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Preterm infant follow-up project: a multi-site field experiment of hospital and home intervention programs for mothers and preterm infants.

This study was designed as a multi-site field experiment to test the efficacy of hospital and home visit interventions to improve interaction between mothers and preterm infants. Hospital intervention consisted of State Modulation (SM) treatment, which focused on teaching mothers to read the behavioral cues and modulate the states of consciousness of preterm infants during feedings. Home visit intervention was a field-tested program, Nursing Systems for Effective Parenting-Preterm (NSTEP-P), implemented during the first five months after the infant's hospital discharge. A hospital program on car seats (CS) and standard public health nursing home visits (PHN) served as comparison treatments. The sample consisted of 327 mothers and their preterm infants who were less than 36 weeks of gestational age at hospital discharge. Mothers were randomly assigned to intervention groups on the basis of their education. High education (HE) was > or = 13 years of education, while low education (LE) was < or = 12 years of education. HE mothers were only assigned to hospital programs, while LE mothers were assigned to combinations of hospital and home visit programs. Evaluations were conducted at 40 weeks conceptual age (expected date of birth), at 46 weeks conceptual age (1.5-months-corrected age), and 60 weeks conceptual age (5-months-corrected age). Comparisons were made within each educational group. For HE groups, SM infants gave significantly more clear cues during observations of feeding interactions at 1.5-months-corrected age and teaching interactions at 5-months-corrected age than infants in the CS group. During the teaching interaction, well-educated SM mothers provided significantly more social-emotional and cognitive stimulation than CS mothers. For LE groups, infants in the SM group combined with either PHN or NSTEP-P exhibited significantly more responsive behavior during feeding observations than those infants in the CS/PHN group at 1.5-months-corrected age. LE mothers in the SM/NSTEP-P group demonstrated more sensitivity and more stimulation during teaching interactions at 5-months-corrected age than mothers in the SM/PHN or CS/PHN groups. Findings suggest that State Modulation treatment is effective in influencing positive social interaction of infants regardless of the level of maternal education. State modulation treatment combined with NSTEP-P is most effective in improving the social interaction between preterm infants and mothers with limited formal education. Such treatment-specific programs suggest avenues for providing cost-effective care that complements the changing transactional needs of mothers and preterm infants.

Adolescent↗

Used infant mattresses and sudden infant death syndrome in Scotland: case-control study.

OBJECTIVE: To examine the proposition that a used infant mattress is associated with an increased risk of sudden infant death syndrome. DESIGN: Case-control study. SETTING: Scotland (population 5.1 million, with about 53 000 births a year). PARTICIPANTS: 131 infants who died of sudden infant death syndrome between 1 January 1996 and 31 May 2000 and 278 age, season, and obstetric unit matched control infants. MAIN OUTCOME MEASURES: Routine use of an infant mattress previously used by another child and place of last sleep. RESULTS: Routine use of an infant mattress previously used by another child was significantly associated with an increased risk of sudden infant death syndrome (multivariate odds ratio 3.07, 95% confidence interval 1.51 to 6.22). Use of a used infant mattress for last sleep was also associated with increased risk (6.10, 2.31 to 16.12). The association was significantly stronger if the mattress was from another home (4.78, 2.08 to 11.0) than if it was from the same home (1.64, 0.64 to 4.2). CONCLUSION: A valid significant association exists between use of a used infant mattress and an increased risk of sudden infant death syndrome, particularly if the mattress is from another home. Insufficient evidence is available to judge whether this relation is cause and effect.

Bedding and Linens↗

Developmental characteristics of apnea in infants who succumb to sudden infant death syndrome.

