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Acquisition of linguistic and cognitive skills by children with cleft palate.

This study compared the early cognitive and linguistic development of young children with cleft palate (N = 28) to that of noncleft children (N = 29). Measures included the Mental scale of the Bayley Scales of Infant Development, the Minnesota Child Development Inventory, Mean Length of Utterance, and words acquired by 24 months. Children with cleft palate, although well within the normal range, performed significantly below the children in the control group on the Mental Scale of the Bayley Scales of Infant Development, some subscales of the Minnesota Child Development Inventory, and words acquired by 24 months. Differences observed in the cognitive development of children with and without cleft palate were verbal as opposed to nonverbal (i.e., linguistic in nature) and were related to hearing status at 12 months and velopharyngeal adequacy.

Child Development↗

Growth and development of infants surviving respiratory distress syndrome: a 2-year follow-up.

In a regional birth cohort of 5,356 live-born infants, during 12 consecutive months, 46 (0.9%) infants suffered from respiratory distress syndrome. Ten of them died before the age of 2 years. The cause of death was respiratory distress syndrome in two cases, intracerebral hemorrhage in four cases, asphyxia in one case, and congenital erythropoietic anemia in one case. Of the 36 survivors, 34 could be traced for the follow-up. Growth and development of the survivors with respiratory distress syndrome were compared with that of 3,375 term infants in the birth cohort with birth weights at the tenth percentile or above with no risk factors recognized during pregnancy, labor, delivery, or the neonatal period. Normal development was found in 85% of the survivors with respiratory distress syndrome and 99% of the control infants at the age of 2 years. Intracerebral hemorrhage and low one- and five-minute Apgar scores were associated with unfavorable outcome at 2 years in the survivors with respiratory distress syndrome. The developmental scores were significantly poorer than those of the controls at 2 years for gross motor, audiovisual, and psychosocial categories, whereas for fine motor development, the difference disappeared by the 2 years of age. The growth of the survivors with respiratory distress syndrome was satisfactory even if their heights remained below that of their control peers.

Anthropometry↗

Emergent control of manual and vocal-motor activity in relation to the development of speech.

Babbling typically precedes, resembles, and conceivably facilitates development of speech, and yet there is no accepted neurobiological characterization of babbling. Here we report a study of infants' developing control of vocal behavior in relation to manual activity performed under differing conditions of audibility. We hypothesized that babbling is associated with the onset of left-lateralized motor control, as expressed in repetitive right-handed activity, and that audibility facilitates such activity. Sixty-one normally developing infants were seen before (N = 21) or at various intervals following (N = 40) the onset of babbling. In experimental trials, audible or inaudible rattles were placed in left or right hands equally often. Analysis of manual activity revealed little shaking movement in the youngest and vocally least differentiated infants, and a sharp increase in shaking in slightly older infants who had recently begun to babble. Surprisingly, audibility only marginally enhanced shaking activity. A dextral bias was evident in the shaking of infants who had recently begun to babble, but not in younger or older infants. These and other findings suggest that the left cerebral hemisphere may be disproportionately involved in the production of repetitive vocal-motor activity as occurs in babbling.

Brain↗

Usefulness of a non-experimental study design in the evaluation of service developments for infant feeding in a general hospital.

