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PubMed1995

Management of premature infants with extensive bowel resection with high volume enteral infusates.

To avoid long-term parenteral nutrition (PN), three premature infants with extensive bowel resections were fed high volume enteral infusates (HVEI). Following surgery an elemental hypo-osmolar gastric infusate was initiated. The infants were weaned of PN and were subsequently maintained on HVEI feeding. Rather than using the volume of the ileostomy outputs or the presence of reducing substances as guides for adjustment of enteral intake, we tolerated large ileostomy output and focused instead on the patients' hydration, serum electrolytes and acid base status. During HVEI feeding, the patients had sustained weight gain, while the mean +/- SD enteral intakes were 373 +/- 67, 689 +/- 132, and 415 +/- 108 ml/kg per day; osmolarity of enteral infusates were 250 +/- 25, 225 +/- 40 and 228 +/- 27 mosmol/l; caloric intakes were 163 +/- 29, 258 +/- 54, and 153 +/- 44 Kcal/kg per day; and ileostomy outputs were 113 +/- 47, 228 +/- 59, and 175 +/- 69 ml/kg per day, respectively. Gut adaptation lasted 122, 141, and 205 days, respectively. Re-anastomoses of the intestines were performed at the ages of 8, 78, and 36 months. At 18, 108, and 58 months, infants' weights were in the 50th, 20th, and 5th percentiles, respectively. No infant developed cirrhosis. High volume enteral infusate feeding in infants with extensive bowel resection may help achieve gut adaptation and may serve as an alternative nutrition modality to prolonged PN.

Acid-Base Equilibrium↗
PubMed1998

Correlation between neonatal cranial ultrasound, MRI in infancy and neurodevelopmental outcome in infants with a large intraventricular haemorrhage with or without unilateral parenchymal involvement.

UNLABELLED: During a 7-year-period, 1625 infants of 34 weeks gestation or less were enrolled in a prospective ultrasound (US) study. One hundred and eleven (6.8%) infants developed a large intraventricular haemorrhage (IVH) with or without unilateral parenchymal involvement (PI). Fifty-six of these 111 infants survived (50.4%) and in 23 (41%) of them a magnetic resonance imaging (MRI) study was performed beyond 12 months corrected age. There appeared to be a good agreement between neonatal ultrasound findings and MRI changes noted in infancy. Of the 10 cases with a large IVH without PI (group A), seven had a VP shunt with complete decompression of previously enlarged ventricles. Six of these seven infants had periventricular hyperintensity (PVHI) but none developed cerebral palsy (CP). Two of the ten cases without a VP shunt had irregular ventricular enlargement (VE) with PVHI in one. Both developed CP. Seven cases showed thinning of the corpus callosum. Of the 13 cases with a large IVH associated with PI (group B), the site of the PI could still be recognised on MRI and the degree of communication of the porencephalic cyst (PC) with the lateral ventricles correlated well with neonatal US findings. On MRI, VE was present in only 6 cases. Wallerian degeneration was present in 9/13 infants and all but one developed a hemiplegia. In 12/13 cases there was thinning of the corpus callosum, either focal or diffuse. PVHI was present in all infants. In 6/13 PVHI was only present around the PC. Neurodevelopmental outcome differed for both groups. CP was only present in 2/10 infants in group A, compared to 11/ 13 in group B. Global delay, in the absence of CP, was more common in infants with a large IVH than in those with associated PI. CONCLUSION: Combining neonatal US with MRI in infancy enhances our understanding of the long-term effects of severe haemorrhagic brain lesions, occurring in preterm infants.

Brain↗
PubMed1989

Prospective study of community-acquired rotavirus infection.

