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PubMed1982

Home monitoring of infants considered at risk for the sudden infant death syndrome. Four years' experience (1977-1981).

From 1977 to 1981, 500 infants had been referred to evaluate their risk for the sudden infant death syndrome (SIDS). These included 186 infants who had presented an event (prolonged apnea, hypotonia, pallor or cyanosis) initiated while asleep, 133 siblings and 181 "controls". All-night polygraphic recordings were performed in all infants, and if indicated by the history of the infants, complementary clinical investigations were done. These procedures led to the identification of 50 infants considered at risk for SIDS (10% of all referrals): 30 near-misses for SIDS, 10 siblings and 10 infants with a minor incident during sleep but with abnormal polygraphic recordings. These 50 infants (group I) were monitored at home during sleep with the help of a cardiac and respiratory monitor. Eight infants not considered at risk were monitored similarly at the request of their parents (group II). Forty of the 50 infants in group I presented with repetitive sleep apneas and bradycardias, and required stimulation by their parents to regain normal cardiorespiratory rhythm. Twelve had to be resuscitated at least once for a life-threatening event. None of the infants in group II showed alarms during sleep. Monitoring could be discontinued after a mean length of 7.2 months for the infants in group I, 4.1 months in group II. It is concluded that if identified in time through adequate investigations, some infants may be protected against SIDS through home monitoring. This approach requires expensive and well trained teams, ready, at any time, to cope with the problems that may arise in the homes of the monitored infants.

Ambulatory Care↗

PubMed2000

Obstructive sleep apnea in infants: relation to family history of sudden infant death syndrome, apparent life-threatening events, and obstructive sleep apnea.

OBJECTIVES: Familial aggregation of obstructive sleep apnea (OSA) has been shown to be associated with sudden infant death syndrome (SIDS) and apparent life-threatening events (ALTE) in infants. We wanted to determine the incidence of OSA in infants with siblings with ALTE and SIDS referred to our sleep clinic and to ascertain whether OSA was more common in infants who have family histories of SIDS, ALTE, and OSA. STUDY DESIGN: We studied 125 infants (mean age, 11.5 +/- 0.6 weeks) who were separated into 2 groups on the basis of their family history; polysomnographic studies were performed on each infant. RESULTS: Twenty infants had a multiple family history of SIDS, ALTE, or OSA (group 1), whereas the other 105 infants (group 2) had only one case of SIDS or ALTE within the family and no known history of OSA. We found that 19 of 20 infants in group 1 had OSA, whereas only 31 of 105 infants in group 2 had OSA (chi-squared analysis, P <.05). The OSA recorded was more frequent in infants of group 1 than in those of group 2. Follow-up studies in some infants with OSA demonstrated a progressive decrease in OSA, which resolved between 6 and 12 months of age. CONCLUSION: We conclude that infants of families with multiple histories of SIDS, ALTE, and OSA are more likely to have OSA than infants of families with only one case of SIDS or ALTE.

Age Factors↗

PubMed2003

Infant feeding practices and associated factors in the first six months of life: the Norwegian infant nutrition survey.

AIM: To describe and evaluate infant feeding practices during the first 6 mo of life in relation to recommendations, and to study infant feeding practices in relation to maternal and infant characteristics. METHODS: Data from 2383 Norwegian infants aged 6 mo were collected by a self-administered semi-quantitative food-frequency questionnaire measuring feeding practices at 6 mo and feeding practices retrospectively at < or = 5.5 mo of age. RESULTS: Only 1% of the infants had never been breastfed. The proportion of breastfed infants was 96% at 1 mo, 85% at 4 mo and 80% at 6 mo. The proportion of exclusively breastfed infants was 90% at 1 mo, 44% at 4 mo and 7% at 6 mo. Twenty-one percent of the infants were introduced to solid foods before the age of 4 mo. For exclusive breastfeeding at 4 mo, breastfeeding at 6 mo and timely introduction of solid foods (not before 4 mo) significant positive trends were found for maternal age, education and degree of urbanization. Negative associations were found for maternal smoking. Furthermore, exclusive breastfeeding at 4 mo was associated with infant gender and marital status, and the odds of breastfeeding at 6 mo significantly decreased with decreasing infant birthweight. Finally, both the odds of exclusive breastfeeding at 4 mo and of breastfeeding at 6 mo increased with increasing numbers of children. CONCLUSION: These results indicate that a majority of Norwegian infants are fed in accordance with infant feeding recommendations during their first 6mo of life. However, the duration of exclusive breastfeeding is shorter than recommended. Infant feeding practices are significantly associated with maternal and infant characteristics.

