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Stability of Bayley Motor Scale scores in the first year of life.

The purpose of this study was to determine whether Bayley Motor Scale scores were stable in infants during the first year of life, that is, whether each individual infant's score was essentially the same at each of the five test ages. Subjects were 15 low-risk and 8 high-risk infants with Bayley Scales of Infant Development Motor Scale scores at 2, 3, 4, 8, and 12 months. All high-risk and most low-risk infants also had outcome scores at either 24 or 36 months. For the group as a whole, and for all infants with "normal" outcomes, subjects did not change ranks over the six test ages (ie, high-scoring infants' ranks remained high and low-scoring infants' ranks remained low), but scores varied significantly from test to test. Scores of infants with "non-normal" outcomes did not vary significantly from test to test. The highest and lowest scores of 75% of the infants with normal outcomes and 57% of the infants with non-normal outcomes differed significantly. Four patterns of variations of Bayley Motor Scale scores over the five test ages of the first year after birth were identified. The first pattern included three infants with the most stable scores. The three remaining patterns were different from each other, but a consistent feature of each was a peak at 4 months. Finally, scores at 3 and 8 months were best able to correctly identify outcome. A single Bayley Motor Scale score may not reflect an infant's true abilities; some factor may be inflating scores at age 4 months.

Child Development↗

Successful outcome of pregnancy in women with hypothyroidism.

Published data on the influence of hypothyroidism on fertility, gestation, and the offspring are controversial. We studied nine hypothyroid women during 11 pregnancies. Mean serum values for thyroxine, triiodothyronine (T3), resin T3 uptake ratio, and thyroid-stimulating hormone were 2.3 microgram/dL, 82 ng/dL, 0.64, and 105 mU/mL, respectively. Four patients had iatrogenic hypothyroidism (three remote thyroidectomy, one remote 131I therapy), two Hashimoto's thyroiditis, and three idiopathic primary hypothyroidism. Seven patients first presented untreated after the 24th week of gestation. Two patients needed cesarean section; seven delivered vaginally. There was one stillborn infant in the only patient with pre-eclampsia. Another infant had Down's syndrome and an ostium primum defect (mother's age, 41 years). The remaining nine infants were normal at birth. All placentas were normal. Follow-up in seven infants up to 2.7 years showed normal thyroid function and somatic development. Infants of hypothyroid mothers may be normal because their hypothalamic-pituitary thyroid axis develops independently from the mother.

Adult↗

Giftedness. Can it be predicted in infancy?

A cohort of 200 children, who were followed from birth and periodically evaluated as part of a longitudinal study of child development, was used to determine the ability of the Bayley Scales of Infant Development (BSID) to predict children who would be considered intellectually gifted at 7.5 years. The cohort was predominantly white (91%), upper middle class (70% in Hollingshead class 1 or 2), and had preschool educational experiences (94%). At outcome, 36 children had WISC-R verbal, performance, or full scale IQs greater than 135 and were called gifted. On average, gifted children walked 0.7 months earlier and spoke two-word sentences 2.2 months earlier than the non-gifted group. As a group, gifted children showed statistically significant, but clinically small, advantages for age of walking, age of speaking two-word sentences, BSID, and Stanford Binet IQ. Of the 36 children who later proved to be gifted, only two had BSID IQs greater than 134. Of the four children who had BSID IQs greater than 134, two maintained their superior function but 2 did not. A discriminant function analysis was used to predict giftedness for individual children based on BSID performance. The resulting classification achieved sensitivity = 0.69 and specificity = 0.39. Although groups of infants who will be gifted have higher BSID scores, the BSID cannot be endorsed as a method of identifying individual infants who will later demonstrate superior cognitive function.

Child↗

[Effects of supplementing calcium, iron and zinc on the fetus development and growth during pregnancy].

