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PubMed1995

Assessment of compliance with home cardiorespiratory monitoring in infants at risk of sudden infant death syndrome. Collaborative Home Infant Monitoring Evaluation (CHIME).

OBJECTIVES: Documented monitoring was used to evaluate prospectively (1) the level of compliance among infants in whom cardiorespiratory monitoring was clinically indicated and (2) factors that might influence compliance: diagnosis, socioeconomic status, maternal age and education, and alarms. STUDY DESIGN: Sixty-seven infants (51% female, 49% term) were sequentially enrolled, and monitoring was prescribed for the following indications: siblings of sudden infant death syndrome victims (16%), apnea of prematurity (45%), and apparent life-threatening events or apnea of infancy (39%). Demographic data, alarm and event data, and a summary report of monitor use from the first monitor download were obtained. RESULTS: Maternal age, education, and insurance status did not differ significantly by indication for monitoring. The median number of monitor alarms per 10 hours of use was 0.7 for apnea or bradycardia and 0.6 for loose lead alarms. Monitors were available for use in the home from 2 to 106 days (median, 11 days). Median hours of monitor use per full day in the home was 15.5 hours. Of 67 infants, 58 used the monitor for at least part of every day in the home. The number of hours of monitor use per day did not differ significantly by diagnostic category, chronologic age, alarms, maternal age, education, or insurance type. This study population of infants at increased risk of sudden infant death syndrome had excellent compliance; 75% of the infants were monitored more than 10.5 hours per day, and 25% were monitored more than 21 hours per day. CONCLUSIONS: Documented monitoring provides an objective measure of compliance. These data provide a potential goal for level of compliance with home cardiorespiratory monitoring.

Analysis of Variance↗
PubMed2005

Concurrent validity of the Comprehensive Developmental Inventory for Infants and Toddlers with the Bayley Scales of Infant Development-II in preterm infants.

BACKGROUND AND PURPOSE: The Comprehensive Developmental Inventory for Infants and Toddlers (CDIIT) is a new developmental test designed in Taiwan and lacks concurrent validity information. This study investigated the concurrent validity of the CDIIT with the Bayley Scales of Infant Development-II (BSID-II) in preterm infants aged 6-18 and 21-40 months, respectively. METHODS: We recruited 160 preterm infants (84 boys, 76 girls) with a corrected age of 6-18 months and followed them up until 21-40 months of age. One tester administered the CDIIT and BSID-II to all infants. Developmental ages (DAs) and developmental quotients (DQs) from both tests were analyzed with Pearson correlation and kappa tests. RESULTS: Correlation coefficients for DAs and DQs between the 2 cognitive and motor subtests and classification agreements were high at 6-18 months (r = 0.80-0.97; kappa = 0.80, 0.85) and moderate to high at 21-40 months (r = 0.60-0.77; kappa = 0.44, 0.57). DQ classification for the CDIIT motor subtests tended to be higher than for the BSID-II motor scales at 21-40 months. CONCLUSIONS: In preterm infants, concurrent validity between the motor and cognitive subtests of the CDIIT and the BSID-II was acceptable. The CDIIT can be thus used in clinics for the early identification of developmental delay in infants and toddlers.

Child Development↗
PubMed2000

Radiant warmers versus incubators for regulating body temperature in newborn infants.

