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PubMed1985

Language development in infants and toddlers.

Speech and language problems constitute the nation's number one handicapping condition. Nurse practitioners are in a unique position to observe the language development of a young child and the social-communicative interaction between parents and child. They need to be aware of the early milestone information regarding language development so that a problem can be identified. It is imperative that these problems be noted early and managed correctly in order to insure the development of adequate communication skills.

Child Development↗
PubMed2005

Hypothyroxinemia in mechanically ventilated term infants is associated with increased use of rescue therapies.

OBJECTIVE: Although common in preterm infants, transient hypothyroxinemia (TH) has not been investigated extensively in ill term infants. The objectives of this study were to investigate serum thyroxine (T4) and thyroid-stimulating hormone (TSH) in sick term infants and to determine whether there is any association between measures of thyroid function and short-term outcome in term infants who receive mechanical ventilation. METHODS: The investigation consisted of both a prospective observational study and a retrospective cohort study. In the prospective study, T4 and TSH were measured after birth in a group of sick term infants (n = 38) and compared with a group of well term infants (n = 18). Infants in the sick group received mechanical ventilation or continuous positive airway pressure and/or had neonatal seizures. Illness severity was quantified using the Score for Neonatal Acute Physiology. The retrospective cohort study included term infants who required mechanical ventilation and were born over a 5-year period (n = 347). Routine T4 screening was collected on the fifth day of life. TH was diagnosed in infants with a T4 <10%, with a TSH <25 microIU/mL. Clinical outcomes in infants with TH were compared with infants without TH. RESULTS: In the prospective study, infants in the sick group had lower T4 on the fifth day of life as compared with infants in the well group (11.7 +/- 4.9 vs 18.9 +/- 5.4 microg/dL), and 34% of infants in the sick group had a T4 <10th percentile compared with 6% of infants in the well group. T4 on day of life 5 was inversely correlated with Score for Neonatal Acute Physiology (R = -0.52). In the retrospective study, 21% of mechanically ventilated infants developed TH and were given statistically more inhaled nitric oxide, high-frequency ventilation, vasopressors, and pharmacologic paralysis when compared with infants without TH. Moreover, infants with TH were statistically more likely to die or require transfer to an extracorporeal membrane oxygenation center compared with infants without TH. CONCLUSION: Our data show that, similar to preterm infants, ill term infants develop TH. Term infants with TH required more intensive rescue interventions, including inhaled nitric oxide and transfer to an extracorporeal membrane oxygenation center. However, whether T4 levels are a marker or a mediator of clinical outcome remains to be determined.

Continuous Positive Airway Pressure↗
PubMed1995

Infant visual development: an overview of studies using visual evoked potential measures from Harter to the present.

Studies of sensory and perceptual abilities in infants require creative, innovative techniques. Although the young infant's response repertoire may appear limited to the naive individual, a number of highly refined procedures have been developed and implemented with these non-verbal humans over the last twenty years. The most successful protocols for evaluating visual development rely either on behavioral responses or on electrophysiological recordings. The first published report using visual evoked potentials to study the development of pattern vision in human infants was presented by M. Russell Harter. This work provided the impetus for a wealth of studies exploring issues of visual information processing abilities in early infancy. The available range of data and experimental techniques are now sufficiently refined that many clinical issues are currently being addressed. The purpose of this review is to document the evolution of scientific studies since Harter's seminal work. The selection of protocols presented focuses on those with either current clinical applications or those which hold promise for future applications in the evaluation and treatment issues of abnormal visual development.

Albinism, Ocular↗
PubMed1978

The malleability of infant motor development: cautions based on studies of child-rearing practices in Yucatan.

Tests with the Bayley Motor Scale were given to 288 infants, equally divided by sex, in Yucatan, Mexico. These were 2 to 54 weeks in age and came from three sociocultural levels. In comparison to USA infants, early acceleration of motor development was followed by a marked downward trend. This phenomenon, if observed in a single child, may indicate progressive neurologic disease. Child-rearing practices would appear to account for the difference in pattern of test performance.

Child Development↗
PubMed1994

Development of infant botulism in a 3-year-old female with neuroblastoma following autologous bone marrow transplantation: potential use of human botulism immune globulin.

