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PubMed1995

Prenatal and perinatal influences on long-term psychomotor development in offspring of diabetic mothers.

OBJECTIVE: Our purpose was to assess to what extent disturbances in antepartum maternal metabolism and perinatal complications and morbidities contribute to poorer psychomotor development in offspring of diabetic mothers. STUDY DESIGN: One hundred ninety-six pregnant women and their singleton offspring participated in this prospective cohort-analytic study. Ninety-five women had pregestational diabetes mellitus, and 101 women had gestational diabetes mellitus. Serial estimates of circulating maternal fuels were obtained throughout each index pregnancy along with detailed records of the perinatal course and outcome. Offspring were administered the psychomotor development index of the Bayley Scales of Infant Development at age 2 years and the Bruininks-Oseretsky Test Of Motor Proficiency at ages 6, 8, and 9 years. Tests were performed blinded to the mother's antepartum metabolic status, and perinatal history, and the child's previous test scores. Partial correlations and analyses of covariance were used to control for other influences and confounds, such as family socioeconomic status, racial or ethnic origin, patient group (i.e., pregestational or gestational diabetes mellitus), and sex of child. RESULTS: Children's average score on the Bruininks-Oseretsky test at ages 6 to 9 years correlated significantly with maternal second (p < 0.02) and third trimester (p < 0.001) beta-hydroxybutyrate. There was also a borderline association between the children's scores on the psychomotor development index at age 2 years and maternal third-trimester beta-hydroxybutyrate levels (p = 0.06). No other correlations approached significance. CONCLUSIONS: Intrauterine metabolic experiences continue to influence the neurodevelopmental course in offspring of diabetic mothers. Prevailing practices in diabetes management and obstetric and neonatal care appear to effectively mitigate the potential long-term effects of most perinatal complications and morbidities. Management and obstetric and neonatal care appear to effectively miltigate the potential long-term effects of most perinatal complications and morbidities.

Child↗

PubMed2005

Severe fetal acidemia and subsequent neonatal encephalopathy in the larger premature infant.

The contribution of intrapartum hypoxia-ischemia to neonatal encephalopathy in the larger preterm infant remains poorly defined. Such infants could become potential candidates for neuroprotective strategies. The objective of this study was to determine in preterm infants of gestation 31 to 36 weeks, with severe fetal acidemia (i.e., cord arterial pH < 7.00) the incidence of moderate to severe neonatal encephalopathy as well as the perinatal characteristics that may facilitate early identification. The data of 61 preterm infants of mean birth weight 1998 gm and mean gestation of 33.6 weeks were retrieved. Short-term abnormal neurologic outcome measures included evidence of encephalopathy with or without seizures or neuroimaging abnormalities. Eight (13%) of 61 infants developed an abnormal neonatal neurologic outcome. More infants with abnormal vs normal outcome had 1-minute Apgar of 0, i.e., 4/8 vs 3/53, 5-minute Apgar score </=5 (7/8 vs 17/53), required chest compressions (5/8 vs 6/53), cord pH (6.75 vs 6.90), and base deficit 20 vs 18 (P < 0.05). By multivariate analysis, only gestation was associated with abnormal outcome (P = 0.0003). We conclude that the larger depressed preterm infant is at increased risk for moderate to severe encephalopathy. Such infants could also be considered potential candidates for neuroprotective strategies.

Acidosis↗

PubMed1986

Management of posthemorrhagic hydrocephalus in the preterm infant.

We studied the use of a subcutaneous ventricular catheter reservoir in 19 preterm infants with birth posthemorrhagic hydrocephalus. These infants were a poor risk for insertion of ventriculoperitoneal shunt due to their small size and hemorrhagic ventricular fluid at the time of diagnosis. The age at reservoir insertion was 29 +/- 9 days and the weight was 1,217 +/- 414 g. The reservoir was kept in place for 51 +/- 29 days with the removal of 527 +/- 421 mL of fluid by 57 +/- 42 taps. All infants tolerated the procedure well. Only two infants developed infection despite multiple reservoir taps. One infant expired due to unrelated causes. Three infants did not require a permanent shunt, while 15 infants had a ventriculoperitoneal shunt inserted prior to discharge at 3 to 4 months of age. We conclude that ventricular catheter reservoir is a safe and effective palliative procedure in the management of post hemorrhagic hydrocephalus in small preterm infants.

