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PubMed2005

Proteins in whole saliva during the first year of infancy.

During the first year of an infant's life, the oral environment is subject to drastic changes that coincide with the eruption of teeth. Proteins in saliva are important for protecting oral surfaces and provide receptors for bacterial adhesins. The objective of this longitudinal study was to monitor the general composition and expression of proteins in whole saliva of infants, to prove the hypothesis that expression of certain proteins changes during infant development, and might be associated with tooth eruption. The results showed a remarkable constancy in the overall pattern of salivary proteins and glycoproteins during infancy. Exceptions were the mucins and albumin. The mucins are expressed differentially, with first MUC7 and later MUC5B being predominant. Albumin, a marker of serum leakage, started to rise in whole saliva preceding tooth eruption. Thus, the expression of only few proteins appears to be changed during infant development.

Albumins↗
PubMed1981

Improved thin-layer chromatography of disaturated phosphatidylcholine in amniotic fluid.

We describe an indirect test of fetal lung maturity: the quantitation of disaturated phosphatidylcholine in amniotic fluid. The lipids in samples of amniotic fluid from 172 patients were reacted with osmium tetroxide, and disaturated phosphatidylcholine was then isolated by thin-layer chromatography. Interfering substances were retained by a pre-adsorbent layer. The charred disaturated phosphatidylcholine, quantitated by densitometry, was compared to standard dipalmitoyl phosphatidylcholine. Both within-run and between-run coefficients of variation were about 10%. Blood and meconium do not interfere. Six infants developed respiratory distress when disaturated phosphatidylcholine concentrations of amniotic fluid drawn within 72 h of delivery were less than 5.5 mg/L. A concurrently determined lecithin/sphingomyelin ratio falsely predicted lung maturity in one of these. In seven other samples for which lecithin/sphingomyelin ratios suggested lung immaturity but disaturated phosphatidyl-choline predicted maturity, none of the infants developed respiratory distress. In normal pregnancies, measurement of disaturated phosphatidylcholine in amniotic fluid appears to be a better predictor of fetal lung maturity than is measurement of the lecithin/sphingomyelin ratio. Further studies are needed to determine if this analysis is a better predictor in diabetic pregnancies.

Amniotic Fluid↗
PubMed1978

Fiber and the development of gastrointestinal function.

Dietary lipid represents a major calorie source for the developing infant, yet dietary lipid absorption is relatively inefficient by adult standard. Recent studies are presented, indicating that the developmentally related improvement in lipid absorption observed in the preterm and fullterm infant relate to the maintenance of an intact intraluminal phase and completion of the enterohepatic circulation for bile salts. Critical issues including the absorption of nonpolar vitamins, iron, and the type of dietary lipid are discussed. The possible influence of the introduction of dietary fiber to the food of the developing infant is examined, and areas for future investigation are discussed.

Cellulose↗
PubMed1996

A controlled trial of nurse practitioners in neonatal intensive care.

OBJECTIVE: To compare a clinical nurse specialist/neonatal practitioner (CNS/NP) team with a pediatric resident team in the delivery of neonatal intensive care. DESIGN: Randomized, controlled trial. SETTING: A 33-bed tertiary-level neonatal intensive care unit. PATIENTS: Of 821 infants admitted to the neonatal intensive care unit between September 1991 and September 1992, 414 were randomized to care by the CNS/NP team, and 407 were randomized to care by the pediatric resident team. INTERVENTION: Infants assigned to the CNS/NPs team were cared for by CNS/NPs during the day and by pediatric residents during the night. Infants assigned to the pediatric resident team were cared for by pediatric residents around the clock. Neonatologists supervised both teams. MEASURES: Outcome measures included mortality; number of neonatal complications; length of stay; quality of care, as assessed by a quantitative indicator condition approach; parent satisfaction with care, measured using the Neonatal Index of Parent Satisfaction; long-term outcomes, measured using the Minnesota Infant Development Inventory; and costs. RESULTS: There were 19 (4.6%) deaths in the CNS/NP group and 24 (5.9%) in the resident group (relative risk [RR], 0.78; confidence interval [CI], 0.43 to 1.40). In the CNS/NP group, 230 (55.6%) neonates had complications, in comparison with 220 (54.1%) in the resident group (RR, 1.03; CI 0.91 to 1.16). Mean lengths of stay were 12.5 days in the CNS/NP group and 11.7 days in the resident group (difference in means, 0.8 days; CI, -1.1 to 2.7). The performance on the indicator conditions was comparable in the two groups except for two instances, jaundice and charting, both of which favored the CNS/NP group. Mean scores on the Neonatal Index of Parent Satisfaction were 140 in the CNS/NP group and 139 in the resident group (difference in means, 1.0; CI, -3.6 to 5.6). In the CNS/NP group, 6 (2.6%) infants performed 30% or more below their age level in the Minnesota Infant Development Inventory, in comparison with 2 (0.9%) in the resident group (RR, 2.87; CI, 0.59 to 14.06) The cost per infant in the CNS/NP group was $14,245 and in the resident group $13,267 (difference in means, $978; CI, -1303.18 to 3259.05). CONCLUSIONS: CNS/NP and resident teams are similar with respect to all tested measures of performance. These results support the use of CNS/NPs as an alternative to pediatric residents in delivering care to critically ill neonates.

