Research in behavioral-developmental pediatrics: new frontiers and elusive boundaries.
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Biomedical subjects
Publications and source records attributed to J H Kennell.
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We describe 2 patients with primary absence of corticospinal tracts. Both presented with delayed motor development, head lag, and spasticity of the limbs. We could not identify precentral cortex, and there were no corticospinal fibers below the internal capsules. We postulate that the fibers were displaced or interrupted early in their development.
Two different care procedures are presented to raise the difficult question of whether we should completely reevaluate our paradigms of care in the perinatal period. In this thorough review, should we continue to use the same framework of beliefs in deciding on the benefits and risks of any care procedure?
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Because continuous social support during labour is a component of care in many societies but inconsistent in our own, the clinical effect of support during labour on maternal and neonatal morbidity were studied. Social support was provided by female companions. Four hundred and sixty five healthy primigravidous women were enrolled using a randomised design. Compared with 249 women undergoing labour alone 168 women who had supportive female companions throughout labour had significantly fewer perinatal complications (p less than 0.001), including caesarean sections (7% v 17%, p less than 0.01) and oxytocin augmentation (2% v 13%, p less than 0.001), and fewer infants admitted to neonatal intensive care (p less than 0.10). Of the women who had an uncomplicated labour and delivery requiring no interventions, those with a companion had a significantly shorter duration of labour (7.7 hours v 15.5 hours, p less than 0.001). This study suggests that constant human support may be of great benefit to women during labour.
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The frequency and duration of infectious illnesses in 408 pregnant rural women and 417 poor urban infants in Guatemala have been investigated, together with morbidity and mortality among the offspring of the rural women. Rural women suffered high rates of infection during the gestation period. Symptomatic illnesses, mainly acute respiratory infection and diarrhoeal disease, usually showed a higher incidence during the last months of pregnancy. Significant bacteriuria was identified in 21% of the women, though symptoms of urinary tract infection were found in about 25%. Vaginal infection was found in 38% of women at the beginning of pregnancy and in 79% at its end. Twelve per cent of women showed evidence of reactivated infections with cytomegalovirus, herpes simplex virus and Toxoplasma gondii. The neonatal mortality rate in the rural population was 37.7 per 1000 liveborn infants. Most deaths were among preterm babies. Significant bacteriuria was related to low birth weight. Morbidity in rural neonates was also high, but the illnesses were not severe and had a short duration. Neonatal morbidity in poor urban infants was also high. Breast-feeding had a protective effect: breast-fed rural and poor urban infants had a lower incidence of illness than urban babies who were not breast-fed. The influence of infection during pregnancy on the conceptus and some low-cost measures for reducing it are discussed. Measures for decreasing neonatal morbidity in rural and poor urban ureas are proposed.
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Studies of the differing means of definition problems of parturition and neonatal dependence, the extent of human variability underlying them, and the possibilities for enrichment of experience in early human interaction call into question such standard practices as isolation of the newborn, separation of mother and infant immediately after birth, and division of the family unit at the very time when it is symbolically and in reality becoming a family unit.
Specific kinds of maternal behaviour such as nesting, retrieving, grooming and exploring, are seen in non-human mammalian mothers immediately before, during and after delivery. In this study 22 human mothers were filmed during the first 10 minutes of contact with their normal nude full-term infants, who were placed beside them in private rooms in hospitals in Guatemala and the US; and nine mothers of premature infants were filmed on their first three visits to the nursery. Another 10 Guatemalan mothers and infants were observed for 10 minutes almost immediately after delivery in hospital. These observations were compared to maternal behaviour after home deliveries in California. After hospital delivery all US mothers, but only half of the Guatemalans, began touching their infants' extremities with their fingertips and proceeded within a few minutes to palm contact on the trunk. US mothers had an intense interest in eye-to-eye contact. Mothers of premature infants showed only fragments of this behaviour. In home births when the mothers are active participants in delivery, they pick up the infant immediately after birth, stroke its face with their fingertips and start breast-feeding within the first minutes after delivery. Initially the infant only licks the nipples. there is striking elevation in mood in the parents. These observations focus attention on reciprocal behaviour patterns that develop early between mother and infant and which serve to unite them.
In certain animal species immediate separation of a mother from here young for a brief period after deliver (the sensitive period) may result in aberrant maternal behaviour. In the human, disorders of mothering, including child abuse, increase disproportionately in situations associated with early neonatal separation of mother and infant, such as prematurity. Mothers in the United States who were offered early contact with their premature infants showed differences in attachment behaviour when compared with mothers whose first contact with their infants was three weeks after delivery. Mothers who had one hour of close physical contact with their nude full-term infants within the first two hours after delivery and who had 15 extra hours of contact in the frist three days behaved significantly differently during a physical examination of the infant at one month and one year, and in their speech to their infants at two years, from a control group of mothers who had only routine contact. In a similar study in Guatemala, mothers who had 45 minutes of early extra contact showed significantly more attachment behaviour at the time of the first breast-feeding (12 hours). These and other studies in the human suggest that shortly after birth there is a sensitive period which appears to have long-lasting effects on maternal attachment and which may ultimately affect the development of the child.
Ten primiparous mothers were randomly selected from two groups of women who had spent different amounts of time with their newborn infants. The speech behavior of the mothers in the two groups was compared while they were addressing their 2-year-old children in an informal play situation. Speech patterns of the mothers revealed that those who had been given extra contact with their infants during the neonatal period used significantly more questions, adjectives, words per proposition, and fewer comands and content words than did the control mothers. These observations suggest that the linguistic behavior of the young child may be shaped by hospital-care practices for mother and her infant.