Apgar Score↗

PubMed2005

Lack of effect of L-carnitine supplementation on weight gain in very preterm infants.

OBJECTIVE: Carnitine transfer across the placenta occurs predominantly during the third trimester. Unless L-carnitine is provided, very preterm infants develop carnitine deficiency. Although breast milk and infant formulas contain L-carnitine, parenteral nutrition solutions do not routinely provide L-carnitine. We hypothesized that prolonged L-carnitine supplementation in very preterm infants would improve weight gain and shorten length of stay in the hospital. STUDY DESIGN: The study was a double-blind parallel placebo-controlled randomized clinical trial. Eligible patients were <29 weeks of gestation, <72 hours of age, and did not have a potentially life-threatening congenital malformation or hereditary metabolic disorder. Patients were stratified by gestational age (23 to 25(6/7) and 26 to 28(6/7) weeks), and randomized to receive, either L-carnitine at a dose of 50 mumol/kg/day, or placebo. Carnitine was provided intravenously until the infants tolerated 16 ml/day of feeds. The sample size was calculated to have 80% power to detect a 10% increase in weight gain from birth until 36 weeks of postmenstrual age or discharge from the hospital. Secondary outcome variables included food efficiency (defined as weight gain divided by caloric intake), weight gain at 4 weeks of age, time to regain birth weight and length of stay. RESULTS: Among the 63 infants enrolled in the trial, 32 were randomized to L-carnitine and 31 to placebo. L-Carnitine supplementation did not significantly affect average daily weight gain from birth until 36 weeks or hospital discharge, or any of the secondary outcome variables. CONCLUSION: Prolonged supplementation of L-carnitine did not improve long-term weight gain in very preterm infants.

Carnitine↗

PubMed2001

An immune hypothesis of sexual orientation.

Sexual orientation is encoded within immune-cell subsets (ICS) of mucosal and epithelial tissues. Gender orientation may be encoded within other ICS. Many immune cells: recognize and react to H-Y and H-X antigens; and enact these perceptions and reactions in accord with the perceiver's and the perceived's MHC haplotype, XX or XY status, and immune-self recognition. Non-heterosexual orientations derive from excessive cross-priming, accompanied by clonal deletions, clonal expansions, anergy and tolerance. For at least some tissues, cross-priming sufficient to induce altered orientations may occur during critical periods of immunological development and can occur during fetal and infant development via maternal-fetal transfusion, placental pathology, and impaired maternal nutrient-status or via excessive peripheral apoptosis during postnatal illness. Mast cell interactions with neurons illustrate how mucosal perceptions can be transduced into neuronal signals that modulate CNS events. This hypothesis is testable by mixed-lymphocyte reactions in appropriate cell subsets. Dendritic-cell immunizations are a potential therapy.

Clonal Anergy↗

PubMed1993

Early colonic damage and invasion of Campylobacter jejuni in experimentally challenged infant Macaca mulatta.

Experimental challenge studies with Campylobacter jejuni were conducted in 3.5-month-old infant Macaca mulatta. One infant monkey (92-1) was challenged with 2.7 x 10(10) cfu of strain 78-37. A second infant was infected intentionally by natural transmission. The infants developed diarrhea 32 h after challenge of infant 92-1. Electron microscopic observations indicate that cell invasion is the primary mechanism of colon damage and diarrheal disease caused by C. jejuni. Intracellular C. jejuni were located in membrane-bound vacuoles and were free in the cytoplasm. Damaged epithelial cells exhibited premature apoptosis and were exfoliated into the lumen of the colon. C. jejuni were also located extracellularly in the mucosa and submucosa. Some cells had dilated endoplasmic reticulum, indicating possible alteration in ion and water transport.