Female↗
PubMed1991

Hospital and other influences on the uptake and maintenance of breast feeding: the development of infant feeding policy in a district.

Hospital practices in the post-natal period are now recognised as one of a wide range of influences affecting the success of breast feeding. A study of 48 non-medical maternity unit staff and 250 recently delivered mothers at a District General Hospital was carried out in order to identify obstacles and sources of support in the establishment and maintenance of breast feeding. This study formed part of an evaluation of local policy development which included the appointment of a Baby Feeding Adviser. Eighty-two percent of mothers (95% confidence interval; 87.0-96.4) began breast feeding, and this fell to 57.4% (50.6-64.2) at 6 weeks. A majority of mothers reported that advice was at least partly conflicting, and of those who began breast feeding 92.7% had used supplements within 2 days. In multivariate analysis, factors significantly associated with a lower rate of initial breast feeding were: non-attendance at antenatal classes, Caucasian ethnicity, social class and religious denomination. Social factors were much less important in the maintenance of breast feeding, but mothers who had undergone Caesarian section were more likely to give up breast feeding by 6 weeks. The reported quality of advice and support from the hospital and community were not associated with the maintenance of breast feeding. Many of the maternity unit midwifery staff reported inadequate time for discussion of feeding with mothers. Although two-thirds of the staff felt that there should be an infant feeding policy or were not sure, most of those favouring a policy felt that it should not actively promote breast feeding. Their main reason for this view was the fear of inducing guilt in bottle-feeding mothers. The social and service-related factors associated with the initiation and maintenance of breast feeding may be useful for targeting additional support for some mothers. The ambivalence and concerns among maternity unit midwifery staff about promoting breast feeding must be addressed if successful policy implementation is to be achieved. Plans for implementing change and evaluation are described.

Adult↗
PubMed2002

Gelatinase activities in the airways of premature infants and development of bronchopulmonary dysplasia.

Matrix-degrading metalloproteinases may play a role in the pathophysiology of bronchopulmonary dysplasia (BDP). We, therefore, evaluated correlations between gelatinase activities [metalloproteinase (MMP)-2 and MMP-9] or tissue inhibitor of metalloproteinase (TIMP)-1 levels present in the airways during the initial phase of hyaline membrane disease and the onset of BPD. Tracheal aspirates were obtained within 6 h of birth (day 0) from 64 intubated neonates with a gestational age < or =30 wk. Forty-five neonates were resampled on day 3 or 5. Total MMP-2 level measured by zymography fell with time, whereas total MMP-9 level and TIMP-1 levels, assayed by ELISA, increased; the MMP-9 increase correlated with the increase in airway inflammatory cell numbers. Among the parameters measured on day 0, 3, or 5, lower total MMP-2 level, lower birth weight, and higher fraction of inspired oxygen on day 0 were significantly and independently associated with the development of BPD. In conclusion, MMP-9 level and TIMP-1 levels increased after birth but are not linked to BPD outcome. In contrast, low MMP-2 level at birth is strongly associated with the development of BPD.