BACKGROUND: This section is under preparation and will be included in the next issue. OBJECTIVES: To assess the effects of radiant warmers versus incubators (in the neonatal period) on fluid and electrolyte balance, neonatal morbidity and mortality. SEARCH STRATEGY: The standard strategy of the Cochrane Neonatal Review Group was used. This includes searches of the Oxford Database of Perinatal Trials, Medline, previous reviews including cross references, abstracts, conference and symposia proceedings, expert informants, journal handsearching mainly in the English language. SELECTION CRITERIA: All randomised or quasi-randomised trials in which radiant warmers are compared to incubators in a neonatal population. DATA COLLECTION AND ANALYSIS: Methods used to collect data from the included studies: Each author extracted data separately, then compared and resolved differences. A referee was sought for unresolved differences. Methods used to synthesise the data : Standard method of Neonatal Review Group with the use of weighted mean difference for outcome data measured on a continuous scale. MAIN RESULTS: A statistically significant increase in insensible water loss (IWL) was shown in neonates nursed under radiant warmers (WMD 0.94g/Kg/day, 95% CI 0.48, 1.41). A trend towards increased oxygen consumption which was not statistically significant was shown for the radiant warmer group (WMD 0. 27mL/kg/min, 95% CI -0.10, 0.63). A comparison of the radiant warmers with heat shields vs incubator without heat shields showed a similar trend for increased IWL in the radiant warmer group which was not statistically significant (WMD 1.00g/kg/day, 95% CI -0.10, 2. 10). No difference was shown in the rate of oxygen consumption when radiant warmers with heat shields were compared to incubators (WMD -0.05, 95% CI -0.84, 0.74). REVIEWER'S CONCLUSIONS: Radiant warmers result in increased IWL compared to incubators which needs to be taken into account when calculating daily fluid requirements.The results of this review do not provide sufficient evidence on important outcomes with the use of radiant warmers vs incubators to guide clinical practice. Further randomised controlled trials are required to assess the role of radiant warmers in neonatal care with particular attention to the extremely low birthweight population.

Body Temperature Regulation↗
PubMed2003

Mother-infant interactions of medically fragile infants and non-chronically ill premature infants.

At 6 months corrected for prematurity, 41 medically fragile prematures, 20 medically fragile full-terms, and 28 prematures without chronic illnesses were observed interacting with their mothers for 1 hr. Mothers of non-chronically ill prematures gestured to and touched their infants less, were uninvolved with them for a longer time, and spent less time interacting and looking at their infants than did mothers of medically fragile infants. Medically fragile full-terms slept more than the non-chronically ill prematures. The non-chronically ill premature group played with objects more and exhibited more locomotion. Thus, the non-chronically ill prematures had more mature behaviors but less frequent interactions than did the medically fragile infants. These disparities reflect differences both in the infants' functional maturity and in maternal compensation for infant vulnerability.

Adult↗
PubMed2001

Propranolol treatment of congestive heart failure in infants with congenital heart disease: The CHF-PRO-INFANT Trial. Congestive heart failure in infants treated with propanol.

AIM: Infants with congenital heart disease and left-to-right shunts may develop significant clinical symptoms of congestive heart failure in spite of therapy with digoxin and diuretics. We investigated the effects of beta-blockade in infants with severe heart failure. METHODS AND RESULTS: We performed a prospective, randomized, open monocenter trial in infants treated with digoxin and diuretics (n=10) in comparison to 10 infants receiving additional beta-blocker therapy. After 17 days on average beta-blocker treated infants (propranolol:1,6 mg/kg/day) improved significantly with respect to Ross heart failure score (3.3+/-2.3 vs. 8.3+/-1.9, P=0.002), lower renin levels (338+/-236 vs. 704+/-490 microU/l, P=0.008) and lower mean heart rates in Holter ECG (118+/-10 vs. 142+/-11 beats/min, P<0.001). While digoxin and diuretic treated infants had unchanged mean heart rate (149+/-8 vs. 148+/-10 beats/min), less decrease of symptoms (Ross Score: 8.5+/-1.7 vs. 6.8+/-2.3, P=0.02) but a significant increase of renin levels (139+/-102 vs. 938+/-607 microU/l, P=0.001). CONCLUSION: Additional propranolol treatment but not digoxin and diuretics alone can effectively reduce clinical symptoms of heart failure in infants with congenital heart disease, who suffer from increased neurohormonal activation.

Adrenergic beta-Antagonists↗
PubMed1996

Dynamics of respiratory patterning in normal infants and infants who subsequently died of the sudden infant death syndrome.

