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PubMed1994

Influence of breast-feeding on the infant's intellectual development.

The objective of this study was to analyze the effects of breast-feeding on the intellectual development of the infant, controlling for possible confounding factors. A prospective study of cohorts was carried out in a group of 229 healthy infants, studied from birth to 2 years of age. The infants were divided into two groups: group 1, 99 infants who were bottle-fed; and group 0, 130 who were breast-fed. All other characteristics in both groups were similar. Psychomotor development was measured between 18 and 29 months using the Bayley scales. Lower results on the Index of Mental Development were associated with bottle-fed infants, lower-middle and lower social class, elementary education of the mother, temper tantrums, and having siblings. Lower results on the Index of Motor Development were associated only with lower and lower-middle social class.

Adult↗

PubMed2004

Influence of breast-feeding and parental intelligence on cognitive development in the 24-month-old child.

This study was designed to analyze the relationship between breast-feeding and mental development at 24 months of age, independently of the influence of other factors. A total of 238 babies born between October 1995 and February 1998 were enrolled in an observational prospective cohort study. Cognitive development was assessed using the Bayley Infant Development Scale. The results of multiple linear regression analysis showed that infants breast-fed for longer than 4 months scored 4.3 points higher on the mental development scale than those breast-fed for less time. No differences were found in psychomotor development as a function of feeding regimen or duration. The positive linear correlation observed between parental IQ and mental development scores at 24 months was also statistically significant (mother: r = 0.39; p < 0.001; father: r = 0.43; p < 0.001). It may be concluded that breast-feeding for longer than 4 months has a positive effect on the child's mental development at 24 months of age. Parental intelligence also appears to influence cognitive development.

Bottle Feeding↗

PubMed1994

MRI characterization of cerebral dysgenesis in maternal PKU.

MPKU pregnancies, with or without dietary treatment to reduce maternal plasma phenylalanine (phe), show variable, increased non-physiologic levels, as the putative cause of fetal teratogenicity. Cerebral dysgenesis with clinical neonatal microcephaly and congenital heart disease indicates altered organ morphogenesis. Although there is not an established precise relationship between maternal phe levels and outcome, dietary restriction before or early in gestation is universally advised. Both human experience and animal research have suggested differential organ responses to high and low phe levels. Structural microencephaly may be due to reduced brain volume or abnormal regional brain development. Infants in MPKU are also at risk to develop PKU. Microencephaly was evident by MRI in 8 of 21 infants born to 12 MPKU mothers; 2 infants of one mother developed PKU. All levels of gestational plasma phe were associated with otherwise structurally normal infant microencephalic brains appropriate for age in myelination. CHD occurred in one microencephalic infant of a classic MPKU treated in the first trimester. Maternal, cord and neonatal plasma phenylalanine at delivery did not correlate with teratogenic effects. Only untreated 'classic' MPKU fetal effects appear predictable.

Abnormalities, Multiple↗

PubMed1987

Longitudinal analyses of prenatal and postnatal lead exposure and early cognitive development.

In a prospective cohort study of 249 children from birth to two years of age, we assessed the relation between prenatal and postnatal lead exposure and early cognitive development. On the basis of lead levels in umbilical-cord blood, children were assigned to one of three prenatal-exposure groups: low (less than 3 micrograms per deciliter), medium (6 to 7 micrograms per deciliter), or high (greater than or equal to 10 micrograms per deciliter). Development was assessed semiannually, beginning at the age of six months, with use of the Mental Development Index of the Bayley Scales of Infant Development (mean +/- SD, 100 +/- 16). Capillary-blood samples obtained at the same times provided measures of postnatal lead exposure. Regression methods for longitudinal data were used to evaluate the association between infants' lead levels and their development scores after adjustment for potential confounders. At all ages, infants in the high-prenatal-exposure group scored lower than infants in the other two groups. The estimated difference between the overall performance of the low-exposure and high-exposure groups was 4.8 points (95 percent confidence interval, 2.3 to 7.3). Between the medium- and high-exposure groups, the estimated difference was 3.8 points (95 percent confidence interval, 1.3 to 6.3). Scores were not related to infants' postnatal blood lead levels. It appears that the fetus may be adversely affected at blood lead concentrations well below 25 micrograms per deciliter, the level currently defined by the Centers for Disease Control as the highest acceptable level for young children.

