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PubMed2005

Interleukin-8 in bronchoalveolar lavage fluid of premature infants at risk of chronic lung disease.

BACKGROUND AND PURPOSE: Persistence of neutrophils in the tracheal fluid of premature infants is associated with chronic lung disease (CLD). Interleukin-8 (IL-8) is a potent neutrophil chemoattractant. This study investigated whether IL-8 is increased in the bronchoalveolar lavage fluid of premature infants with different types of CLD. METHODS: Forty two very low birth weight infants who required mechanical ventilation were recruited. Twenty eight of these infants developed CLD and 14 infants recovered without developing CLD. Four additional infants receiving mechanical ventilation for non-respiratory reasons were also enrolled as controls. CLD was defined as requirement for supplemental oxygen at 28 days of age and chest radiograph showing characteristic appearance. CLD was further classified into 3 subtypes: bronchopulmonary dysplasia (BPD), Wilson-Mikity syndrome (WMS) and chronic pulmonary insufficiency of prematurity (CPIP). RESULTS: IL-8 in bronchoalveolar lavage fluid was significantly increased in the CLD group by 8 days of age compared to those who did not develop CLD (p < 0.05). For infants without CLD, IL-8 increased from 963 pg/mL on day 1 after delivery to 1463 pg/mL on day 4, and decreased to 1,000 pg/mL on day 8. For infants with BPD, IL-8 increased from 925 pg/mL on day 1 after delivery to 2,650 pg/mL on day 8, and then gradually decreased to 1,500 pg/mL on day 28. Infants with WMS had significantly higher IL-8 from the first day after delivery (4,567 pg/mL) than infants with BPD or CPIP and this difference persisted to age 28 days (2475 pg/mL). CONCLUSIONS: Persistent inflammation could be a major contributory factor in the development of CLD. The different patterns of response to inflammation in different types of CLD may have implications for the design of appropriate strategies to prevent and treat CLD.

Bronchoalveolar Lavage Fluid↗
PubMed1977

Falling amniotic fluid palmitates in diabetic pregnancies.

Palmitic acid levels were measured in samples of amniotic fluid obtained from 15 patients with diabetes. Seven patients had palmitate values which decreased at some time in pregnancy but only one of the infants developed respiratory distress. Eight of the 15 patients had final amniotic fluid palmitate values which were greater than 0.07 mmol/l and one infant developed respiratory distress. The other seven patients had final amniotic fluid palmitate values of 0.07 mmol/l or less and one of the infants developed respiratory distress. The significance of falling amniotic fluid palmitate values is discussed.

Amniotic Fluid↗
PubMed2001

Ascorbate acid concentration in airways lining fluid from infants who develop chronic lung disease of prematurity.

Chronic lung disease of prematurity (CLD) remains a common cause of morbidity and mortality in preterm infants. Oxygen toxicity remains a major risk factor for the development of CLD and as a consequence the antioxidant status of CLD babies is a major focus of interest. In the present study, we determined whether ascorbate, urate, and total glutathione concentrations were decreased in infants who developed CLD when compared to those who did not. From 34 preterm infants, 141 serial bronchoalveolar lavage fluid (BALF) and plasma samples were collected: 12 developed CLD (median gestation 26 weeks, range 23-28 weeks, median birth weight 780 g, range 630-1070 g), 16 developed and recovered from respiratory distress syndrome (RDS) (median gestation 31 weeks, range 26-39 weeks, median birth weight 1820 g, range 840-4160 g), and six were ventilated for non-respiratory reasons, (median gestation 35 weeks, range 32-38 weeks, median birth weight 2180 g, range 1100-2860 g). Following birth, the concentration of BALF ascorbate, urate and glutathione decreased over the 1st week in all three groups. Thereafter, BALF ascorbate increased in RDS and control infants during the 2nd week but this increase was delayed by 2 weeks in the CLD infants. No differences were noted between the RDS and CLD groups for urate and total glutathione in BALF or urate in plasma. BALF protein concentration was similar in all three groups except for a rise at day 7 in the CLD group but this did not reach statistical significance. Conclusion. A delayed increase in bronchoalveolar lavage fluid ascorbate concentration might be associated with an increased risk of developing chronic lung disease of prematurity.