Despite evidence that respiratory control mechanisms may be altered in infants who succumb to the sudden infant death syndrome (SIDS), overall respiratory variability in SIDS victims is comparable to that of control infants. We assessed dynamic characteristics of breathing in 16 recordings of apparently healthy infants who subsequently died of SIDS, and 35 recordings of age-matched control infants. Each breath-to-breath interval in 10-min epochs of quiet sleep and rapid eye movement sleep was plotted against the previous interval. Dispersion of next-intervals was determined after short, intermediate, and long interbreath intervals. In SIDS victims, dispersion after long intervals (slow respiratory rates) was significantly restricted relative to control infants. Moreover, after long breath-to-breath intervals, SIDS victims showed smaller mean breath-to-breath changes in respiratory rate than did controls. The findings indicate that breath-to-breath respiratory patterns differ in infants who succumb to SIDS, and the differences occur preferentially at low respiratory rates.

Analysis of Variance↗
PubMed1995

An evaluation of infant growth: the use and interpretation of anthropometry in infants. WHO Working Group on Infant Growth.

In reviewing the growth of infants who live under favourable conditions and are fed according to WHO feeding recommendations, the Working Group found significant differences between the growth patterns of these infants and the patterns reflected in the NCHS-WHO international reference. Given the short- and long-term consequences of growth failure, and the dangers of both the premature introduction of complementary foods and their undue delay--described as the "weanling's dilemma", the Working Group concluded that use of the current NCHS-WHO reference appears to accentuate the difficulty of avoiding these extremes rather than to help ensure optimal infant nutritional management. The Working Group identified the following requirements: (a) a new reference which will enhance the nutritional management of infants; (b) the reference population should reflect current health recommendations because of the frequent use of such reference data as standards; (c) evaluation, in a broad range of settings, of the practical utility of using reference data based on infants for whom the WHO feeding recommendations are being followed; (d) close investigation of the effects of different complementary foods on the growth of infants who are being fed according to the WHO recommendations; (e) criteria for evaluating abnormal growth patterns; (f) research for identifying proxy measures for length; and (g) evaluation of reference data based on other anthropometric measurements, such as skinfold thickness and arm and head circumferences.

Anthropometry↗
PubMed1978

Polygraphic studies of normal infants and infants at risk for the sudden infant death syndrome: heart rate and variability as a function of state.

Spontaneous heart rate and variability were examined as a function of age and state from birth to 6 months of age in 10 normal infants and 10 infants at risk for sudden infant death syndrome (SIDS). The risk group showed a higher heart rate at 3 months of age, particularly in the waking state. The risk infants' heart rate also increased more markedly during the first month after birth in both quiet and active sleep. Heart rate in both groups declined after 2 months in every state; however, the risk infants lagged in the 2- to 3-month decline seen with the normal infants. In the awake state, heart rate variability in the risk group did not follow the increase seen with the normals during the 1-week to 2-month age period.

Age Factors↗
PubMed1982

Clostridium difficile in normal infants and sudden infant death syndrome: an association with infant formula feeding.

Large numbers Clostridium difficile were found in the stools of two victims of sudden infant death syndrome (SIDS). This prompted a study of normal infants in the SIDS age group. Thirty-two infants were studied, using two selective culture techniques and two assays for bacterial products. Thirteen of the normal infants (39%) were found to carry C difficile, and fecal toxins were detected in eight of these, four with cytotoxin detectable at 10(-4) or higher dilution. Colonization was observed in one of 13 (7%) breast-fed babies and 12 of 17 (71%) of those whose primary milk source was infant formula (P less than .01). Fecal C difficile toxin was detected only in the latter group. The isolation of C difficile or its toxins in the stools of infants with SIDS, diarrhea, or even if large quantities of fecal cytotoxin are present.

Antigens, Bacterial↗
PubMed1990

Fathers' hospital visits to their preterm infants as a predictor of father-infant relationship and infant development.

