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PubMedDate not supplied

Absent pulmonary valve syndrome diagnosed by fetal echocardiography.

Prenatal echocardiographic diagnosis of heart defects is important because it permits counseling of the parents with regard to prognosis and treatment options and prepares the medical team for the treatment postnatally. A male infant with absent pulmonary valve syndrome diagnosed prenatally at 22 weeks' gestation is reported. This congenital anomaly is characterized by absent or rudimentary pulmonary valve cusps, conoventricular septal defect, and massive dilatation of the pulmonary arteries. Soon after delivery the infant developed cyanosis and respiratory distress. The infant was placed in prone position for the relief of bronchial compression and nasal continuous positive airway pressure was (CPAP) started. Although the clinical status of the infant improved after supportive treatment, he deteriorated acutely and died at the age of five days. Fetal diagnosis remains an integral part of successful management of children with heart disease. Despite the potential benefits of prenatal diagnosis, it is hard to show significant improvement in mortality, especially in severely affected cases.

Adult↗

PubMed1990

Side effects and long-term follow-up of corticosteroid therapy in very low birthweight infants with bronchopulmonary dysplasia.

Seventy-seven very low birthweight (VLBW) infants (mean birthweight 891 +/- 209 g) with a diagnosis of bronchopulmonary dysplasia (BPD) were treated with a steroid (dexamethasone) in an attempt to wean them from mechanical ventilation. Seventeen of 77 (22%) treated infants died. Death from respiratory failure occurred in 13 infants; sepsis occurred in six infants (7.8%) and contributed to death in one. During steroid therapy systemic hypertension occurred in 18 surviving infants (30%), glucose intolerance occurred in 29 infants (38%), and marked irritability occurred in three infants (3.8%). Elevated blood pressure returned to normal and glucose intolerance resolved in all infants following discontinuation of therapy. Fifty infants were available for follow-up at a mean corrected age of 14.9 +/- 9.8 months. Twenty-two percent required rehospitalization in the first year of life for respiratory illnesses. Results of testing by Bayley Scales of Infant Development were normal in 60% of infants. Fifty percent were considered normal based on both developmental testing and physical examination. Twenty-eight percent had mild to moderate abnormalities, and 22% were severely handicapped. These follow-up results are statistically similar to those recorded in LBW infants with BPD not treated with steroids who were hospitalized during the same period. We conclude that the side effects of steroid therapy for BPD consist primarily of blood pressure elevation, glucose intolerance, and irritability. Causes of death are unchanged by steroids. The incidence of severe infection and the long-term neurologic outcome of high-risk infants with BPD are not appreciably compromised by this therapy. These data suggest that concern for steroid side effects should not prevent additional prospective investigation to determine the role of steroid therapy in the overall management of BPD.

Blood Glucose↗

PubMed1975

Assisted ventilation in infants with meconium aspiration syndrome.

In a retrospective analysis of infants born with meconium staining over an 18-month period at Cook County Hospital, 32 infants met two of the three criteria for the diagnosis of meconium aspiration syndrome: (1) history of meconium in the oropharynx or trachea; (2) clinical evidence of respiratory distress; and (3) x-ray evidence of aspiration pneumonia. Seventeen infants developed respiratory failure; nine of these infants died. One infant without respiratory failure died of sepsis. Analysis of sequential arterial blood pH and gas tension showed that nonsurviving infants had persistently high PCO2 and A-a gradient in spite of initiation of assisted ventilation. These changes seem to be related to severe right-to-left shunting and ventilation perfusion abnormalities. The data further suggest that asphyxia and acidosis occur well before the infant is born and that intrapartum monitoring to recognize fetal asphyxia may help in improving morbidity and mortality from meconium aspiration syndrome.

Blood Gas Analysis↗

PubMedDate not supplied

[Care of the newborn infant with respiratory distress syndrome using continuous negative pressure. 5 years' experience].

Continuous Negative Pressure (CNP) was utilized as sole form of respiratory assistance in the treatment of 40 newborn infants with Respiratory Distress Syndrome (RDS). The average duration of CNP therapy was less than 7 days in all cases. 38 of these infants survived without sequelae (95%); an infant developed severe bronchopulmonary dysplasia (2.5%); another infant died from intracranial hemorrhage (2.5%). CNP appears to be an effective respiratory support in the treatment of neonatal RDS, when used early in spontaneously breathing infants weighing greater than 1500 grams.