Analysis of Variance↗
PubMed2004

Serious bacterial infections in newborn infants in developing countries.

PURPOSE OF REVIEW: The overwhelming majority of the world's annual 4 million neonatal deaths occur in developing countries. This review therefore briefly addresses the burden, aetiology, prevention and management of serious neonatal bacterial infections in low-income settings. RECENT FINDINGS: Bacterial infection is the biggest cause of neonatal admissions to hospitals, and probably the biggest cause of morbidity in the community, but its burden is unclear. The commonest serious infections involve bacteraemia, meningitis and respiratory infection, and case fatality rates may be as high as 45%. Key pathogens are Escherichia coli, Klebsiella species, Staphylococcus aureus and Streptococcus pyogenes. The incidence of neonatal infections with group B streptococcus is highly variable, as is the spectrum of antimicrobial resistance. SUMMARY: Current areas of research include the rectification of micronutrient deficiencies, neonatal skin care, appropriate breastfeeding recommendations, cleansing of the birth canal, and simplified methods of diagnosis of infection. Operational activities include the control of neonatal tetanus, the diagnosis and treatment of sexually transmitted infections, integrated strategies for improving pregnancy, childbirth and neonatal survival, community-based management of acute respiratory infections, and community-based management of neonatal sepsis.

Bacterial Infections↗
PubMed1988

Continuities in infant memory development.

Fifty-five 6- to 7-month-old human infants were trained in an operant conditioning procedure, adapted from a procedure developed for 3-month-olds, in which kicks were reinforced by conjugate movement of a mobile. Retention was assessed in a simple forgetting paradigm (Expt. 1) or in a reactivation paradigm (Expt. 2) with either the training mobile or a different one serving as the retrieval cue. In Experiment 1, retention was tested 1, 7, 14, or 21 days after training. When the training and test mobiles were the same, infants exhibited virtually no forgetting for 14 days, but forgetting was complete by 21. When the training and test mobiles were different, infants exhibited no retention, discriminating the novel mobile for as long as they could remember the contingency. In Experiment 2, when the training mobile was presented as a reminder, the forgetting previously seen after 21 days was alleviated; when a different mobile was the reminder, it was not. These findings reveal that the efficacy of a reminder is predicted by the efficacy of that same stimulus in cuing the original memory 24 hr following training. Although the 6-month-olds learned more rapidly and remembered longer than infants half their age, their memory processing was described by the same basic principles.

Child Development↗
PubMed2001

Differential development of infants at risk for psychopathology: the moderating role of early maternal responsivity.

The development of behaviour problems in infants born with biological risk (low birthweight) and psychosocial risk (psychosocially disadvantaged family) was studied in a sample of 347 children (171 males, 176 females) at the ages of 2, 4:6, and 8 years. In the search for factors that moderate the effects of early risks, the role of early responsive caregiving was examined. Results indicate that infants at psychosocial risk exhibited both more externalizing and internalizing problems across ages than infants not at psychosocial risk, while no overall differences were apparent between normal- and low-birthweight groups. With one exception, no interactions between biological and psychosocial risk factors emerged, suggesting that their simultaneous effect is largely additive. Maternal responsivity was found to moderate the effects of low birthweight on hyperkinetic and internalizing problems as well as to influence the consequences of family disadvantage on total problems. These findings stress the importance of early parenting in the behavioural development of at-risk children.

Analysis of Variance↗
PubMed2005

[Neuropsychomotor development of infants born of mothers with gestational hypertension].

