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PubMed1990

A study of periventricular haemorrhage, post-haemorrhagic ventricular dilatation and periventricular leucomalacia in Chinese preterm infants.

Serial cranial ultrasound scans were performed in 178 preterm Chinese infants (gestation less than 35 weeks, birthweight less than 2000 g) to study the incidence, age of onset and associating risk factors of periventricular haemorrhage (PVH), and also the occurrence of post-haemorrhagic ventricular dilatation and periventricular leucomalacia (PVL). Sixty-four infants developed haemorrhage, giving an incidence of 36%. Among infants of birthweight less than 1500 and less than 1000 g the respective incidence was 52 and 69%. Seventy-two per cent (46 of 64) of haemorrhages were initially detected within the first 3 days of life, but delayed haemorrhage occurring after 1 week of age occurred in nine infants. In eight of these infants PVH had been shortly preceded by a major clinical disaster. Eleven perinatal factors were found to be significantly associated with PVH but only systemic hypotension showed a significant independent association. Post-haemorrhagic ventricular dilatation developed in 17 (46%) of the 37 infants who survived for more than 1 month after PVH. This was transient in 41%, persistent but stable in 29% and progressive in 29%. PVL was detected in eight infants who survived the initial period following PVH.

Cerebral Hemorrhage↗

PubMed2001

Long-chain polyunsaturated fatty acids in breast milk: are they essential?

The need for long-chain polyunsaturated fatty acids (LC-PUFA), such as docosahexaenoic acid (DHA, C22:6n3) and arachidonic acid (AA, C20:4n6), in the diet of infants in order to achieve full developmental potential is a matter of intense investigation by several research groups worldwide. It has been widely reported that breast-fed infants perform better on tests that assess neurodevelopmental outcomes than do formula-fed infants. Although human milk contains LC-PUFA that are absent from formula, it is necessary to demonstrate that any beneficial effects of human milk on infant development are purely attributed to the presence of LC-PUFA in human milk and their absence from formula to establish causality. The hypothesis that dietary DHA is associated with developmental outcome needs to be plausible; the effect must be consistent, specific, and independent of confounding factors. The hypothesis is certainly plausible. DHA is avidly incorporated and retained in brain cerebral phospholipids, and a most consistent finding has been the lower level of cerebral DHA in the brains of formula-fed infants (receiving no DHA) relative to those fed human milk (receiving DHA). The formula-fed infants in these studies were generally fed formulas with adequate alpha-linolenic acid levels, and this may indicate a nutritional requirement for preformed DHA. Several studies have compared the effects of breast- and formula-feeding on functional outcomes in preterm and term infants. While many of the outcomes have involved visual testing, others have attempted more global assessments. The results have shown differences in favor of breast-feeding but have been colored by the strong socioeconomic differences between mothers who choose to breast feed and those who choose formula-feeding. Randomized clinical trials involving preterm infants have shown a clear requirement for DHA for full visual and neural development. These results are consistent with primate studies. However, intervention studies with term infants that have attempted to improve the DHA supply of infant formula and hence infant development have not yielded consistent results. Some randomized studies have demonstrated improved visual and developmental indices in supplemented over unsupplemented infants, others have failed to demonstrate an effect. This disparity could be due to methodological and environmental differences. It is also notable that supplemental regimens have not specifically added DHA and have included other LC-PUFA, raising the question as to the specificity of the effect. However, only tissue DHA levels have consistently correlated with outcomes.

Animals↗

PubMed1990

Cerebral blood-flow velocity patterns in post-hemorrhagic ventricular dilation.

To evaluate the effect of ventricular dilation (VD) on cerebral hemodynamics, serial cerebral bloodflow velocity patterns from the anterior and middle cerebral, and circle of Willis arteries were examined by range-gated, pulsed Doppler sonography in premature infants developing post-hemorrhagic VD. Nine infants (25 to 30 weeks gestation) without a patent ductus arteriosus were studied until resolution of VD. Forty-nine cranial sonograms from all nine infants were reviewed independently and grouped cross-sectionally into mild, moderate and severe VD prior to shunt. The corresponding pulsatility index (PI) showed a consistent trend of increase with VD in all three studied vessels. In six infants, absent or reversed diastolic flow was observed at the height of VD. Four of these infants required V-P shunt. Immediate fall in PI occurred in all three vessels. Serial measurement of PI during VD reflects global changes in cerebrovascular resistance. Results confirmed PI could be a useful index in monitoring cerebral hemodynamic changes.

