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PubMed1993

[Retinal hemorrhage in newborn infants].

The fundi of the 527 infants born within one week were investigated. The results showed that 54 cases (78 eyes) had retinal hemorrhage. Among them, 23 cases (28 eyes) accompanied macular hemorrhage. The retinal hemorrhage in newborn infants was higher in vaginal delivery than in cesarean section, and the incidence of the fetal distress was higher in the newborn infants with macular hemorrhage. The essential causes of the retinal hemorrhage in newborn infants, development of infant macular and the mechanism of amblyopia induced by macular hemorrhage were discussed.

Adult↗

PubMed1998

Optimal timing of retina examinations for premature infants.

Developments in modern neonatal intensive care have resulted in increased survival of very premature infants. Along with this increase in survival, there has been a concomitant increase in the frequency of retinopathy of prematurity (ROP). We investigated the relationship between the severity and the time course of ROP as well as the optimal time for retinal examinations of premature infants of various birth weights and gestational ages. A total of 80 premature infants were enrolled for analysis. The mean postnatal age of infants at the time of diagnosis was 7.3 +/- 3.4 weeks for stage 1 retinopathy, 9.2 +/- 5.8 for stage 2 retinopathy, 9.5 +/- 3.8 for stage 3 retinopathy, 10.7 +/- 3.7 for threshold disease, and 11.7 +/- 3.2 for stage 4 retinopathy. The mean postconceptional age of infants at the time of diagnosis was 35 +/- 3 for stage 1 retinopathy, 36.4 +/- 3 for stage 2 retinopathy, 37.6 +/- 3.5 for stage 3 retinopathy, 38.4 +/- 3.5 for threshold disease, and 40 +/- 3.7 for stage 4 retinopathy. The age at the time of the initial detection of ROP was from the ninth to 10th week among infants weighing less than 1,000 g at birth and from the fifth to seventh week among those weighing 1,000 g or more at birth. However, the postconceptional age at the time of initial detection of ROP for the whole group was 36 weeks and was not influenced by birth weight or gestational age. Therefore, we suggest that postconceptional age, rather than postnatal age, should be used to decide the timing of retinal examinations for premature infants.

Female↗

PubMed2004

Hypothalamic contribution to sleep-wake cycle development.

Infant mammals cycle rapidly between sleep and wakefulness and only gradually does a more consolidated sleep pattern develop. The neural substrates responsible for this consolidation are unknown. To establish a reliable measure of sleep-wake cyclicity in infant rats, nuchal muscle tone was measured in 2-, 5-, and 8-day-old rats, as were motor behaviors associated with sleep (i.e. myoclonic twitching) and wakefulness (e.g. kicking, stretching). Sleep-wake cycles of 2-day-old rats were characterized by short periods of muscle atonia followed by equally short periods of high tone. In 8-day-olds, sleep periods lengthened significantly and disproportionately in relation to awake periods. Next, locus coeruleus (LC) lesions in 8-day-olds resulted in rapid sleep-wake cycling similar to that exhibited by 2-day-olds; in addition, LC lesions had no effect on the duration of awake periods. Finally, transections caudal, but not rostral, to the anterior hypothalamus also reinstated rapid cycling in 8-day-olds, again without affecting the duration of awake periods. This last finding implicates neural structures within the anterior hypothalamus (e.g. ventrolateral preoptic area) in the modulation of sleep-wake cyclicity. The temporal coherence of atonia and myoclonic twitching was not disrupted by any of the manipulations. These results suggest the presence of a bistable mesopontine circuit governing rapid sleep-wake cycling that does not include the LC and that comes increasingly under hypothalamic control during the first postnatal week. This circuit may represent a basic building block with which other sleep components become integrated during ontogeny.

Activity Cycles↗

PubMed1976

Retardation and twin concordance in infant mental development: a reassessment.

A reappraisal is made of Nichols and Broman's conclusion that there is no evidence that genetic influences are important in infant mental development if severely retarded twins are excluded from the sample. The reappraisal touches on certain idiosyncrasies of their sample, the test scores reported, and their definition of severe retardation. Data are presented for a sample of White twins who have been followed longitudinally since birth. For Bayley Mental Scale scores at 9 months of age, the monozygotic within-pair correlation was 0.85 and the dizygotic within-pair correlation was 0.62. With 13 retarded twins excluded, the correlations became 0.81 and 0.64, respectively, with the monozygotic correlation still being significantly larger (p less than 0.01). The present results indicate that genetic factors play a role in infant mental development.