We determined titers of group A rotavirus common antibodies and neutralizing antibodies against serotypes 1 to 4 of prototype human rotavirus (HRV) in cord blood and serum specimens obtained from 38 infants at 4-month intervals from birth until 2 years of age. Nineteen of the infants developed one episode of HRV diarrhea each, and they were matched by age and birth weight with the other 19 infants, who did not develop HRV diarrhea during the follow-up period. We estimated the incidence rate of HRV infection for the two groups of infants combined to be a minimum of 1.34 episodes per infant per year, which is 22 times more common than the occurrence of overt disease caused by the virus in this community. The infection occurred constantly throughout the first 2 years of infancy, whereas all but one of the 19 episodes of overt disease occurred before 12 months of age. Seven of these overt episodes were preceded by at least one episode of subclinical infection earlier, and the other seven were probably due to primary HRV infection. The remaining five episodes occurred before 4 months of age, so that we could not ascertain whether they were due to primary infections because of the presence of maternal antibodies. We showed that levels of HRV antibodies in serum specimens obtained before clinical onset of diarrhea varied widely, and, for most infants in the diarrheal group, levels of these antibodies were similar to those in the serum specimens obtained at the same times from the corresponding age- and birth weight-matched control infants. Nevertheless, the age at which overt disease caused by HRV was most prevalent coincided with the time when the maternal antibodies had declined to low levels but the infants had not yet acquired high titers of these antibodies in their sera.

Antibodies, Viral↗
PubMed2005

Immunological development of preterm infants in early infancy.

To evaluate the immunological development of preterm infants, especially in early infancy, we examined the serum cytokine levels and the expression of Th2 and Th1 chemokine receptors, CCR4 and CCR5, on days 0, 14 and 28 in 16 low birth weight infants (1720.38 +/- 502.80 g) born at less than 37 (33.63 +/- 3.29) weeks of gestation. Using an enzyme-linked immunosorbent assay (ELISA), serum interleukin (IL)-4 levels exhibited an increase on day 14, but decreased to the initial level on day 28 (P < 0.05). The significant elevation of serum transforming growth factor (TGF)-beta levels was confirmed on day 14 (P < 0.05) but decreased to the initial level on day 28 (P < 0.05). The expression of CCR4 and CCR5 were examined using reverse transcription-polymerase chain reaction (RT-PCR) and flow cytometric analysis. The RT-PCR confirmed the expression of CCR5-mRNA soon after birth, while there was no expression of CCR4-mRNA. Thereafter, the expression of CCR4-mRNA increased significantly and reached the level of CCR5-mRNA expression on day 28 (P < 0.05). Flow cytometric analysis, however, revealed that the expression levels of both CCR4 and CCR5 were low at birth. Thus, CCR4(+) CD4(+) cells were significantly increased from days 0-28 (P < 0.05), while CCR5(+) CD4(+) cells were not. Increased IL-4 and TGF-beta synthesis as well as increased CCR4(+) CD4(+) cells suggest that, under extra-maternal circumstances, there is a shift in bias toward Th2 responses even in preterm infants soon after delivery, while they may be capable of developing Th1 mediated responses soon after birth.

Actins↗
PubMed2003

Follow-up of children of depressed mothers exposed or not exposed to antidepressant drugs during pregnancy.

OBJECTIVE: To compare the structural growth and developmental outcome of children born to mothers diagnosed with major depressive disorder during pregnancy who were exposed or not exposed to selective serotonin reuptake inhibitors (SSRIs) in utero. STUDY DESIGN: Children whose mothers were diagnosed with major depressive disorder in pregnancy and elected not to take medication (n = 13) were compared with children of depressed mothers treated with SSRIs (n = 31) on birth outcomes and postnatal neurodevelopmental functioning between ages 6 and 40 months. Children underwent blinded standardized pediatric and dysmorphology examinations and evaluations of their mental and psychomotor development with the use of the Bayley Scales of Infant Development (BSID II). RESULTS: The Bayley mental developmental indexes were similar in both groups. Children exposed to SSRIs during pregnancy had lower APGAR scores and scored lower on the Bayley psychomotor development indexes and the motor quality factor of the Bayley Behavioral Rating Scale than unexposed children. CONCLUSIONS: The findings that SSRIs during fetal development might have subtle effects on motor development and motor control are consistent with the pharmacologic properties of the drugs.