INTRODUCTION: Gestational hypertension is a major cause of maternal death in our country and may be associated with neonatal hypoxic-ischemic encephalopathy with serious neurological complications. OBJECTIVE: To correlate gestational hypertension with risk factors of neuropsychomotor development in infants. METHOD: This was a prospective study. We evaluated 30 consecutive infants born of mothers with gestational hypertension. The following risk factors were considered: small for gestational age; fetal asphyxia; age of onset of gestational hypertension; term/preterm newborn; Apgar scores; central cyanosis; O2 mask; meconium. The study followed two steps. In the first step, newborns underwent neurological examination soon after birth (48-72 hours of life). In the second step, children underwent another neurological assessment between 7 and 15 months of life. RESULTS: Six newborns presented neurological signs on the first evaluation. The only risk factor that showed a significant correlation with the neurologic examination was the Apgar score. Other risk factors did not show any correlation. All children evaluated on the second step of the study showed normal neurological development and examination, which did not allow any correlation with risk factors. CONCLUSION: Our data suggest that gestational hypertension per se is not sufficient to cause fetal neurological impairment.

Adult↗
PubMed2000

Developmental outcomes and cognitive functioning in infant and child heart transplant recipients.

Pediatric heart transplantation has become a mainstay in the treatment of end-stage heart disease in infants and children. There is, however, sparse information on post-transplant developmental and cognitive functioning. At Loma Linda University Children's Hospital 223 infants have undergone heart transplantation surgery with a survival rate of 73% (n=165). This article reports on four areas of investigation of this cohort of infants. Infant development: Two studies were done utilizing the Bayley Scales of Infant Development (mean 100, S.D.+/-15). The first study (n=48) showed mean values within the normal range [Mental Development Index (MDI) 87; Psychomotor Developmental Index (PDI) 90]. The second study (n=23) showed developmental scores within normal limits in 4-8 month olds with a tendency for decline in development at 12-24 months (MDI 83, PDI 77). Child development: Ninty-one infant recipients were greater than 5 years old. Forty-five children were excluded because of long distances from the hospital, second transplantation, abnormal karyotype, primary language non-English, or invalid testing. The Wechsler Preschool and Primary Scale of Intelligence-Revised testing of 5-6-year-olds (n=23) showed a Full Scale IQ of 74, Performance IQ of 76, and Verbal IQ of 77. The Wechsler Intelligence Scale for Children-III testing of 7-10-year-olds (n=23) showed a Full Scale IQ of 86, Performance IQ of 89, and Verbal IQ of 86. The Wechsler Individual Achievement Test (mean 100, S.D.+/-15) yielded a Total Composite of 91, Mathematics Composite of 86, Language Composite of 98, and a Reading Composite of 94. Visual spatial skills: Visual motor integration (mean 100, S.D.+/-15) was evaluated in 5-10-year-olds with a mean of 87; however, 52% of the children had scores below 1 S.D. Subtests from the Wechsler scales that assess visual motor and visual spatial skills indicated significant deficits. Behavior: Younger children (n=33) demonstrated behaviors indicative of social isolation. Older children (n=36) showed behavior that was within the normal limits, but depression was noted in a significant number of them. Conclusions: Infant heart transplant recipients demonstrate IQ and achievement levels within the normal range, but there is a significant amount of variability with more children than would be expected scoring in the lower ranges. Children with heart transplantation are at risk for visual spatial skill deficits. Young children are at risk for social isolation while symptoms of depression are noted in older children.

Journal Article↗
PubMed2006

Intellectual development of infants, children and adolescents with congenital heart disease.

Cardiac disease is the most common congenital defect in children, affecting between 3 and 10 in every 1000 live births. While significant advances in medical and surgical management have resulted in increasing numbers of survivors, it is also recognized that there is a growing population of children living with neurological impairment and lowered intellectual function. The aetiology of such impairment is multi-factorial and hypoxia is one of the factors involved. This article provides an overview of the effects of hypoxia on the intellectual development of infants, children and adolescents with congenital heart disease.

Adolescent↗
PubMed1990

Enhancing the outcomes of low-birth-weight, premature infants. A multisite, randomized trial. The Infant Health and Development Program.