Child Development↗

PubMed1988

Twins and triplets with necrotizing enterocolitis.

We reviewed 2856 multiple-gestation pregnancies from 1980 to 1985 to identify whether birth order or other features (eg, asphyxia) were significant risk factors for the development of necrotizing enterocolitis (NEC). There were 42 infants identified as having NEC from 30 pairs of twins and three sets of triplets. The firstborn was diagnosed with NEC in 19 (45%) of the cases, with the disorder occurring in the secondborn in 23 cases (55%). While infants A and B were simultaneously affected in nine cases, among the three sets of triplets, no thirdborn infants developed NEC. Although the secondborn infants had significantly lower one-minute Apgar scores and a more frequent need for resuscitation, they were no more prone to develop NEC than were firstborn infants. Multiple gestation, birth order, feeding practices, and a number of other features we evaluated were not associated with the development of NEC. Our findings support the contention that prematurity is the only consistent risk factor in the development of NEC.

Birth Order↗

PubMed1996

Neurodevelopmental outcome of hydrocephalus following intra-/periventricular hemorrhage in preterm infants: short- and long-term results.

Over a 5-year period (1984-1988) intra- and periventricular hemorrhage (IVH/PVH) was observed in 299 preterm infants. Sixty-eight infants developed posthemorrhagic hydrocephalus (PH); of these, 23 infants died and 40 infants could be followed up for assessment of neurological development (5 patients were lost to follow-up). At 1 year of corrected age 15% (25% at 5 year follow-up) of the infants were determined to have developed normally, 35% (25% at 5-year follow-up) showed mild neurological symptoms and/or slight developmental delay, 32.5% (28% at 5-year follow-up) had handicaps and/or moderate mental retardation, and 17.5% (22% at 5-year follow-up) had severe handicaps and/or severe mental retardation. There was a significantly worse outcome in infants with grade 4 IVH/PVH (P < 0.05) and a significantly worse outcome in the group requiring ventriculoperitoneal (VP) shunt (P < 0.05). The results at 1 year of corrected age proved to be a quite realistic predictor of neurological functioning at 5 years of age (80% predicted correctly in the non-shunted-group--one patient lost to follow-up; 95% predicted correctly in the shunted group--four patients lost to follow-up). Cystic periventricular leukomalacia had been diagnosed in 7 (10%) patients and was associated with poor neurodevelopmental outcome. Gestational age, birth weight, time of shunt placement, and peripartum asphyxia had no significant influence on neurodevelopmental outcome. Infants with shunt infections and a high number of shunt revisions were found to have a significantly worse neurodevelopmental outcome (P < 0.01).

Cerebral Hemorrhage↗

PubMed1982

Quantitative evaluation of the development of tracheal submucosal glands in infants with cystic fibrosis and control infants.

The development of the tracheal submucosal glands has been determined quantitatively in 22 infants with cystic fibrosis and in 25 control infants, all under 4 months of age. In cross-sections of normal trachea significant relationships were found between postconceptional age (PCA) and gland area (P less than 0.001), submucosal area (P less than 0.02), tracheal airway diameter (P less than 0.05), and acinar diameter (P less than 0.001). In infants with cystic fibrosis the pattern of development was similar to that of the control infants. No statistically significant differences were found between three subgroups of infants with cystic fibrosis, which included those with meconium ileus with no lung infection, those with meconium ileus with lung infection, and those with lung infection and no history of meconium ileus. The normal pattern of development of tracheal submucosal glands in infants with cystic fibrosis was in contrast to the deficiency of normal maturation seen in the exocrine pancreas of these infants. The lumen fraction, an index of dilatation of acinar lumina, showed no significant relationship with PCA in either the control group or the group with cystic fibrosis. However, statistically significant dilatation of acini was observed in the tracheal submucosal glands of infants with cystic fibrosis (0.14, P less than 0.005).

Age Factors↗

PubMed2002

Human adenovirus and human cytomegalovirus infections in preterm newborns: no association with bronchopulmonary dysplasia.