OBJECTIVES: The purpose of the present study is to determine the effects of supplementing the biscuits fortified with calcium (Ca), iron (Fe) and zinc (Zn) for pregnant women from the 5th month of gestation until delivery on the growth and development of fetus and to explore the best way to improve infant growth. METHODS: A total of 313 healthy and primary pregnant women were enrolled and divided into five study groups based on their order visiting the hospitals for prenatal care. Each woman of the study groups was given three pieces of biscuit fortified with VD, Ca and VD, Ca, Zn and VD (Ca + Zn + VD), Ca, Fe, VC and VD (Ca + Fe + VD), Ca, Fe, VC, Zn and VD (Ca + Fe + Zn + VD), respectively, from the 5th month of gestation until delivery (24 weeks in total) daily. The fortified levels were 10 micrograms Ca from carbonate calcium, 10 mg Zn from lactate zinc, 10 mg Fe from ferrous lactate, and 50 mg VC, respectively. A parturient women was selected from the same hospital as control after one trial subject for each study groups selected. Placenta was weighed and umbilical cord venous blood and placenta tissue samples were collected after delivery for measuring Ca and other trace elements. Body weight and height of the new-born babies were measured. RESULTS: The weight of placenta in control group (551.1 +/- 64.2) g was significantly (P < 0.05) heavier than other trial groups with Ca + Fe + Zn + VD (467.1 +/- 36.6) g, but contents of Ca and other trace elements in placenta of the control group were lower, which probably because of the lower nutrients intake of mothers in control group that would result in a compensation enlargement of placenta to get enough nutrients for fetus from mother. The Hb level in cord venous blood was significantly higher than that of maternal blood. There was no significant difference in activity of alkaline phosphatase between cord venous blood and material blood. The contents of Ca, Fe and Zn in cord venous plasma were all significantly higher than those in maternal plasma. Birth weight and height in Ca + Fe + Zn + VD group were the highest in all the groups, with birth weight of (3.53 +/- 0.33) kg, as compared with (3.28 +/- 0.54) kg in the control group. There was significant correlation between birth weight, weight for age and intake of Ca, Fe and Zn during pregnancy. CONCLUSION: Supplementation of Ca + Fe + Zn + VitD during pregnancy is the best way to improve infant development and growth, based on the current Recommended Dietary Allowances (RDA) for pregnant women.

Adult↗

Visual acuity and retinal function in infant monkeys fed long-chain PUFA.

Previous randomized clinical trials suggest that supplementation of the human infant diet with up to 0.35% DHA may benefit visual development. The aim of the current study was to assess the impact of including arachidonic acid (AA) and a higher level of DHA in the postnatal monkey diet on visual development. Infant rhesus monkeys were fed either a control diet (2.0% alpha-linolenic acid as the sole n-3 FA) or a supplemented diet (1.0% DHA and 1.0% AA) from birth. Visual evoked potential acuity was measured at 3 mon of age. Rod and cone function were assessed in terms of parameters describing phototransduction. Electroretinogram (ERG) amplitudes and implicit times were recorded over a wide intensity range (-2.2 to 4.0 log scot td-sec) and assessed in terms of intensity response functions. Plasma DHA and AA were significantly increased (P < 0.001) in the diet-supplemented monkeys compared with the control monkeys. There was an approximately equal effect of diet for the rod phototransduction parameters, sensitivity, and capacitance but in the opposite directions. Diet-supplemented monkeys had significantly shorter b-wave implicit times at low retinal illuminances (<-0.6 log scot td-sec). There were no significant effects of diet for visual acuity or the other 23 ERG parameters measured. The results suggest that supplementation of the infant monkey diet with 1.0% DHA and 1.0% AA neither harms nor provides substantial benefit to the development of visual acuity or retinal function in the first four postnatal months.

Animals↗

Administration of 25,000 IU vitamin A doses at routine immunisation in young infants.

