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PubMedDate not supplied

Estimation of the caries-related risk associated with infant formulas.

PURPOSE: Baby bottle tooth decay (BBTD) affects 6% of children under three years of age and is associated with inappropriate bottle use. The objective of this study was to estimate the caries-related risk associated with 26 infant formulas and whole milk. METHODS: First, the plaque pH of adult volunteers was monitored before and after an oral rinse with infant formula to determine the minimum pH obtained in response to each formula. Second, Streptococcus sobrinus 6715 was cultured in each infant formula, and the increase in the number of colony forming units was measured. Third, each infant formula was incubated with powdered enamel and the solubility of enamel mineral was calculated in the absence of bacteria. Fourth, each formula was mixed with standardized concentrations of acid to determine the buffering capabilities. Finally, enamel windows were created on extracted permanent molars and exfoliated primary incisor crowns that were then colonized with mutans streptococci and incubated with infant formula. Caries was assessed visually and radiographically for 18 weeks. The length of time required for the development of enamel caries, dentinal caries and pulpal involvement was recorded. RESULTS: One-way or two-way ANOVA of these five assays demonstrated that 1. Plaque pH varied in response to oral rinsing with infant formula and most formulas did have the ability to reduce the pH significantly below the pH obtained after rinsing with water 2. Some infant formulas supported significant bacterial growth 3. Enamel mineral was dissolved by incubation with certain infant formula 4. The buffer capacity varied among the infant formulas tested 5. The length of time required for caries to reach dentin or pulp differed for the formulas, with some formulas causing dentinal caries by 3.4 weeks and pulpal involvement by 7.2 weeks.

Acids↗
PubMed1999

Effect of nappy liners on temperature stability in very preterm infants.

OBJECTIVE: To determine whether absorbent liners used in posturally supportive cloth nappies influence temperature stability in infants < 31 weeks gestation. METHODOLOGY: Randomized cross-over trial conducted at King Edward Memorial Hospital for Women, Perth, Western Australia. Twenty-three infants nursed in incubators on Infant Servo Control were randomly assigned to wear cloth postural support nappies alternately with or without absorbent liners for 24-h periods over 4 days. Measurements of skin and incubator temperatures were recorded hourly. Times of all nappy changes and infant handling procedures were also recorded. RESULTS: There was no change in any temperature measurement over time, between days, or between day/night periods. Infants nursed with the liner demonstrated a higher skin temperature (0.04 degrees C), and a lower incubator temperature (1.05 degrees C). A drop in skin temperature of 0.02 degrees C and an increase in incubator temperature of 0.28 degrees C occurred following handling of infants. There was no effect due to sex, gestational age, or actual age of the infants. CONCLUSION: Use of an absorbent liner within a cloth postural support nappy promotes better temperature regulation in infants < 31 weeks gestation, by reducing incubator temperature and increasing skin temperature.

Analysis of Variance↗
PubMed2003

Cot-nursing versus incubator care for preterm infants.