Connatal infection with human adenovirus (HAdV) has been recently proposed as a cofactor for the development of bronchopulmonary dysplasia (BPD) in preterm infants [Couroucli et al. 2000 Pediatr Res 47:225-232]. In another study, BPD was associated with an increased incidence of human cytomegalovirus (HCMV) infection [Sawyer et al. 1987 Am J Dis Child 141:303-305]. During a 18-mo study period, we investigated tracheal aspirates or pharyngeal aspirates and urine samples collected during the first month of life from 66 preterm newborns with very low birth weight (< or =1.500 g) for replication-potent HAdV as well as for adenoviral and HCMV DNA by virus culture and qualitative DNA PCR. Thus, our study included not only prenatal but also peri- and postnatal infections. Thirty-seven percent (24/66) of infants developed BPD(1), as defined by persistent oxygen dependency at day 28 of life. Replication-potent HAdV and/or adenoviral DNA could be detected repeatedly in tracheal aspirates/pharyngeal aspirates and/or urine from 20% (13/66) of preterm infants. Seventeen percent (4/24) of infants in the BPD(1) group and 21% (9/42) of infants in the non-BPD group had an HAdV infection, indicating that in our study the very recently proposed association between HAdV infection of the lung and BPD could not be confirmed. For comparison, active HCMV infection was diagnosed in 18% (12/66) of infants, 3 of which developed HCMV disease. 29% (7/24) in the BPD(1) group and 12% (5/42) in the non-BPD group were positive for HCMV. Again, there was no statistically significant association between HCMV infection and BPD. In summary, our findings indicate that HAdV and HCMV infection are frequent in preterm newborns with very low birth weight; however, a causal association with the development of BPD seems unlikely.

Adenoviridae↗

PubMed2003

Maternal docosahexaenoic acid supplementation during pregnancy and visual evoked potential development in term infants: a double blind, prospective, randomised trial.

AIM: To test the hypothesis that maternal docosahexaenoic acid (DHA) supplementation during pregnancy enhances maturation of the visual evoked potential (VEP) in healthy term infants. METHODS: One hundred women were supplemented with either fish oil capsules rich in DHA (n = 50) or placebo capsules (n = 50) from week 15 of pregnancy until delivery. Total fatty acids in red blood cells and plasma were measured at weeks 15, 28, and 40 of pregnancy and at delivery in umbilical cord blood. Infant visual pathway development was assessed using VEPs recorded to flash stimuli shortly after birth and to both flash and pattern-reversal stimuli at 50 and 66 weeks post-conceptional age (PCA). RESULTS: Maternal supplementation did not significantly elevate the level of DHA in umbilical cord blood. Moreover, there were no significant differences in any of the VEP measures observed between supplementation groups. However, maturity of the pattern-reversal VEP at 50 and 66 weeks PCA was associated with DHA status of the infants at birth. Infants with higher DHA status, both as a concentration and as a percentage of total fatty acids, showed shorter P100 peak latencies of the pattern-reversal VEP than those with lower DHA status. CONCLUSIONS: Maternal DHA supplementation during pregnancy did not enhance VEP maturation in healthy term infants. However, these results show an association between the DHA status of infants at term and early postnatal development of the pattern-reversal VEP, suggesting that DHA status itself may influence maturation of the central visual pathways.

Body Height↗

PubMed1990

Effects of electronic fetal-heart-rate monitoring, as compared with periodic auscultation, on the neurologic development of premature infants.