There are likely to be many situations in which it is not possible to use a randomized controlled trial (RCT) for the evaluation of local service developments, and the usefulness of non-experimental study designs need to be assessed. This is examined with reference to a study carried out to evaluate the appointment of a baby feeding adviser (BFA) and other policy changes for infant feeding at a district general hospital (DGH). Surveys of Maternity Unit staff attitudes and practices, and of mothers' experiences were carried out in 1988 (prior to the changes) and afterwards in 1990. Service changes were; appointment of a BFA, removal from the postnatal wards of dextrose, seminars on baby feeding for midwifery staff, and a reduction of night-only shifts. There was no change in the initial breast feeding rate of about 80%, but there was an increase in breast feeding at 6 weeks postnatally from 57% (95% CI; 51-64) to 64% (95% CI; 59-69); P = 0.15. The percentage of women who stopped breast feeding by 6 weeks fell from 30% in 1988 to 22% in 1990; P = 0.11. Mothers who did not see the BFA (1990 only) were significantly less likely to begin breast feeding (P = 0.03), independent of social class and age, but a similar association was not seen at 6 weeks. There were significant reductions in the percentage of midwifery staff viewing feeding policy as unimportant (P = 0.02), and in the use of supplements for breast-fed babies (P < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Emerging developmental sequelae in the 'normal' extremely low birth weight infant.

Thirty-six extremely low birth weight (less than 1000 g birth weight) children received neurodevelopmental testing in infancy (mean age = 19.1 months), and again in early childhood (mean age = 46.5 months). Children were categorized into a high-risk group (n = 20) if bronchopulmonary dysplasia and/or Grades III or IV intracranial hemorrhage were present or a low-risk group (n = 16) if neither were present. Using standardized testing and neuromotor examination, 24 (67%) of 36 children showed normal infant development. Only 11 (31%) of 36 children (P less than .005) had normal development upon reassessment in early childhood. A decline in developmental status occurred in both groups. This indicates that for the extremely low birth weight population, normal infant development is poorly predictive of continued normal development. With or without major complications, extremely low birth weight places children at substantial risk for ongoing and emerging developmental problems with age.

Child Development↗

Genotypes at the internal transcribed spacers of the nuclear rRNA operon of Pneumocystis jiroveci in nonimmunosuppressed infants without severe pneumonia.

The frequency of Pneumocystis jiroveci (human-derived Pneumocystis) in immunocompetent infants developing acute respiratory syndromes has recently been evaluated and has been shown to be close to 25%. Until now, there have been no data on the genomic characteristics of the fungus in these patients, while molecular typing of P. jiroveci organisms was mostly performed with samples from immunosuppressed patients with pneumocystosis (Pneumocystis carinii pneumonia [PCP]). The present report describes the genotypes of P. jiroveci organisms in 26 nonimmunosuppressed infants developing a mild Pneumocystis infection contemporaneously with an episode of bronchioloalveolitis. The typing was based on sequence analysis of internal transcribed spacers (ITSs) 1 and 2 of the rRNA operon, followed by the use of two typing scores. By use of the first score, 11 P. jiroveci ITS types were identified: 10 were previously reported in immunosuppressed patients with PCP, while 1 was newly described. By use of the second score, 13 types were identified, of which 2 were newly described. The most frequent type was identified as type B(1)a(3) (first score), which corresponds to type Eg (second score). Mixed infections were diagnosed in three infants. The occurrence of such diversity of P. jiroveci ITS types, an identical main type, and mixed infections has previously been reported in immunosuppressed patients with PCP. Thus, the P. jiroveci ITS genotypes detected in immunocompetent infants and immunosuppressed patients developing different forms of Pneumocystis infection share characteristics, suggesting that both groups of individuals make up a common human reservoir for the fungus. Finally, the frequency of P. jiroveci in nonimmunosuppressed infants with acute respiratory syndromes and the genotyping results provide evidence that this infant population is an important reservoir for the fungus.

Ascomycota↗

Comparison of calcium- and phosphorus-supplemented soy isolate formula with whey-predominant premature formula in very low birth weight infants.