Infant botulism is a rare disease caused by the release of toxin produced in the intestinal tract by Clostridium botulinum. The disease primarily affects infants under 1 year of age. We report a 3-year-old child with stage IV neuroblastoma who developed symptoms of progressive motor weakness, bulbar palsy and respiratory failure 42 days after autologous BMT. The diagnosis of infant botulism was established by identifying botulism toxin in the stool. Human botulism immune globulin (HBIG) was administered. Following the diagnosis, the patient made significant recovery over the next 7 weeks and was successfully extubated from mechanical ventilation. However, her neuroblastoma eventually recurred and she subsequently died of progressive disease. Although the etiology of the development of infant botulism in this case following autologous BMT still remains unclear, alteration of the intestinal microbial environment from gut sterilization and laminar airflow room isolation or, alternatively, immune suppression during pre- and post-autologous BMT and activation of endogenous spores may have contributed to the development of this disease. The use of HBIG in children with botulism over 1 year of age may be beneficial.

Bone Marrow Transplantation↗
PubMed2006

Lower parathyroid hormone-related protein content of tracheal aspirates in very low birth weight infants who develop bronchopulmonary dysplasia.

Since parathyroid hormone-related protein (PTHrP) secreted by pulmonary alveolar type II cells is a key physiologic paracrine factor in maintaining alveolar homeostasis, we hypothesized that its levels in the tracheal aspirates (TA) of ventilated very low birth weight infants (VLBWI) would correlate with the development of bronchopulmonary dysplasia (BPD). Therefore, we examined whether TA PTHrP content during the first week of life correlates with the later development of BPD. Forty VLBWI [birth weight, 943 +/- 302 g (mean +/- SD); gestational age, 27 +/- 2 wk; 21 males and 19 females], who were ventilated for respiratory distress syndrome, were studied. The TA were collected once daily until the infants were extubated and immediately frozen at -70 degrees C for subsequent assays for PTHrP and matrix metalloproteinase-8 (MMP-8), a previously described, nonspecific TA biomarker for BPD. The levels of these proteins were correlated with the later development of BPD. PTHrP in the TA during the first week of life was significantly lower in those infants who developed BPD (12/40) than among those who did not (28/40). The PTHrP levels also correlated with the duration of mechanical ventilation needed in these infants. In contrast, MMP-8 levels did not correlate with BPD. We conclude that lower TA PTHrP content during the first week of life in ventilated VLBWI inversely correlates with prolonged ventilation and the later development of BPD.

Bronchopulmonary Dysplasia↗
PubMed1987

Growth and development in infants after renal transplantation.

Between January 1, 1978, and August 31, 1985, 13 infants aged 6 to 11 months received primary renal transplants (12, living related donor; one cadaver) at the University of Minnesota. Twelve infants are alive with functioning grafts (10 primary and two second transplants) after 4 months to 7.5 years. To assess the long-term outcome, we analyzed growth and development in the first nine infants 2 to 7.5 years after receiving their first transplant. Before transplantation, head circumference and height standard deviation scores in six of nine infants were less than -2. Five had seizures; four had delayed mental development, and six delayed motor development. The mean increment in height standard deviation scores for six boys after transplantation was +1.4 (P less than 0.05), and one achieved complete catch-up growth. The mean difference in height standard deviation scores for three infant girls with primary hyperoxaluria was -2.1; nevertheless, two infants with oxalosis are currently alive 2.7 to 3.3 years later. All eight surviving children achieved normal head circumference (mean improvement +2.2 SDS, P less than 0.001), and no child had further seizures. Of seven infants reassessed with the Bayley Scales after transplantation, mental development was normal in all and motor development was normal in five. Our findings suggest that early living related renal transplantation is an important option in the management of end-stage renal disease in infants.

Body Height↗
PubMed2026

Longitudinal development of infant oral ecosystem: salivary metabolomic, bacteriome, and virome dynamics in early infancy.