Age Factors↗

PubMed2002

Why do foreign-born blacks have lower infant mortality than native-born blacks? New directions in African-American infant mortality research.

OBJECTIVE: This study focuses attention on maternal nutrition and stress as possible reasons for excess black infant mortality after exploring lower infant mortality for the infants of foreign-born black mothers compared to native-born black mothers. METHODS: All births to non-Hispanic black women in New York City from 1988-1992 were examined and infant mortality for the infants of native-born women was compared to infant mortality for the infants of foreign-born women. RESULTS: Before controlling for potential confounders on the birth certificate, the infants of native-born black women had a greater risk of infant mortality than the infants of foreign-born black women: OR = 1.48 (95% confidence interval [CI] = 1.38, 1.58). After controlling for potential confounders, the infants of native-born black women still had a greater risk of infant mortality than the infants of foreign-born black women: OR(a) = 1.32 (95% Cl = 1.21, 1.43). CONCLUSIONS: Maternal nutrition and stress are possible causes of excess black infant mortality. They should be topics for research and program development.

Black or African American↗

PubMed2004

Developmental function of very-low-birth-weight infants and full-term infants in early childhood.

BACKGROUND AND PURPOSE: Despite general recognition that surviving very-low-birth-weight (VLBW) infants are at risk for neurodevelopmental impairments and educational achievement difficulties, there has been relatively little study on their functional status in areas such as locomotion, communication, cognition, self-care, and interpersonal relationships. This study assessed the functional status of VLBW infants and full-term infants in early childhood, and sought to identify risk factors for functional morbidity. METHODS: A total of 238 VLBW infants and 91 full-term infants were included in this prospective follow-up study. The functional status of the infants was assessed using the Chinese Child Development Inventory (CCDI) and neurodevelopment was evaluated using the Bayley Scales of Infant Development, second version (BSID-II) at 3 years of corrected age. Perinatal and sociodemographic data were collected through review of medical records. RESULTS: The VLBW infants had lower scores on all the CCDI measures compared with the full-term infants. Functional limitation (defined as more than 2 standard deviations below the means of the full-term infants) occurred more frequently in the VLBW infants than in the full-term infants: gross motor, 23% vs 3%; fine motor, 12% vs 1%; expressive language, 21% vs 2%; comprehension-conceptual, 23% vs 4%; situation comprehension, 17% vs 4%; self-help, 17% vs 1%; and personal-social, 19% vs 3% (all p < 0.01). Significant risk factors associated with functional morbidity included gestational age < 30 weeks, grade III-IV intraventricular hemorrhage, chronic lung disease, stage III-IV retinopathy of prematurity, male gender, and maternal education below high school. CONCLUSION: VLBW infants have a higher risk of functional morbidity than their full-term counterparts in early childhood. Infants with functional limitations on CCDI screening might require comprehensive developmental assessment and continued follow-up.

Developmental Disabilities↗

PubMed1983

'Near-miss' for sudden infant death syndrome infants: a clinical problem.

Three hundred six infants were referred for evaluation of "near-miss" sudden infant death syndrome (SIDS) from 1973 to 1980. Following the hospitalization and medical evaluation, there were 156 infants (115 term and 41 preterm) for whom there was no explanation for the presenting event and who were considered near-miss infants; 88% of these infants were seen during the first 3 months of life. A repeat near-miss event was reported in 63% (term) and 83% (preterm) infants. Twelve percent of term infants and 17% of the preterm infants had ten or more repeat events. A home apnea/cardiac monitor was prescribed for 88% of the infants for an average duration of 5.6 months in term infants and 3.5 months in preterm infants. Monitoring had been discontinued in 69% of the infants by 7 months of age. One full-term infant was later a SIDS victim. The risk of a repeat near-miss event is concluded to be sufficiently great to demand immediate hospitalization, medical evaluation, home monitoring when there is no specific treatment, and close clinical follow-up. Follow-up studies are needed to determine whether there is any long-term morbidity for infants who have had near miss events.

Age Factors↗

PubMed1998

Influence of increased survival in very low birth weight, low birth weight, and normal birth weight infants on the incidence of sudden infant death syndrome in the United States: 1985-1991.