In a random, controlled study of very low birth weight (VLBW) infants from 3 to 8 weeks of age, 17 infants were fed soy isolate formula supplemented with calcium (92 mg/kg/day), phosphorus (44 mg/kg/day), and vitamin D (500 IU/kg/day), and 15 were fed a new whey-predominant, low osmolality formula designed for small preterm infants. Mean birth weight (1,206 g, SD 178) and gestational age (30 weeks, SD 1.9) of the soy-fed group were not significantly different from the whey formula group (1,143 g, SD 158, and 30 weeks, SD 1.8, respectively). Caloric and protein intakes were not different between the formula groups throughout the study period. However, mean weight gain in g/kg/day was significantly greater for the whey formula group: 15.3 g, SD 2.5, vs. 11.3 g, SD 2.3, p less than 0.0001. Serum protein and albumin were higher in the whey formula-fed group during the latter 2 weeks of the study (p less than 0.05). The incidence of vomiting, gastric residual, abdominal distension, diarrhea, and constipation was low and not different between the two groups. No infant developed necrotizing enterocolitis. Serum calcium, phosphorus, alkaline phosphatase, 25-hydroxy vitamin D and parathyroid hormone were similar in both groups, and no infant developed radiographic evidence of rickets. Although soy isolate formula supplemented with calcium, phosphorus, and vitamin D was not associated with rickets, no fewer complications were observed with this lactose-free, low solute formula.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Proteins↗

Pregnancy outcome following first trimester exposure to cocaine in social users in Toronto, Canada.

Studies of drug-dependent women reveal high rates of adverse fetal effects of cocaine. However, no data are available on the effect of the chemical in social users who discontinue cocaine upon realizing they are pregnant. We report the results of the first phase of a prospective study examining the outcome of pregnancy in women seeking counseling from the Motherisk Program in Toronto. Of 25 women seen in our clinic for 1st trimester cocaine exposure, 92% reported use of less than 10 g of cocaine and 36% reported marijuana use. Other illicit drug use was rare; cigarette and alcohol use was common. The study group did not experience adverse pregnancy outcome above the rate expected in the general population. There were 23 single births 1 pair of twins, and 1 spontaneous abortion. Birth weight and gestation were within normal limits. Only 1 child had a major malformation, syndactyly. Infant development was within normal limits, as measured by developmental milestones. All children are scheduled for assessment using the Bayley Scales of Infant Development. The results of the BSID will be compared to results from a cannabis-exposed control group and a no-drug control group.

Canada↗

[Nutrition and somatic development of infants in the canton of Berne (with special emphasis on the question of obesity)].

160 babies of 3, 6 or 9 month were investigated in weight, length, subscapular and triceps skinfolds and a history of their nutrition since birth was taken. At the age of three month purely breast-fed babies are significantly lighter and show less weight gain since birth than purely bottle-fed ones. Girls fed on demand are significantly lighter and show thinner subscapular skinfolds than girls fed in fixed intervals. Boys show a similar tendency in weight, but the opposite tendency in skinfolds. The results suggest that feeding on demand supports the natural course of somatic growth of babies. The frequency of feeding on demand and the source of information about baby-foods vary greatly with social class.

Child Development↗

Quetiapine augmentation in lactation: a series of case reports.

Treating psychiatric disorders with pharmacotherapy in the breast-feeding period presents a dilemma as such treatment carries the risk of infant exposure to medication through breast milk. However, failure to institute pharmacotherapy in postnatal women in need of such treatment exposes both mother and baby to detrimental effects of the illness. Because women presenting with psychiatric disorders during the postpartum period often have complex sets of symptoms, monotherapy may not be sufficient for symptom resolution. In this case series of 6, we examined levels of psychotropic medications secreted in breast milk and performed developmental assessments of the exposed babies with the Bayley Scales of Infant Development, Second Edition. In 3 of the 6 cases, no medication was detected in the breast milk; in all but 1 case, estimated levels of infant medication exposure were calculated to be less than 0.01 mg/kg per day for each medication. Four of the 6 babies scored as being within normal limits on the Bayley Scales of Infant Development, Second Edition, whereas 2 showed mild developmental delays. In comparison to the 4 cases of typical development, the 2 showing mild delays did not have higher estimated levels of psychotropic medication exposure through breast milk. Based on these results, in our limited sample, there appears to be low levels of infant exposure to the medications through breast milk; no association was seen between developmental outcomes and exposure through breast milk of multiple pharmacological agents. These results should be interpreted with caution, and vigilance should be exercised when advising women on combinations of medications for severe mental illness who choose to nurse.