Adult↗
PubMedDate not supplied

Extremely low birthweight infants: issues related to growth.

While survival rates are increasing in the extremely low birthweight (ELBW) group of preterm infants, the most common morbidity among these infants is inadequate growth. By the time of discharge from the neonatal intensive care unit, many ELBW infants develop extrauterine growth restriction. Several issues related to improving the growth of ELBW infants, including defining adequate growth and developing evidence-based nutritional strategies, are discussed in this article. Suggestions for future research are also presented.

Body Composition↗
PubMed1984

The Pennsylvania Infant and Family Development Project, III: The origins of individual differences in infant-mother attachment: maternal and infant contributions.

In order to test 4 specific hypotheses regarding the interactional histories associated with variation in quality of infant-mother attachment, data gathered during naturalistic home observations at 1, 3, and 9 months on 60 babies seen in the Ainsworth and Wittig strange situation were examined. Planned comparisons revealed, as predicted, that securely attached infants had experienced intermediate levels of reciprocal interaction and maternal stimulation, considered to be reflective of sensitive care, and that resistant babies had experienced less responsive care than securely attached infants. No support was provided for the hypothesis that avoidant babies had experienced less physical contact with mothers than securely attached infants. Insecurely attached infants were observed to cry significantly more than securely attached infants at 3 and 9 months. A cross-lag panel analysis, designed to assess longitudinal processes of influence, revealed that fussiness was caused by mothering and did not serve to influence mothering. These results are discussed in terms of mothers' relatively greater influence in determining individual differences in attachment, with overstimulation leading to avoidance, understimulation leading to resistance, and intermediate levels of stimulation leading to security.

Child Behavior↗
PubMed1986

Developmental changes of oculomotor characteristics in infants when awake and in the 'active state of sleep'.

Since the principal criterion for identifying sleep in the young infant is eye closure, a study was undertaken to ascertain whether fast or 'saccadic-type' movements which occur in the eyes-closed condition differ in any respect from those which are observed in the eyes-open (awake) state. Specific parameters included the amplitude-velocity relationship, the numbers and types of non-conjugate movements (disjunctive and monocular), directionality and densities (EM/min). Measurements were made on 12 infants at 4-week intervals as they progressed in age from 4 weeks to 12 weeks. The results disclosed that in the main as the infants developed, a change, if any, of ocular characteristic in the awake state was paralleled by a similar change in the eyes-closed state, although the absolute number of eye movements was higher in the eyes-open state compared to the eyes-closed state. This suggests that the eye movement characteristics, whether the eyes were open or shut, were dictated primarily by oculomotor development and the mechanics of eye closure rather than by different mechanisms of neural control effected through different states of consciousness. Of special interest was the finding that the velocity-amplitude relationship in the infant's eyes-open state was almost identical to that reported for adults in the eyes-open state whereas the value for the eyes-closed state was comparable to that of the adult's eyes-closed awake state rather than to the value obtained for adults in REM sleep.

Aging↗
PubMed1992

Temperament prediction for neonate twins: relation to size for gestational age in same-sex pairs.