Bronchial Diseases↗

PubMed1985

Clinical, laboratory, and environmental features of infant botulism in Southeastern Pennsylvania.

Forty-four cases of botulism occurred in infants in Southeastern Pennsylvania between 1976 and 1983. Forty-three were caused by Clostridium botulinum type B. Progressive weakness necessitated ventilatory support in 39 infants. Complications during hospitalization included otitis media in 13 patients and aspiration pneumonia in 11. Eight infants developed the syndrome of inappropriate secretion of antidiuretic hormone and two developed adult respiratory distress syndrome. One infant died of progressive bradycardia despite adequate control of ventilation. Manifestations of autonomic nervous system dysfunction recognized on admission to the hospital were constipation, distention of the urinary bladder, and decreased salivation and tearing. During hospitalization, some infants had unexpected fluctuations of skin color, blood pressure, and heart rate. Infants' strength improved despite persistent intestinal elaboration of toxin. C botulinum was isolated from seven of nine home or work environments sampled. All 44 infants were white and were receiving breast milk at the time of onset of symptoms. The majority had first feedings of nonhuman food substances within 4 weeks prior to onset of symptoms. Delineation of fecal flora in seven infants revealed predominance of enterobacteriaceae. Perturbations of intestinal flora during infancy, especially at weaning, may cause transient permissiveness to colonization by C botulinum.

Botulinum Toxins↗

PubMed1995

[Slow development of multiorgan tuberculosis in an infant].

Slowly developing tuberculosis in a BCG-vaccinated infant was analysed in a 2-month-old child suffering from cervico-lymphadenitis. It was diagnosed after 8-months period of non-specific treatment as tuberculosis. Further observation revealed severe forms of disease-miliary tuberculosis and meningoencephalitis. Familial contact with tuberculosis was established. The outcome after 9 months of anti-tuberculosis therapy was successful.

Humans↗

PubMed1997

Parenting the prematurely born child.

The purpose of this chapter is to summarize the findings of the nursing research on parenting the prematurely born child. This research focused on eight general areas: impact of the home environment on infant development status, the relationship between premature infants and their mothers during the first 2 years, parenting during hospitalization, maternal concerns about infant discharge, fathering, subpopulations of premature infants, parenting after the first 2 years, and interventions to improve parenting. There is a need to strengthen the design and conceptualization of these studies, to move toward more intervention research, and to do research that is more culturally sensitive, especially toward fathers, ethnic and cultural minority groups, and the poor.

Child↗

PubMed1982

Influence on retrolental fibroplasia of intramuscular vitamin E administration during respiratory distress syndrome.

The effect of vitamin E administered during the acute phase of therapy for respiratory distress syndrome (RDS) on the development of retinopathy of prematurity (ROP) was evaluated in a randomized double-masked study. One hundred neonates received either vitamin E or placebo intramuscularly within the first 24 hours of birth and at 24, 48, and 168 hours respectively. Additional doses were given twice weekly while the infant remained in an oxygen-enriched environment and could not tolerate feedings and vitamin supplements. Parenteral vitamin E-treated infants had significantly increased serum vitamin E levels compared to placebo-treated infants. Most placebo-treated patients attained normal serum vitamin E levels during the second week of life because of nutritional sources of vitamin E. Infants in both groups had RDS of similar severity. Seventy-four infants, 37 vitamin E-treated and 37 placebo-treated, survived longer than 10 days and had ophthalmologic examinations. Active changes of Stage I and Stage II ROP were noted in 17 of those patients; 9 (24.3%) vitamin E-treated and 8 (21.6%) placebo-treated patients (P = 0.572). No infants developed severe cicatricial changes, and their retinal findings regressed. The incidence of risk factors associated with ROP development occurred equally in the vitamin E-treated and placebo-treated infants that developed ROP. Thus, vitamin E-administration as described in this study did not result in any further reduction in the incidence of the active stages of ROP over that seen with standard neonatal care, which included daily oral Vitamin E supplements.

Clinical Trials as Topic↗

PubMed2004

[Psychological condition of children from pregnancies after assisted reproduction in the third year of life].