Cerebral Hemorrhage↗

PubMed1978

Risk factors in early-onset neonatal group b streptococcal infections.

Newborn infants with "early-onset" disease due to group B beta hemolytic streptococcus were studied over a 40-month period. Clinical presentations included asymptomatic bacteremia, mild transient illness, respiratory distress, meningitis, and overwhelming sepsis. Chronologically, 18 were ill at birth; 10 became ill after a symptom-free period; and four were asymptomatic. Sixty-six percent of the cases weighted less than 2500 grams, and 56% were born to mothers whose amniotic membranes were ruptured for over 20 hours. All 15 of the deaths occurred in low birth weight infants who were criticially ill from birth. A review of 128 consecutive deliveries of infants weighing under 2000 grams revealed 28 cases with prolonged ruptured membranes, and three of these 28 infants developed group B streptococcal infection. The infant of the colonized gravid woman in premature labor or with prolonged ruptured membranes is clearly at risk, and these results suggest that the management of "early-onset" disease should begin prior to delivery.

Female↗

PubMed1988

The impact of milk and weaning diet on gastrointestinal permeability in English and Gambian infants.

To test the hypothesis that cow's milk formula and weaning diet may damage the gut mucosa, the gastrointestinal permeability of 77 healthy English and Gambian infants was measured from the urinary recovery of the markers lactulose and mannitol included in feeds. All infants were born at term and studied at 6, 12 and 18 weeks of age. No infant developed diarrhoea or failed to thrive. Infants fed on cow's milk formula had higher urinary lactulose: mannitol excretion ratios than breast-fed infants at 6 weeks of life (P less than 0.05). There was no significant difference in the urinary marker excretion ratios of English formula-fed and Gambian breast-fed infants at 12 weeks. An increase in urinary lactulose: mannitol excretion ratios was seen in all infants at 18 weeks. This was more probably due to increasing age than to the introduction of weaning diet. Cow's milk formula feeding was associated with greater intestinal permeability than breast feeding in infants aged 6 weeks. The introduction of weaning diet after 6 weeks did not appear to have an impact on the gastrointestinal permeability of healthy growing infants born in either England or rural Gambia.

Aging↗

PubMed1998

Immune response to measles vaccine in 6-month-old infants of measles seronegative mothers.

Determinants of measles vaccine-induced immune response in infancy include maternal immune status and the infant's age at immunization. In a previously published study, 74% of 19 6-month-old infants developed neutralizing antibody. Two of the infants were born to measles seronegative mothers. In order to (1) assess the prevalence of measles seronegativity in a population of US mothers born after 1960 and (2) assess the immunogenicity of standard titer measles vaccine in 6-month-old infants of measles seronegative mothers, mothers with healthy term (> or = 37 weeks gestation) infants attending well child care clinics at MetroHealth Medical Center were prospectively screened for measles antibody by EIA. If negative, maternal samples were retested for neutralization (NT) antibody. Fifteen of 169 women were seronegative by both assays. Six-month-old infants of 9 of these 15 seronegative mothers were enrolled in the pediatric vaccine study. Serological response of these 9 infants to monovalent measles vaccine (Attenuvax) was compared to the responses of 17 6-month-old infants of seropositive mothers and 15 15-month-old toddlers from our previous study. All 9 infants of seronegative mothers became EIA seropositive after the vaccine compared to 9 of 17 6-month-old infants born to seropositive mothers (p = 0.02). Differences in NT seroconversion rates (100% vs 70.6%) were not statistically significant. The comparison group of 15-month-old vaccinees showed 100% seroconversion by both assays. The NT geometric mean titer (GMT) was higher in the 15-month-old toddlers than in the 6-month-old infants born to seronegative mothers (87.2 vs 33.9, p < 0.01), suggesting age-related differences in humoral immune response unrelated to passively transferred maternal antibody.

Antibodies, Viral↗

PubMed2005

Amiel-Tison Neurological Assessment at term age: clinical application, correlation with other methods, and outcome at 12 to 15 months.