This short-term longitudinal study assessed the degree to which the frequency of fathers' visits with their preterm infants in the hospital was associated with the quality of ongoing and long-term fathering and infant development. Data on fathering and infant development were collected during the hospital stay, at discharge, at 8 months of age, and at 18 months of age, using both questionnaires and observational schedules. The frequency of visits was significantly correlated with more extensive and positive patterns of fathering at discharge and later periods. It was also associated with more positive perceptions of the infant, as well as with weight gain during hospitalization and psychosocial aspects of later infant development during the first 18 months. The discussion emphasized possible ways in which early paternal contact in the hospital might influence fathers, mothers, and infants. The frequency of paternal visits was high-lighted as a variable useful in predicting high-risk parenting.

Body Weight↗
PubMed1986

Infant mortality among subsequent siblings of infants who died of sudden infant death syndrome.

A specially designed method for measuring infant mortality among families with subsequent siblings of sudden infant death syndrome (SIDS) victims in the state of Washington, 1969 to 1984, yielded results similar to those from an earlier study in Norway. In both studies the SIDS rates among siblings were substantially lower than prior estimates. The rate of SIDS in siblings of infants who died of SIDS did not differ significantly from the SIDS rate among control infants matched for maternal age and birth order. Total infant mortality rates in the two groups were virtually identical. From the data at hand, it appears that earlier estimates of the risk of SIDS in siblings were inflated and that parents of SIDS victims can be counseled accordingly.

Birth Order↗
PubMed1984

The Pennsylvania Infant and Family Development Project, III: The origins of individual differences in infant-mother attachment: maternal and infant contributions.

In order to test 4 specific hypotheses regarding the interactional histories associated with variation in quality of infant-mother attachment, data gathered during naturalistic home observations at 1, 3, and 9 months on 60 babies seen in the Ainsworth and Wittig strange situation were examined. Planned comparisons revealed, as predicted, that securely attached infants had experienced intermediate levels of reciprocal interaction and maternal stimulation, considered to be reflective of sensitive care, and that resistant babies had experienced less responsive care than securely attached infants. No support was provided for the hypothesis that avoidant babies had experienced less physical contact with mothers than securely attached infants. Insecurely attached infants were observed to cry significantly more than securely attached infants at 3 and 9 months. A cross-lag panel analysis, designed to assess longitudinal processes of influence, revealed that fussiness was caused by mothering and did not serve to influence mothering. These results are discussed in terms of mothers' relatively greater influence in determining individual differences in attachment, with overstimulation leading to avoidance, understimulation leading to resistance, and intermediate levels of stimulation leading to security.

Child Behavior↗
PubMed1993

Infant-parent co-sleeping in an evolutionary perspective: implications for understanding infant sleep development and the sudden infant death syndrome.

Evidence suggests that infant-parent co-sleeping represents the species-wide pattern of sleep in which human infant physiology evolved. The hypothesis evaluated in this manuscript is that the co-sleeping environment may foster development of optimal sleep patterning in infants and confer other benefits, including reducing the risk of the sudden infant death syndrome (SIDS). These postulations by McKenna are considered from different perspectives by the coauthors. Using evolutionary, cross-species, crosscultural, physiological and behavioral data, our objective was to present a conceptual framework for assessing the developmental consequences of solitary sleeping and infant-parent co-sleeping.

Adult↗
PubMed1988

Spectral analysis assessment of respiratory sinus arrhythmia in normal infants and infants who subsequently died of sudden infant death syndrome.

Reduced heart rate variability has been found in infants who later succumb to the sudden infant death syndrome (SIDS). To determine whether respiratory sinus arrhythmia, a major component of heart rate variability, is also reduced in SIDS victims, nighttime portions of eighteen 24-h recordings of ECG and respiration from infants who later died of SIDS and 52 recordings from control infants were assessed using spectral analysis. Two aspects of respiratory sinus arrhythmia were examined: "extent" (the absolute heart rate variation at the respiratory frequency) and "coherence" (the degree to which heart rate follows respiration regardless of the absolute amount of variation). Respiratory parameters were used to classify each 1-min epoch as quiet sleep, rapid eye movement sleep, waking, or indeterminate state. Median extent and coherence values across the night were then computed for each sleep-waking state. Two-way (group X state) repeated measures analysis of variance tests were then used to compare respiratory sinus arrhythmia values for 13 SIDS victims and 13 control infants matched by postnatal age, birth weight, sex, and gestational age. Extent of respiratory sinus arrhythmia was significantly lower in the SIDS victims across all sleep-waking states, a finding that persisted after adjusting for heart rate. Coherence values did not differ significantly. These results suggest that even before the time of maximal risk for the syndrome, SIDS victims, as a group, differ from controls in the extent to which cardiac and respiratory activity couple, and this difference is independent of basal heart rate.