OBJECTIVE: To analyse psychological development of children born after assisted reproductive technology. DESIGN: Psychological analysis of the child's development related to the technology of assisted reproduction, length of pregnancy and multiple birth was performed and compared with the control group. SETTING: Institute for the Care of Mother and Child, Prague. METHODS: Out of the total number of 123 children born after assisted reproductive technology during the 1st half of the year 1998 in the Center ISCARE IVF, psychological development was evaluated in 109 children (88.6%). Ninety four children from this sample were assessed using mental, motor and behavior scales of the Bayley Scales of Infant Development II. RESULTS: Mental and motor development of infants born after intracytoplasmatic injection (ICSI) and after in-vitro-fertilisation (IVF) was not significantly different. Fullterm singletons born after assisted reproductive technology did not differ from control fullterm children. There was a developmental delay in both fullterm and preterm children from multiple pregnancies in comparison to control children. No child had serious impairment of psychic functions (developmental index <50). There were no significant differences in behavior records between children born after assisted reproductive technology and control children, but some parents had problems in educational care of their children born after assisted reproductive technology. CONCLUSION: From children born after assisted reproductive technology, those from multiple pregnancies may be at risk for later psychological development. The occurrence of educational problems in assisted reproductive families indicates a need of accessible professional care in this field.

Adult↗

PubMed1996

Growth and development in preterm infants receiving fluoroquinolones.

Growth and development were followed in 7 preterm newborn infants who received fluoroquinolones in the neonatal period. Quinolones were used as a "life saving" therapy in cases of sepsis caused by bacterial agents sensitive only to these drugs. Two other groups of neonates matched for gender, birth weight and gestational age served as controls. Although the quinolone group had more severe illness, no statistically significant differences were observed in growth and development between the groups. No osteoarticular problems or joint deformities were observed in the quinolone group. Therefore, quinolones could be a therapeutic option for newborns with sepsis caused by multiply resistant organisms.

Anti-Infective Agents↗

PubMed2006

Increased energy intake for preterm infants with (or developing) bronchopulmonary dysplasia/ chronic lung disease.

BACKGROUND: Preterm infants with bronchopulmonary dysplasia/chronic lung disease have nutritional deficits that may contribute to short and long term morbidity and mortality. Increasing the daily energy intake for these infants may improve their respiratory, growth and neurodevelopmental outcomes. OBJECTIVES: To assess the effect of increased energy intake on mortality and respiratory, growth and neurodevelopmental outcomes for preterm infants with (or developing) CLD/BPD. Secondarily, the review examines any adverse effects associated with increased energy intake. SEARCH STRATEGY: The standard search strategy of the Cochrane Neonatal Review Group was used. This included searches of the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 1, 2006) , MEDLINE (accessed via Ovid), references cited in previous relevant Cochrane reviews and in other relevant studies, review articles, standard textbooks, and manuals of neonatal medicine. Hand search results of the Cochrane Neonatal Review Group were also assessed. SELECTION CRITERIA: All randomized and quasi-randomized trials comparing the outcomes of preterm infants with (or developing) CLD/BPD who had either increased (> 135 kcal/kg/day) or standard energy intake (98 to 135 kcal/kg/day). Increasing energy intake might be achieved enterally and/or parenterally, enterally by increasing the energy content of the milk, increasing feed volume, or by nutrient supplementation with protein, carbohydrate or fat. The primary outcomes were the development of CLD and neonatal mortality; secondary outcomes included respiratory morbidities, growth, neurodevelopmental status and possible complications with increased energy intake. DATA COLLECTION AND ANALYSIS: We planned to extract data using the standard methods of the Cochrane Neonatal Review Group. Relevant trials would be scrutinized for methodological quality independently by the reviewers to determine their eligibility for inclusion. Data of the included trials would be expressed as relative risk, risk difference, NNT and weighted mean difference where appropriate, using a fixed effect model. MAIN RESULTS: No eligible trials were identified. Twelve studies that appeared to be relevant were excluded, as no study directly compared increased versus standard energy intakes in infants with CLD/BPD. However, two excluded trials provided some insights into the topic. One study showed that infants with CLD/BPD who were fed formula enriched with protein and minerals had improved growth parameters up until the cessation of the intervention at three months of corrected age. The other study compared different energy density of formula but identical energy intake by setting different feed volumes for both groups. It showed that both groups were unable to achieve the pre-designated feed volumes, and that there were no differences in growth, respiratory outcomes, oedema and the diuretic requirements. AUTHORS' CONCLUSIONS: To date, no randomized controlled trials are available that examine the effects of increased versus standard energy intake for preterm infants with (or developing) CLD/BPD. Research should be directed at evaluating the effects of various levels of energy intake on this group of infants on clinically important outcomes like mortality, respiratory status, growth and neurodevelopment. The benefits and harms of various ways of increasing energy intake, including higher energy density of milk feed and/or fluid volume (clinically realistic target volume should be set), parenteral nutrition, and the use of various constituents of energy like carbohydrate, protein and fat for this purpose also need to be assessed.