Animals↗

PubMed2004

The Movement Assessment of Infants (MAI) as a predictor of two-year neurodevelopmental outcome for infants born at term who are at social risk.

PURPOSE: This prospective longitudinal study was designed to evaluate whether the four-month Movement Assessment of Infants (MAI), predicted two-year cognitive and motor developmental status measured by the Mental (MDI) and Psychomotor (PDI) Scales of the Bayley Scales of Infant Development (BSID). METHODS: The subjects were 134 infants born at term who were considered at developmental risk due to biological and social risk factors. Different masked examiners assessed the infants at each age. RESULTS: Infants' average MAI total risk scores (MAI TRS) at four months were negatively correlated with their BSID MDI scores (r = -0.23, p = 0.007) but not PDI scores at two years. Infants classified as high risk on the MAI (TRS >13) were approximately three times more likely than infants with a lower risk MAI classification (TRS < or =13) to have a high-risk MDI (< or =84) classification. Lower MAI risk status at four months was a predictor of cognitive functioning falling within normal limits for age (MDI >84) at two years, with 76% negative and 50% positive predictive values. CONCLUSION: The MAI appears to be valid for use with infants born at term who are at risk of developmental delay and may be a useful tool to help clinicians make decisions about intervention services.

Journal Article↗

PubMed1985

Perinatal factors, periventricular haemorrhage and mortality in very low birthweight infants.

In a population of 225 very low birthweight infants born over a 21 month period the cerebroventricular system was scanned by ultrasound. One third of the infants developed a periventricular haemorrhage; in 41% of infants the haemorrhage was detected before an hour of age and 66% of all haemorrhages occurred within the first 24 hours. Statistically significant associations with periventricular haemorrhage included vaginal delivery, endotracheal intubation and intravenous sodium bicarbonate when this was administered in the first 24 hours. In a stepwise regression analysis, however, these and other potentially significant variables added little to the total accountable variance. A similar analysis of perinatal factors and mortality revealed that decreasing gestation was the major association with death.

Bicarbonates↗

PubMed1980

Vitamin D supplements in pregnant Asian women: effects on calcium status and fetal growth.

In a double-blind trial of vitamin D supplements in pregnant Asian women calciferol (ergocalciferol, 1000 IU/day) was administered to 59 women and placebo to 67 controls during the last trimester. The two groups had similar distributions of maternal age, height, parity, number of vegetarians, countries of origin, and sex and gestation of the infants. At entry to the trial maternal serum 25-hydroxy vitamin D (25-OHD) concentrations were low in both treatment and control groups and significantly lower in vegetarians than non-vegetarians. Mothers in the treatment group gained weight faster in the last trimester than those in the control group, and at term they and their infants all had adequate plasma 25-OHD concentrations, Mothers and infants in the control group, however, had low plasma concentrations of 25-OHD and calcium and raised plasma alkaline phosphatase (bone isoenzyme) activity. Five of these infants developed symptomatic hypocalcaemia. Almost twice as many infants in the control group were small for gestational age (29% v 15%), but there were no significant differences between the two groups of infants in antropometric measurements. Infants in the control group, however, had larger fontanelles, suggesting impaired ossification of the skull. Because of the benefits to mothers and infants in the treatment group and the absence of side effects, vitamin D supplements should be given to all pregnant Asian women in the United Kingdom.

Alkaline Phosphatase↗

PubMedDate not supplied

Factors associated with toilet training in the 1990s.