The Infant Health and Development Program is an eight-site clinical trial designed to evaluate the efficacy of a comprehensive early intervention in reducing the developmental and health problems of low-birth-weight (less than or equal to 2500 g) premature (less than or equal to 37 weeks) infants. Nine hundred eighty-five infants, stratified by site and weight (less than or equal to 2000 g or 2001 to 2500 g), were randomly assigned to receive an educational curriculum focused on child development, as well as family support and pediatric follow-up, or only pediatric follow-up. At corrected age 36 months, the intervention group had significantly higher mean IQ scores than the follow-up group (mean difference in the heavier group was 13.2 and in the lighter group 6.6), significantly fewer maternally reported behavior problems, and a small, but statistically significant, increase in maternally reported minor illnesses for the lighter-birth-weight group only, with no difference in serious health conditions.

Child Behavior↗
PubMed2005

Perturbations in the development of infants with Rett disorder and the implications for early diagnosis.

The gene discovery in Rett disorder has opened the way for the development of clinical intervention. Initial recognition of affected infants will depend on observation by clinicians and the development of key diagnostic criteria is of crucial importance. Perturbations in the development of very young infants are emerging in studies of home videos. Observations from experienced health practitioners and home video transcriptions are presented which indicate the nature of early clues to the disorder and their fluctuating nature. Early diagnosis is likely to be available before the development of effective treatment. Most children are not diagnosed before regression and, currently, no therapies are equipped to offer support to pre-regression infants and their families. When earlier diagnosis becomes available, parents of the newly-diagnosed infant will be aware of their infant's difficult future before her problems are fully apparent. Practitioners in regular contact with families will have the sensitive task of supporting infants in early infancy and into regression.

Community Health Nursing↗
PubMed1997

Longitudinal follow-up of a cohort of newborn infants treated with inhaled nitric oxide for persistent pulmonary hypertension.

OBJECTIVE: To describe the outcome of a group of term newborn infants treated with inhaled nitric oxide for severe persistent pulmonary hypertension. STUDY DESIGN: We performed a prospective longitudinal medical and neurodevelopmental follow-up of 51 infants treated as neonates for persistent pulmonary hypertension of the newborn with inhaled nitric oxide. The original number of treated infants was 87, of whom 25 died in the neonatal period; of 62 infants who survived, 51 were seen at 1 year of age and 33 completed a 2-year evaluation. Statistical analysis used population medians, means, and standard deviations for parameters assessed. Paired t tests and chi-square analysis were used to compare outcomes measured at 1 year with assessment at 2 years for the 32 infants seen at both 1- and 2-year visits. RESULTS: At 1-year follow-up median growth percentiles were 20%, 72.5%, and 50% for weight, length, and occipitofrontal circumference, respectively. Thirteen of 51 infants (25.5%) were < 5th percentile in weight. Nine of 51 infants (17.6%) had feeding problems (need for gastrostomy feeding or gastroesophageal reflux), and 14 (27.5%) had a clinical diagnosis of reactive airways disease. Infant development as measured by the Bayley Scales of Infant Development was 104 +/- 16 for the mental development index and 97 +/- 20 for the psychomotor index. Six of 51 infants (11.8%) were found to have severe neurologic handicaps, defined as a Bayley score on either the mental development or psychomotor index of < 68, abnormal findings on neurologic examination, or both. Fewer children (6.1% vs 15.7%) required supplemental oxygen at 2 years compared with 1 year, and performance on the psychomotor index of the Bayley Scales improved significantly. CONCLUSIONS: One- and 2-year follow-up of a cohort of infants with persistent pulmonary hypertension of the newborn who were treated with inhaled nitric oxide had an 11.8% (1 year) and 12.1% (2-year) rate of severe neurodevelopmental disability. There are ongoing medical problems in these infants including reactive airways disease and slow growth that merit continued close longitudinal follow-up.

Administration, Inhalation↗