PubMed Health⌕ Search

Biomedical subjects

T B Brazelton

Publications and source records attributed to T B Brazelton.

At least 19 recordsLinked to original sources
PubMed1999

The psychological status at school age of children conceived by in-vitro fertilization.

This study assessed the behavioural and psychological profiles of children conceived by in-vitro fertilization (IVF) who are now at school age. A total of 743 IVF children born at one institution and now of school age, over 4 years old, were surveyed with Achenbach questionnaires. Follow-up telephone interviews were conducted with non-responders. The results from the study group were compared to the questionnaire control group using one-tailed t-test with statistical significance set less than 0.05. There was an 84% overall response rate. Sixty-seven per cent returned questionnaires. An additional 17% completed a telephone interview. The study group had no statistically significant increase in the rate of behavioural or psychological problems compared with the control group. There were no statistically significant differences within the study group related to sex or to multiple gestation IVF births. This large group of school-age IVF children has normal psychological development with no identified adverse effect of their status as IVF children. Determining the role, if any, of IVF in the very small number of children with behavioural and psychological problems will require additional study.

Adolescent↗
PubMed1995

Neonatal-onset propionic acidemia: neurologic and developmental profiles, and implications for management.

OBJECTIVES: To document the clinical and neurodevelopmental profiles of a cohort of patients with neonatal-onset propionic acidemia and to determine the efficacy of current therapy with respect to outcome. METHOD: The clinical, neurologic, and developmental status of six patients was prospectively evaluated during a 15-month period. Previous clinical and biochemical data were ascertained from hospital records to determine longitudinal nutritional status, number of episodes of hyperammonemia with ketoacidosis, and developmental performance with respect to age. RESULTS: No deaths resulted from propionic acidemia since the identification of the oldest patient in the series in 1980. Therapeutic intervention (e.g., gastrostomy tube feeding) resulted in improved nutritional status and possibly contributed to improved survival. All children had hypotonia, resulting in a significant effect on motor development; however, focal neurologic deficits and evidence of movement or seizure disorder were absent. Mild cortical atrophy was evident on cranial magnetic resonance imaging in four patients. All children, including two patients with no significant episodes of hyperammonemia and normal growth since the neonatal period, had a mild to moderate degree of intellectual impairment. CONCLUSIONS: The results of our study suggest that current therapy for neonatal-onset propionic acidemia is associated with improved survival and nutritional status, and an absence of focal neurologic deficits. However, hypotonia and cognitive delay were still present, even in children with "optimal" metabolic control. Additional therapeutic advances are required to improve the developmental and cognitive outcome.

Carboxy-Lyases↗
PubMed1995

Working with families. Opportunities for early intervention.

The birth or arrival of a baby is a defining event for families. Most infants progress through predictable, yet individual, patterns of development. All families want the opportunity to optimize their children's futures, yet each spurt of development is a transition that can stress the child and the entire family system. These biobehavioral shifts, or "touchpoints," provide opportunities for the pediatrician to help the family understand, adapt, enhance, and promote the child's outcome. This family level approach serves as a form of anticipatory guidance that helps both parent and child successfully manage the challenging phases of development: motor, cognitive, social, and emotional. The "touchpoints" concept can be adapted for the pediatrician to help older children and their families.

Child Development↗
PubMed1995

Specificity of preventative pediatric intervention effects in early infancy.

The efficacy of two contrasting short term preventative interventions administered to a heterogeneous sample of new mothers during the perinatal period was evaluated. The first was infant-centered and used the Brazelton Neonatal Behavioral Assessment Scale (NBAS) as a method of highlighting newborn behavior to new mothers. The second was mother-centered and consisted of an in-depth interview focused on the mothers' concerns about parenting. Mothers were randomized into groups and were administered intervention by experienced clinicians at 3 days in the hospital and again at 14 and 30 days at home. Effects of intervention on maternal reports of parenting stress, mother-infant interactive behavior, and infant developmental quotient were evaluated at 4 months infant age. It was hypothesized that participation in the infant-centered intervention would be related to more positive maternal and infant outcomes at 4 months. It was also expected that the impact of each intervention would be moderated by differences in maternal and infant risk and parity. Hierarchical multiple regressions controlling for risk and parity yielded no significant main effects of intervention at 4 months. However, significant interactions of intervention with parity and risk were observed, indicating that intervention was beneficial for specific groups of mothers. These data suggest that early intervention should be tailored to the needs of individual groups of mothers.

Child Behavior Disorders↗
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↗
PubMed1990

[Preventive approach to at-risk newborn infants, early intervention: what significance does it have? 1].

