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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↗

PubMed1994

Are infants with bronchopulmonary dysplasia at risk for sudden infant death syndrome?

OBJECTIVE: To compare the incidence of sudden infant death syndrome (SIDS) and apparent life-threatening event (ALTE) in infants with bronchopulmonary dysplasia (BPD) and birth weight-matched control infants in view of the changing pattern of chronic lung disease of prematurity. METHODS: The study population consisted of 78 preterm infants of 26 to 33 weeks gestation who were diagnosed as having BPD and discharged. The 78 control infants were matched with the study infants for birth weight categories. Infants unable to maintain adequate oxygenation without supplemental oxygen when they were feeding well and thriving were discharged on home oxygen. All infants were at least 8 months of age at follow-up and information concerning the occurrence of any ALTE was obtained by direct parent interview. RESULTS: No infant died during the period of follow-up. Seven (8.9%) of the study group compared with eight (10.5%) of the control infants had an ALTE. Three infants (one study, two control infants) were hospitalized for further investigation. No infant discharged on the home oxygen program had an ALTE. CONCLUSIONS: The data from this study suggest that preterm infants with BPD are not at increased risk from SIDS compared with preterm infants without this condition. This may be related to close monitoring of the infants' oxygenation status and the provision of home oxygen when appropriate, which should eliminate episodes of unrecognized and untreated hypoxemia. Home monitoring for infants with BPD may not be warranted.

Bronchopulmonary Dysplasia↗

PubMed2003

Vitamin E supplementation for prevention of morbidity and mortality in preterm infants.

BACKGROUND: Treating very low birth weight (VLBW) infants with pharmacologic doses of vitamin E as an antioxidant agent has been proposed for preventing or limiting retinopathy of prematurity, intracranial hemorrhage, hemolytic anemia, and chronic lung disease. However, excessive doses of vitamin E may result in side effects. OBJECTIVES: The aim of this systematic review was to assess the effects of vitamin E supplementation on morbidity and mortality in preterm infants. SEARCH STRATEGY: We searched MEDLINE (October 2002), EMBASE (March 2002), the Cochrane Controlled Trials Register (CCTR) from the Cochrane Library, 2003, Issue 1, and personal files for clinical trials assessing vitamin E in preterm infants. SELECTION CRITERIA: We selected trials analyzing primary outcomes (mortality or combined long-term morbidity) or secondary outcomes (other morbidity) in infants with gestational age less than 37 weeks or birth weight less than 2500 grams. The intervention was allocation to routine supplementation with vitamin E in the treatment group versus placebo, no treatment or another type, dose or route of administration of vitamin E. DATA COLLECTION AND ANALYSIS: We used standard methods of the Cochrane Collaboration and of the Cochrane Neonatal Review Group. MAIN RESULTS: Twenty-six randomized clinical trials fulfilled entry criteria. No study assessed combined long-term morbidity. Routine vitamin E supplementation significantly reduced the risk of germinal/intraventricular hemorrhage (typical relative risk [RR] 0.85, 95% confidence interval [CI] 0.73, 0.99), increased the risk of sepsis (typical RR 1.52, CI 1.13, 2.04) and increased hemoglobin concentration by a small amount, but did not significantly affect mortality and other morbidity. In VLBW infants, vitamin E supplementation increased the risk of sepsis, and reduced the risk of severe retinopathy and blindness among those examined. Subgroup analyses in VLBW infants showed (1) an association between serum tocopherol levels greater than 3.5 mg/dl and increased risk of sepsis and reduced risk for severe retinopathy among those examined; and (2) an association between intravenous, high-dose administration of vitamin E and increased risk of sepsis. REVIEWER'S CONCLUSIONS: Vitamin E supplementation in preterm infants reduced the risk of intracranial hemorrhage but increased the risk of sepsis. In very low birth weight infants it increased the risk of sepsis, and reduced the risk of severe retinopathy and blindness among those examined. Evidence does not support the routine use of vitamin E supplementation by intravenous route at high doses, or aiming at serum tocopherol levels greater than 3.5 mg/dl.

Humans↗

PubMed2004

Detection of specific antibodies in cord blood, infant and maternal saliva and breast milk to staphylococcal toxins implicated in sudden infant death syndrome (SIDS).