Infants from 22 pairs of appropriate-for-gestational-age/small-for-gestational-age (AGA/SGA) same-sex twins were assessed for temperament stability between the neonatal period and 30 months of age. The evaluation of neonatal temperament included observers' ratings of irritability, resistance to soothing, activity level while awake, activity level during sleep, reactivity, and reinforcement value. At 6, 9, 12, 18, 24, and 30 months mothers rated their infants' temperament on standardized questionnaires which yielded nine temperament categories: activity level, rhythmicity, approach or withdrawal, adaptability, intensity of reaction, quality of mood, attention span, distractibility, and threshold of responsiveness. The Bayley Scales of Infant Development were administered at 6, 9, 12, 18, 24, and 30 months to assess mental development. The results of longitudinal correlational analyses indicated that, for the AGA infants, there was a pattern of significant predictive relations between the neonatal ratings of temperament and maternal ratings of temperament at 6, 9, 12, 18, 24, and 30 months. The SGA infants did not demonstrate similar behavioral stability from the lying-in period up to 30 months of age. Furthermore, for AGA infants there was a consistent trend for both reactivity and neonatal activity during sleep to predict mental development scores between 6 and 30 months. A similar pattern was not observed for the SGA cotwins. The results indicated that temperament stability is an additional area of risk for SGA twins, and that the developmental function of the underlying processes in the neonatal measures is different for AGA and SGA infants.

Birth Weight↗
PubMedDate not supplied

Early sensory-motor development and prenatal exposure to lead.

As part of a longitudinal study of the early developmental effects of exposure to lead, we administered the Bayley Scales of Infant Development at age 6 months to infants classified into three groups based on their umbilical cord blood lead levels ("low": mean = 1.8 micrograms/dl; "mid": mean = 6.5 micrograms/dl; "high": mean = 14.6 micrograms/dl). No infant had a cord blood lead level greater than 30 micrograms/dl, the level currently regarded as the upper limit of "normal" for young children. Multiple regression analyses indicated that high cord blood levels were associated with lower covariance-adjusted scores on the Mental Development Index. Scores on the Psychomotor Development Index were not significantly related to cord blood lead level. The level of lead in blood at 6 months of age was not associated with scores on either the Mental or Psychomotor Development Index. These data are compatible with the hypothesis that low levels of lead delivered transplacentally are toxic to infants.

Child Development↗
PubMed1978

[Cholestatic jaundice and hypophosphataemia in parenterally-fed premature infants--coincidence or causal connection? (author's transl)].

A report is presented of the chemical pathological findings in 14 premature and one full-term infant receiving almost exclusively parenteral nutrition during the first two weeks of life. Six infants developed cholestatic jaundice. The underlying diseases were the idiopathic respiratory distress syndrome in 10, gastroschisis in 3 and renal insufficiency in 1, while one was an otherwise healthy small for dates infant. After parenteral nutrition had been discontinued obstructive jaundice cleared by the third month of life except in one infant. Apart from the higher glucose intake during the second week, jaundiced infants principally differed from non-jaundiced infants by the development of significant hypophosphataemia. An attempt was made to correlate aetiologically the presence of cholestatic jaundice with the finding of hypophosphataemia on the possible basis of a disturbance of energy metabolism.

Abdominal Muscles↗
PubMedDate not supplied

Effects of developmental care on behavioral organization in very-low-birth-weight infants.

The purpose of this study was to determine whether modifying care to reduce stressors in the neonatal intensive care unit and support infant development affected physiological, motor, and behavioral state organization. Twenty-one infants weighing less than 1501 g were studied prior to a nursing staff-training program (control) and 24 infants were studied posttraining (study). Nurses were taught to lower environmental stress, reduce procedural stress, and facilitate motor and sleep-wake organization. Oxygen saturation, motor activity, posture, and sleep-wake states were measured biweekly during routine care. Study infants showed higher oxygen saturation levels, fewer disorganized and jerky movements, more flexor movements, more flexed posture, and more alert-wakefulness than controls. Results suggest that this approach to care may have potential to improve behavioral organization during the preterm period.

Behavior↗
PubMed1991

Baroda development screening test for infants.

A screening test for the assessment of the motor-mental development of infants was developed by selecting items from the Bayley Scales of Infant Development (BSID). Baroda norms as a simple and quick test for use in the door to door survey by health workers. The reason for choosing BSID and the criteria for the selection of items are described. The method of using the screening test in community surveys (by health workers) and in office practice is discussed. Some aspects of the development of our screening test and the Denver Development Screening Test (DDST) are compared. A routine use of our test is recommended for following the development of normal children as well as for screening from the community children with possibility of development delay. The latter must be referred for detailed testing on the full scales.