OBJECTIVE: To investigate whether monthly administration of vitamin A at routine immunisation produces any side-effects, and to examine the effect of this supplementation on the vitamin A nutrition status of infants. DESIGN: A double-blind randomised placebo-controlled clinical trial. SETTING: Immunisation clinic of a large diarrhoea treatment centre. SUBJECTS: Infants aged 6-17 weeks who will receive their first diphtheria-pertussis-tetanus/oral polio vaccine (DPT/OPV) dose. METHODS: Infants were randomly assigned to receive either 25,000 IU vitamin A or placebo. Three such doses were given with each immunisation dose at monthly intervals. Infants were examined by a physician before and during 24 h after the doses and any signs of toxicity were recorded. Venous blood was drawn at entry and 1 month after the 3rd dose for retinol assay. RESULTS: One hundred and one infants received vitamin A and 98 received placebo. Decreased feeding, irritability, diarrhoea, and vomiting were comparable between the two groups. In the vitamin A group five infants developed bulging fontanelle; three of them developed it once (after 1st, 2nd and 3rd dose respectively), one developed it twice (after both the 2nd and 3rd dose), and the other infant after all three doses. In the placebo group a single child developed bulging fontanelle after the 3rd dose. In all the cases the bulging disappeared within 48 h of onset except in one infant, in whom it subsided at 60 h. The total bulging episodes in the vitamin A and placebo groups were 8 and 1 respectively (RR = 7.7; P < 0.04). However, none of these infants had irritability. At entry fasting retinol level was < 10 micrograms/dl in 35% infants and in 87% infants it was < 20 micrograms/dl. After the third dose fasting retinol level was marginally better in the vitamin A group (mean +/- s.d.: 21.9 +/- 8.2 vs 19.2 +/- 7.8; P = 0.05). However, 47% infants receiving supplementation still had serum retinol level <20 micrograms/dl. CONCLUSION: The results suggest that administration of 25,000 IU of vitamin A in young infants along with routine immunisations, though associated with increased incidence of transient bulging fontanelle without any associated adverse signs or symptoms, may still be inadequate to prevent deficiency in this population. SPONSORSHIP: This study was funded by the United States Agency for International Development (USAID) under grant no. DPE-5986-A-1009-00 with the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B). The ICDDR,B is supported by countries and agencies which share its concern for the health problems of developing countries.

Double-Blind Method↗

The effects of short-term oral iron therapy on developmental deficits in iron-deficient anemic infants.

To assess the effects of iron therapy on developmental test scores in infants with iron deficiency anemia, 68 Guatemalan babies 6 to 24 months of age, with and without mild iron deficiency anemia, were tested with the Bayley Scales of Infant Development before and after one week of oral iron treatment. The two major findings of the study were developmental deficits in the anemic group prior to treatment, and lack of rapid improvement with short-term oral iron therapy. The mean pretreatment Mental Development Index of the anemic group was significantly lower than that of nonanemic infants. The anemic group's pretreatment Psychomotor Development Index was also lower than that of the nonanemic control group. In a double-blind randomized study, six to eight days of oral iron therapy did not reverse these deficits. Consequently, the deficits of the anemic group cannot be unequivocably attributed to iron lack. However, no significant differences were found between anemic and nonanemic groups in birth histories, socioeconomic level, or general nutritional status which might otherwise explain the lower developmental test scores of the anemic babies.

Anemia, Hypochromic↗

Normative data on mental and motor development in Nigerian children.

BACKGROUND: In Nigeria and sub-Saharan Africa at large, there has been heavy reliance on the "Caucasian data" in the developmental assessment of children. Hence, this study set out to establish normative data for psychomotor development on Nigerian children. STUDY DESIGN: One hundred and twenty eight children distributed equally to eight different integrative age groups between 8 weeks and 30 months were included in the cross-sectional study. The subjects were assessed for the five fields of development using Developmental Screening Inventory (DSI) and Bayley Scales of Infant Development (BSID): a screening and performance instruments respectively. A trained research assistant administered the DSI on each of the subjects, and the scores made blind to the researchers until after the subject's assessment with the BSID within maximum of 24 hours interval. RESULTS: The subjects scored above the normal values in the five fields of development for each of the instruments. Furthermore, from the normative data derived, there were high scores in the motor and personal -social fields, especially among subjects in the lower age groups of 8,16,and 32 weeks when compared to data from the western world. CONCLUSION: It is concluded that this normative data will be of much clinical value to practitioners in Nigeria, especially the pediatricians, psychiatrists, clinical psychologists, etc.