We compared the breathing characteristics of 40 infants who subsequently died of sudden infant death syndrome (SIDS) with those of 607 healthy infants matched for sex and age. The infants were between 2 and 19 wk old at the time of recording. Compared with the control group, the infants who died of SIDS experienced significantly more frequent episodes of obstructive and mixed sleep apnea. The duration of the apneic episodes did not exceed 15 s. Moreover, the SIDS group had a greater proportion of infants with obstructive and mixed apneic episodes than did the control group. In both groups, the frequency of episodes among male infants with apnea was greater than that among female infants. After the age of 9 wk, the proportion of male infants with episodes of obstructive apnea was greater in the SIDS group than in the control group. The frequency of apneic episodes decreased with age. The rate of decrease was significantly greater in the control subjects than in the SIDS group. This finding was made mainly in male infants. The present study provides further indirect evidence for a slower maturation of respiratory control in some infants who ultimately die of SIDS.

Female↗

Assessment of an infant whole-body plethysmograph using an infant lung function model.

In order to facilitate international multicentre studies and improve the quality control of infant pulmonary function measurements, the European Respiratory Society-American Thoracic Society Task Force for infant lung function testing has recently developed specifications for standardized infant lung function equipment and software. A mechanical infant lung model analogue has been developed to assess whether infant lung function equipment is able to meet these requirements. However, the practical testing of infant lung function equipment using such models is highly complex because of the need to use very small pressure and flow changes, and the numerous potentially confounding factors associated with both the design of the device and the testing procedure. The aim of this study was to determine whether the infant lung model is capable of assessing the overall function of an whole-body infant- plethysmograph, using the only infant plethysmograph that was commercially available at the time as an example. The mechanical characteristics of the model such as vibrations or noise did not disturb the delicate plethysmographic measurements and thereby allowed a reliable assessment of the system. A series of tests revealed that the plethysmograph was able to measure airway resistance 1-3.5 kPa.L(-1).s with an accuracy of +/-2.5% and lung volumes 75-300 mL with an accuracy of +/-2.5% under in vitro conditions. To conclude, the infant lung model is a useful means of assessing the overall in vitro performance of infant whole-body plethysmographs, but thermal, mechanical and frequency response characteristics of such a device must be taken into account when interpreting the results of such assessments.

Airway Resistance↗

Respiratory syncytial virus hospitalizations among American Indian and Alaska Native infants and the general United States infant population.

OBJECTIVE: To determine the burden of respiratory syncytial virus (RSV) disease among American Indian (AI) and Alaska Native (AN) infants, by examining RSV-associated hospitalizations. METHODS: Infant hospitalizations from 1997 through 2001 with RSV listed as a diagnosis were selected by using Indian Health Service/tribal hospital discharge data for AIs/ANs and National Hospital Discharge Survey data for the general US population. RESULTS: In 2000-2001, RSV disease was listed as a diagnosis for 14.4% of all AI/AN infant hospitalizations, with bronchiolitis attributable to RSV infection (12.2%) being among the top 5 listed diagnoses. The rate of RSV-specific hospitalizations was 34.4 hospitalizations per 1000 infants for AI/AN infants and 27.4 hospitalizations per 1000 births for the general US infant population. The hospitalization rates for AI/AN infants living in the Alaska and Southwest regions (70.9 and 48.2 hospitalizations per 1000 infants, respectively) were much higher than the overall rate for US infants. CONCLUSIONS: RSV infection is one of the leading causes of hospitalization among all infants in the United States, and AI/AN infants living in the Southwest and Alaska regions are at especially high risk for hospitalizations associated with RSV infection. Development of vaccines, antiviral agents, and other strategies to prevent RSV disease could yield substantial public health benefits.

Alaska↗

Effect of infant formula on stool characteristics of young infants.