The aims of this study were: (1) to perform the Amiel-Tison Neurological Assessment (ATNA) in a group of infants with different risk factors for brain damage; (2) to analyze the results of the examinations in light of the risk factors and presumed aetiology; (3) to compare results of examinations with results of cranial ultrasound, electroencephalography (EEG), and cerebral function monitoring (CFM); and (4) to evaluate neurological outcome at 12 to 15 months of age using the Amiel-Tison and Gosselin method, and developmental outcome using the Bayley Scales of Infant Development. Participants were 52 term, newborn infants (31 males, 21 females) with risk factors for brain damage. Mean birthweight was 3288g (SD 661g) and mean gestational age was 39.4wks (SD 1.2wks); range 38 to 41.3wks. Mean age at admission to a neonatal special care unit was 75h, (SD 13.7h). The group with a dynamic (evolving) clinical profile differed significantly from the group with a static (stable) profile in terms of aetiology, while the group with signs of prenatal brain damage differed from the group without these signs regarding aetiology and the level of severity of neurological signs. Sensitivity of the ATNA to detect infants with abnormal ultrasound was 0.97, with EEG 0.89, and with CFM 0.88. At follow-up at 12 to 15 months 47 children were examined: neurological examination was normal in 25 and five children had a minor, five a moderate, and 12 a severe neurological deficit. Agreement of the ATNA with neurological and developmental assessment at follow-up was very good. Our findings suggest that the ATNA is also of value in assessing aetiology and timing of brain lesions.

Brain Damage, Chronic↗

PubMed1980

Necator americanus in infant rabbits: complete development, humoral antibody, leukocyte response and serum protein changes following infection.

Necator americanus, originally isolated from man, developed completely in infant rabbits (RSG-1). This infection was serially passed in infant rabbits up to the 6th generation without using any immunosuppressant. Two day old infant rabbits demonstrated a high degree of susceptibility to N. americanus. Studies revealed the retention of worms in the intestine for more than 150 days during which egg production was high. In this experimental model the leukocyte, antibody and serum protein responses due to N. americanus infection were monitored. Results showed that eosinophil numbers rose significantly from day 28 to 170. A maximum was observed on day 80 (41%) in rabbits of the fourth generation. Antibodies to N. americanus were detectable in infected rabbits by counterimmunoelectrophoresis using third stage larval antigen (Rabbit strain). Generally, total globulins increased with decrease in albumin. Serum protein increase was associated with alpha-2, beta and gamma globulin components.

Animals↗

PubMed1978

Verbal information gathering strategies: the child's use of language to acquire language.

Recent investigations suggest that normally developing infants are active participants in a language-transmission partnership with the mature speakers in their environments. In a recent paper, (Snyder, McLean, 1977) we noted that available data suggest several specific language acquisition strategies exhibited by children in these interactions. While the earlier paper focused on a set of posited nonverbal strategies, this sequel focuses on two broad types of early verbal behavior that function as effective strategies for the language-learning child. These posited verbal acquisition strategies are referred to as selective imitation and metalinguistic utterance production. The conflicting theory and data on the role of early verbal imitation are reviewed, and it is concluded that selective imitation is most functional at specific stages of the language acquisition process. A hierarchy of metalinguistic utterance types is suggested, ranging from those reflecting the highest apparent intentionality (that is, interrogative utterances) to those reflecting the least (referred to as evocative utterances). Suggestions for future research are offered and implications for language intervention are discussed.

Adult↗

PubMed1983

[Calcium-phosphate metabolism in pre-term infants].

Physiological and clinical aspects are discussed in this review on calcium-phosphate metabolism in pre-term infants. Calcium accumulation in the bone mass of the foetus is related to the gestational age, and mainly occurs during the last weeks of gestation. Therefore, after birth, hypocalcemia is more frequent in pre-term than term infants. However, clinical symptoms of hypocalcemia, e.g. attacks of apnea, hyperexcitability and hypotonia, are rarely observed. Such symptoms depend upon the serum concentration of ionized calcium and this concentration is influenced by various metabolic factors. During the first two weeks of life phosphate is elevated in comparison to later periods. In spite of sufficient vitamin D supplementation low serum phosphate levels occur due to insufficient supply of phosphate. This correlates with evidence of rickets. An increased alkaline phosphatase activity can be considered an early and sensitive indicator. Pre-term infants develop rickets more frequently than term infants due to calcium-phosphate deficiency. Vitamin D supplementation alone is insufficient and should be combined with phosphate, as had been stated previously.