Algorithms↗
PubMed1992

Dynamic analysis of cardiac R-R intervals in normal infants and in infants who subsequently succumbed to the sudden infant death syndrome.

Infants who subsequently succumb to the sudden infant death syndrome (SIDS) have higher heart rates and reduced heart rate variation compared with other infants. We examined dynamic changes in cardiac interbeat intervals to explore these differences in cardiac control. Recordings of electrocardiographic activity and respiratory movement were acquired from 13 SIDS victims before their deaths. Moment-to-moment changes in R-R intervals during quiet sleep, rapid eye movement sleep, and waking were compared with values of 13 matched control infants. For each sleep-waking state, every R-R interval was plotted against the previous interval (Poincaré plots), and each change in interbeat interval was plotted against the previous change. Dispersion of interbeat intervals at different heart rates was reduced in SIDS victims, resulting in Poincaré plots markedly different from those of controls. The dispersion, sampled at the 10th and 90th percentiles of heart rates, was reduced across all sleep-waking states in SIDS victims. At high heart rates, the difference between groups disappeared after correcting for basal rate; however, the reduced range at low heart rates was independent of basal rate. SIDS victims also showed smaller beat-to-beat changes in heart rate and fewer sustained runs of consistent heart rate changes during waking relative to controls. The differences in cardiac rate dynamics suggest altered autonomic control in infants who succumb to SIDS. We speculate that the autonomic disturbance may lead to cardiac instability or may indicate CNS alterations with the potential to affect other vital functions.

Autonomic Nervous System↗
PubMed1986

[Transcutaneous oxygen tension and apnea during sleep stages in normal infants and infants at risk for sudden infant death syndrome].

The relationship between chronic hypoxemia and sudden infant death syndrome (SIDS) has been reported by several authors. In order to study the influence of the apnea-time during a sleep state on transcutaneous oxygen tension (tcPO2), we have studied polygraphically 30 full-term infants (10 controls, 10 SIDS siblings and 10 near-miss for SIDS), aged from 5 to 13 weeks. No significant difference was observed either for apnea-time or tcPO2 between infant-groups studied in different sleep states. We could not find any correlation between apnea-time and tcPO2 in all groups of infants studied during different states of sleep. It is therefore concluded that in normal and at risk for SIDS infants, tcPO2 levels during sleep states cannot be explained only by the apnea-time.

Blood Gas Monitoring, Transcutaneous↗
PubMed1996

Tracking strategies involving fourteen sources for locating a transient study sample: parents of sudden infant death syndrome infants and control infants.

Strategies involving 14 sources were used to locate 230 parents of sudden infant death syndrome infants who died in Southern California between 1989 and 1992 and 255 parents of healthy, living infants matched by birth hospital, birth date, race and sex. The sample consisted of adults of reproductive age residing in Southern California. After an event of sudden infant death, many parents moved without a forwarding address; only their names, last known address, and the infant's race, birth date, and sex were available. There was no access to birth certificates, obstetric or pediatric medical records, parents' Social Security numbers, or parents' birth dates. The most successful tracking sources for case parents were the Department of Motor Vehicles, postal service, reverse directory and neighbors, private investigator, and California Medicaid services. For control parents, the post office, Department of Motor Vehicles, and Folks Finders proved the most helpful. Using a combination of the 14 sources achieved an adequate sample size.

Adult↗