Bronchopulmonary Dysplasia↗
PubMed1997

[Reference values in vision development of infants with clinical use of the Teller Acuity Cards].

BACKGROUND: Using Teller Acuity Cards (TAC) for clinical visual testing, the question arose how our measurements fitted in the different standard tables of the producer's hand-book. In addition, we wanted to investigate how reliable the measurements of newborn and infants were and what the examination success rate under clinical conditions was. METHODS: At the paediatric clinic of the University of Erlangen, we tested the binocular grating acuity of 98 infants up to the age of one year, using the complete set of Teller acuity cards. In addition, 41 of the children underwent a monocular vision test. RESULTS: 1. Theoretical: At first we calculated conversion data for our card set. Using this conversion scale from cy/cm in cy/deg and the corresponding vision equivalent we produced our own standards for the development of grating acuity up to the age of one year. 2. Clinical: In 3-5 min per clinical examination we could determine for 90.8% of the patients a vision equivalent. The reliability of the results was age dependent and was at its best at the age of 5-11 months. The reliability was also very dependent on the duration of the test and the number of test runs. This resulted in a limited card choice for each age group.

Age Factors↗
PubMedDate not supplied

[Intracranial hemorrhages in the full-term newborn infant. Psychomotor development and neurologic sequelae].

Recently increased utilization of high definition T. C. scan and U. S. has led, in recent years, to diagnose and to localize the intracranial haemorrhage of the term newborns. It has been possible to study the outlook of this disease. The neuro-psychological development of the children, affected by intracranial haemorrhage at the birth, is more impaired when the haemorrhage is intraparenchimal: intracerebellar or intracerebral. Our cases show that a haemorrhage causes only discord on the neuro-psycholological development. When, on the other hand, haemorrhage is associated with anoxicbrain damage, especially bilateral, take place major sequelae.

Brain Ischemia↗
PubMed1986

The effect of intensity of training on sensori-motor development in infants with Down's syndrome.

Twenty-four children with Down's syndrome involved in an early intervention programme were divided into matched intensive training (ITG) and control groups (CG), at a mean age of 42 weeks. Parents of children in the ITG were given exercises to carry out daily to train object permanence, imitation and span of attention. Parents of children on the CG were given general advice. All children were assessed on check lists in the three areas and on standard developmental tests. Results showed small short-term effects in favour of the ITG during the training but no long-term effects on development. It was suggested that the short-term effects were mainly due to improved stability of performance in the ITG.

Attention↗
PubMed1993

Virus-specific antibody responses in mothers and their newborn infants with asymptomatic congenital cytomegalovirus infections.

Human cytomegalovirus (HCMV)-specific antibody response was analyzed to determine its relationship with sequelae in children with asymptomatic congenital HCMV infection. IgG antibodies reactive with envelope glycoprotein gB were significantly higher in cord and maternal delivery serum of infants developing hearing loss than in those without any sequelae. Women of hearing impaired children had higher levels of serum anti-gB IgG and HCMV IgM at first prenatal visit (8-16 weeks gestation) than did those with children with normal hearing. Kinetics of the antibody response revealed that women with hearing impaired children had peak anti-gB and IgM response at the first prenatal visit compared with at or near delivery in mothers of normal children. These results suggested that women who delivered infants developing hearing loss had a more intense and prolonged antibody response, and factors such as early virus acquisition during pregnancy might contribute to the development of sequelae in asymptomatic congenital HCMV infection.

Antibodies, Viral↗
PubMed2003

Innovation in infant formula development: a reassessment of ribonucleotides in 2002.

Nucleotides play a significant role in many physiologic functions, ranging from the encoding of genetic information to signal transduction. Accumulating evidence from recent animal and clinical studies supports the original notion that nucleotides are semi-essential dietary nutrients. The development of a new technique, total potentially available nucleosides, to accurately quantify the nucleotide content in various biological fluids has allowed investigators to properly assess the importance of nucleotide function and availability in various conditions. Data from animal studies indicate that exogenous nucleotides produce beneficial gastrointestinal and immunologic effects, especially during times of rapid growth, when nucleotide availability may be low. Infant studies confirm these findings and are presented in this review. Regulatory agencies are currently using this information collectively to support the rationale for the supplementation of infant formulas with higher amounts of nucleotides.