BACKGROUND: Many infants are switched between multiple formula preparations early in life because of perceived abnormalities in stooling pattern as well as gastrointestinal symptoms. OBJECTIVE: To investigate the relationship between the type of formula consumed and the stooling characteristics and gastrointestinal symptoms of young infants. METHODS: Healthy 1-month-old infants were fed one of four commercial formula preparations (Enfamil, Enfamil with Iron, ProSobee, and Nutramigen) for 12 to 14 days in a prospective double-blinded (parent/physician) fashion. Parents completed a daily diary of stool characteristics as well as severity of spitting, gas, and crying for the last 7 days of the study period. A breast-fed infant group was studied as well. RESULTS: Two hundred eighty five infants were enrolled and 238 completed the study. Infants receiving breast milk or Nutramigen had twice as many stools as other formula groups (P < .001). Infants receiving ProSobee had hard/firm stools more often than breast-fed or other formula-fed groups (P < .00001). Watery stools were more common in infants fed Nutramigen than other formula groups (P < .04). Green stools were more common in 12 mg/L iron preparations (Enfamil with iron, ProSobee, Nutramigen) than in those with 1 mg/L (Enfamil, breast milk) (P < .00001). Spitting, gassiness, and crying were of equal severity in all formula groups. CONCLUSIONS: The interpretation of stool frequency, color, and consistency must take into account the infant's formula type as significant variations in normal infants occur. Parental education on the range of infant stooling characteristics as well as the common occurrence of spitting, gas, and crying may alleviate concern for formula intolerance and underlying gastrointestinal disease.

Analysis of Variance↗

Feeding infants and toddlers study: Improvements needed in meeting infant feeding recommendations.

OBJECTIVE: To assess adherence to infant feeding recommendations among a sample of infants and toddlers four to 24 months of age in the United States. DESIGN: Descriptive analysis of data collected in the 2002 Feeding Infants and Toddlers Study (FITS) based on telephone interviews and 24-hour dietary recalls collected with the Nutrition Data System for Research of the University of Minnesota. SUBJECTS: A national random sample of 3,022 infants and toddlers age four to 24 months, including 2,024 infants age four to 11 months. MAIN OUTCOME MEASURES: Breastfeeding, timing of introduction of complementary foods, and adherence to infant feeding recommendations. STATISTICAL ANALYSES: Means and standard errors, percentile distributions, and percentages by age group (four to six months, seven to eight months, and nine to 11 months). RESULTS: About 76% of infants and toddlers were fully or partly breastfed at birth. This percentage declined to 30% at six months and 16% at 12 months-short of Healthy People 2010 goals of 50% and 25%, respectively. The average duration of breastfeeding was 5.5 months for all who initiated breastfeeding. About two-thirds of infants had been introduced to complementary foods between four and six months-the period recommended by the American Academy of Pediatrics (AAP); 17% consumed juice before the AAP recommended age of six months or later. Twenty-two percent of infants nine to 11 months consumed cow's milk on a daily basis before the recommended age of 12 months or later, and one in 10 consumed french fries and/or sweetened beverages on any given day. APPLICATIONS/CONCLUSIONS: More parents and caregivers can benefit from guidance about the introduction of developmentally appropriate, micronutrient-rich first solid foods such as iron-rich infant cereals, iron-fortified grain products, meats, soft fruits, and cooked vegetables and the importance of breastfeeding through the first year of life. A smaller proportion of parents and caregivers require guidance on delaying the introduction of juices until six months of age and cow's milk other than formula until one year of age.

Age Factors↗

Supplementation of infant formula with the probiotic lactobacillus reuteri and zinc: impact on enteric infection and nutrition in infant rhesus monkeys.