Bronchopulmonary Dysplasia↗

PubMed1984

Maternal-infant interactions at one-year adjusted age in infants at low- and high-risk as newborns.

To compare maternal-infant interactions in high- and low-risk groups, we observed infants who had required neonatal intensive care and otherwise similar infants with normal perinatal histories in a follow-up clinic at one year adjusted age. The developmental level as assessed by the Bayley Scales of Infant Development was significantly lower for the high-risk infants than for the control infants at one year of age. Principal component analyses were used to define interaction patterns in each of five situations. Principal component analyses allow a more meaningful analysis of interrelated maternal and infant behaviors than do standard statistical analyses and minimize the likelihood of misleading 'significant' findings resulting from multiple comparisons. Prior to being examined, mothers of control infants were more likely to adopt an 'en face' position, play with, comfort, talk to, and smile at their infants than were mothers of high-risk infants. Control infants were more likely to smile in return. These differences between control and high-risk mother-infant dyads disappeared when the infants' developmental level was statistically controlled. Group differences in maternal-infant interactions independent of the infants' developmental level were observed in only one situation (collection of blood). Specific medical risk factors had little relation to findings at one year. Maternal-infant interaction should be interpreted in relation to the postconceptional and developmental age as well as the postnatal age of the infant.

Child Behavior↗

PubMed2003

The effect of neonatal sepsis on bone turnover in very-low birth weight premature infants.

Neonatal sepsis is very common in preterm infants, and severe morbidity during the neonatal period is a major cause of osteopenia of prematurity. We examined the effect of neonatal sepsis on bone turnover markers in premature infants. Twenty-four premature infants participated in the study. Ten of the premature infants developed sepsis during their hospitalization in the neonatal intensive care unit (mean gestational age [GA] 27.3 +/- 0.4 weeks; mean birth weight [BW] 898 +/- 82 g). Fourteen infants who did not develop sepsis served as controls (GA: 26.8 +/- 0.8 weeks, BW: 892 +/- 66 g). Blood samples for bone turnover markers were collected during the initial sepsis workup, and at the end of the first week of treatment, and were compared to the corresponding weekly changes in bone markers in the controls. In addition, samples were collected at the end of the 10th week of life to determine long-term effects of sepsis on bone turnover. Bone osteoblastic activity was assessed by measurements of circulating osteocalcin, bone-specific alkaline phosphatase (BSAP) and the C-terminal procollagen peptide (PICP) levels. Bone resorption was assessed by measurements of circulating carboxy terminal cross-links telopeptide of type I collagen (ICTP). There were no significant differences in the weekly changes of all bone turnover markers in premature infants who developed or did not develop sepsis. No significant differences were found in bone turnover markers at the age of 10 weeks between the groups. Neonatal sepsis in premature infants was not associated with biochemical evidence of reduced bone turnover.

Alkaline Phosphatase↗

PubMedDate not supplied

Parents' report of sensory responsiveness and temperament in preterm infants.

OBJECTIVES: Although most infants born prematurely do not have major developmental problems, those with perinatal medical problems and lengthy stays in the neonatal intensive care unit are at risk for sensory modulation problems and developmental sequelae. This study compared sensory responsiveness in preterm and full-term infants and examined the relationship of sensory responsiveness to temperament and developmental function. METHOD: Caregivers of infants with (n = 45) and without (n = 22) prematurity were asked to complete the Sensory Rating Scale. The preterm infants were also evaluated with the Bayley Scales of Infant Development, Second Edition (BSID-II). RESULTS: The preterm infants exhibited more frequent behaviors indicating tactile defensiveness and difficult temperament than did the full-term infants. When specific items were examined, the preterm infants displayed sensory-seeking behaviors and high activity levels. As measured by caregivers' report, sensory responsiveness was significantly related to temperament. It was not related to BSID-II Mental and Psychomotor scale scores. CONCLUSION: This study supports the findings of others that preterm infants have mild problems in sensory responsiveness and temperament. Correlational results do not support a definitive relationship between parents' reports of their infants' sensory responsiveness and developmental function.