Black People↗

Temperament profiles and their role in neurodevelopmental assessed preterm children at two years of age.

The aim of this study was to determine whether preterms (n = 80, mean birth weight 1,205 g) differ from full-terms (n = 80) in temperament profile at 24 months of age and to explore the relationship between temperament, neurodevelopment, and behavior. Temperament was assessed using the Toddler Temperament Questionnaire, which defines nine temperament dimensions: activity, rhythmicity, approach/withdrawal, adaptability, mood, intensity, distractability, persistence, and sensory threshold. Neurodevelopment was assessed by the Bayley Scales of Infant Development and by neuropediatric examination. Behavior was assessed using the Infant Behavior Record, which is a part of the Bayley Scales. When temperament was considered, the preterms were significantly less active, more adaptive, more positive in mood, less intense, and lower in threshold to respond than the controls. The results on IBR showed that preterms were significantly less goal directed, less attentive, and lower in endurance than the controls. The preterms performed significantly less well than the controls on the Bayley test. Low Bayley scores correlated with temperament scores of high rhythmicity, positive mood, low persistence, and high threshold and with IBR scores of poor social orientation, negative emotional tone, poor co-operation, short attention span, and poor endurance.

Case-Control Studies↗

Relationships among the Brazelton Neonatal Scale, Bayley Infant Scales, and early temperament.

The present study investigated whether the Brazelton Neonatal Assessment Scale predicts 10-week performance on the Bayley Scales of Infant Development and examined whether early temperament relates to performance on both scales. 18 normal, term infants were studied. Conceptual, a priori scoring dimensions were applied to neonatal assessments at a mean of 8.6 days. Infant temperament data were available for 12 of the subjects at a mean of 13.3 days, and mental and motor development were assessed for all subjects at a mean of 68.8 days. The results indicate that the total of a priori Brazelton scoring dimensions and neonatal state control were predictive of Bayley mental quotients at 10 weeks. Caretakers' judgments of temperamental intensity and distractability at 2 weeks correlated with the Bayley scales and the Brazelton dimensions. Furthermore, dividing the infants into worrisome and optimal groups on the basis of the total produced significant differences in Bayley mental scores.

Attention↗

The development and predictive relations of play and language across the second year.

The play and language development of 171 toddlers was examined at 14 and 18 months by observing their activities on the Symbolic Play Test and by assessing their language skills using the MacArthur Communicative Development Inventories (MCDI) and the Reynell Developmental Language Scales. Additionally, data from the Bayley Scales of Infant Development and the MCDI were obtained at 24 months, in order to investigate how play and language measures taken at 14 and 18 months predict children's development at the age of 2 years. The results showed that the vocabulary production and symbolic play of the 14-month-old toddlers made a unique contribution to their language and cognitive skills at the age of 2 years, while at 18 months only language variables made a similar contribution. Other-directed pretense discriminated between the children's subsequent language and cognitive skills best, whereas nonsymbolic play had no independent predictive contribution. Significant gender differences were found in the use of nonsymbolic and symbolic play acts already at 14 months. Gender did not, however, contribute to the prediction of the children's subsequent skills, whereas maternal education significantly added to the prediction of the 2-year-olds' maximum sentence length and that of their cognitive development.

Analysis of Variance↗

Prediction of developmental patterns through 40 months from 6- and 12-month neurologic examinations in very low birth weight infants.