UNLABELLED: Gut colonization by may have beneficial effects on infant health or capacity to resist infectious disease. Zinc supplementation has also been proposed to increase infants' resistance to disease; however, many studies have yielded conflicting results. OBJECTIVES: To study effects of probiotic supplementation of infant formula (with or without supplemental zinc) on nutritional status, gut colonization and the ability to resist gastrointestinal infection in an infant rhesus monkey model. METHODS: Infant monkeys were fed control infant formula (5 mg Zn/L), control formula with or control formula with and supplemental zinc (15 mg Zn/L) from birth to 4 months. Growth, nutritional status, mineral absorption, intestinal colonization and frequency and severity of enteropathogenic -induced gastroenteritis were monitored. RESULTS: Gastrointestinal colonization was achieved and was associated with increased ileal villous surface area and improved hematocrit, with no adverse effects on growth or nutritional indices. Fortification to 15 mg Zn/L reduced plasma copper, erythrocyte Cu/Zn-superoxide dismutase, hemoglobin, and iron absorption. Infants fed -supplemented formula had reduced diarrhea severity throughout the study period and recovered more rapidly from acute diarrhea than the other groups. CONCLUSION: -supplementation of infant formula is safe, improves iron status and decreases diarrhea severity in infant rhesus monkeys and thus may help protect formula-fed human infants from infection and nutritional deficiencies.

Animals↗

Comparison of normal infants and infants with cystic fibrosis using forced expiratory flows breathing air and heliox.

SUMMARY. The detection of early airway disease in infants with cystic fibrosis (CF) may lead to earlier intervention and an improved prognosis. We hypothesized that the ratio of maximal expiratory flows while breathing a mixture of helium and oxygen (heliox) and air, referred to as density dependence (DD), would identify early airway disease in infants with CF who have normal lung function. We also hypothesized that these infants with CF might be better differentiated from normal infants when the flows breathing heliox are compared instead of room air flows. We evaluated 10 infants with CF and 21 infants without CF and with normal lung function, defined as a forced vital capacity (FVC) and forced expiratory flows between 25-75% of expired volume (FEF(25-75)) of greater than 70% predicted (z-score > -2.0). Full forced expiratory maneuvers by the rapid thoracic compression technique were obtained while breathing room air and then heliox. Flow at 50% and 75% of expired volume (FEF(50), FEF(75)), FEF(25-75), and FVC were calculated from the flow volume curve with patients and control subjects breathing each gas mixture. The ratio of heliox to air flow at FEF(50) and FEF(75) was calculated (DD(50), DD(75)), and the point where the two flow-volume curves crossed (V(iso) V') was also measured. DD parameters did not distinguish the infants with CF from the infants without CF; length-adjusted FEF(50) breathing air was significantly lower in the infants with CF compared to the infants without CF (P < 0.05). Length-adjusted flows breathing heliox did not distinguish the two groups. We conclude that the lower FEF(50) value may reflect early airway obstruction in healthy infants with CF, and that measurements obtained with the less dense gas mixture did not improve detection of airway disease in this age group.

Air↗

Gas trapping in normal infants and in infants with cystic fibrosis.

Two different methods for estimating trapped gas volume have been described in the literature. The purpose of this study was to use both of these methods to estimate and compare trapped gas volumes in normal infants and infants with cystic fibrosis (CF). Thirty normal infants and 29 infants with CF, ages 1 month to 3 years, were studied. Pulmonary function tests, including raised volume forced expiratory flows, plethysmographic functional residual capacity (FRC(pleth)), and fractional lung volumes, were measured. Then functional residual capacity was measured by nitrogen washout (FRC(nitrogen)). Following nitrogen washout, lungs were then inflated three times to 30 cm H(2)O, using 100% oxygen. This process was repeated until no further nitrogen could be washed from the lungs. The volume of trapped gas (tg) was calculated from the total additional amounts of nitrogen expired following lung inflations. The difference between FRC(pleth) and FRC(nitrogen) provided a second estimate of trapped gas volume (delta V). Mean tg and delta V values for normal infants were 2.5 +/- 3.5 ml and 15.6 +/- 30.4 ml, respectively. Mean tg and delta V values for infants with CF were 5.8 +/- 7.7 ml and 33.2 +/- 43.8 ml, respectively. Both tg and delta V did not differ significantly between normal infants and infants with CF. Measured following raised volume forced expiratory maneuvers, delta V and tg do not distinguish infants with CF from normal infants as well as do other currently available tests of infant lung function.