Diseases in Twins↗

PubMed1975

Iatrogenic respiratory distress syndrome. An analysis of obstetric events preceding delivery of infants who develop respiratory distress syndrome.

The obstetric events leading to the birth of infants who developed respiratory distress syndrome (RDS) were evaluated. In a retrospective study of 100 consecutive cases it was determined that untimely or unwarranted physician intervention in the pregnancy was responsible for 15 per cent of cases and possibly responsible for another 18 per cent. Recommendations for prevention of "iatrogenic" RDS are made.

Cesarean Section↗

PubMed1998

Psychotropic drugs in breast milk: no evidence for adverse effects on prepulse modulation of startle reflex or on cognitive level in infants.

Reversals in modulation of the startle reflex probably reflect maturational processes in the central nervous system. This study has investigated the longitudinal changes in prepulse modulation of the blink reflex in three groups of individual infants: (a) breast-fed infants of mentally ill mothers who were prescribed selected psychotropic drugs, (b) bottle-fed infants of similarly ill and medicated mothers, and (c) breast-fed infants of healthy control mothers. The acoustic stimulation paradigm and neurophysiological methods were similar to those used in previous studies and, in addition, the infants' development was simultaneously assessed using the Bayley Scales of Infant Development. All the infants were found to be developing normally and across all three groups we observed a clear transition in prepulse modulation of the eye-blink reflex from small inhibition or facilitation in early infancy (1-4 months) to a robust facilitation in middle infancy (5-8 months). This reversal probably reflects the changing balance of developing neural function in normal infants. There were, therefore, no discernible effects in breast-fed infants of exposure to small doses of antidepressant or neuroleptic drugs.

Acoustic Stimulation↗

PubMed1993

[Influence of prematurity and intrauterine hypotrophy on development of infants in the Szczecin population].

Longitudinal evaluation of development at the infantile period involved 415 children, born during the period from 1985.12.01 to 1987.03.31 in two Obstetric Clinics, PMA, in Szczecin. The studied group comprised 108 eutrophic premature infants, 25 premature babies with hypotrophy, 116 full-term neonates with intrauterine hypotrophy. The control group was made up of 166 infants born at term, being eutrophic neonates. Physical development was analyzed on the basis of measuring 13 anthropometric parameters, determined in monthly compartments. Evaluation of psychomotoric development was performed by the aid of Denver's test in the 3, 6, 9 and 12 month of life. The accomplished studies have disclosed that delays in physical and psychomotor development persisted still in the 12th month of life in children of the investigated group as compared with the control one. Retardations in somatic development were more pronounced in children with hypotrophy, while disturbances in psychomotor development were recorded more frequently in premature infants, and involved spheres of locomotion and visual-motorial coordination. In the studied population the achievements in children's development were significantly correlated with the degree of maturity after birth, and past infectious diseases. Among the environmental factors, an essential influence was exerted by the education of parents, social-existential conditions of the family as well as cigarette-smoking by the mother.

Anthropometry↗

PubMed2003

The relevance of maternal immune responses to inhalant allergens to maternal symptoms, passive transfer to the infant, and development of antibodies in the first 2 years of life.