Animals↗
PubMedDate not supplied

Fatal early onset infection in an extremely low birth weight infant due to Morganella morganii.

OBJECTIVE: This paper reports a case of chorioamnionitis due to Morganella morganii in a mother who presented with ruptured membranes at 24 weeks' gestation and was treated with dexamethasone and prophylactic ampicillin. Her premature infant developed severe early onset infection due to the same organism and expired. STUDY DESIGN: A clinical case report of M. morganii infection complicating preterm rupture of membranes is presented. Possible risk factors for maternal and neonatal infection with this organism as well as the therapy of neonatal M. morganii infection are discussed. RESULTS: Risk factors in the mother included having a cervical cerclage in place and treatment with dexamethasone and prophylactic ampicillin. The major risk factors in the infant were maternal chorioamnionitis and extreme prematurity. The mother responded to treatment with ampicillin, metronidazole, and gentamicin following delivery and had an uncomplicated recovery. Her infant developed severe early onset M. morganii infection complicated by neutropenia, thrombocytopenia, and severe acidosis and expired. Postmortem cultures of pleural fluid, peritoneal fluid, and blood were positive despite treatment with gentamicin, an antibiotic to which the organism was sensitive. CONCLUSION: M. morganii may cause serious infection in pregnancy and in the neonatal period. The use of dexamethasone and prophylactic ampicillin may have increased the risk of infection with this ampicillin-resistant organism. The failure of gentamicin to sterilize the infant's blood and body fluids emphasizes the necessity of treating such infections with a combination of an aminoglycoside and a third-generation cephalosporin, such as cefotaxime.

Adult↗
PubMed2004

Feeding interventions for growth and development in infants with cleft lip, cleft palate or cleft lip and palate.

BACKGROUND: Cleft lip and cleft palate are common birth defects, affecting about one baby of every 700 born. Feeding these babies is an immediate concern and there is evidence of delay in growth of children with a cleft as compared to those without clefting. In an effort to combat reduced weight for height, a variety of advice and devices are recommended to aid feeding of babies with clefts. OBJECTIVES: This review aims to assess the effects of these feeding interventions in babies with cleft lip and/or palate on growth, development and parental satisfaction. SEARCH STRATEGY: We searched the Cochrane Oral Health Group's Trials register (June 2001), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 2, 2004), MEDLINE (1966 to May 24th 2004), EMBASE (1980 to August 7th 2002), CINAHL (1982 to August 7th 2002), PsychINFO (1967 to August 13th 2002), AMED (1985 to August 13th 2002). Attempts were made to identify both unpublished and ongoing studies. There was no restriction with regard to language of publication. SELECTION CRITERIA: Studies were included if they were randomised controlled trials (RCTs) of feeding interventions for babies born with cleft lip, cleft palate or cleft lip and palate up to the age of 6 months (from term). DATA COLLECTION AND ANALYSIS: Studies were assessed for relevance independently and in duplicate. All studies meeting the inclusion criteria were data extracted and assessed for validity independently by each member of the review team. Authors were contacted for clarification or missing information whenever possible. MAIN RESULTS: Four RCTs with a total of 232 babies, were included in the review. Comparisons made within the RCTs were squeezable versus rigid feeding bottles (two studies), breastfeeding versus spoon-feeding (one study) and maxillary plate versus no plate (one study). No statistically significant differences were shown for any of the primary outcomes when comparing bottle types, although squeezable bottles were less likely to require modification. No statistically significant difference was shown for infants fitted with a maxillary plate compared to no plate. A statistically significant difference in weight (kg) at 6 weeks post-surgery was shown in favour of breastfeeding when compared to spoon-feeding (mean difference 0.47; 95% CI: 0.20, 0.74). REVIEWERS' CONCLUSIONS: Squeezable bottles appear easier to use than rigid feeding bottles for babies born with clefts of the lip and/or palate, however, there is no evidence of a difference in growth outcomes between the bottle types. There is weak evidence that babies should be breastfed rather than spoon-fed following surgery for cleft lip. No evidence was found to assess the use of any types of maternal advice and/or support for these babies.