This study examines whether neurologic examinations at 6 and 12 months of age can predict developmental patterns in very low birth weight infants and fullterm controls through 40 months of age. We performed neurologic examinations at 6 and 12 months; the Bayley Scales of Infant Development at 6, 12, and 24 months; and the Stanford-Binet and the McCarthy Motor scale at 40 months. The very low birth weight infants were categorized on the basis of socioeconomic status and high or low risk for early medical complications. More abnormal neurologic scores predicted greater deceleration of cognitive development for high-risk infants only. The 12-month neurologic examination predicted the degree of deceleration in motor development. Medical risk was an independent predictor of curvature of the psychomotor development curve. We conclude that neurologic examinations during the 1st year of life might be used with other factors in decision concerning referrals to early-intervention programs.

Analysis of Variance↗

Individualized developmental care for the very low-birth-weight preterm infant. Medical and neurofunctional effects.

OBJECTIVE: To investigate the effectiveness of individualized developmental care in reducing medical and neurodevelopmental sequelae for very low-birth-weight infants. DESIGN: Randomized controlled trial. SETTING: Newborn intensive care unit. PATIENTS: Thirty-eight singleton preterm infants, free of known congenital abnormalities, weighing less than 1250 g, born before 30 weeks' gestation, mechanically ventilated within 3 hours of delivery and for more than 24 hours in the first 48 hours, randomly assigned to a control or an experimental group. INTERVENTION: Caregiving by nurses specifically trained in individualized developmental care; observation and documentation of the infants' behavior within 12 hours of admission, and subsequently every 10th day; developmental care recommendations and ongoing clinical support for the nurses and parents based on regular observation of the infant by developmental specialists; and the availability of special caregiving accessories. MAIN OUTCOME MEASURES: Medical outcome, including average daily weight gain; number of days the infant required mechanical ventilation, oxygen, gavage tube feeding, and hospitalization; severity of retinopathy of prematurity, bronchopulmonary dysplasia, pneumothorax, and intraventricular hemorrhage; pediatric complications; age at discharge; and hospital charges. Neurodevelopmental outcome, including Assessment of Preterm Infants' Behavior scale and quantified electroencephalography (2 weeks after due date); and Bayley Scales of Infant Development and Kangaroo Box Paradigm (9 months after due date). RESULTS: The infants in the experimental group had a significantly shorter duration of mechanical ventilation and supplemental oxygen support; earlier oral feeding; reduced incidence of intraventricular hemorrhage, pneumothorax, and severe bronchopulmonary dysplasia; improved daily weight gain; shorter hospital stays; younger ages at hospital discharge; and reduced hospital charges compared with the infants in the control group. At 2 weeks after their due dates, these infants also showed improved autonomic regulation, motor system functioning, self-regulatory abilities, and visual evoked potential measures; and at 9 months, they had improved Bayley Mental and Psychomotor Developmental Index scores, as well as Kangaroo Box Paradigm scores. CONCLUSION: Very low-birth-weight preterm infants may benefit from individualized developmental care in the neonatal intensive care unit in terms of medical and neurodevelopmental outcome.

Child Development↗

Effects of in utero drug exposure on children's development. Review and recommendations.

Effects of in utero drug exposure on pregnancy outcome, infant development, and preschool functioning are reviewed. Six possible mechanisms underlying possible negative outcomes seen in children exposed to drugs in utero are considered. Recommendations and opportunities for future research focus on process-oriented assessments, methodological and procedural issues, research design, and interventions.

Amphetamines↗

Use of the barium enema in the diagnosis of necrotizing enterocolitis.

Necrotizing enterocolitis (NEC) is associated with considerable morbidity and mortality in infants. The diagnosis relies heavily upon radiographic and clinical features. Failure to accurately diagnose NEC is associated with a risk of complications and death, however overdiagnosis also causes both morbidity and mortality as well as excessive medical costs. This report documents the use of barium enema to evaluate suspected clinical or radiographic NEC in 31 premature infants with ambiguous clinical and radiographic signs. The enema was normal in 26 infants and no treatment for NEC was given. Only one of these infants developed signs of NEC subsequent to the examination. Five infants had radiographic evidence of colitis including small ulcerations, spasm, intramural extravasation of barium and mucosal irregularity. Two of the five positive cases are pathologically documented. The barium enema can represent a significant improvement in the specificity of the diagnosis of NEC. Its greatest value is in the exclusion of NEC in ambiguous cases.