OBJECTIVE: To examine the relationship between infant survival and the rates sudden infant death syndrome (SIDS) in very low birth weight (VLBW), low birth weight (LBW), and normal birth weight (NBW) infants from 1985 to 1991. METHODS: The National Center for Health Statistics Birth Cohort Linked Birth/Infant Death Data Sets were used to determine birth weight, age at death, and cause of death for US-born singleton infants with birth weights of 500 g or more. RESULTS: Increasing infant and postneonatal survival rates were greatest in VLBW infants. In contrast, SIDS rates did not change in VLBW infants (3.66 to 3.69; P = .70) but declined in both LBW (3.51 to 3.32; P = .041) and NBW (1.07 to 1.03; P = .008) infants. Postneonatal SIDS rates (per 1000 neonatal survivors) did not change in VLBW (4.93 to 4.58; P = .58) or LBW (3.36 to 3.22; P = .07) infants but declined in NBW infants (1.00 to 0.97; P = .018). Although there were differences among the slopes of survival rates, there was no statistical evidence of differences in the slope of SIDS rates among the three groups. CONCLUSIONS: The marked increase in survival of VLBW infants increased the pool of babies at potential risk for SIDS. VLBW infants' SIDS rates have not changed while they have declined in NBW and LBW infants.

Birth Weight↗

PubMedDate not supplied

Feeding of premature infant formula after hospital discharge of infants weighing less than 1800 grams at birth.

A randomized, double-blind study was conducted to determine whether continued feeding of premature infant formula after hospital discharge improve biochemical measures of bone mineral or protein status and anthropometrics during the first 8 and 12 weeks, respectively, after initial hospital discharge. Forty-three subjects were randomized to receive either a 20 kcal/ounce standard cow's milk-based formula with iron or a 20 kcal/ounce premature infant formula with iron for 8 weeks after hospital discharge. Sixteen exclusively breast-fed infants (mother's own milk) who received a multivitamin supplement with iron were compared with infants in both formula groups. There were no differences among the three groups in gender, birth weight, gestational age, or weight and age at the time of study entry. Alkaline phosphatase values were lower in infants receiving premature infant formula than in those receiving standard formula 8 weeks after discharge. Phosphorus values were lower and alkaline phosphatase values higher in the human milk-fed group than in both formula groups 8 weeks after discharge despite supplementation with calcium, phosphorus, and vitamin D before and during the study. At 8 weeks after discharge, human milk-fed infants also had lower transferrin levels than infants fed formulas. Infants in both formula groups grew similarly in weight, whereas the infants fed human milk weighed less throughout the study. The group fed premature infant formula had greater mean length and head circumference than the standard formula or human milk-fed groups. These data indicate that premature infants weighing < 1800 gm at birth may benefit from the continuation of premature infant formula during the first 8 weeks after initial hospital discharge.

Analysis of Variance↗

PubMed1999

Frontal brain electrical activity in infants of depressed and nondepressed mothers: relation to variations in infant behavior.

In previous studies, infants of depressed mothers have been found to exhibit reduced left frontal brain electrical activity (EEG). The left frontal region has been hypothesized to mediate social approach behaviors and positive affective expression. These findings raise important questions about the cause and nature of atypical EEG patterns in infants of depressed mothers. The present study begins to address some of these questions by examining whether or not variations in patterns of frontal brain activity in infants of depressed and nondepressed mothers are related to variations in infant behavior as observed in naturalistic situations. If such relations exist, are they specific to certain behaviors hypothesized to be mediated by the frontal region (i.e., positive approach behaviors)? Frontal and parietal brain electrical activity was recorded from 14- to 15-month old infants of depressed versus nondepressed mothers during a baseline condition and during conditions designed to elicit interest and positive affect. Infant behavior was observed in naturalistic play conditions, with and without mother, on a separate day from EEG testing. Mothers provided information on infant temperament. Infants of depressed mothers showed less affection and touching of their mothers. For infants of depressed mothers only, reduced left frontal brain activity was found to be related to lower levels of affection toward mother, but not to infant temperament. Furthermore, increased generalized frontal activation was found to be related to higher levels of negative affect, hostility, and tantrums and aggression. Relations between infant brain activity and behavior were not found for parietal EEG activity. These results suggest that infant frontal electrical brain activity is related to variations in infant behavior, especially those involved in positive affiliative behavior and the expression and regulation of negative affect. The nature and cause of atypical patterns of brain activity and question of whether such atypical patterns of frontal brain activity predispose infants to affective disorders in later life are discussed.