The common bacterial toxins hypothesis of sudden infant death syndrome (SIDS) is that nasopharyngeal bacterial toxins can trigger events leading to death in infants with absent/low levels of antibody that can neutralise the toxins. The aim of this study was to investigate nasopharyngeal carriage of Staphylococcus aureus and determine levels of immunity in the first year of life to toxic shock syndrome toxin (TSST-1) and staphylococcal enterotoxin C (SEC). Both toxins have been implicated in SIDS cases. Seventy-three mothers and their infants (39 males and 34 females) were enrolled onto the study. The infants had birth dates spread evenly throughout the year. In infants, S. aureus carriage decreased significantly with age (P<0.001). Between 40% and 50% of infants were colonised with S. aureus in the first three months of life and 49% of the isolates produced one or both of the staphylococcal toxins. There was a significant correlation between nasopharyngeal carriage of S. aureus in mothers and infants in the three months following the birth (P<0.001). Carriage of S. aureus in infants and their mothers was not significantly associated with levels of antibody to TSST-1 or SEC in cord blood, adult saliva or breast milk. Infants colonised by S. aureus had higher levels of salivary IgA to TSST-1 than infants who were culture negative. Analysis of cord blood samples by a quantitative ELISA detected IgG bound to TSST-1 and SEC in 95.5% and 91.8% of cases respectively. There was a marked variation in levels of maternal IgG to both TSST-1 and SEC among cord blood samples. Maternal age, birth weight, and seasonality significantly affected the levels of IgG binding to TSST-1 or SEC. Analysis of infant saliva samples detected IgA to TSST-1 and SEC in the first month after birth; 11% of samples tested positive for salivary IgA to TSST-1 and 5% for salivary IgA to SEC. By the age of two months these proportions had increased to 36% and 33% respectively. More infants who used a dummy tested positive for salivary IgA to TSST-1 compared to infants who did not use a dummy. Levels of IgA to TSST-1 and SEC detected in the breast-milk samples varied greatly among mothers. There was a trend for infants receiving breast milk with low levels of antibody to TSST-1 or SEC to have higher levels of salivary antibody to the toxins. In conclusion, passive immunity to toxins implicated in SIDS cases varies greatly among infants. Infants are able to mount an active mucosal immune response to TSST-1 and SEC in the first month of life.

Adolescent↗

PubMed1996

Sudden infant death syndrome in Australian aboriginal and non-aboriginal infants: an analytical comparison.

Our previous research has shown that the sudden infant death syndrome (SIDS) rate for Aboriginal infants in Western Australia (WA) is markedly higher than that for non-Aboriginal infants. The aim of this study was to identify factors that may be important in explaining this disparity. A case-control study was conducted based on routinely collected data for the population of WA singleton births from 1980 to 1990 inclusive. Cases were infants born and classified as dying from SIDS in WA (Aboriginal n = 88, non-Aboriginal n = 409). Controls were infants born in WA and not classified as dying from SIDS; 2% samples of both Aboriginal and non-Aboriginal infants were included. The risk of dying from SIDS in Aboriginal infants was 3.86 times [95% confidence interval (CI) = 2.98 to 5.02] that in non-Aboriginal infants. Statistically significant univariable risk factors for SIDS in Aboriginal infants were preterm birth, low birthweight and small-for-gestational-age; for non-Aboriginal infants they included these factors as well as single marital status, young maternal age, parity of one or greater and male sex. Comparing Aboriginal with non-Aboriginal controls, most of the risk factors were more common in the Aboriginal population. Multiple logistic regression analysis indicated that Aboriginal infants were 1.43 times [95% CI = 1.04 to 1.95] more likely to die from SIDS than non-Aboriginal infants. Differences in the risk factor profile for Aboriginal and non-Aboriginal infants were sought using interaction terms. The only important differences were that the risk of SIDS in Aboriginal infants, unlike that in non-Aboriginal infants, appeared not to be strongly related to male sex or to single marital status. Thus, the results show that the disparity between the incidence of SIDS in the Aboriginal and non-Aboriginal populations can be explained largely, although not totally, by the high prevalence of routinely recorded risk factors in the Aboriginal population. A limitation of this study is that data on the postnatal risk factors of prone sleeping, maternal smoking and non-breastfeeding were unavailable. The residual excess risk for Aboriginal infants may be a result of these recognised postnatal risk factors and/or other infant care practices that are not routinely recorded in our data base, or to underlying social and economic conditions. Further study of all these potential risk factors is warranted.