Adult↗

Effect of an early intervention programme on low birthweight infants with cerebral injuries.

OBJECTIVE: To determine the effect of an early intervention programme (EIP) on low birthweight infants with cerebral injuries. METHODS: Subjects were 23 high-risk low birthweight infants (periventricular leukomalacia 15, intraventricular haemorrhage 5, both 3) receiving care in the neonatal intensive care unit (NICU) at Nagasaki University Hospital. Subjects were randomly assigned to the EIP group (n = 12) or the control group (n = 11). Participants in the EIP group received a Neonatal Behavioral Assessment scale (NBAS)-based intervention combined with developmental support designed to enhance the infants' development and the quality of the parent-infant relationship. The control group received routine medical nursing care without the EIP. The EIP began prior to discharge from the NICU and lasted until 6 months of corrected age. All children were examined on the NBAS preintervention and again at 44 weeks postconceptional age. Maternal anxiety status (STAI) and maternal feelings of confidence in dealing with her baby (LCC) were measured pre and postintervention. Mental and motor development was assessed postintervention using the Bayley Scale of Infant Development. RESULTS: Orientation and State Regulation of infant behavioural profiles, the STAI and LCC scores significantly improved in the EIP group (mean difference (95% CI): Orientation 0.7 (0.4, 1.1), State Regulation 0.9 (0.3, 1.5), STAI -5.5 (- 9.1, -1.9, LCC 5.3 (4.2, 6.5)), but not in the control group. Bayley mental developmental index (MDI) score in the EIP group was higher than in the control group, but there was no significant difference between the two groups (mean difference (95% CI): MDI 8.5 (- 0.8, 17.8), PDI 6.7 (- 1.9, 15.4)). CONCLUSION: The EIP has beneficial effects on neonatal neurobehavioural development and maternal mental health of low birthweight infants with cerebral injuries. This evidence suggests that short-term changes in maternal mental health and infant neurobehaviour promoted by an EIP may serve to initiate a positive interaction between parents and infants.

Apgar Score↗

Perinatal predictors of neurodevelopmental outcome in small-for-gestational-age children at 18 months of age.

OBJECTIVE: Our purpose was to explore the influence of a range of perinatal variables on neurodevelopment at 18 months in a cohort of small-for-gestational-age (SGA) children born in the mid 1990s. STUDY DESIGN: Two hundred eighty-two SGA children (birth weight <10th centile) were followed up prospectively; 220 (78%) had Bayley Scales of Infant Development II performed at 18 months' corrected age. RESULTS: The mean (SD) gestation at delivery was 36.5 (2.7) weeks and mean birth weight was 2095 (549) g. The mean Bayley Scales of Infant Development scores were as follows: Mental Developmental Index score, 95.6 (14.5); Psychomotor Developmental Index score, 97.9 (14.8); and Behavioural Rating Scale score, 110.6 (13.5). SGA children whose mothers had pregnancy-induced hypertension were less likely to have low Mental Development Index scores than SGA children whose mothers were normotensive during pregnancy (10 [23%] vs 78 [44%]. P =.01). Low Psychomotor Development Index scores were associated with not being breast-fed at 3 months (odds ratio [OR] 3.5; 95% CI 1.2-10.1) and long neonatal nursery stay (OR 2.8, 95% CI 1.02-7.05). A low Behavioral Rating Scale score was associated with a large z score for head circumference at birth (OR 2.4, 95% CI 1.2-4.8) and cord arterial base deficit (OR 1.2, 95% CI 1.01-1.4). CONCLUSION: Few of the perinatal variables previously reported are predictive of early childhood outcome in this modern cohort of SGA infants.

Adult↗