Air↗

Judgments of infant pain: the impact of caregiver identity and infant age.

OBJECTIVE: To examine whether caregiver judgments of infant pain would vary systematically with different infant caregiver groups and infant age. METHODS: A total of 123 caregivers (41 parents, 41 in patient nurses, 41 pediatricians) viewed videotapes of the vigorous behavioral responses of healthy infants (aged 2, 4, 6, 12, and 18 months) to a routine immunization injection and provided ratings of both the affective distress and pain intensity observed. RESULTS: A principal components analysis of affective and intensity ratings yielded a weighted pain summary score for each injection event. Older infants were attributed significantly more pain than younger infants, even though the vigor of the behavioral reactions was experimentally controlled across age groups. A profile analysis contrasting observer groups indicated that pediatricians attributed significantly lower levels of pain than parents, while nurses were intermediate to the other groups, not significantly differing from either group. These systematic differences in judgments were consistent across infant age groups. CONCLUSIONS: The findings reveal systematic sources of significant variations in observer judgments of infant pain. Despite an absence of differences in the behavioral reactions of the children, both the type of caregiver and their knowledge of the child's age systematically influenced attributions of pain to infants. This work suggests the important role of caregiver role variation and perceived developmental maturity as determinants of infant pain judgments and highlights potential areas of difficulty in controlling the unnecessary suffering of infants.

Adult↗

Mother-infant bedsharing is associated with an increase in infant heart rate.

OBJECTIVES: We hypothesized that mother-infant bed sharing, compared to solitary sleeping, would be associated with higher infant heart rates. The objective was to compare infant heart rates between the 2 environments and, secondarily, to test for relationships between heart rate and other, previously reported, differences in the same infants. DESIGN: Heart rate was measured in 15 infants over a bed-sharing night and a solitary-sleeping night. Eight of the 15 infants routinely bed shared with the mother at home; the other 7 routinely slept in a room alone. SETTING: The Sleep Disorders Center, University of California, Irvine Medical Center. PARTICIPANTS: Fifteen mother-infant pairs who met criteria for routinely bed sharing or sleeping solitarily. All were healthy, and infants were more than 38 weeks gestation at birth and 11 to 15 weeks old at the time of the study. INTERVENTIONS: None. RESULTS: Analysis of variance indicated that, irrespective of routine sleeping condition, heart rate was lower during solitary sleeping than during bed sharing in all sleep stages. Significant regressions were found with infant temperature. Heart-rate variability was higher during solitary sleeping than during bed sharing (both routine groups) in stages 1 and 2 and rapid eye movement sleep, but only stages 1 and 2 sleep effects were independent of basal heart rate. CONCLUSIONS: Infant heart rate is affected by the mother's presence in the sleep environment. The increase in sympathetic activity in stages 3 and 4 and rapid eye movement sleep might be partly explained by differences in thermoregulation between bed-sharing and solitary-sleeping environments. These results support the notion that sensory differences between bed-sharing and solitary-sleeping environments account for some of the physiologic differences between infant sleep in the 2 sleeping conditions.

Adult↗

Infants at social risk: maternal depression and family support services as mediators of infant development and security of attachment.

31 infants at high social risk due to the combined effects of poverty, maternal depression, and caretaking inadequacy were assigned to weekly home-visiting services. At 18 months infant age, the home-visited infants were compared with 2 groups of socioeconomically similar unserved infants on measures of infant development, infant attachment, mother-infant interaction, maternal depression, and maternal social contacts. Home-visited infants of depressed mothers outperformed unserved infants of depressed mothers by an average of 10 points on the Bayley Mental Scale and were twice as likely to be classified as securely attached, with unserved high-risk infants showing a high rate of insecure-disorganized attachments. Duration of services was positively correlated with maternal involvement at 12 months. Results of the study point both to the negative developmental consequences associated with severe social risk conditions and to the buffering effects of developmentally oriented home-visiting services for infants at greatest social risk.