Adult↗

PubMed2006

Breastfeeding plus infant zidovudine prophylaxis for 6 months vs formula feeding plus infant zidovudine for 1 month to reduce mother-to-child HIV transmission in Botswana: a randomized trial: the Mashi Study.

CONTEXT: Postnatal transmission of human immunodeficiency virus-1 (HIV) via breastfeeding reverses gains achieved by perinatal antiretroviral interventions. OBJECTIVE: To compare the efficacy and safety of 2 infant feeding strategies for the prevention of postnatal mother-to-child HIV transmission. DESIGN, SETTING, AND PATIENTS: A 2 x 2 factorial randomized clinical trial with peripartum (single-dose nevirapine vs placebo) and postpartum infant feeding (formula vs breastfeeding with infant zidovudine prophylaxis) interventions. In Botswana between March 27, 2001, and October 29, 2003, 1200 HIV-positive pregnant women were randomized from 4 district hospitals. Infants were evaluated at birth, monthly until age 7 months, at age 9 months, then every third month through age 18 months. INTERVENTION: All of the mothers received zidovudine 300 mg orally twice daily from 34 weeks' gestation and during labor. Mothers and infants were randomized to receive single-dose nevirapine or placebo. Infants were randomized to 6 months of breastfeeding plus prophylactic infant zidovudine (breastfed plus zidovudine), or formula feeding plus 1 month of infant zidovudine (formula fed). MAIN OUTCOME MEASURES: Primary efficacy (HIV infection by age 7 months and HIV-free survival by age 18 months) and safety (occurrence of infant adverse events by 7 months of age) end points were evaluated in 1179 infants. RESULTS: The 7-month HIV infection rates were 5.6% (32 infants in the formula-fed group) vs 9.0% (51 infants in the breastfed plus zidovudine group) (P = .04; 95% confidence interval for difference, -6.4% to -0.4%). Cumulative mortality or HIV infection rates at 18 months were 80 infants (13.9%, formula fed) vs 86 infants (15.1% breastfed plus zidovudine) (P = .60; 95% confidence interval for difference, -5.3% to 2.9%). Cumulative infant mortality at 7 months was significantly higher for the formula-fed group than for the breastfed plus zidovudine group (9.3% vs 4.9%; P = .003), but this difference diminished beyond month 7 such that the time-to-mortality distributions through age 18 months were not significantly different (P = .21). CONCLUSIONS: Breastfeeding with zidovudine prophylaxis was not as effective as formula feeding in preventing postnatal HIV transmission, but was associated with a lower mortality rate at 7 months. Both strategies had comparable HIV-free survival at 18 months. These results demonstrate the risk of formula feeding to infants in sub-Saharan Africa, and the need for studies of alternative strategies. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00197587.

Anti-HIV Agents↗

PubMed2001

Validity of the Test of Infant Motor Performance for discriminating among infants with varying risk for poor motor outcome.

OBJECTIVE: The objective was to assess the ability of the Test of Infant Motor Performance (TIMP) to discriminate among infants with varying degrees of risk for motor developmental morbidity on the basis of perinatal medical complications. STUDY DESIGN: Ninety-eight infants were tested weekly with the TIMP until 4 months of age. Comparisons were made among 5 groups of infants: (1) term infants without significant medical problems (low risk); (2) infants born prematurely with no significant medical problems (medium risk); (3) infants born at <30 weeks' gestational age or with birth weight <1500 g (high risk); (4) infants with chronic lung disease (high risk); and (5) infants with brain insults (high risk). A random-effects growth curve analysis assessed differences between the groups in slope and level of development across time. RESULTS: Infants in the low- and medium-risk groups did not differ from each other but were significantly better performers than infants in the high-risk groups. Infants with brain insults performed significantly less well than all other infants, both in absolute level of performance and in developmental slope across time. Performance by black infants averaged 2 points higher than that of other infants. CONCLUSIONS: The TIMP can discriminate among infants with differing risks for motor developmental delay.