BACKGROUND: Asthma and other atopic diseases are strongly hereditary. Although the mother might play a special role, the mechanisms for such an effect are not clear. OBJECTIVE: We sought to investigate the influence of maternal immune responses to cat and mite allergens on (1) maternal symptoms, (2) the development of immune responses in the infant, and (3) the development of allergic disease during the first 3 years of life. METHODS: In sera from 465 mothers and 424 infants (cord blood), as well as in sera from 230 of the children at age 2 to 3 years, total IgE and IgE antibodies were measured by using CAP testing; IgG and IgG4 antibodies for the cat allergen Fel d 1 were measured by means of radioimmunoprecipitation. RESULTS: In both mothers and children, approximately 15% of sera contained IgG antibodies to Fel d 1 without IgE antibodies to cat. The strongest predictor of the maternal IgG antibody response was exposure to greater than 8 microg of Fel d 1/g of dust. Thus approximately 70% of children living in a house with a cat had received IgG antibodies from their mothers. In many cases the infant received IgG and IgG4 antibodies to Fel d 1 from a nonallergic mother. Maternal IgE antibodies were consistently associated with asthma; by contrast, the IgG antibody was not independently related to asthma but was related to rhinitis in the mothers (odds ratio, 2.6; 95% CI, 1.1-6.2) and to eczema in children. At age 3 years, 13 of 230 sera contained IgE antibodies to mite, but only 5 had IgE antibodies to cat. CONCLUSIONS: A significant proportion (approximately 15%) of mothers and children exposed to high concentrations of cat (but not mite) allergens have serum IgG antibodies without IgE antibodies. This IgG antibody is freely transferred to the infant and might influence IgG antibody production in the child. The results indicate the importance of understanding the mechanisms of tolerance to cats and raise questions about the independent role of the mother in the inheritance of allergy.

Allergens↗

PubMed2000

Aerosolized diuretics for preterm infants with (or developing) chronic lung disease.

BACKGROUND: Lung disease in preterm infants is often complicated with lung edema. OBJECTIVES: The aim of this review is to assess the risks and benefits of aerosolized diuretic administration in preterm infants with or developing chronic lung disease (CLD). Primary objectives are to assess effects on short term outcome (changes in need for oxygen or ventilatory support) and effects on long-term outcome. Secondary objectives are to assess changes in pulmonary mechanics and potential complications of therapy. SEARCH STRATEGY: We used the standard search method of the Cochrane Neonatal Review Group. We used the following keywords: ¿ or ¿ and , limited to and limited to or . We searched Medline (1966-1998), Embase (1974-1998) and the Cochrane Controlled Trials Register (CCTR) from the Cochrane Library (1998, Issue 4). In addition, we hand searched several abstract books of national and international American and European Societies. SELECTION CRITERIA: We included in this analysis trials in which preterm infants with or developing chronic lung disease and at least five days of age were all randomly allocated to receive an aerosolized loop diuretic. Eligible studies needed to assess at least one of the outcome variables defined a priori for this systematic review. Primary outcome variables included important clinical outcomes, and secondary outcome variables included pulmonary mechanics and potential complications of therapy. DATA COLLECTION AND ANALYSIS: We used the standard method for the Cochrane Collaboration which is described in the Cochrane Collaboration Handbook. Two investigators extracted, assessed and coded separately all data for each study, using a form that was designed specifically for this review. Any disagreement was resolved by discussion. We combined parallel and cross-over trials and, whenever possible, transformed baseline and final outcome data measured on a continuous scale into change scores using Follmann's formula. MAIN RESULTS: We identified eight studies which met selection criteria. Most studies focused on pathophysiological parameters and did not assess effects on important clinical outcomes defined in this review or the potential complications of diuretic therapy. No study assessed the amount of diuretic effectively delivered to the patient. Furosemide was the only diuretic used in the eight studies included in this review. Among preterm infants < 3 weeks of age developing CLD, not enough information is available to assess the effect of aerosolized furosemide on outcome or lung function. Among infants > 3 weeks with CLD, a single aerosolized dose of 1 mg/kg of furosemide may transiently improve pulmonary mechanics. Not enough information is available to assess the effect of chronic administration of aerosolized furosemide on oxygenation and pulmonary mechanics. REVIEWER'S CONCLUSIONS: In preterm infants > 3 weeks with CLD administration of a single dose of aerosolized furosemide improves pulmonary mechanics. In view of the lack of data from randomized trials concerning effects on important clinical outcomes, routine or sustained use of aerosolized loop diuretics in infants with (or developing) CLD cannot be recommended based on current evidence. More double-blinded randomized trials are needed (1) to analyze factors likely to affect the response to aerosolized furosemide, e.g. , washout period and delivery of furosemide to distal airways, and (2) to assess the effects of chronic administration of aerosolized furosemide on mortality, O2 dependency, ventilator dependency, length of hospital stay and long-term outcome.

Aerosols↗

PubMed2001

Decision-making: initiation and withdrawing life support in the asphyxiated infants in developing countries.