Depression↗

PubMed2000

Non-nutritive sucking for promoting physiologic stability and nutrition in preterm infants.

BACKGROUND: Non-nutritive sucking is used during gavage feeding and in the transition from gavage to breast/bottle feeding in preterm infants. The rationale for this intervention is that non-nutritive sucking facilitates the development of sucking behaviour and improves digestion of enteral feedings. Non-nutritive sucking has been considered to be a benign intervention, although it has the potential to have a negative effect on breastfeeding or on the incidence of later oral aversion. OBJECTIVES: To determine whether non-nutritive sucking (NNS) in preterm infants influences: a) weight gain, b) energy intake, c) heart rate, d) oxygen saturation, e) length of hospital stay, f) intestinal transit time, g) age at full oral feeds, or h) any other clinically relevant outcomes. SEARCH STRATEGY: MEDLINE and CINAHL databases back to 1976 and the Cochrane Controlled Trials register were searched. Reference lists/bibliographies of relevant articles and reviews were also searched. A comprehensive list of relevant articles was sent to two major authors in this area. They were asked if they knew of any other published or unpublished studies relevant to the area that had not been included in the original list. SELECTION CRITERIA: All trials utilizing experimental or quasi-experimental designs in which non-nutritive sucking in preterm infants was compared to no provision of non-nutritive sucking. Measured clinically relevant outcomes. Reports were in English or a language for which a translator was available. Computerized searches were conducted by both reviewers. All potentially relevant titles and abstracts identified by either reviewer were extracted. All retrieved articles were assessed for relevance independently by each reviewer, based on a pre-determined set of criteria. The reference lists/bibliographies of each article were reviewed independently for additional relevant titles and were also retrieved and assessed for relevance. Articles that met all relevance criteria were then assessed for methodologic quality based on a predetermined set of criteria. Those articles judged to have the appropriate quality by both reviewers were included in the analysis. DATA COLLECTION AND ANALYSIS: Data were extracted independently by the two authors. No subgroup analyses were performed because of the small number of studies related to the relevant outcomes. MAIN RESULTS: This review consisted of 19 studies, 13 of which were randomized controlled trials. NNS was found to decrease significantly the length of hospital stay in preterm infants. The review did not reveal a consistent benefit of NNS with respect to other major clinical variables (weight gain, energy intake, heart rate, oxygen saturation, intestinal transit time, and age at full oral feeds). The review identified other positive clinical outcomes of NNS: transition from tube to bottle feeds and behavior. No negative outcomes were reported in any of the studies. REVIEWER'S CONCLUSIONS: This review found a significant decrease in length of stay in preterm infants receiving a NNS intervention. The review did not reveal a consistent benefit of NNS with respect to other major clinical variables (weight gain, energy intake, heart rate, oxygen saturation, intestinal transit time, and age at full oral feeds). The review identified other positive clinical outcomes of NNS: transition from tube to bottle feeds and behavior. No negative outcomes were reported in any of the studies. There were also a number of limitations of the presently available evidence related to the design of the studies, outcome variability, and lack of long-term data. Based on the available evidence, NNS in preterm infants would appear to have some clinical benefit. It does not appear to have any short-term negative effects. In view of the fact that there are no long-term data, further investigations are recommended. In order to facilitate meta-analysis of these data, future research in this area should involve outcome measures

Humans↗

PubMed1982

Physiological and clinical aspects of respiration control in infants with relation to the sudden infant death syndrome.