Child Abuse↗

Transfer of olanzapine into breast milk, calculation of infant drug dose, and effect on breast-fed infants.

OBJECTIVE: This study characterized infant drug doses and breast-milk-to-plasma area-under-the-curve ratios for olanzapine and determined plasma concentrations and effects of this drug on breast-feeding infants. METHOD: Seven mother-infant nursing pairs were studied. Olanzapine was measured in plasma and milk with high-performance liquid chromatography over a dose interval (for six patients) or at a single time after dose ingestion (for one patient) at steady state. Infant drug exposure was estimated as the product of an assumed milk production rate and average drug concentration in milk, normalized to body weight, and expressed as a percentage of maternal drug dose, normalized to body weight. RESULTS: The median infant dose of olanzapine ingested through milk was 1.02% of the maternal dose; the median milk-to-plasma area-under-the-curve ratio was 0.38 for the six patients with data collected over the dose interval. Corresponding values in the patient with single-point data were 1.13% and 0.75. Olanzapine was not detected in the plasma of the six infants with an evaluable plasma sample. All of the infants were healthy and experienced no side effects. CONCLUSIONS: Breast-fed infants were exposed to a calculated olanzapine dose of approximately 1%-well below the 10% notional level of concern. In infant plasma, olanzapine was below the detection limit; there were no adverse effects on the infants. These data support the use of olanzapine during breast-feeding. However, the authors recommend that breast-fed infants be monitored closely and the decision to breast-feed be made after individual risk-benefit analysis.

Adult↗

Methylxanthine treatment for apnea in preterm infants.

BACKGROUND: Recurrent apnea is common in preterm infants, particularly at very early gestational ages. These episodes of loss of effective breathing can lead to hypoxemia and bradycardia which may be severe enough to require resuscitation including use of positive pressure ventilation. Methylxanthines have been used to stimulate breathing and prevent apnea and its consequences. OBJECTIVES: The objective of this review is to determine if methylxanthine treatment in preterm infants with recurrent apnea leads to a clinically important reduction in apnea and use of intermittent positive pressure ventilation (IPPV), without clinically important side effects. SEARCH STRATEGY: Searches were made of the Oxford Database of Perinatal Trials, MEDLINE, EMBASE, previous reviews including cross references, abstracts of conferences and symposia proceedings, expert informants, journal handsearching mainly in the English language. SELECTION CRITERIA: All trials utilising random or quasi-random patient allocation, in which methylxanthine (theophylline or caffeine) was compared with placebo or no treatment for apnea in preterm infants, were included. DATA COLLECTION AND ANALYSIS: Methodological quality was assessed independently by the two authors. Data were extracted independently by the two authors. Treatment effects were expressed as relative risk (RR) and risk difference (RD) and their 95% confidence intervals, using a fixed effect model. For significant results, the inverse of the risk difference (1/RD) was used to calculate the number needed to treat (NNT). MAIN RESULTS: The results of four trials which enrolled a total of 110 preterm infants with apnea indicate that methylxanthine therapy leads to a reduction in apnea and use of IPPV in the first 2 - 7 days. There are insufficient data to evaluate side effects and no data to examine effects within different gestational age groups. There are no trial data which examine long term effects. REVIEWER'S CONCLUSIONS: Methylxanthines are effective in reducing the number of apneic attacks and the use of mechanical ventilation in the two to seven days after starting treatment. In view of its lower toxicity, caffeine would be the preferred drug. Although the safety of methylxanthine therapy has been suggested in cohort studies, there are no trial data on longterm outcome. In order to indicate which infants are likely to benefit from treatment, there is a need for stratification by gestation and/or other risk factors in future studies. In any future studies the longer term effects of treatment on growth and development should be evaluated.

Apnea↗

Sudden infant death syndrome and sleeping position in pre-term and low birth weight infants: an opportunity for targeted intervention.