The issues of life support in the asphyxiated infant are not only whether cardiopulmonary resuscitation or CPR will be successful, but also whether if successful, the infant will be severely damaged. This is particularly important in the developing countries because the damaged infants may burden the society. The country has to allocate huge financial and human resources to look after them. When it comes to decisions in initiation and withdrawal of life support, there are differences between the East and the West. Physicians are searching for reliable predictors of outcome of term asphyxiated infants to enable early decision-making, initiation and withdrawal life support, as well as counselling and planning appropriate level of treatment including trials of cerebroprotective therapies. Markers commonly used to identify birth asphyxia are not good predictors of brain injury or death. There is a myriad of reports on clinical or laboratory tests, some using single parameter, to help determine neurological outcome of asphyxiated term infants. Much frequently used equipment in developed countries can be expensive and inaccessible to developing countries. There is an urgent need to look for relevant, simple and inexpensive methods. A combination of measurements may look promising in the early selection of at-risk neonates for decision and counselling. Recently measurement of urinary lactate: creatinine ratio to identify early newborn infants at risk for HIE was proposed. Withdrawal of life support is an ethical issue. In withdrawing life support of the severely asphyxiated infants, one must be aware of the differences of approach. There are differences in religion and culture; in beliefs and philosophies, between the East and West The importance of neonatal resuscitation should be emphasised. Some regions still adhere to obsolete resuscitation methods. Neonatal Resuscitation Program (NRP) should be promulgated and organised resuscitation should be introduced. There is an urgent need to train the trainers in CPR in the developing countries.

Asphyxia Neonatorum↗

PubMed2000

Does low IgA in human milk predispose the infant to development of cow's milk allergy?

We sought a relationship between total and cow's milk-specific IgA levels in colostrum and human milk and subsequent development of cow's milk allergy (CMA) in the breast-fed infant. The study included 87 nursing mothers and their infants (age, 2 d to 7 mo), followed prospectively up to 1 y. At 1 y, 48 mothers (69% with an atopic constitution) had an infant with CMA, verified by clinical cow's milk challenge, eight (38% with an atopic constitution) had a baby who had had protracted infantile colic but no CMA (disease control group), and 31 (23% with an atopic constitution) had a healthy infant. Total breast-milk IgA was measured by radial immunodiffusion, and IgA antibodies to cow's milk were measured by ELISA during the breast-feeding period. The levels of total and cow's milk-specific IgA antibodies in colostrum and human milk were significantly lower in the mothers whose baby later developed CMA [estimated third day value, 0.38 g/L (95% confidence interval, 0. 24-0.82)] than in the ones whose infant remained healthy or had had infantile colic but not CMA [0.82 g/L (95% confidence interval, 0. 99-1.51); p < 0.05]. The infants developed CMA significantly more often if the concentration of total IgA antibodies in milk was <0.25 g/L, when measured between 6 d and 4 wk postpartum [sensitivity, 0. 55; specificity, 0.92; odds ratio, 14.7 (95% confidence interval, 3. 1-70.2); p < 0.001]. The levels of cow's milk-specific IgA positively correlated with the levels of total IgA but not with the development of CMA in the infant. The levels of total or cow's milk-specific IgA did not correlate with maternal atopy. IgA antibodies in colostrum and human milk may prevent antigen entry at the intestinal surface of the breast-fed infant. A low IgA content in human milk may lead to defective exclusion of food antigens and thus predispose an offspring to develop food allergies.

Animals↗

PubMed2001

Growth and development in term infants fed long-chain polyunsaturated fatty acids: a double-masked, randomized, parallel, prospective, multivariate study.