In a multicenter, randomized clinical trial, we assessed the early neurologic development of 93 children born prematurely whose heart rates were monitored electronically during delivery and compared it with that of 96 children born prematurely whose heart rates were periodically monitored by auscultation. All the children were singletons with cephalic presentation, and all weighed less than or equal to 1750 g at birth. The mental and psychomotor indexes of the Bayley Scales of Infant Development (standardized mean score +/- SD, 100 +/- 16) and a formal neurologic examination were administered at three follow-up visits (at 4, 8, and 18 months of age, corrected for gestational age). At 18 months, the mean mental-development scores in the groups receiving electronic fetal monitoring and periodic auscultation were 100.5 +/- 2.4 and 104.9 +/- 1.8, respectively (P greater than 0.1). The mean psychomotor-development scores in the two groups at 18 months were 94.0 +/- 2.4 and 98.3 +/- 1.8, respectively (P greater than 0.1). The incidence of cerebral palsy was higher in the electronically monitored group--20 percent as compared with 8 percent in the group that was monitored by auscultation (P less than 0.03). In the electronic-fetal-monitoring group (but not in the periodic-auscultation group), the risk of cerebral palsy increased with the duration of abnormal fetal-heart-rate patterns, as assessed by retrospective review (chi 2 trend = 12.71, P less than 0.001). The median time to delivery after the diagnosis of abnormal fetal-heart-rate patterns was 104 minutes with electronic fetal monitoring, as compared with 60 minutes with periodic auscultation. We conclude that as compared with a structured program of periodic auscultation, electronic fetal monitoring does not result in improved neurologic development in children born prematurely.

Birth Weight↗

PubMed1985

Use of the Bayley Scales to characterize abilities of premature infants.

The Bayley Scales of Infant Development were administered to 92 white, middle-class infants, half of them premature and half full-term, at 1 year of age from term to determine whether this instrument is useful in characterizing the abilities of premature infants. Although both full-term and premature infants achieved mental and motor development scores within the average range, full-term infants attained significantly higher scores on both the Mental and Motor Scales. Both groups scored significantly lower on motor than mental functioning; however, the difference was significantly greater for premature infants. As a group, premature infants also evidenced greater variability in their performance on both the Mental and Motor Scales, and they showed greater intra-individual variability in performance of motor ability. Furthermore, premature infants were less likely to succeed on items testing eye-hand coordination, imitation, and vocalization. Preselected perinatal risk variables accounted for a significant amount of variance in both mental and motor ability of premature infants.

Birth Weight↗

PubMed1980

Immediate and long-term memory for reinforcement context: the development of learned expectancies in early infancy.

Infants were pretrained to move crib mobiles containing 6 or 10 identical objects by means of footkicking and were then exposed to a reinforcer containing only 2 objects. Relative to infants with no prior history of reinformcement with either of the "larger mobiles, infants shifted to the "smaller" mobile had higher kick rates, and, in addition, their visual attention decreased and negative vocalizations increased. These effects were not transient but persisted 24 hours later in infants experiencing the larger (10- to 2-object) shift. The results suggested that infants develop reward-expectation habits which continue to influence behavior for periods of at least 24 hours.

Arousal↗

PubMedDate not supplied

Relationship of sodium bicarbonate to intraventricular hemorrhage in premature infants with respiratory distress syndrome.

It has been suggested that hypertonic loads of saline built up in the administration of sodium bicarbonate to correct acidosis in infants with respiratory distress syndrome (IRDS) can precipitate intraventricular hemorrhage (IVH). Therefore, from medical records we noted the daily intake of sodium of 36 babies with IRDS who were on mechanical respirators. Eighteen of the infants developed IVH, and for these infants total sodium intake 24 hours prior to IVH was also recorded. The mean was 5.83 +/- 4.22 mEq/kg per day, a dose substantially less than the recommended limit of 8 mEq/kg per day. The difference between means was not significant (p = .071), but the variance was significant (p = .016). The results indicated that the total sodium dose, particularly that taken in during the sodium bicarbonate administration, did not regularly contribute to the development of IVH, when given under controlled conditions, that is, conservative doses, dilution, and slow injection to minimize the hypertonic load.

Bicarbonates↗

PubMed1989

Risk in infancy. Origins and implications.

This article focuses on biological risks that can adversely influence development during infancy and later. In the first part of the article, the origins of risks and their potential consequences are discussed relative to prepregnancy, prenatal, perinatal, and postnatal periods. Epidemiological data are presented. The second part of the article addresses issues pertaining to assessment of infant development and interventions provided for infants whose development may be in jeopardy. Finally, goals for prevention are highlighted and the need for a nationally derived data base on risk and outcomes is emphasized.

Brain Damage, Chronic↗

PubMed1983

The role of intracranial hypotension in neonatal intraventricular hemorrhage.