BACKGROUND: An optimal thermal environment is desirable for preterm infants. These infants are usually nursed in incubators, but cot-nursing may provide an alternative. Measures to assist the maintenance of body temperature for smaller infants in open cots include extra clothing/bedding, warming up the nursery and heating the cot mattress. Recently a heated water-filled mattress has been developed to maintain the temperature of a cot-nursed preterm infant. While there may be benefits of nursing preterm infants in open cots, there may be potential risks such as nosocomial infection caused by more handling due to easier access. OBJECTIVES: Among preterm infants allocated to cot-nursing vs incubator care in neonatal period, to assess effects on their temperature control and weight gain. SEARCH STRATEGY: The standard search strategy of the Cochrane Neonatal Review Group was used. This included searches of electronic databases: Oxford Database of Perinatal Trials; Cochrane Controlled Trials Register (Cochrane Library Issue 4 2001); MEDLINE (1966-2001); and CINAHL (1982-2001), previous reviews including cross references. SELECTION CRITERIA: All trials using random or quasi-random patient allocation in which infants receiving care in standard newborn cots were compared to infants managed in a conventional air heated incubator. DATA COLLECTION AND ANALYSIS: The authors independently assessed trial quality and extracted data for the primary outcomes of temperature control and weight gain. Meta-analysis was conducted using a fixed effects model. Results are presented as relative risk (RR) for categorical data and mean difference (MD) and weighted mean differences (WMD) for data measured on a continuous scale. MAIN RESULTS: Nine potential studies were identified of which four, involving 173 babies, were included in this review. When compared to incubator care, cot-nursing resulted in a statistically significantly higher mean body temperature (MD 0.30 degrees C; 95% CI 0.10, 0.50, one trial) and a decrease in proportion of infants not breast feeding at hospital discharge (RR 0.52; 95% CI 0.28, 0.94, two trials, 77 infants). No statistically significant difference was shown in weight gain, reported by two trials involving 69 infants. The comparison of cot-nursing using a heated water-filled mattress versus incubator care, which included four trials and a total of 149 infants, produced similar results. Cot-nursing with warming of the nursery resulted in statistically significantly smaller weight gain during week one compared to the incubator group in one trial that involved 49 infants (MD -5.90 g/kg/day; 95% CI -11.13, -0.67) with no significant difference found for weeks two and three. REVIEWER'S CONCLUSIONS: Due to the small numbers of trials included and infants studied, and the resulting imprecision in the measures of effect for all outcomes, the review does not give a clear indication for the role of cot-nursing for preterm infants. Further assessment of the role of cot nursing for preterm infants using randomised controlled trials is necessary.

Beds↗
PubMed1994

Effect of insulated skin probes to increase skin-to-environmental temperature gradients of preterm infants cared for in convective incubators.

Thermal support systems for premature infants that are based on skin servocontrol depend on accurate measurement of skin surface temperature. We examined prospectively the effect of probe insulation to alter measured skin temperature in 10 preterm infants. The use of insulated probes resulted in significant alteration in incubator servocontrol, with lower incubator air temperatures and higher skin-to-environment temperature gradients.

Equipment Design↗
PubMed1983

Extent of 14C incorporation into cholesterol of infant skin fibroblasts incubated with carboxyl-labeled oleic, -linoleic or -arachidonic acid.

In order to determine the incorporation of C1-14C derived from mono- and poly-unsaturated fatty acids into cholesterol of human cells cultured in exponential phase, infant skin fibroblasts (SF) were used at the 5th passage. On Day 6, the SF were preincubated 36 h in a medium containing 5 per cent lipoprotein-deficient serum, and thereafter [1-14C] oleic, -linoleic or -arachidonic acid-without (OL1, LI1 and AR1 group SF), or with the addition of 0.25 mM cold fatty acids (OL2), LI2 and AR2 group SF). Cholesterol specific radioactivity (SRA) peaked 1 h after, and leveled off afterwards in the OL1, LI1 and AR1 groups. Cholesterol-SRA was relatively low in the other groups, but increased progressively, giving a biphasic response: C1-14C derived from from linoleic and arachidonic acids was actively incorporated into cholesterol during the first hours, as compared to C1-14C derived from oleic acid, but stabilized between 6 and 12 h for the LI2 and AR2 group SF incubation. This result appears to be due to the stimulation of pyruvate decarboxylation, observed elsewhere, and consequently to the dilution of the radioactive units in a large pool of non-labeled acetyl-CoA units derived from glucose, when these SF were incubated with 0.25 mM polyunsaturated fatty acids.

Arachidonic Acid↗
PubMed2004

Inspired gas temperature in ventilated neonates.