Brain Injuries↗

PubMed2000

Doxapram versus methylxanthine for apnea in preterm infants.

BACKGROUND: Recurrent apnea is common in preterm infants, particularly at very early gestational ages. These episodes of loss of effective breathing can lead to hypoxemia and bradycardia which may be severe enough to require resuscitation including use of positive pressure ventilation. Doxapram and methylxanthine drugs have been used to stimulate breathing and so prevent apnea and its consequences. OBJECTIVES: In preterm infants with recurrent apnea, how does treatment with doxapram compare with treatment with theophylline in leading to a clinically important reduction in apnea and use of mechanical ventilation, without clinically important side effects. SEARCH STRATEGY: The standard search strategy of the Neonatal Review Group, as outlined in the Cochrane Library, was used. SELECTION CRITERIA: All trials utilising random or quasi-random patient allocation, in which doxapram was compared with methylxanthine (e.g. theophylline) for the treatment of apnea, were eligible. There must have been an effort to exclude specific causes of apnea. DATA COLLECTION AND ANALYSIS: The standard methods of the Cochrane Collaboration and its Neonatal Review Group were used to select trials, assess quality and to extract and synthesize data. The methodological quality of each trial was reviewed by the second author blinded to trial authors and institution(s). Additional information was requested from authors to clarify methodology. Each author extracted the data separately, then they were compared and differences resolved. Meta-analysis was carried out with use of relative risk and risk difference. MAIN RESULTS: In these trials involving a relatively small number of preterm infants with apnea of prematurity, there is no apparent difference between the effect of intravenous treatment with doxapram or methylxanthine on the incidence of apnea within 48 hours. There were no infants reported to have been given mechanical ventilation on either treatment. No adverse effects were reported. REVIEWER'S CONCLUSIONS: Implications for practice. The overall results of these small trials suggest that intravenous doxapram and intravenous methylxanthine are not different in their effectiveness in the short term in the treatment of apnea of prematurity. Caution is warranted as the number of patients in these trials is too small to exclude an important difference between these two treatments or to exclude the possibility of less common side effects. Longer term outcome of infants treated in these trials has not been reported. Implications for research. Further studies would require a large number of infants, stratified by gestation, to clarify which infants are likely to benefit and whether there might be differences in responses or side effects with these two drugs at different ages. It would be valuable to include important clinical outcomes such as use of mechanical ventilation as well as subsequent growth and development in future studies. Responses to treatment would have to take account of co-interventions, such as nasal continuous airway pressure which is frequently used post-intubation.

Aminophylline↗

PubMed2000

Concentrations of antimony in infants dying from SIDS and infants dying from other causes.

OBJECTIVES: Raised concentrations of antimony have been found in infants dying of sudden infant death syndrome (SIDS). The presumed source of this antimony is toxic gases generated from fire retardants that are present in cot mattresses. The aim of this study was to determine the role of antimony in SIDS. DESIGN: Samples of liver, brain, serum, and urine were collected from all patients dying from SIDS and a group of aged matched control infants who had died of other causes. SETTING: Nationwide study in Ireland. SUBJECTS: 52 infants dying from SIDS and 19 control infants aged > 7 days and < 1 year. RESULTS: The median concentration of antimony in the liver and brain of infants dying of SIDS was < 1 ng/g, with no difference detected between the infants dying from SIDS and the control infants. The range of antimony in the serum of infants dying of SIDS was 0.09-0.71 microg/litre (median, 0.26). Although no difference was found between infants dying from SIDS and control infants, SIDS infants were found to have higher concentrations when compared with healthy infants in the 1st year of life, probably as a result of release of antimony into serum after death. Urine antimony concentrations in infants dying from SIDS were < 3.91 ng/mg (corrected for creatinine) and similar to values found both in control infants and healthy infants. CONCLUSION: There is no evidence to support a causal role for antimony in SIDS.

Antimony↗

PubMed2006

The effects of infant massage on weight, height, and mother-infant interaction.