We have examined the behavior of several variables which are related to respiratory control in 114 infants (up to 6 months of age) in order to assess the risk for the sudden infant death syndrome (SIDS), 23 of the infants had already had demonstratable serious or life threatening apneas or respiratory problems during surgical anesthesia. These infants were assigned as a risk group, and the rest of the investigated babies was taken as a control group. We found that practically all infants of the risk group had apneas during sleep, which lasted longer than 8 s each. Only 22% of the infants of the control group had apneas of such a duration. As a statistical parameter, calculated from at least 1 hour recording of respiration, we defined the mean apnea duration (MA-value) as average value of apnea duration time in seconds per minute of recording. The MA-value proved to be significantly elevated in the infants of the risk group. The trend to hypoxia in the infants of the risk group was also indicated by the observation of lower transcutaneous PO2-values (tc-PO2) during sleep, when compared with control infants. In agreement with this observation is the increase of the 2,3-DPG concentration and the decrease of the density of erythrocytes of the infants of the risk group. Breathing hypoxic gas mixtures tended to depress respiration in all infants tested, and, especially in the risk group, to elicit irregular respiratory patterns. On the other hand, we observed that inhalation of pure oxygen markedly stimulated respiration in all infants investigated. We conclude from these observations that a risk for SIDS may be related to a particular response pattern of the respiratory center during the early postnatal life. We are able to distinguish infants with a higher risk for SIDS from other children by determination of the MA-value during sleep.

Aminophylline↗

PubMed2004

Preterm male infants need more initial respiratory and circulatory support than female infants.

AIM: The aim of this study was to investigate possible gender-related differences in clinical parameters during the first week of life that could explain the higher morbidity and mortality of preterm male infants. METHODS: In total, 130 clinical variables were collected from 236 inborn infants (130 male and 106 female infants) with gestational age (GA) < 29 wk. A subgroup of 175 extremely low birthweight infants (ELBW) < 1000 g (n = 86 males; n = 89 females) was analysed separately. RESULTS: At 6 postnatal h, 60.8% of the male infants needed mechanical ventilation versus 46.2% of the females (p = 0.026). Chronic lung disease (CLD) developed in 36.2% of males versus 9.8% of female infants (p = 0.004). Inotrope support with dopamine was used in more than 50% of the infants; additional inotrope support to dopamine was needed by 19.4% of male and 9.7% of female infants (p = 0.041). The gender-related difference in need for inotrope support was more evident among the ELBW infants; 67.1% of male infants needed inotrope support versus 50.6% of females (p = 0.028). At 12-24 h, male ELBW infants had lower minimum mean arterial blood pressure (mean (SD) 25(4) mmHg vs 28(6) mmHg, p = 0.004)) and lower minimum PaCO2 than females infants (4.3 (1.1) kPa vs 4.7 (0.9) kPa, p = 0.043). CONCLUSIONS: There are early gender-related differences in need for ventilatory and circulatory support that may contribute to the worse long-term outcome in prematurely born male infants.

Apgar Score↗

PubMed1979

[Calcium requirement in infants with intrauterine dystrophy (ID). Report II. Effect of differentiated diets with regard to quantity and quality of protein and fat on the calcium balance in infants with intrauterine dystrophy].

In the former report on he calcium requirement in Small-for Date (S-f-D) infants it was observed that the ability of calcium absorption of S-f-D infants is lowered in 1-st semester of life. From this point of view it seemed purposeful to study the influence of 3 modified cow's milk formulas (see table) on the calcium absorption in S-f-D infants. Modification of these diets in regard to cow's milk depended on: 1) partial replacement of cow's milk fat with soya oil. 2) change of the proportion between fat and protein. 3) partial replacement of milk casein with lactoalbumin . The infants were divided into 3 groups G, H and C according to the kind of diet. Observation in the first 2 groups lasted for the whole first year of life, C group of infants was observed only in 1-st half year of life. In the first month of life G and H infants were fed the same unmodified cow's milk formulas (diet S) 3-day balance-studies. Were carried out once a month. The data of these 3 groups of infants were compared with each other and the data of S-f-D infants fed unmodified cow's milk formulas (group S) described in he former report. In group S, calcium intake was the highest in 1-st and in 2-nd semester of life among all compared infant groups, but the difference was not statistically significant. The lowest (%) absorption was noted in group G infants (fig. 2, table III and IV). The difference was statistically significant in 1-st semester of life between group G and S and in 2-nd semester between G and S as well as G and H groups. Calcium retention mg/kg was also the lowest in group G infants, and the difference was statistically significant in 1-st and in 2-nd semester between G and S groups. The infants fed H formula in spite of the lowest indices of calcium absorption % and retention mg/kg in the first (see table) and the second month of life and in spite of the lowest intake of calcium among all compared infants groups cough up absorption (%) and retention (mg/kg b.w.) with groups S in 2 semester of life.(ABSTRACT TRUNCATED AT 400 WORDS)

Age Factors↗

PubMed2000

Postnatal phenobarbitone for the prevention of intraventricular hemorrhage in preterm infants.