In this study, the bases of the principle of early intervention have been examined. At-risk neonates should be assessed as early as possible via a preventive and therapeutic approach. Before the situation aggravates to such an extent that treatment administered has no effect, early intervention can in fact prevent a number of difficulties from occurring, which arise when the environment cannot be adapted to the at-risk. neonates. During early childhood, the association of the child's developmental processes and the parent's available energy, resulting in development of the child's optimum potential, has in fact exceeded our expectations. The assessment of the infant's capacity to organize positive interaction experiences with a nurturing adult has led us to understand more fully the plasticity process which permits the neonate's recuperation from damage to the central nervous system (CNS). Informing the parents in question of our observations and approach in order to improve the child's behaviour has resulted in gained confidence and co-operation, and therefore optimum recuperation. Our assessments of normal and premature neonates have, both for ourselves and the parents, led to a better understanding of organization and ongoing development, which in early childhood may also include the direct interview procedure. In other words, assessment by observation of a neonate's state of health consists not only of evaluating organizational capacities connected with his or her present state, but also how the infant will affect parental attitudes, and in turn what the parents will have to do to organize the child. By sharing our assessment with the parents, and with close co-operation, we can aid them in identifying the positive elements as well as the defects in the child's potential. Thus, the parents can utilize their nurturing capacities in their relationship with the child to bring about the best recuperation possible. Repeated observations enable an evaluation to be made of the neonate's organizational capabilities during the recuperative period following birth, and adaptation to the new environment. Adopting the same procedure throughout the child's first year of life has permitted us to share with the parents observation of the child's progress, and to point out to them the effect that they have in this area. The above system has aided the parents by showing them that the child can be organized and that its health is recuperable, even after damage to the CNS or premature birth.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1990

Saving the bathwater.

This article presents an account of the development and use of the Neonatal Behavioral Assessment Scale (NBAS) over the past 15 years. It deals with both the formal and informal ways in which administering the NBAS has increased our understanding of the forces for development in the newborn, of states of consciousness in the infant, of the potential for predicting from one point in development to the next, and of a clinician's opportunities to share information with parents and to participate in the enterprise of parenting. It draws attention to the value of the qualitative insights that are gained by investigators, alongside the more quantitative fruits of a research endeavor.

Child↗
PubMed1990

[Preventive approach to newborn infants, at risk, early intervention: what is its purpose? 2].

In this study, the bases of the principle of early intervention have been examined. At-risk neonates should be assessed as early as possible via a preventive and therapeutic approach. Before the situation aggravates to such an extent that treatment administered has no effect, early intervention can in fact prevent a number of difficulties from taking place, which arise when the environment cannot be adapted to the at-risk neonates. During early childhood, the association of the child's developmental processes and the parent's available energy, resulting in development of the child's optimum potential, has in fact exceeded our expectations. The assessment of the infant's capacity to organize positive interaction experiences with a nurturing adult has led us to better understand the plasticity process which permits the neonate's recuperation form damage to the central nervous system (CNS). Informing the parents in question of our observations and approach in order to improve the child's behaviour has resulted in gained confidence and cooperation, and therefore optimum recuperation. Our assessments of normal and premature neonates have both for ourselves and the parents led to a better understanding of organization and ongoing development, which in early childhood may also include the direct interview procedure. In other words, assessment by observation of a neonate's state of health consists not only of evaluating organizational capacities connected with his or her present state, but also how the infant will affect parental attitudes, and in turn what the parents will have to do to organize the child. By sharing our assessment with the parents, and with close cooperation, we aid them in identifying the positive elements as well as the defects in the child's potential. Thus the parents can utilize their nurturing capacities in their relationship with the child to bring about the best recuperation possible. Repeated observations enable an evaluation to be made of the neonate's organizational capabilities during the recuperative period following birth, and adaptation to the new environment. Adopting the same procedure throughout the child's first year of life has permitted us to share with the parents observation of the child's progress, and to point out to them the effect that they have in this area. The above system has aided the parents by showing them that the child can be organized and that its health is recuperable, even after damage to the CNS or premature birth.(ABSTRACT TRUNCATED AT 400 WORDS)

Child Behavior↗
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

The infant at risk.

The opportunity in early infancy for joining the developmental processes of infants with the energy in the parents for bringing the infants to their best potential has been out of proportion to our expectations. By visualizing the capacity of babies to organize around the positive experiences of interaction with a nurturing adult in our neonatal assessments, we have better understood normal recovery processes from labor and delivery and plasticity for recovery from CNS insults in the neonate. As we observed and identified with them to produce best behavior in the infants, their parents were able to believe in our methods and to work toward their infants' optimal recovery. Hence, our assessments of premature and normal infants became a window for us and for parents into organization and ongoing development. In later infancy, the face-to-face procedure served a similar purpose. In other words, within the observational assessment of a small baby is contained not only the organizational capacities of his or her present status, but also an opportunity to see what he will do to his parents and what they will have to do to organize him. By sharing this observation with them, we share these processes and give them an opportunity to identify the baby's positive potential in addition to his or her deficits. As such, parents can utilize the forces for nurturance in their relationship to produce the baby's optimal recovery. Serial observations over time provide an opportunity to observe the baby's capacity to organize himself as he recovers from a known set of experiences surrounding labor, delivery, and a new environment.(ABSTRACT TRUNCATED AT 250 WORDS)

Central Nervous System↗