PURPOSE: The purpose of this study was to test the effects of infant massage (auditory (mother's voice), tactile/kinesthetic (massage) and visual (eye to eye contact) stimulation) on weight and height of infant and mother-infant interaction with normal infants over a period of 4 weeks. METHOD: This study was designed as a nonequivalent control group pretest-posttest design. The experimental group infants (aged 2-6 months) participated in one of the infant massage programs at the health district center for 4 weeks. The control group (N=26) was paired with the experimental group (N=26) by matching the infant's age and sex. Infant weight, height, and mother-infant interaction were measured two times and recordings of the mother-infant interaction were done using the video equipment in a room at the health center for 10 minutes. RESULTS: After 4 weeks of massage, there were no significant differences weight gain and height increase between the two groups. Comparison of the total scores for the mother-infant interaction between the two groups showed a significant difference (t=5.21, p=.000). There were also significant differences on maternal response (t=3.78, p=000), infant response (t=5.71, p=000) and dyadic response (t=4.05, p=000) in the mother-infant interaction between the two groups. CONCLUSION: Overall, the results of this study reassure that infant massage facilitates the mother-infant interaction for infants and mothers who give massage to their baby.

Anthropometry↗

PubMed2000

Early versus late discontinuation of oxygen in preterm or low birth weight infants.

BACKGROUND: This section is under preparation and will be included in the next issue. OBJECTIVES: In preterm or low birth weight infants, does early versus late weaning from supplementary oxygen influence mortality, retinopathy of prematurity, lung function, growth or development? SEARCH STRATEGY: The standard search strategy of the Neonatal Review Group was used. This included searches of the Oxford Database of Perinatal Trials, MEDLINE, previous reviews including cross references, abstracts, conferences and symposia proceedings, expert informants, journal handsearching mainly in the English language. An additional literature search of the MEDLINE, EMBASE, and CINAHL databases was conducted in order to locate any trials in addition to those provided by the Cochrane Controlled Trials Register (CENTRAL/CCTR). SELECTION CRITERIA: All trials utilising random or quasi-random patient allocation, in which early weaning was compared with late discontinuation of supplemental oxygen in preterm or low birth weight infants, were eligible for inclusion. DATA COLLECTION AND ANALYSIS: The methodological quality of the one eligible trial was assessed independently by each author for the degree of selection, performance, attrition and detection bias. Data regarding clinical outcomes including mortality, retinopathy of prematurity, and long term growth and development were extracted and reviewed independently by each author. Results were compared and differences resolved as required. Data analysis was conducted according to the standards of the Cochrane Neonatal Review Group. MAIN RESULTS: In the single eligible trial of 99 infants with birthweights less than 1650g, there were no significant differences in neonatal death rates or retrolental fibroplasia (any grade or severe) for all infants, or among infants with birth weights of less than 1000g. No other outcome measures specified a priori as clinically meaningful were reported in enough detail or with satisfactory follow-up rates to include in the analysis (early death; chronic lung disease; and long term growth, development, lung or visual function). REVIEWER'S CONCLUSIONS: The results of this systematic review do not provide strong evidence for either the benefits or harms of early oxygen weaning in preterm/LBW infants. Future research should be directed toward addressing the question of what are the most appropriate target levels of oxygenation, in both the early and late neonatal periods, rather than whether oxygen should be weaned early or late.

Humans↗

PubMed2005

Risk factors associated with sudden unexplained infant death: a prospective study of infant care practices in Kentucky.

OBJECTIVE: To ascertain the prevalence of infant care practices in a metropolitan community in the United States with attention to feeding routines and modifiable risk factors associated with sudden unexplained infant death (specifically, prone sleeping position, bed sharing, and maternal smoking). METHODS: We conducted an initial face-to-face meeting followed by a telephone survey of 189 women who gave birth at a level I hospital in Kentucky between October 14 and November 10, 2002, and whose infants were placed in the well-infant nursery. The survey, composed of questions pertaining to infant care practices, was addressed to the women at 1 and 6 months postpartum. RESULTS: A total of 185 (93.9%) women participated in the survey at 1 month, and 147 (75.1%) mothers contributed at 6 months. The racial/ethnic composition of the study was 56.1% white, 30.2% black, and 16.4% biracial, Asian, or Hispanic. More than half of the infants (50.8%) shared the same bed with their mother at 1 month, which dramatically decreased to 17.7% at 6 months. Bed sharing was significantly more common among black families compared with white families at both 1 month (adjusted odds ratio [OR]: 5.94; 95% confidence interval [CI]: 2.71-13.02) and 6 months (adjusted OR: 5.43; 95% CI: 2.05-14.35). Compared with other races, white parents were more likely to place their infants on their back before sleep at both 1 and 6 months. Black parents were significantly less likely to place their infants on their back at 6 months compared with white parents (adjusted OR: 0.14; 95% CI: 0.06-0.33). One infant succumbed to sudden infant death syndrome at 3 months of age, and another infant died suddenly and unexpectedly at 9 months of age. Both were bed sharing specifically with 1 adult in the former and with 2 children in the latter. CONCLUSIONS: Bed sharing and prone placement were more common among black infants. Breastfeeding was infrequent in all races. This prospective study additionally offers a unique perspective into the risk factors associated with sudden infant death syndrome and sudden unexplained infant death associated with bed sharing by examining the survey responses of 2 mothers before the death of their infants combined with a complete postmortem examination, scene analysis, and historical investigation.