OBJECTIVE: To evaluate the effects of dietary intake of the long-chain polyunsaturated fatty acids, arachidonic acid (AA), and docosahexaenoic acid (DHA) on multiple indices of infant growth and development. DESIGN: A double-masked, randomized, parallel trial was conducted with term infants fed formulas with or without AA+DHA for 1 year (N = 239). Reference groups of breastfed infants (N = 165) weaned to formulas with and without AA+DHA were also studied. Infants in the formula groups were randomized at </=9 days of age to a control formula with no AA or DHA (n = 77) or 1 of 2 otherwise identical formulas containing AA+DHA (AA, 0.46% and DHA, 0.14% of total fatty acids) from either egg-derived triglyceride (egg-DTG [n=80]) or fish oil and fungal oil (fish/fungal [n = 82]) at levels similar to the average in breast milk samples as measured in the reference group. All formulas contained 50% of energy from fat with the essential dietary fatty acids, linoleic acid (20% fatty acids) and alpha-linolenic acid (2% fatty acids). The main study outcomes were AA and DHA levels in plasma and red blood cells, and multiple measures of infant development at multiple ages from birth to 14 months: growth, visual acuity, information processing, general development, language, and temperament. RESULTS: AA and DHA levels in plasma and red cells were higher in AA+DHA-supplemented groups than in the control formula group and comparable to those in reference groups. No developmental test results distinguished these groups. Expected differences in family demographics associated with breastfeeding were found, but no advantages to breastfeeding on any of the developmental outcome demonstrated. CONCLUSIONS: These findings do not support adding AA+DHA to formulas containing 10% energy as linoleic acid and 1% energy as alpha-linolenic acid to enhance growth, visual acuity, information processing, general development, language, or temperament in healthy, term infants during the first 14 months after birth.infant development, breast feeding, infant formula, long-chain polyunsaturated fatty acids, docosahexaenoic acid.

Arachidonic Acid↗

PubMed1997

Early increase of TNF alpha and IL-6 in tracheobronchial aspirate fluid indicator of subsequent chronic lung disease in preterm infants.

AIM: To investigate if early changes in concentrations of proinflammatory cytokines in tracheobronchial aspirate fluid (TAF) from preterm infants could be used to detect infants at risk of chronic lung disease (CLD) and help in the selection of patients for early steroid treatment. METHODS: Twenty eight preterm infants less than 34 weeks of gestation (median 26 weeks) were intubated and daily measurements of TAF concentrations of tumour necrosis factor alpha (TNF alpha) and the interleukins IL-1 beta, IL-6, and IL-8 were made, using enzyme immunoassay techniques. RESULTS: Seventeen of the infants developed CLD. The infants who developed CLD had significantly increased concentrations of TNF alpha, IL-1 beta, IL-6 on days 2 and 3. TNF alpha, IL-6, and IL-8 concentrations were significantly related to gestational age and duration of supplemental oxygen; TNF alpha, IL-6, and IL-8 concentrations also correlated with length of time on the ventilator. CONCLUSION: These data indicate that tracheobronchial aspirate fluid cytokine concentrations may be used as a predictor of subsequent CLD and may help select a group of preterm infants at high risk of developing CLD for early treatment.

Biomarkers↗

PubMed1988

Haematopoietic progenitor cells in an infant who developed pancytopenia following an extensive burn.

We observed a 24-month-old infant who developed anaemia, thrombocytopenia and neutropenia while recuperating from an extensive burn. In order to determine the mechanism(s) responsible for the pancytopenia, we quantified marrow-derived haematopoietic progenitor cells, assessed the relative proliferative rate of haematopoietic progenitor cells, and sought the presence of progenitor cell inhibitors. The concentration and relative proliferative rate of pluripotent progenitors (CFU-GEMM) were elevated. No inhibitors of progenitor cells were observed; in fact, the patient's serum contained very high levels of stimulatory activity for CFU-GEMM as well as for granulocyte-macrophage progenitors (CFU-GM). However, the marrow concentration of erythroid progenitors (BFU-E and CFU-E) was diminished. We conclude that the anaemia in this patient was the result of either hypoproduction of differentiated erythroid progenitors or intramyeloid destruction of early erythroid cells. In contrast, the neutropenia was likely to be due to accelerated neutrophil consumption at a rate that exceeded the capacity for increasing neutrophil production.

Anemia↗

PubMed1997

Smooth pursuit development in infants.