BACKGROUND: This section is under preparation and will be included in the next issue. OBJECTIVES: To determine whether postnatal administration of phenobarbitone to preterm infants reduces the risk of intraventricular hemorrhage (IVH), neurodevelopmental impairment or death. SEARCH STRATEGY: See the Search Strategy of the Neonatal Collaborative Review Group. The reviewer has been a active trialist in this area and has personal contact with many groups in this field. Journals handsearched from 1976 (when cranial CT scanning started) to November 1998 include: Pediatrics, J Pediatrics, Archives of Disease in Childhood, Pediatric Research, Developmental Medicine and Child Neurology, Acta Paediatrica, European J of Pediatrics, Neuropediatrics, New England J of Medicine, Lancet and British Medical J. The National Library of Medicine (USA) database (via PubMed) and the Cochrane Controlled Trials Register were searched through to November 1998 using the MeSH terms intraventricular hemorrhage, newborn infants, premature infant, intracranial hemorrhage, phenobarbitone, phenobarbital. The searches were not limited to the English language, as long as the article included an English abstract. Promising articles were read in the original language or translated. SELECTION CRITERIA: Included were randomized or quasi-randomized controlled trials in which phenobarbitone was given to preterm infants identified as being at risk of IVH because of gestational age below 34 weeks, birthweight below 1500 g, or respiratory failure. Adequate determination of IVH by ultrasound or CT was also required. DATA COLLECTION AND ANALYSIS: In addition to details of patient selection and control of bias, the details of the administration of phenobarbitone were extracted. The end-points searched for included: IVH ( with grading), posthemorrhagic ventricular dilatation or hydrocephalus, neurodevelopmental impairment and death. In addition, possible adverse effects of phenobarbitone such as hypotension, mechanical ventilation, pneumothorax, hypercapnia, and acidosis were searched for. MAIN RESULTS: Nine controlled trials were included with 740 infants recruited. There was heterogeneity between trials for the outcome IVH, with one trial finding a significant decrease in IVH and another trial finding an increase in IVH in the group receiving phenobarbitone. Meta-analysis showed no difference between the phenobarbitone treated group and the control group in either IVH (typical relative risk 1.04, CI 0.87, 1.25), severe IVH (typical relative risk 0.91, CI 0.66, 1.27), posthemorrhagic ventricular dilatation (typical relative risk 0.89, CI 0.38, 2.08), severe neurodevelopmental impairment (typical relative risk 1.44, CI 0.41, 5.04) or death before hospital discharge (typical relative risk 0.88, CI 0.64, 1.21) There was a consistent trend in the trials towards increased use of mechanical ventilation in the phenobarbitone treated group, which was supported by the meta-analysis (typical relative risk 1.18, CI 1.06, 1.32; typical risk difference 0.129, CI 0.045, 0.213), but there was no significant difference in pneumothorax, acidosis or hypercapnia. REVIEWER'S CONCLUSIONS: Postnatal administration of phenobarbitone cannot be recommended as prophylaxis to prevent IVH in preterm infants and is associated with an increased need for mechanical ventilation.

Cerebral Hemorrhage↗

PubMed2003

Effects of infant risk status and maternal psychological distress on maternal-infant interactions during the first year of life.

The associations of infant medical risk, prematurity, and maternal psychological distress with the quality of maternal-infant interactions during the first year of life were evaluated in a prospective, longitudinal follow-up from birth. A total of 103 high-risk very low birth weight (VLBW) infants with bronchopulmonary dysplasia, 68 low-risk VLBW infants without bronchopulmonary dysplasia, and 117 healthy term infants were seen at 1, 8, and 12 months of age. Videotaped feedings at each age were rated using the Nursing Child Assessment Feeding Scale, and mothers completed the Brief Symptom Inventory as a measure of psychological distress. VLBW infant status was related to both maternal and infant behaviors as well as to maternal distress, and these relationships varied with infant age. Overall, VLBW infants displayed fewer responsive, clear interactions, with differences from term infants increasing over time. Maternal distress was related to less cognitive growth fostering for all mothers. Because maternal distress is more prevalent in mothers of VLBW infants postpartum, intervention efforts should focus on assessment of maternal distress and the challenges posed by the interactive behaviors of VLBW infants.

Adult↗

PubMed2006

Mother's early perception of her infant's difficult temperament, parenting stress and early mother-infant interaction.