CONTEXT: Few studies have systematically evaluated the factors influencing toilet training in children with normal development. OBJECTIVES: To determine those child, parent, and environmental factors associated with toilet training completion, focusing on the influence of the child's temperament and development. DESIGN AND SETTING: Cross-sectional descriptive study of normal children, ages 15-42 months, attending 1 of 4 pediatric clinics in Milwaukee in 1995 and 1996. METHODS: Demographics for child, parents, and household were surveyed. Temperament was assessed using the Toddler Temperament Scale and the Behavioral Style Questionnaire. Child development was measured using the Bayley Scales of Infant Development II. MAIN OUTCOME MEASURE: Toilet training status was by parental report and was categorized as not trained, not currently training, in training, or training complete. RESULTS: The study population included 496 children, comprising 219 that had not started training, 70 that were not currently training, 148 that were in training, and 59 that were completely trained. The ages at which 50% of the children were predicted to be toilet trained were 35 and 39 months for girls and boys, respectively. In the multivariate regression model, statistically significant factors best predicting toilet training completion were older age, non-Caucasian race, female gender, and single parenthood. Temperament, development, maternal employment, or use of day care were not statistically significant factors. CONCLUSION: Innate factors such as older age, non-Caucasian race, and female gender are the best predictors of completing toilet training (rather than a child's temperament and developmental stage). Day care and maternal employment appear to be unimportant variables. Parents should not be discouraged, because children are completing toilet training at older ages. Research is needed to discover why single parents are more successful at toilet training.

Age Factors↗

PubMed2003

Phase 1 trial of prevention of hydrocephalus after intraventricular hemorrhage in newborn infants by drainage, irrigation, and fibrinolytic therapy.

OBJECTIVE: Treatment of posthemorrhagic ventricular dilation in premature infants is fraught with failures and complications. We have piloted a new treatment aimed at removing intraventricular blood and the cytokines associated with hydrocephalus. METHODS: Twenty-four infants were enrolled with ventricular width enlarged to 4 mm over the 97th centile after a large intraventricular hemorrhage. Sixteen had parenchymal brain lesions before treatment. Median gestation was 28 weeks, and birth weight was 1150 g. At a median postnatal age of 17 days, 2 ventricular catheters (1 right frontal, 1 left occipital) were inserted with 13 infants also having a reservoir frontally. Tissue plasminogen activator 0.5 mg/kg was given intraventricularly 8 hours before the ventricles were irrigated with artificial cerebrospinal fluid at 20 mL/h for a median of 72 hours. RESULTS: Seventeen of 23 survivors (74%) did not require a ventriculoperitoneal shunt. One infant (of 23 weeks' gestation) died. Two infants developed reservoir-associated infection, and 2 infants had a second intraventricular hemorrhage. Of the 19 survivors aged >12 months postterm, 8 were normal, 7 (37%) had single disability, and 4 (21%) had multiple disabilities. CONCLUSIONS: Shunt surgery was reduced compared with historical controls with similar treatment criteria. Mortality and single and multiple disability rates all showed downward trends. Reducing pressure, free iron, and proinflammatory and profibrotic cytokines may reduce periventricular brain damage and permanent hydrocephalus. Additional advances will require a controlled trial and better knowledge of the mechanisms of hydrocephalus.

Brain Damage, Chronic↗

PubMed1994

Neurobehavioral assessment of high-risk infants in the neonatal intensive care unit.

Neurobehavioral organization describes infants' abilities to organize themselves within their central nervous system maturation and environment. As part of infants' environment, caregivers can structure the environment to support infants' development. Care of the high-risk infant emphasizes support of infants' emerging neurobehavioral organization. This article describes the theoretical rationale of neurobehavioral organization, effect on the infant and family, and assessments available to the neonatal occupational therapist for use with high-risk infants. Information gained via neurobehavioral assessment can be used to engage parents in better understanding their infant's behaviors and interact at a level appropriate with their infant.

Child Behavior Disorders↗

PubMed1989

The effect of initial operative repair on the recovery of intestinal function in gastroschisis.