Adolescent↗

PubMed1999

Changing infants' sleep position increases risk of sudden infant death syndrome. New Zealand Cot Death Study.

OBJECTIVE: To examine whether the prone sleeping position may increase the risk for sudden infant death syndrome (SIDS), particularly in infants unused to prone sleep. DESIGN: A 3-year (1987-1990) case-control study. SETTING: Nationwide study in New Zealand. SUBJECTS: Four hundred eighty-five infants who died of SIDS and 1800 controls. MAIN OUTCOME MEASURES: Infants were classified as unaccustomed to prone if their usual sleep position was nonprone and they were placed prone for the last sleep. Secondary prone was used to describe infants placed nonprone but found prone. RESULTS: Infants usually and last placed nonprone were at the lowest risk for SIDS (odds ratio [OR], 1.0); those usually and last placed prone were at increased risk (adjusted OR, 4.6; 95% confidence interval, 3.4-6.3). Risk was greatly increased among infants unaccustomed to the prone position (adjusted OR, 19.3; 95% confidence interval, 8.2-44.8). These infants accounted for 8% (31/ 386) of all SIDS deaths. Ninety percent (28/ 31) of infants in this group were found prone, and 71% (20/28) of those found prone were found with their faces turned down into bedding-a position in which asphyxia has been implicated as a mechanism of death. In addition, 138 infants who died of SIDS were last placed nonprone. Forty-seven infants (34%) in this group were found prone (secondary prone), and 60% (28/47) of those found prone were found with their faces turned down into the bedding. This group accounted for 12% of all SIDS deaths. Most of these infants (91% [43/47]) were usually placed nonprone. CONCLUSIONS: Infants placed supine to sleep were at the lowest risk of SIDS, which supports the recommendation that this is the preferred sleeping position for healthy infants. In New Zealand, 20% of SIDS deaths involved lack of experience with the prone sleeping position. Our findings suggest the possibility that an infant's competence in escaping from potentially lethal situations during prone sleep (eg, the face-down position) may be impaired by inexperience in prone sleeping. Great caution should be exercised in placing infants unaccustomed to the prone sleeping position in the prone position.

Case-Control Studies↗

PubMed2000

Intravenous dexamethasone for extubation of newborn infants.

BACKGROUND: Endotracheal tubes are foreign bodies that may injure the upper airway causing laryngeal edema. This in turn may result in failure of extubation in preterm infants. Corticosteroids have been used prophylactically to reduce upper airway obstruction and facilitate extubation. OBJECTIVES: In newborn infants having their endotracheal tube removed following a period of intermittent positive pressure ventilation (IPPV), what are the effects of intravenous corticosteroids on the incidence of endotracheal reintubation, stridor, atelectasis and adverse side effects? SEARCH STRATEGY: Searches were made of the Oxford Database of Perinatal Trials, Medline (MeSH search terms "dexamethasone", "extubat*" and "exp infant, newborn"), previous reviews including cross references, abstracts of conferences and symposia proceedings, expert informants, journal handsearching mainly in the English language and expert informant searches in the Japanese language by Prof. Y. Ogawa. SELECTION CRITERIA: Trials were included which used random or quasi-random patient allocation, and which compared intravenous steroids given immediately prior to a planned extubation with placebo. DATA COLLECTION AND ANALYSIS: Data were extracted independently by the two authors and analysed in Revman for all trials. Prespecified subgroup analyses were performed to examine differences in response between infants at high risk for upper airway edema and those receiving routine prophylaxis prior to extubation. MAIN RESULTS: Administration of dexamethasone prior to extubation significantly reduced the need for reintubation of the trachea. This result applies to both the high risk group and to the total population of infants enrolled. However, the incidence of extubation failure was zero in the trial that attempted to exclude infants at high risk of airway edema. The side effects of higher blood sugar levels and glycosuria were found in the 2 trials where these were sought. REVIEWER'S CONCLUSIONS: Implications for practice Dexamethasone reduces the need for endotracheal reintubation of neonates after a period of IPPV. In view of the lack of effect in low risk infants and the documented and potential side effects, it appears reasonable to restrict its use to infants at increased risk for airway edema and obstruction, such as those who have received repeated or prolonged intubations. Implications for research Issues of dosage and applicability to the extremely low birthweight population could be addressed in future trials. Longer term outcomes such as chronic lung disease, duration of assisted ventilation and length of hospital stay should also be examined.