The warming and humidification of inspired gases for ventilated neonates are routine. There are no data on the temperature of the gas at the airway opening in ventilated neonates. Is the inspired gas temperature at the airway opening, as expected and set on the humidifier, around 37 degrees C? We aimed to measure temperature at the airway opening and compare this with the circuit temperature. This was an observational study in a neonatal intensive care unit. Twenty-five mechanically ventilated infants were studied. All had humidifiers with chamber temperature set at 36 degrees C and the circuit temperature set at 37 degrees C. Two temperature probes were inserted and rested at the circuit-exit and at the airway opening, and temperatures were measured for 2 min in each infant. At this time, the circuit temperature was also noted. The mean (SD) temperature at the airway opening in infants nursed in incubators was 34.9 (1.2) degrees C, compared with radiant warmers where the mean (SD) was 33.1 (0.5) degrees C. The mean (SD) difference in temperature from the circuit temperature probe to the airway opening was greater under radiant warmers, with a mean (SD) drop of 3.9 (0.6) degrees C compared with a mean (SD) drop of 2.0 (1.3) degrees C in the incubators. In conclusion, the temperature at the circuit temperature probe does not reflect the temperature at the airway opening. Inspired gas temperatures are lower than the expected 37 degrees C with the normal circuits and usual humidifier settings.

Body Temperature↗
PubMed1997

Control of temperature during newborn transport: an old problem with new difficulties.

OBJECTIVE: To explore any changes in temperature control during neonatal emergency inter-hospital transport between 1977 and 1996. METHODS: Records were reviewed of all infants undergoing emergency transfer by the statewide Victorian Newborn Emergency Transport Service (NETS). Per axillary temperatures were recorded prospectively on arrival of transport team and at conclusion of transfer for all infants. RESULTS: The rate of hypothermia (< 36.0 degrees C) when NETS reached the infant has decreased overall (22% in 1977-79 to 7% in 1995-96) and for all weight groups; although in 1995-96 hypothermia was present in 36% of infants less than 1000 g when NETS arrived. The rate of hypothermia (< 36.0 degrees C) at the end of the transfer has remained at 3% overall for many years. The rate of hyperthermia at both times has increased significantly overall (12% in 1977-79 to 24% in 1995-96 on NETS arrival, 4%-19%, respectively at end of transfer) and for all weight groups except infants less than 1000 g. The range of abnormal temperatures has not substantially changed over time. CONCLUSION: There has been significant improvement in avoidance of hypothermia and cold stress amongst infants requiring emergency neonatal transport from 1977 to 1996. However, in order to improve the number of infants transferred who achieve a temperature in the normal range the need to avoid hyperthermia is highlighted. Infants who require incubator care for optimal medical management require continual monitoring of temperature and review of environmental conditions to optimise the conditions both prior to and during transport.

Fever↗
PubMed2006

Admission temperatures following radiant warmer or incubator transport for preterm infants <28 weeks: a randomised study.

Sixty two infants <28 weeks were occlusively wrapped and randomised to radiant warmer or incubator transport to the neonatal unit. Median axillary temperature on arrival was 36.8 degrees C in both groups. Target temperatures (36.5-37.5 degrees C) were achieved in 60% of the incubator group compared to 75% in the warmer group (not statistically significant). While powered to detect a 35% difference between warming devices, a more modest difference is not excluded.

Birth Weight↗
PubMed1980

Oxygen consumption and insensible water loss in premature infants in single-versus double-walled incubators.

Fifteen studies were performed in ten premature infants whose birth weight (mean +/- SD) was 1,444 +/- 250 gm, gestational age 32.7 +/- 1.0 weeks, and postnatal age 10.7 +/- 3.3 days. Each study consisted of three hours simultaneous measurement of insensible water loss and oxygen consumption under two conditions for the same infant: (1) inside a single-walled incubator and (2) inside a double-walled incubator. The double-walled incubator provided significantly (P < 0.001) higher operative temperature and incubator wall temperature than did the single-walled incubator. Infants inside the double-walled incubator had significantly lower (P < 0.01) IWL (30% reduction) and lower (P < 0.05) VO2 (17% reduction) than inside the single-walled incubator--a net caloric saving of 11.8 kcal/kg/day. This saving of energy expenditure may be important in affecting the growth and outcome of the low-birth-weight infants.

Carbon Dioxide↗