The current study investigated factors contributing to mother's early perception of her infant's difficult temperament. One hundred and twenty-four mother-infant dyads participated in the study. Mother's perception of the infant's temperament was assessed with the Infant Characteristics Questionnaire (ICQ). The influence of mother-infant interaction, mother's mental health and parenting stress were investigated. Mother-infant interaction was videotaped during a face-to-face interaction and analysed using the Global Rating Scale. Mother's mental health was assessed through a structured interview (Structured Clinical Interview for DSM-IV, SCID) and parenting stress was examined by a questionnaire (Parenting Stress Index). First, the difficulty scale of the ICQ was used as a continuous variable and factors contributing to mother's perception of her infant's temperament as more or less difficult were examined. Secondly, infants were categorized into difficult and non-difficult, and factors increasing the infant's risk of being perceived as difficult were examined. The model including mother's mental health and parental distress accounted for 24% of the variance in perceived infant difficulty, with parental distress in particular being an influential contributor. When infants categorized as difficult were examined, mother's intrusiveness and infant's poor interactive behaviour in early mother-infant interaction as well as parental distress significantly increased the infant's risk of being perceived as difficult.

Adult↗

PubMed2005

Evolution in the hypervariable region of the hepatitis C virus in two infants infected by mother-to-infant transmission.

BACKGROUND: There is little data on the evolution of hepatitis C virus (HCV) quasispecies in infants infected by mother-to-infant transmission during long-term follow up. The hypervariable region 1 (HVR1) of the HCV genome was investigated in two mother-infant pairs from birth to 7.6 and 10.2 years, respectively. METHODS: Ten cDNA clones of HVR1 generated from HCV-RNA and extracted from serum samples of both pairs were analyzed. The sequences were compared with regard to variability, identity, and hydrophobia profile, and analyzed by phylogenetic studies. RESULTS: The alanine aminotransferase (ALT) level was high with fluctuation in infant A and almost within the normal range in infant B. Sequence diversity was higher in infant A at 7.6 years than in infant B at 9.3 years (sequence identity with the mothers'; 69.3-70.7% vs 85.3-90.7% for nucleotides, and 48% vs 68-72% for amino acids, respectively). Compared to the first samples, amino acid changes greatly increased in infant A (35.2% at 4.9 years and 52% at 7.6 years), but not in infant B (4% at 5.6 years and 27.5% at 9.3 years). Phylogenetic studies revealed that quasispecies in infant A evolved to a greater extent than that in infant B. Hydrophobia profile analyses revealed that dynamic shifts between hydrophilia and hydrophobia occurred in both infants. CONCLUSIONS: As in adults, the evolution of HVR1 and variability of quasispecies increased in infants infected through mother-to-infant transmission for 10 years after birth. A large episode of ALT elevation suggested the emergence of escape mutants and the evolution of new quasispecies.

Alanine Transaminase↗

PubMed2003

Emotion in the infant's face: insights from the study of infants with facial anomalies.

Darwin viewed "experiments in nature" as an important strategy for elucidating the evolutionary bases of human emotional expressions. Infants with craniofacial anomalies are of special interest because morphological abnormalities and resulting distortions or deficits in their facial expressions could make it more difficult for caregivers to read and accurately interpret their signals. As part of a larger study on the effects of craniofacial anomalies on infant facial expression and parent-infant interaction, infants with different types of craniofacial conditions and comparison infants were videotaped interacting with their mothers at 3 and 6 months. The infants' facial expressions were coded with Baby FACS. Thirty-seven slides of 16 infants displaying 4 distinctive infant expressions (cry face, negative face, interest, and smile) were rated by 38 naive observers on a 7-point scale ranging from intense distress to intense happiness. Their ratings were significantly correlated with ratings based on objective Baby FACS criteria (r > 0.9 in all infant groups). A 4 (infant group) x 4 (expression category) ANOVA showed a significant main effect for expression category, F(3) 5 71.9, P 5 0.000, but no significant effect for infant group or group 3 expression interaction. The observers' ratings were thus highly "accurate" in terms of a priori Baby FACS criteria, even in the case of infants with severely disfiguring facial conditions. These findings demonstrate that the signal value of infant facial expressions is remarkably robust, suggesting that the capacity to read emotional meaning in infants' facial expressions may have a biological basis.

Affect↗