Anti-Inflammatory Agents↗

PubMedDate not supplied

First-time mothers' and fathers' transition to parenthood: infant care self-efficacy, parenting satisfaction, and infant sex.

The threefold purposes of our study were to determine differences between first-time mothers' and fathers' development of infant care self-efficacy and parenting satisfaction, relationships between mothers' and fathers' infant care self-efficacy and parenting satisfaction, and the effect of infant sex on the development of mothers' and fathers' infant care self-efficacy and parenting satisfaction during the first 4 months following the infant's birth. A convenience sample of 44 couples in a midwestern state completed the Demographic Questionnaire, the Infant Care Survey, and What Being the Parent of a New Baby is Like-Revised. Fathers' reports of infant care self-efficacy increased linearly during the first 4 months following the infant's birth while mothers' reports of infant care self-efficacy increased linearly during the first 3 months. At all data collection times, fathers reported significantly lower infant care self-efficacy than mothers. Reports of parenting satisfaction increased over time for mothers and fathers. At 8, 12, and 16 weeks following the infant's birth, mothers' infant care self-efficacy scores were significantly related to their parenting satisfaction scores. Fathers' infant care self-efficacy scores were significantly related to their parenting satisfaction scores at 12 and 16 weeks. Fathers of male infants had significantly higher parenting satisfaction scores than fathers of female infants at 12 and 16 weeks following the infant's birth. Nurses can develop individualized interventions to assist mothers and fathers during the transition to parenthood.

Adaptation, Psychological↗

PubMed1999

Comprehensive assessment of the components of energy expenditure in infants using a new infant respiratory chamber.

BACKGROUND: Current methods for energy expenditure (EE) measurements in term infants do not include simultaneous measurements of basal and sleeping metabolic rates (BMR and SMR) or a measure of physical activity (PA). Furthermore, prediction equations for calculating EE are not appropriate for use in infants with metabolic disorders. OBJECTIVE: To develop and utilize a new infant respiratory chamber for simultaneous measurements of EE (kJ/d), preprandial BMR (kJ/d), SMR (kJ/d) and an index of PA (oscillations/min/kg body weight) in infants with a variety of metabolic disorders, for up to four hours in a hospital setting, while allowing parental interaction in a comfortable environment. METHODS: We obtained simultaneous measurements of EE, BMR, SMR and PA in 21 infants (66+/-73 days of age, 4.5+/-1.7 kg body weight, 55+/-8 cm in length and 16+/-7% body fat) using our new infant respiratory chamber. Six of these infants were healthy, seven had thyroid dysfunction, five were HIV-exposed, one had AIDS, one had intrauterine and postnatal growth retardation and one was a hypothermic preterm infant. Energy expenditure, BMR and SMR were extrapolated for 24 hours. Body composition was estimated by skin-fold thickness, using age-appropriate formulae. Basal metabolic rate obtained with the infant respiratory chamber was compared to BMR that was calculated using the appropriate World Health Organization (WHO) equations. RESULTS: In all infants both extrapolated 24-hour EE and BMR correlated with fat-free mass (r = 0.89, p<0.01 and r = 0.88, p<0.01 respectively). Twenty-four hour EE also correlated with PA (r = 0.52, p<0.05). The HIV-exposed infants had higher BMR (p<0.05) than that calculated by the appropriate WHO equation. We found that the caloric requirements for the infant with growth retardation were underestimated based on the infant's weight and age. CONCLUSIONS: The infant respiratory chamber can measure all of the main components of EE. Some of the results obtained differed significantly from those obtained by the WHO equations; therefore, the new infant respiratory chamber is necessary for estimating EE in infants with metabolic and growth disorders.