Child, Preschool↗
PubMed1999

Neonatal temperament, maternal interaction, and the need for "alonetime".

In one of a set of studies exploring the need for time alone throughout development, infant temperamental characteristics, their relation to infant needs for time alone, and maternal perceptions of these needs are examined via videotapings of the infants' signals of disengagement and engagement. Descriptive data based on three mother-infant dyads suggest that infants clearly signal their needs for rest and disengagement in the first eight weeks, and develop unique patterns of "alonetime" behavior that may be related in part to temperamental differences.

Adult↗
PubMed1994

Relationship between the parachute reactions and standing and walking in normal infants.

Assumption of the vertical position and independent walking are potentially hazardous motor milestones in the developing infant. It has been presumed that the parachute reactions evolved to protect infants from injury during this developmental stage. To determine the relationship between the appearance of the upper and lower parachute reactions and the developmental milestones of unsupported standing and independent walking, 190 normal infants were prospectively studied. The upper parachute reaction was found to precede the lower by less than a month (mean age of appearance: 8.9 and 9.2 months, respectively). More than one-half of the cohort achieved standing without either the upper (49%) or lower parachute reaction (57%); however, no independent walking occurred without the upper parachute reaction, and only 2 of 190 infants (1%) walked independently without the lower parachute reaction. Onset of walking occurred about 4 months after the appearance of the upper parachute reaction. The significance of these findings is discussed.

Accidental Falls↗
PubMed2002

Developmental assessment of preterm and term children at 18 months: reproducibility and validity of a postal questionnaire to parents.

AIM: To examine the degree of agreement between the paediatrician's assessment and parental reporting of infants' development using a postal questionnaire. METHODS: The developmental status of 241 infants in the charge of 9 community paediatricians or discharged from one Neonatal Intensive Care Unit (NICU) was assessed by their parents 18 mo after delivery, using a postal questionnaire regarding child's height, weight. respiratory, hearing and vision problems, and items taken mainly from the Griffiths' Developmental Scales. At this age, infants were seen by the community or NICU paediatricians, for a complete physical and neurodevelopmental examination. RESULTS: The mean agreement on items regarding developmental areas between parents and paediatricians was 93.0%. In general, parents and professionals agreed on items describing gross motor behaviour (k from 0.39 to 0.83) and disagreed on individual questions describing language/relational behaviour (k from 0 to 0.38). A 97.9% level of agreement was found for hearing status (k = 0), and 96.2% for assessment of vision (k = 0.29), whereas the level of agreement ranged from 43.2% to 86.2% (k from 0 to 0.15) for the three questions describing respiratory problems. The mean weight and height assessments by paediatricians and parents of infants at 18 mo of age were similar. CONCLUSIONS: Further improvement of the questionnaire is needed, but our findings suggest that this methodology can be considered for use in comparing large cohorts of infants included in randomized clinical trials.

Child Development↗
PubMed1980

The role of perinatal brain injury in the genesis of childhood epilepsy.

In order to elucidate the significance of perinatal brain damage in the etiology of epilepsy, 139 full-term neonates considered to have suffered a severe degree of perinatal hypoxia were examined neurologically and electroencephalographically for two-nine years. Thirty-eight (27.3%) of them developed epileptic seizures during the follow-up period. Sixteen infants developed infantile spasms at ages two-13 months, while 10 manifested generalized motor seizures mainly at one-four years. They all had neonatal background EEGs suggesting a severe degree of brain damage, although the infants with infantile spasms and myoclonic seizures showed more abnormal neonatal EEGs than those with other types of fits. The combination of multiple factors, mainly exogenous and constitutional, is necessary for the development of epileptic seizures, especially in patients with a lesser degree of brain damage.

Birth Injuries↗