Recent reports concerning the treatment of gastroschisis suggest that primary closure results in more rapid return of gastrointestinal function, a shortened hospitalization, diminished perinatal complications, and improved long-term survival. A 4-year retrospective review of infants treated for gastroschisis at the University of Florida yielded 30 infants requiring repair of this abdominal wall defect. The series included 19 males and 11 females, and the average abdominal wall defect measured 4 cm in its greatest dimension. Nine infants (mean weight, 2,275 gm) were repaired using a staged closure using a silastic (six) or cutaneous (three) silo. Complete fascial closure was accomplished in an average of 8 days in the silastic group and 15 days in the infants with skin flaps. Mean age at start of enteral feeds was 23 days, with complete oral feedings at 43 days. Twenty-one infants (mean weight, 2,127 gm) underwent primary fascial closure. Three deaths occurred in the perioperative period: one from acute renal failure and two from sepsis secondary to a segment of necrotic intestine. An additional infant developed postoperative necrotizing entercolitis but recovered. Two infants in this group also had jejuno-ileal atresia requiring extensive small bowel resection. In the remaining 15 infants, oral alimentation was initiated for an average of 23 days, with full oral alimentation at 46 days. The data suggest that the recovery of the gastrointestinal system, adequate enough to support total oral alimentation, is unrelated to the initial surgical procedure chosen to obtain fascial closure in the newborn with gastroschisis. In addition, vigorous attempts at primary fascial closure may jeopardize intestinal viability, diminish ventilatory function, and result in unnecessary morbidity and mortality.

Abdominal Muscles↗

PubMed1987

[Balloon dilatation of congenital aortic stenoses].

Percutaneous balloon valvuloplasty was performed between 1984 and 1987 on 27 occasions in 25 patients with congenital aortic valve stenosis. Eight infants underwent ten dilatation procedures (two redilatations included); seven of these eight infants had critical aortic valve stenosis and one infant asymptomatic severe valve stenosis. One additional 5-day-old newborn died after left ventricular perforation, probably caused by the exchange wire during cardiac catherization immediately before valvuloplasty, despite emergency operation. The transvalvular pressure gradient was reduced in these eight infants from 73 +/- 5 to 36 +/- mmHg (p less than 0.01). Five infants were restudied after an interval of 3-6 months and redilatation performed in two patients with residual stenosis. One infant developed mild aortic incompetence and in one infant, mild aortic regurgitation following commissurotomy did not increase after two dilatation procedures at the age of 2 and 7 months. No aortic regurgitation was noted in the remaining 6 infants after dilatation. Valvuloplasty was also performed in 16 children and adolescents (4-25 years old, mean age 13 +/- 6 years) using balloons with inflated diameters 1 to 3 mm smaller than the aortic valve ring (15 single balloons, 1 trefoil balloon). Peak systolic pressure gradient decreased from 93 +/- 25 to 49 +/- mmHg (p less than 0.01). Mild aortic regurgitation was present in six patients (three following surgery) before dilatation and remained unchanged in five patients. In one patient, aortic incompetence increased slightly after valvuloplasty. Ten patients showed no evidence of aortic regurgitation after dilatation. Embolectomy of the femoral artery was performed in two patients 1-3 days after valvuloplasty. No further complications occurred.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1980

Gram-negative sepsis in neonates: a nursery outbreak due to hand carriage of Citrobacter diversus.

An outbreak of Citrobacter diversus infections occurred in a newborn nursery at a 350-bed community hospital during September and October 1978. Two infants developed sepsis and meningitis and nine additional infants had asymptomatic umbilical colonization. These infants did not differ from control, noncolonized infants with respect to numerous clinical and environmental variables. Surveillance cultures failed to implicate an environmental source for the Citrobacter. However, cultures of nursery personnel identified a hand-carrier whose removal eliminated neonatal colonization with C diversus and decreased the number of isolates of certain other enteric bacteria found on umbilical stumps. Factors implicated in the perpetuation of the carrier state in this nurse included marked dermatitis from repeated hand washing and hand care practices involving the overnight use of plastic gloves and nutritive hand cream. The mode of transmission within the nursery appeared to be from nurse's hands to infant's umbilicus. Use of triple dye on umbilical stumps and chlorhexidine hand washing preparations did not eliminate this cycle. Surgical manipulation of colonized umbilical stumps may have been responsible for illness in two infants.

Carrier State↗

PubMed2003

Developmental outcome at 18 and 24 months of age in very preterm children: a cohort study from 1996 to 1997.