Cleft Lip↗
PubMed1977

Glucose disappearance in infants of diabetic mothers. II. Relationship to lowest neonatal blood glucose and amniotic fluid insulin.

Neonatal glucose disappearance (KT) was measured in 26 infants of insulin-dependent diabetic mothers within the first 2 h of life. A significant correlation was found between the KT and the lowest blood glucose (LBG) in the first day of life (r = 0.64, P less than 0.001). None of 21 infants developed a LBG less than 20 mg/dl when the KT was less than 3.0%/min in contrast to 4 of 5 whose KT was greater than 3.0%/min (P less than 0.001). Amniotic fluid (AF) glucose and insulin were determined in 42 samples from 18 of these patients in the third trimester of pregnancy. There was a significant correlation between AF insulin values and the neonatal KT (R = 0.76, P less than 0.001). The correlation was higher when only amniotic fluid values obtained on the day of delivery were considered (n = 17, r = 0.90, P less than 0.001). 1 of 13 infants developed a LBG less than 20 mg/dl when the amniotic fluid insulin was less than 100 mu U/ml on the day of delivery in contrast to 3 of 4 whose AF insulin was greater than 100 mu U/ml (P less than 0.001). No correlation of AF glucose was found with infants' KT or LBG. These data suggest that both neonatal KT and AF insulin are of value for predicting neonatal hypoglycemia and detecting infants who will require treatment for its prevention.

Amniotic Fluid↗
PubMed1987

Temperament and attachment security in the strange situation: an empirical rapprochement.

In response to Frodi and Thompson's recent demonstration that infants classified A1-B2 in the Strange Situation differ significantly in emotional expression from infants classified B3-C2, several longitudinal data sets were examined to determine whether these group differences might be a function of infant temperament. Data from 3 separate samples revealed significant concordance between infant-mother and infant-father Strange Situation classifications when scored in terms of A1-B2 versus B3-C2, but not when scored in terms of the traditional A-B-C system. In addition, in 2 samples on which newborn behavioral data were available, A1-B2 infants displayed more autonomic stability than B3-C2 infants, and in one of the samples the former infants were more alert and positively responsive as newborns (with means in the same direction in Sample 2). Moreover, mothers of A1-B2 infants described their babies as less difficult to care for at 3 months of age. Considered together, these findings suggest that infant temperament affects the manner in which security or insecurity is expressed rather than whether or not the infant develops a secure or insecure attachment. These findings are discussed in terms of their implications for the study of the interactional antecedents and the developmental consequences of attachment security.

Child Development↗
PubMed2000

A randomized controlled trial of early dietary supply of long-chain polyunsaturated fatty acids and mental development in term infants.

The effects of dietary docosahexaenoic acid (DHA) supply during infancy on later cognitive development of healthy term infants were evaluated in a randomized clinical trial of infant formula milk supplemented with 0.35% DHA or with 0.36% DHA and 0.72% arachidonic acid (AA), or control formula which provided no DHA or AA. Fifty-six 18-month-old children (26 male, 30 female) who were enrolled in the trial within the first 5 days of life and fed the assigned diet to 17 weeks of age were tested using the Bayley Scales of Infant Development, 2nd edition (BSID-II) (Bayley 1993) at the Retina Foundation of the Southwest, Dallas, TX. These children had also been assessed at 4 months and 12 months of age for blood fatty-acid composition, sweep visual evoked potential (VEP) acuity, and forced-choice preferential looking (FPL) acuity (Birch et al. 1998). Supplementation of infant formula with DHA+AA was associated with a mean increase of 7 points on the Mental Development Index (MDI) of the BSID-II. Both the cognitive and motor subscales of the MDI showed a significant developmental age advantage for DHA- and DHA+AA-supplemented groups over the control group. While a similar trend was found for the language subscale, it did not reach statistical significance. Neither the Psychomotor Development Index nor the Behavior Rating Scale of the BSID-II showed significant differences among diet groups, consistent with a specific advantage of DHA supplementation on mental development. Significant correlations between plasma and RBC-DHA at 4 months of age but not at 12 months of age and MDI at 18 months of age suggest that early dietary supply of DHA was a major dietary determinant of improved performance on the MDI.

Analysis of Variance↗