

The effects of maternal epidural anesthesia with bupivacaine on the infant's performance on the Neonatal Behavioral Assessment Scale (NBAS) over the first month of life were examined. 20 non-medicated infants were matched for biomedical and demographic variables with 20 infants delivered with bupivacaine epidural anesthesia. The NBAS was administered on days 1, 3, 7 and 28. The epidural group showed poorer performance on the orientation and motor clusters during the first month of life. Epidural mothers reported spending less time with their infants while in the hospital; post hoc analyses showed that they had longer labor, more forceps deliveries and a greater amount of oxytocin. Controlling for the effects of these medical variables, a dose effect was found for the mean orientation and motor cluster scores. The results are discussed in terms of possible effects of the infant's early disorganization on the mother-infant interaction.

Anesthesia, Epidural↗
PubMed1992

Effects of in utero cocaine exposure on newborn acoustical cry characteristics.

As part of a large, multicenter study of newborn cry analysis and Sudden Infant Death Syndrome, we examined the effects of in utero cocaine exposure on ten acoustical cry characteristics. Newborn cry recording and medical record review was performed for 23,948 newborns. Cocaine use during pregnancy (determined by record review) was identified in 438 (1.8%) women (310 by self-report only; 128 newborns also had positive urine assay). A demographically similar group of 373 newborns, selected from the 23,510 newborns without known cocaine exposure, made up the comparison group. Cry analysis was technically possible for 768 recordings: 404 cocaine-exposed and 364 non-exposed controls. Comparison of cocaine-exposed vs control newborns, after adjustment for potential confounding variables, found significant differences including: fewer cry utterances (P = .001), more short cries (P = .02), and less crying in the hyperphonation mode (P = .01), for the cocaine-exposed neonates. As reported in other studies, cocaine-exposed newborns also were significantly lower in birth weight, length, and head circumference. Newborns who had positive urine tests for cocaine suffered the greatest effects on both cry and growth parameters. These findings suggest a pattern of underaroused neurobehavioral function and are consistent with the emerging picture of the adverse neurobehavioral effects of cocaine. Developmental outcome studies are in progress to determine if acoustical analysis of the newborn cry can be used to identify cocaine-exposed newborns who are at highest risk for poor outcome.

Acoustics↗
PubMed1991

Neurobehavioral syndromes in cocaine-exposed newborn infants.

The effects of fetal cocaine exposure on newborn cry characteristics were studied in 80 cocaine-exposed and 80 control infants. The groups were stratified to be similar on maternal demographic characteristics and maternal use of other illegal substances and alcohol during pregnancy. The hypothesis was that excitable cry characteristics were related to the direct effects of cocaine, while depressed cry characteristics were related to the indirect effects of cocaine secondary to low birthweight. Structural equation modeling (EQS) showed direct effects of cocaine on cries with a longer duration, higher fundamental frequency, and a higher and more variable first formant frequency. Indirect effects of cocaine secondary to low birthweight resulted in cries with a longer latency, fewer utterances, lower amplitude, and more dysphonation. Cocaine-exposed infants had a lower birthweight, shorter length, and smaller head circumference than the unexposed controls. Findings were consistent with the notion that 2 neurobehavioral syndromes, excitable and depressed, can be described in cocaine-exposed infants, and that these 2 syndromes are due, respectively, to direct neurotoxic effects and indirect effects secondary to intrauterine growth retardation.

Birth Weight↗
PubMed1990

Behavioral changes correlated with brain-stem auditory evoked responses in term infants with moderate hyperbilirubinemia.

The purpose of this study was to test the hypotheses that newborn infants with moderate serum bilirubin concentrations have depressed Brazelton scores and increased brain-stem conduction time and that serum bilirubin levels correlate with Brazelton behavior scores and brain-stem auditory evoked response changes. Fifty term infants who were enrolled into either a low serum bilirubin group (less than 8 mg/dl) or a moderate serum bilirubin group (10 to 20 mg/dl) were tested with the Brazelton Neonatal Behavioral Assessment Scale and a brain-stem auditory evoked response test. Partial correlation analysis controlling for phototherapy revealed that increased bilirubin concentration correlated negatively with the Brazelton orientation and with state range clusters and individual Brazelton test items that involve auditory processing. Increased bilirubin concentration correlated with an increased latency of brain-stem auditory evoked response wave 4, 5. An increased interpeak 1-5 (brain-stem conduction time) correlated with the decreased animate visual and auditory item. We conclude that moderate hyperbilirubinemia in term infants affects both infant behavior, as measured by specific components of the Brazelton test, and brain-stem conduction time, as measured by the brain-stem auditory evoked response test.

Arousal↗
PubMed1990

Behavioral and psychophysiologic assessment of the preterm infant.

Cardiorespiratory activity was recorded during attentional responsivity on the Brazelton scale in term and preterm infants. Preterm infants showed less heart rate deceleration, less heart rate variance and less power in the ECG spectrum at frequencies associated with respiratory sinus arrhythmia and oscillations in blood pressure: A lower threshold for attentional stimulation in the preterm infant may trigger a CNS mechanism that protects the infant from stimulus overload. Study of the coordination between behavioral and physiological reactivity provides an understanding of the role of the CNS in mediating information processing.

Child Behavior↗
PubMed1989

Effects of marijuana use during pregnancy on newborn cry.

The effects of maternal marijuana use on the newborn cry were studied in Jamaica, where it was possible to rule out confounding factors such as the use of other substances and demographic variables that have clouded previous studies and where higher dosages may make the effects more visible. The acoustic characteristics of the cries of 20 infants of marijuana users and 20 controls were analyzed. The cries of the infants of marijuana users were shorter, had a higher percentage of dysphonation, a higher and more variable fundamental frequency, and a lower first formant than controls. There was also a dose response relation between the first formant and marijuana use. We suggest that heavy marijuana use affects the neurophysiological integrity of the infant.

Acoustics↗
PubMed1987

Developmental outcome prediction from acoustic cry analysis in term and preterm infants.

It has been suggested that the cry may reflect the neurophysiologic integrity of the infant and relate to later developmental outcome. In this study, the cry was recorded at term conceptional age in 18 preterm and 13 term infants using a standardized procedure and analyzed by high-speed computer. At 18 months of age, a significant number of infants were correctly classified as scoring high or low on the Bayley Scales of Infant Development based on the mean and variability in the fundamental frequency, variability in the first formant, and the amplitude of the cry. At 5 years of age, a significant number of infants were correctly classified on the McCarthy General Cognitive Index and on the verbal, perceptual-performance, and quantitative subscales based on the variability of the fundamental frequency, variability of the first formant, and amplitude and duration of the cry. Although preliminary, this study supports the potential use of the cry as a noninvasive measure to detect developmental outcome in the infant at risk.

Acoustics↗