Alkaline Phosphatase↗

PubMed1981

Maternal locus of control and developmental gain demonstrated by high risk infants: a longitudinal analysis.

The short and long-term effects of a parent-infant training program for biologically handicapped infants was evaluated in terms of maternal locus of control. Twenty-four infants were evaluated on five developmental scales measuring motor, cognitive, and language functioning over a four-year period. Developmental gains on these indices were regressed against maternal locus of control partialing maternal education and socioeconomic status out of the relationship. The results indicated that maternal locus of control accounted for a substantial portion of variance in the developmental gains following the program intervention period. This was especially true for the cognitive and language indices. Locus of control in the mother, however, was not related to the motor indices, nor did it relate to cognitive and language gains achieved during the program intervention period. The results are discussed in terms of the mother's perceived contribution to infant progress in programs designed to produce sustained gains in early infant development.

Adult↗

PubMed1995

Molecular epidemiology of an SHV-5 extended-spectrum beta-lactamase in enterobacteriaceae isolated from infants in a neonatal intensive care unit.

Klebsiella oxytoca that produced extended-spectrum beta-lactamase (ESBL) and were resistant to ceftazidime were isolated from infants in a neonatal intensive care unit (NICU). During a 30-week period, 3 infants developed infections and an additional 60 infants were colonized with these bacteria. The molecular typing data suggested transmission of a single strain of ceftazidime-resistant K. oxytoca among 48 of the 63 infants. The ESBL of 46 of the 48 similar isolates, 14 of the remaining 15 isolates, and 6 other Enterobacteriaceae appeared to be associated with a conjugative plasmid of approximately 85 kb. The ESBL gene was cloned, and DNA sequencing confirmed that the ESBL was an SHV-5. Hybridization data suggested that the SHV-5 gene was transmitted to other Enterobacteriaceae in vivo. The spread of the ESBL was reduced through adherence to infection control practices.

Bacterial Typing Techniques↗

PubMed2005

Ultrasound diagnosis of brain atrophy is related to neurodevelopmental outcome in preterm infants.

BACKGROUND: Intraventricular haemorrhage and periventricular leukomalacia are associated with poor outcome of very preterm infants, while the role of more subtle cerebral alterations, as detected by cranial ultrasound, is less clear. AIM: In this study, we related periventricular echodensities and signs of brain atrophy to neurodevelopmental outcome at 3 y of age. PATIENTS AND METHODS: All preterm infants born in 1997 in our institution with a gestational age <32 wk or birthweight <1500 g were subjected to repeated standardized cranial ultrasound examinations until discharge. Survivors were examined at 3 y of age employing the Bayley Scales of Infant Development II. RESULTS: Eighty-seven infants were enrolled (birthweight 430-2500 g (median 1200 g), gestational age 24-34 wk (median 29 wk)). Periventricular echodensities were detected in 42 infants (48%); in 12 cases persisting <7 d, in 30 cases >7 d. At discharge, 18 infants (22%) had signs of brain atrophy. Neurodevelopmental outcome was assessed in 64 infants. Infants with signs of brain atrophy scored significantly lower on MDI (atrophy 91.8, no atrophy 101.9; p=0.02), PDI (atrophy 91.4, no atrophy 106.5; p=0.001) and Behaviour Rating Scale (atrophy 41.1, no atrophy 66.4; p=0.01) than infants without atrophy. Periventricular echodensities were not related to outcome. CONCLUSION: Our data show that infants with sonographic signs of brain atrophy at discharge achieve lower scores in neurodevelopmental testing at 3 y.

Atrophy↗

PubMed1998

Late onset canonical babbling: a possible early marker of abnormal development.

By their 10th month of life, typically developing infants produce canonical babbling, which includes the well-formed syllables required for meaningful speech. Research suggests that emerging speech or language-related disorders might be associated with late onset of canonical babbling. Onset of canonical babbling was investigated for 1,536 high-risk infants, at about 10-months corrected age. Parental report by open-ended questionnaire was found to be an efficient method for ascertaining babbling status. Although delays were infrequent, they were often associated with genetic, neurological, anatomical, and/or physiological abnormalities. Over half the cases of late canonical babbling were not, at the time they were discovered associated with prior significant medical diagnoses. Late canonical-babbling onset may be a predictor of later developmental disabilities, including problems in speech, language, and reading.