Most preterm infants develop transient intracranial hypotension, which reaches its lowest level on the 2nd day of life. This corresponds to the time when most neonatal intraventricular hemorrhage (IVH) occurs. In order to test the hypothesis that intracranial hypotension may have an etiological role in the development of IVH in premature infants, the authors induced intracranial hypotension in the preterm rabbit by the intraperitoneal injection of glycerol. The rabbit model is well suited for this study because this animal is at risk of developing spontaneous germinal matrix and ventricular hemorrhage. Compared to control littermates, the glycerol-treated animals exhibited a greater than 3.5-fold incidence of germinal matrix and intraventricular hemorrhage.

Animals↗

PubMed2003

Perinatal biochemistry and physiology of long-chain polyunsaturated fatty acids.

Docosahexaenoic acid (DHA) and arachidonic acid (ARA) are important structural components of the central nervous system. These fatty acids are transferred across the placenta, are present in human milk, and are accumulated in the brain and retina during fetal and infant development. The high concentrations of DHA in the retina and of DHA and ARA in brain gray matter suggests that these fatty acids have important roles in retinal and neural function. Animal studies have shown that depletion of DHA from the retina and brain results in reduced visual function and learning deficits. The latter effects may be explained by changes in the membrane bilayer that alter membrane-associated receptors and signal transduction systems, ion channel activity, or direct effects on gene expression. DHA can be formed in the liver from alpha linolenic acid, but it is unclear if the rate of DHA synthesis in humans is sufficient to support optimal brain and retinal development. Although there is no evidence that the ability to form ARA from linoleic acid is limiting, supplementation with DHA reduces tissue ARA, possibly creating a conditional need for ARA in infants with a dietary intake of DHA. The amount of DHA in human milk varies widely and is positively correlated with visual and language development in breast-fed infants. Advances in understanding essential fatty acid requirements will benefit from intervention studies that use functionally relevant tests to probe the deficiency or adequacy of physiologically important pools of DHA and ARA in developing infants.

Animals↗

PubMed2001

Quantitative analysis of MR images in asphyxiated neonates: correlation with neurodevelopmental outcome.

BACKGROUND AND PURPOSE: MR imaging has been shown to be of prognostic significance in the evaluation of asphyxiated neonates. The purpose of this project was to determine whether the use of intensity ratios in key regions of the brain might better detect regions of injured brain and thus improve the correlation of imaging findings with 12-month neurodevelopmental outcome. METHODS: Prospectively acquired MR studies of 53 asphyxiated neonates were reviewed retrospectively. Signal intensities from standard T1- and T2-weighted images of seven major brain regions that are affected in asphyxia were measured. Intensity ratios were calculated by dividing the signal intensity of each brain region by the signal intensity of the ocular vitreous. The intensity ratios were then correlated with 12-month neurodevelopmental outcome. These results were compared with correlations determined by a qualitative scoring system. RESULTS: The only significant statistical correlation between the intensity ratios and 12-month neurodevelopmental outcome were those of anterior watershed injury with the Mental Development Index of the Bayley Scales of Infant Development II. The qualitative measurements showed a strong correlation with many outcome parameters. CONCLUSION: Standard qualitative assessment is more predictive of neurodevelopmental outcome than is quantitative analysis. This finding most likely reflects the inability of the quantitative assessment of intensity ratios to compensate for the day-to-day evolution of signal intensity of the injured neonatal brain. Anterior watershed injury may be predictive of abnormal cognitive outcome; examination of these patients at age 30 months will be important to determine the accuracy of this observation.

Asphyxia Neonatorum↗

PubMed1984

Issues in the early identification of specific learning disability.

Currently the diagnosis of Specific Learning Disability (SLD) requires the demonstration of academic underachievement relative to cognitive potential. However, if the focus is shifted from academic underachievement to the detection of the deviant neurologic substrate, then the potential exists for diagnosing SLD prior to school. Circumstantial evidence from a variety of sources--studies of historical risk, the newborn examination, assessment of newborn behaviors, combination of newborn and subsequent examination, retrospective assessment of early development in SLD children, and aspects of infant development (motor or language) and SLD-suggests that the neurologic substrate for SLD can be identified in infancy. Early identification of SLD will permit early intervention when indicated, aid the assessment of therapeutic efficacy, and facilitate the evaluation of other interventions (e.g., neonatal care).

Child↗