PURPOSE: We set out to assess the development of pursuit eye movements in normal infants in an objective, longitudinal fashion. We asked whether smooth pursuit (SP) was present under 2 months of age and how the saccade ratio changed with increasing infant age. METHODS: Smooth pursuit was recorded longitudinally from 25 infants aged 1-7 months, using DC electro-oculography, in a clinically practical manner. Four uninstructed adults acted as controls. RESULTS: Smooth pursuit was present under 2 months of age. The gain of SP increased with increasing infant age. However, it had still not reached adult levels by 6 months of age. Latency decreased with increasing infant age. Monocular SP asymmetry was present in the younger infants. CONCLUSIONS: Smooth pursuit is present under 2 months of age, but at 6 months SP has still not reached adult levels. The traditional model of SP development is questionable.

Child Development↗

PubMed2001

Effects of exclusive breastfeeding for four versus six months on maternal nutritional status and infant motor development: results of two randomized trials in Honduras.

To examine whether the duration of exclusive breastfeeding affects maternal nutrition or infant motor development, we examined data from two studies in Honduras: the first with 141 infants of low-income primiparous women and the second with 119 term, low birth weight infants. In both studies, infants were exclusively breastfed for 4 mo and then randomly assigned to continue exclusive breastfeeding (EBF) until 6 mo or to receive high-quality, hygienic solid foods (SF) in addition to breast milk between 4 and 6 mo. Maternal weight loss between 4 and 6 mo was significantly greater in the exclusive breastfeeding group (EBF) group than in the group(s) given solid foods (SF) in study 1 (-0.7 +/- 1.5 versus -0.1 +/- 1.7 kg, P < 0.05) but not in study 2. The estimated average additional nutritional burden of continuing to exclusively breastfeed until 6 mo was small, representing only 0.1-6.0% of the recommended dietary allowance for energy, vitamin A, calcium and iron. Women in the EBF group were more likely to be amenorrheic at 6 mo than women in the SF group, which conserves nutrients such as iron. In both studies, few women (10-11%) were thin (body mass index <19 kg/m(2)), so the additional weight loss in the EBF group in study 1 was unlikely to have been detrimental. Infants in the EBF group crawled sooner (both studies) and were more likely to be walking by 12 mo (study 1) than infants in the SF group. Taken together with our previous findings, these results indicate that the advantages of exclusive breastfeeding during this interval appear to outweigh any potential disadvantages in this setting.

Amenorrhea↗

PubMedDate not supplied

Functional brain development in infants: elements of an interactive specialization framework.

One future direction for cognitive development research involves a closer integration with our knowledge about the developing brain. I present a framework for analyzing and interpreting postnatal functional brain development in human infants. Three specific hypotheses contribute to this framework, within which a variety of phenomena associated with the neural basis of perception and cognition in normal and abnormal development can be characterized.

Brain↗

PubMed2002

Cytomegalovirus infection in pregnancy.

OBJECTIVES: To investigate the effects of intrauterine human cytomegalovirus (HCMV) infection on pregnancy outcomes and infant development. METHODS: The study group consisted of the HCMV-IgM-positive offspring of 75 pregnant women, and a control group of the non-infected offspring of 73 pregnant women. Chorionic villi, amnionic fluid, and umbilical blood were obtained to detect HCMV-late mRNA with a reverse transcriptase-polymerase chain reaction (RT-PCR) assay. The pregnancy outcomes were followed up. For all offspring, neurological development was evaluated with neurosonography, audiologic development with the brainstem auditory evoked potential (BAEP), and psychomotor development with the Beyley Scale of Infant Development (BSID). RESULTS: In the study group the positive rate of late mRNA was 50% in the chorionic villi and 67.65% in the amnionic fluid and the umbilical blood; the incidence of abnormal pregnancy outcomes (abortion, preterm delivery, stillbirth, etc.) was much higher than in the control group (40% vs. 6.57%; chi(2)=24.06; P=0.001); the abnormal rate of neurosonography results at birth and 3 months after birth was higher in the study group than in the control group (P<0.05), as were BAEP values 4 months after birth (chi(2)=8.960; P=0.003). Scores for the Infant Mental Development Index (MDI) were apparently lower than in the control group. When congenitally infected children were tested at the age of 5.5-6.5 years with the Wechsler Preschool and Primary Scale of Intelligence (WPPSI), their rate of mental retardation was still found to be approximately 20%. CONCLUSIONS: Intrauterine HCMV infection is closely related to abnormal pregnancy outcomes, infant neurological damage, mental retardation, and hearing loss.

Abortion, Spontaneous↗