Age Factors↗

PubMed1990

Infrequent neonatal opiate withdrawal following maternal methadone detoxification during pregnancy.

The influence of maternal participation in a methadone detoxification program as compared to street drug use on intrauterine growth and neonatal morbidity was analysed in 75 newborns. -58 of 75 pregnant addicts joined the methadone program; in 17 women with successful prepartal detoxification, we found a longer course of pregnancy as well as normalized birth weight, head circumference and respiratory status of the neonates. The HIV-status showed no influence on prenatal growth. 63% of all infants developed a neonatal abstinence syndrome; this incidence was lower after maternal participation in the methadone detoxification program: 55 vs. 88%, p less than 0.05. Postnatal respiratory insufficiency occurred more frequently after methadone exposure than after heroin exposure before birth (p less than 0.05).

Adult↗

PubMed2006

[The 2004 Pelotas birth cohort: methods and description].

OBJECTIVE: To describe a birth cohort which started in 2004, aiming to assess pre and perinatal conditions of the newborns, infant morbimortality, early life characteristics and outcomes, and access, use and financing of health care. METHODS: All children born in the urban area of Pelotas and Capão do Leão municipalities (Southern Brazil) in 2004 were identified and their mothers invited to join the study. In the first year of the study the children were seen at birth, at three and 12 months of age. These visits involved the application of a questionnaire to the mothers including questions on health; life style; use of health services; socioeconomic situation; estimation of gestational age; anthropometric measurements on the newborn (weight, length, head, chest and abdominal circumferences); anthropometric measurements on the mother (weight and height) and assessment of infant development. RESULTS: Out of the eligible infants (4,558), more than 99% were recruited to the study at birth. Follow-up rates were 96% at three months and 94% at 12 months of age. Among the initial results we highlight the following. Infant mortality rate was 19.7 per thousand, with 66% of infant deaths occurring in the neonatal period. There were frequencies of 15% premature babies and 10% low birthweight. Cesarean sections represented 45% of deliveries. CONCLUSIONS: The third Pelotas birth cohort showed an infant mortality rate similar to that of 11 years ago, with most deaths occurring in the neonatal period. The rates of prematurity and cesarean sections increased substantially.

Brazil↗

PubMed2005

Repetitive EEG recordings are necessary for the diagnosis of early myoclonic encephalopathy.

Early myoclonic encephalopathy (EME) is a rare malignant epileptic syndrome. The erratic myoclonus with or without focal motor seizures, time of onset before 3 months of age, and suppression-burst (SB) pattern in EEG are accepted as the diagnostic criteria for EME. We report a 40-day-old infant with the diagnosis of non-ketotic hyperglycinemia (NKHG). The infant developed myoclonic and focal tonic seizures on the first day of life. His first sleep EEG recorded after onset of seizure was normal. Because of the diagnosis of NKHG and early developed myoclonic seizure, we thought the infant might be EME, and repeated sleep EEG on admission in which asymmetrical SB pattern was seen. We concluded that the absence of SB pattern in the first EEG recording does not exclude the diagnosis of EME, but repetition of EEG is necessary to demonstrate the presence of SB pattern to meet the diagnostic criteria for EME.

Child, Preschool↗

PubMedDate not supplied

[Favorable course of cerebral candidiasis in a low-birth newborn treated with liposomal amphotericin B].

A very low birth weight female infant developed a systemic infection by Candida albicans. Her clinical conditions were very poor; involvement of CNS was demonstrated my multifocal hyperechogenic images, spreading to the periventricular and subcortical areas of brain, confirmed by CT as circumscribed hyperdense punctiform granulations suggesting initial cerebritis. The introduction of liposomal Amphotericin-B in the therapy resulted in a marked improvement of clinical conditions together with the disapparance of pathological brain images. Longitudinal examinations carried out every three months during the first year, and every six months during the second, have shown adequate psychomotor development. The results of late cerebral nuclear magnetic resonance (NMR) imaging were within the norm. The patient is now seven-years-old and shows a well-balanced neuropsychological development. Systemic Candida infections of VLBW infants with CNS involvement have usually a very poor prognosis in terms of death or residual brain damage. The use of liposomal Amphotericin-B allowed us to achieve the complete cure of our patient, suggesting an high efficacy together with at a lower toxicity in respect of traditional treatments.

Amphotericin B↗