OBJECTIVE: To determine the effect of prematurity (gestational age (GA) < 32 weeks) on developmental outcome at the corrected age of 18 and 24 months in a regionally defined, prospective cohort study. STUDY DESIGN: The Leiden Follow-Up Project on Prematurity (LFUPP) includes all live-born infants < 32 weeks GA, born in 1996/1997 in three Dutch health regions (n=266). Mental and psychomotor developmental indices (MDI, PDI) were determined with the Bayley Scales of Infant Development I: > or = -1 S.D.: normal, -2 to -1 S.D.: moderate delay and < -2 S.D.: severe delay. RESULTS: At 18 months 168 (71%) and at 24 months, 151 children (64%) of 235 survivors were assessed. Moderate to severely delayed mental and/or psychomotor development occurred in 40% of the children at both ages. Children lost to follow-up were of lower socioeconomic status and more frequently of non-Dutch origin. Since non-Dutch origin negatively affected the outcome at both test ages, availability of the data of these children would probably have worsened the outcome. Postnatal treatment with dexamethasone was associated with an increased risk of delayed development. Other independent predictors of delayed development were bronchopulmonary dysplasia at 18 months and ethnicity, maternal age at birth, birthweight and gender at 24 months. After adjustment for these other predictors of delayed development, the mean PDI of dexamethasone-treated infants was 16.1 points lower than of non-treated infants at 18 months (p=0.03) and 12.7 points lower at 24 months (p=0.04). CONCLUSIONS: At 18 and 24 months corrected age, 40% of the very prematurely born children had both delayed mental and/or psychomotor development. Treatment with dexamethasone postnatally was a major risk factor for delayed (psychomotor) development.

Adult↗

PubMed1996

Dynamics of viral replication in infants with vertically acquired human immunodeficiency virus type 1 infection.

About one-third of vertically HIV-1 infected infants develop AIDS within the first months of life; the remainder show slower disease progression. We investigated the relationship between the pattern of HIV-1 replication early in life and disease outcome in eleven infected infants sequentially studied from birth. Viral load in cells and plasma was measured by highly sensitive competitive PCR-based methods. Although all infants showed an increase in the indices of viral replication within their first weeks of life, three distinct patterns emerged: (a) a rapid increase in plasma viral RNA and cell-associated proviral DNA during the first 4-6 wk, reaching high steady state levels (> 1,000 HIV-1 copies/10(5) PBMC and > 1,000,000 RNA copies/ml plasma) within 2-3 mo of age; (b) a similar initial rapid increase in viral load, followed by a 2.5-50-fold decline in viral levels; (c) a significantly lower (> 10-fold) viral increase during the first 4-6 wk of age. All infants displaying the first pattern developed early AIDS, while infants with slower clinical progression exhibited the second or third pattern. These findings demonstrate that the pattern of viral replication and clearance in the first 2-3 mo of life is strictly correlated with, and predictive of disease evolution in vertically infected infants.

DNA, Viral↗

PubMed1977

Two outbreaks of Flavobacterium meningosepticum type E in a neonatal intensive care unit.

Two separate outbreaks due to Flavobacterium meningosepticum type E occurred in a neonatal intensive care unit in March-April and July 1975. The first outbreak involved all five infants in the unit. Two infants developed meningitis, one had bacteremia, and two were colonized. During the second outbreak, five of seven infants were colonized but none developed disease. The upper respiratory tract was colonized first in most instances, and the organism persisted at this site for a mean of 17.3 days. Duration of colonization was more prolonged in infants receiving antibiotics than in untreated infants. Extensive environmental surveillance failed to demonstrate a reservoir, however, F. meningosepticum was recovered from three nasoendotracheal tubes and from an aerosol tube before colonization of four infants. The organism was resistant to most antimicrobial colonization of four infants. The organism was resistant to most antimicrobial agents tested and developed resistance to others during the treatment course of one infant. Although F. meningosepticum was not recovered from cultures of transport vehicles, several other gram-negative bacteria were isolated and were also resistant to multiple antibiotics.

Anti-Bacterial Agents↗