This prospective cohort study investigated the longitudinal development of the salivary bacteriome, virome, and metabolome during early infancy. We assessed the associations between oral bacteria, viruses, and metabolites from 10 mother-infant dyads, with oral samples collected at 1 and 2 years of age. Forty saliva and plaque samples underwent untargeted metabolomic analysis, and infant saliva samples underwent metagenomic sequencing. Maternal salivary and plaque metabolomic profiles remained largely stable, whereas infant profiles were clearly separated from maternal profiles and changed with age. Notably, infant dental plaque metabolism underwent more substantial changes from year 1 to year 2 than saliva, with age-dependent metabolite shifts mainly involving energy, amino acid, nucleotide, and lipid metabolic pathways. Our findings also revealed significant developmental shifts in salivary bacteriome, virome, and functional pathway profiles during early childhood. The most abundant oral bacteria in early life, comprising over 75% of total abundance, included Veillonella, Streptococcus, Rothia, Prevotella, Neisseria, and Actinomyces species. While human viruses like Roseolovirus were detected, bacteriophages constituted the majority of the virome. Comparing infants at year 1 and year 2, we identified differentially abundant bacteria, viruses, metabolic functional pathways, and specific metabolites. We observed associations between bacteria and viruses, noting that these cross-kingdom relationships attenuated as infants grew. The study results underscore the complex and dynamic development of the oral microbiome, virome, and metabolome during early childhood.IMPORTANCEThe human oral cavity undergoes substantial microbial and metabolic development during early childhood, yet the temporal changes in the infant oral ecosystem remain incompletely understood. In this study, we longitudinally profiled the salivary metabolome, bacteriome, and virome of infants at 1 and 2 years of age. We demonstrated that the infant oral metabolome undergoes substantial developmental shifts, particularly in pathways related to energy, amino acid, and lipid metabolism; whereas maternal metabolic profiles remained stable over the same period. Furthermore, our results revealed the dynamic assembly of infant salivary virome and bacteriome and their associations with the functional pathways and metabolites. These findings provide new insights into the complex and dynamic development of the oral microbiome, virome, and metabolome in early infancy.

bacteriome↗
PubMed2003

Micronutrient status during pregnancy and outcomes for newborn infants in developing countries.

More than 9 million neonatal deaths occur each year, 98% of them in developing countries. Neonatal deaths account for two-thirds of deaths in infancy and 40% of deaths before age 5 y. The major direct causes of neonatal death are infections, preterm delivery and asphyxia. Important indirect causes include low birth weight and hypothermia. The present body of work on multiple micronutrient interventions is not sufficient for us to draw conclusions on their effects on neonatal well-being. Because studies have generally concentrated on single micronutrients and a range of outcomes, this paper reviews the findings for individual nutrients and then summarizes the situation. The evidence for the contribution of micronutrient deficiencies to perinatal mortality and duration of gestation is limited, and the evidence base for individual micronutrient effects on neonatal mortality and morbidity is patchy. To translate knowledge into policy, community evaluations of effect and an expanded evidence base that includes affordability, acceptability and scalability are also required. A balance between supply-side and demand-side interventions must be struck, with an emphasis on effect and sustainability. Among the key requirements are randomized, controlled community effectiveness trials of the effect of micronutrient supplementation in pregnancy on perinatal mortality and neurodevelopment, studies on improving adherence and studies on the relation between micronutrient deficiencies and sepsis and neonatal encephalopathy. It would also be helpful to look at mechanisms for bringing the periconceptional period within the ambit of trials.

Developing Countries↗
PubMed1975

Motor development in Yucatecan infants.

Infant motor development was studied in three socio-cultural groups inYucatan, Mexico, using the Denver Developmental Screening Test f9DDSTF0 AND THEBayley Infant Motor Scale. Eight infants f9four boys and four girlsf0 at each monthof age from two weeks to one year and two weeks were examined in each group, a total of 288infants f996 in each groupf0. There were no significant differences in motor developmentamong the groups or between boys and girls. There was an increase in abilities with age. Compared with the Bayley norms for the USA, fine motor co-ordination was advanced inthese children but there was a delay in walking. The DDST was unable to detect childrenmore than one standard deviation below the mean on the Bayley Infant Motor Scale.

Age Factors↗
PubMed2005

Detecting small for gestational age infants: the development of a population-based reference for Washington state.

Small for gestational age (SGA) infants are at increased risk for morbidity and mortality. The objective of this study was to develop a birthweight for gestational age reference that more accurately represents the Washington state population, focusing on SGA. Washington state birth certificate files of singleton births in 1989 to 1998 were used to develop the 3rd, 10th, 50th, and 90th percentiles of birthweight for gestational age for males and females. The Washington state 10th percentile curve most closely approximates a nationally representative reference, whereas an earlier but widely used California-based reference had the lowest centiles across gestational age with few exceptions. Using the Washington reference, 8.4% of Washington births would be classified as SGA (<10th percentile), compared with 5.5 and 7.4% using the California and national reference, respectively. The new reference may be helpful in assessing local regional data, and other areas with similar demographics, and provide more relevant clinical guidance.

Birth Weight↗