AIMS: To determine the combined effects of sudden infant death syndrome (SIDS) risk factors in the sleeping environment for infants who were "small at birth" (pre-term (<37 weeks), low birth weight (<2500 g), or both). METHODS: A three year population based, case-control study in five former health regions in England (population 17.7 million) with 325 cases and 1300 controls. Parental interviews were carried out after each death and reference sleep of age matched controls. RESULTS: Of the SIDS infants, 26% were "small at birth" compared to 8% of the controls. The most common sleeping position was supine, for both controls (69%) and those SIDS infants (48%) born at term or > or =2500 g, but for "small at birth" SIDS infants the commonest sleeping position was side (48%). The combined effect of the risk associated with being "small at birth" and factors in the infant sleeping environment remained multiplicative despite controlling for possible confounding in the multivariate model. This effect was more than multiplicative for those infants placed to sleep on their side or who shared the bed with parents who habitually smoked, while for those "small at birth" SIDS who slept in a room separate from the parents, the large combined effect showed evidence of a significant interaction. No excess risk was identified from bed sharing with non-smoking parents for infants born at term or birth weight > or =2500 g. CONCLUSION: The combined effects of SIDS risk factors in the sleeping environment and being pre-term or low birth weight generate high risks for these infants. Their longer postnatal stay allows an opportunity to target parents and staff with risk reduction messages.

Analysis of Variance↗

Association between sudden infant death syndrome and prone sleep position, bed sharing, and sleeping outside an infant crib in Alaska.

OBJECTIVE: To determine the contribution of prone sleeping, bed sharing, and sleeping outside an infant crib to sudden infant death syndrome (SIDS). METHODS: We conducted a retrospective descriptive study of all SIDS cases in Alaska from January 1, 1992, through December 31, 1997. Reviewed data sources included maternal and infant medical records, autopsy reports, birth and death certificates, police and state trooper death scene investigations, and occasionally home interviews. RESULTS: The death certificate identified SIDS as a cause of death for 130 infants (cause-specific infant mortality rate: 2.0 per 1000 live births). Among infants for whom this information was known, 113 (98%) of 115 were found in the prone position, sleeping outside an infant crib, or sleeping with another person. By contrast, 2 (1.7%) were found alone and supine in their crib (1 of whom was found with a blanket wrapped around his face). Of 40 infants who slept with a parent at the time of death, only 1 infant who slept supine with a non-drug-using parent on an adult nonwater mattress was identified. CONCLUSION: Almost all SIDS deaths in Alaska occurred in association with prone sleeping, bed sharing, or sleeping outside a crib. In the absence of other risk factors, SIDS deaths associated with parental bed sharing were rare.

Adult↗

Parental weight and its relation to infant feeding patterns and infant obesity.

Mother-infant feeding behaviour as a possible determinant of obesity was studied. Seventy-eight healthy primiparous couples and their newborn children were divided into three groups according to parents' weight status (normal weight parents; one overweight and one normal weight parent; both parents overweight). Infants' weight and length measurements were obtained at birth and at 6 months of age. Mother-infant dyads were observed during feeding sessions at 55-77 hr after birth, at 2 weeks, 1, 2, 4 and 6 months postpartum. Feeding behaviour of mother and infant did not differ, nor did mother-infant interaction differ between the three groups throughout the observation period. However, infant weight status, although not different at birth, differed significantly at 6 months of age. Bartholomew's test showed the proportion of infants greater than or equal to 90%il increased significantly from infants of normal weight parents to infants of one overweight and one normal weight parent, to infants both parents of whom were overweight (chi 2 = 6.904, c = 0.44, P less than or equal to 0.01). While data of this study do not show any behavioural differences between overweight and normal weight parents and their offspring, they confirm results reported by other researchers showing children of overweight parents at risk of becoming overweight at 6 months of age as well.

Adult↗