Barium Sulfate↗

Interferon-alfa treatment of facial infantile haemangiomas: with emphasis on the sight-threatening varieties. A clinical series.

PURPOSE: To report on the efficacy of systemic Interferon-alfa therapy in controlling the endothelial proliferation in expanding facial haemangiomas of infancy threatening the eye. METHODS: The series comprised 9 subjects with facial haemangiomas of rapid growth within the first few months of life. All haemangiomas had relation to an eyelid and affected the visual access to the eye. At least three tumours were also intraorbital, and in one case the glottis was affected. Interferon-alfa was given subcutaneously in daily doses of 3 mio units/m2. Ophthalmic follow-up including ultrasound evaluation was done, initially with intervals of 4-8 weeks. RESULTS: Interferon-alfa was given over 9-41 weeks (median duration 22 weeks) in cumulated doses of 63-287 million units. Progression was arrested in all and with a subsequent tumour regression considered accelerated as judged from earlier clinical giant haemangioma experience. A control series was not possible. One patient had systemic prednisone added over some weeks. Two infants reacted with a flu-like malaise. A premature infant developed a slight spastic diplegia. CONCLUSIONS: In the 9 infants with growing ophthalmic haemangiomas we recorded a good response to systemic Interferon-alfa administered as daily doses by subcutaneous injection. In general the treatment appeared well tolerated. During clinical follow-up diagnostic ultrasound evaluation (the depth dimension) proved helpful; in particular there was a sparing effect on CT and MRI scans which require general anaesthesia.

Antineoplastic Agents↗

End-tidal carbon monoxide is predictive for neonatal non-hemolytic hyperbilirubinemia.

BACKGROUND: The aim of the present study was to evaluate the value of an end-tidal carbon monoxide corrected for inhaled carbon monoxide concentration (ETCOc) at the early neonatal period. The value would be useful for predicting subsequent hyperbilirubinemia in non-hemolytic full-term infants. METHODS: The ETCOc levels were measured every 6 h during the first 72 h of life in healthy, full-term, non-hemolytic, newborn Japanese infants using a breath carbon monoxide analyzer. The ETCOc levels in hyperbilirubinemic infants were compared with those in non-hyperbilirubinemic infants. Hyperbilirubinemia was defined as the level of the peak total serum bilirubin concentration (TBC) greater than or equal to 257 micromol/L (15.0 mg/dL). The ETCOc measurement for predicting subsequent hyperbilirubinemia was evaluated with a receiver-operating characteristic (ROC) curve. RESULTS: Fifty-one infants were enrolled in the study. Seven of the 51 infants developed hyperbilirubinemia. The ETCOc levels in non-hyperbilirubinemic infants were decreased in the first 72 h after birth. However, those in the hyperbilirubinemic infants were not decreased significantly, and were higher than those in non-hyperbilirubinemic infants at 42, 48, 54 and 66 h of age. The ETCOc level at 42 h of age was the most predictive of subsequent hyperbilirubinemia by ROC analysis. At the cut-off level of 1.8 microL/L (p.p.m.), the sensitivity, the specificity, the positive predictive value and negative predictive value were 86, 80, 40 and 97%, respectively. CONCLUSION: Increased ETCOc level in the early neonatal period is associated with subsequent hyperbilirubinemia, even in infants without hemolytic disease. The ETCOc measurement may be useful as a screening test for predicting hyperbilirubinemia without hemolytic diseases.

Breath Tests↗

Polymorphonuclear leucocyte transfusion in neonatal septicaemia.

In one neonatal intensive care unit during a 15 month period 6 infants developed septicaemia which was resistant to antibiotic treatment. The infants' mean gestational age and birthweight were 32.7 weeks and 1519 g respectively. Intravenous infusions of polymorphonuclear leucocytes were given. Three infants died and the remainder survived without complications. No side effects of the treatment were identified.

Anti-Bacterial Agents↗