Child↗

PubMed2002

Facial appearance and attachment in infants with orofacial clefts: a replication.

OBJECTIVE: The current study sought to replicate an unexpected finding reported by: relatively unattractive infants at age 3 months were more likely than attractive infants to show secure maternal attachment at age 12 months, a finding unaffected by the diagnosis of cleft lip and palate (CLP), cleft palate only (CPO), or the absence of a cleft condition. DESIGN: We evaluated the effects of diagnosis (CLP, CPO, or no diagnosis) and age (3, 12, and 24 months) on facial attractiveness ratings derived from a modified Q-sort method. SETTING: Craniofacial clinic in an urban children's hospital. PARTICIPANTS: Infants with CLP and CPO and typically developing infants without clefts (n = 126) and their mothers. Ratings were made by 13 adults unfamiliar with cleft conditions. MAIN OUTCOME MEASURES: Facial attractiveness ratings. RESULTS: Infants with CLP were rated as the least attractive at all time points. At ages 12 and 24 months, infants in the CPO group were rated as less attractive than typical infants but more attractive than infants in the CLP group. Typical infants and those with CLP-but not CPO-received higher attractiveness ratings with age. As hypothesized, less attractive infants, regardless of diagnosis, were more likely to show secure attachment than were more attractive infants. CONCLUSIONS: We tentatively conclude that the perceived vulnerability of young infants, as indexed by atypical or unattractive facial characteristics, engenders extraordinary protectiveness and responsiveness in some mothers, leading to a higher probability of secure attachment. A test of this hypothesis with a new sample of infants is recommended.

Adult↗

PubMed1983

The impact of temporally patterned stimulation on the development of preterm infants.

To test the efficacy of temporally patterned kinesthetic and auditory stimulation for promoting development of infants born prior to term, 88 preterm infants, below 35 weeks gestation, were assigned to 1 of 4 experimental or control groups. Control subjects received regular hospital care; fixed interval subjects received 15 min of rocking/heartbeat stimulation each hour; self-activating subjects received 15 min rocking/heartbeat when inactive for 90 sec, but only for 1 stimulation period per hour. Assessments included measures of neurological functioning, sleep-wake activity, mother-infant interaction, and mental and motor development at 8 and 24 months. All experimental infants, compared to controls, showed decreased rates of activity while in the hospital, fewer abnormal reflexes, and better orienting responses. At 24 months, experimental infants scored significantly higher on the Mental Development Index of the Bayley Scales. Few differences were found in parent-infant interaction patterns. The results indicate that both temporal patterning and contingent responsiveness in the preterm infant's early environment contribute positively to some aspects of the development of such infants.

Acoustic Stimulation↗

PubMed2003

Mental health of parents caring for infants.

The postpartum period is a sensitive time due to the presence and demands of the developing infant. The care provided by a mother to her infant during this period may be compromised if she is suffering from postnatal depression or postpartum psychosis. Evidence has been emerging which suggests that postnatal depression and postpartum psychoses have adverse effects on the quality of the mother-infant relationship and also on the infant's subsequent cognitive and emotional development. Presented is a review of the literature relating to how these conditions impact on parenting and infant outcomes, what measures are in place to detect these conditions and evidence-based models of best clinical practice are proposed.

Adult↗

PubMed1994

Incidence of bronchopulmonary dysplasia during an 11-year period in infants weighing less than 1500 g at birth.

We studied the occurrence of bronchopulmonary dysplasia (BPD) during an 11-year period in infants weighing less than 1500 g at birth and looked for differences between the periods 1980-1985 (216 infants) and 1986-1990 (217 infants). During the neonatal period, 91 infants died, which gives a neonatal survival rate of 79%. Forty-nine infants developed BPD, which is 11% of all infants and 14% of the infants surviving the neonatal period. The incidence of BPD did not change during the two study periods (11.6% and 11.1%). On the other hand, the study populations changed in many respects. The number of infants with a birth weight of less than 1000 g increased, the incidence of severe RDS increased, and infant mortality decreased. Hence, there was a small decrease in the incidence of BPD in infants surviving the neonatal period from 14.9% to 13.8%. Severe RDS and a birth weight of less than 1000 g were clearly related to the development of BPD. In these two risk-groups the decrease in the incidence of BPD in neonatal survivors was pronounced.

Birth Weight↗