Acquired Immunodeficiency Syndrome↗

PubMed1987

Diphtheria-tetanus-pertussis immunization and sudden infant death: results of the National Institute of Child Health and Human Development Cooperative Epidemiological Study of Sudden Infant Death Syndrome risk factors.

The possible association between diphtheria-pertussis-tetanus (DTP) immunization and the subsequent occurrence of sudden infant death has been examined using data from the National Institute of Child Health and Human Development (NICHD) Sudden Infant Death Syndrome (SIDS) Cooperative Epidemiological Study, a large multicenter, population-based, case-control study. In a preliminary report based on the first 400 eligible singleton SIDS victims and 800 matched living control infants, no temporal association between SIDS and DTP immunization was found. From the final sample of 800 eligible singleton SIDS victims, 95% (n = 757) were defined as definitely or probably having died of SIDS on the basis of pathology data. Data from these 757 case infants and their corresponding control infants (n = 1,514) are presented in this report. Two control infants, both living, were randomly selected for each case infant: an age-matched control A and an age-, race-, and low birth weight-matched control B. Overall, case infants were less likely to have received any DTP immunization. Only 39.8% of case infants had received at least one DTP immunization compared to 55.0% of control A infants and 53.2% of control B infants. Based on maternal interviews and postnatal medical records, 1.8% of case infants (five infants) immunized with DTP died within the first 24 hours following immunization. Similarly, 5.0% of control A infants (n = 21) and 2.2% of control B infants (n = 9) had been immunized within 24 hours of the maternal interview, which represents the comparable time frame for the age-matched control infants. These results confirm the earlier preliminary findings from the NICHD SIDS Cooperative Epidemiological Study and suggest that DTP immunization is not a significant factor in the occurrence of SIDS.

Black or African American↗

PubMed2000

Long-chain polyunsaturated fatty acid supplementation in infants born at term.

BACKGROUND: This section is under preparation and will be included in the next issue. OBJECTIVES: The n-3 and n-6 essential fatty acids alpha linolenic acid and linoleic acid are the precursors of the n-3 and n-6 longchain polyunsaturated fatty acids (LCPUFA). Controversy exists over whether LCPUFA are essential nutrients during infancy. The aim of this review is to assess whether supplementation of formula with LCPUFA is safe and of benefit to term infants. SEARCH STRATEGY: Trials were identified by MEDLINE, checking reference lists of articles and conference proceedings, and by personal communication. SELECTION CRITERIA: All randomised trials of formula supplemented with LCPUFA and with clinical endpoints were reviewed. DATA COLLECTION AND ANALYSIS: Eight randomised studies were identified. One of these studies was excluded due to supplementation commencing after three weeks of age, and one is awaiting assessment. The remaining six trials were assessed to be of good quality. MAIN RESULTS: Visual acuity was assessed by visual evoked potentials at 4 and 7-8 months in the studies of Makrides et al (1995 & 1996). The supplemented infants had an improved rate of visual maturation at both time points in the first study, but no difference was found between the groups at 4 months in the second study. Visual acuity was assessed by Teller acuity cards in the study of Carlson et al (1996), Clausen et al (1996) and Austed et al (1997). Supplementation had no consistent effect on visual acuity over the first year of life. General development was measured in five studies, all with small numbers. Two suggested a benefit of supplementation. One reported a benefit with supplementation at 4 months ( developmental quotient, DQ measured with the Brunet Lezine test, Agostini et al 1995), but when the groups were reassessed with the same test at 1 and 2 years, no differences were found in DQ (Agostini et al 1997). The other study reported a benefit with supplementation at 9 months (novelty preference measured by Fagan Infantest, Clausen et al 1996). The Adelaide studies showed no effect of supplementation on DQ at one year (Bayley Scales of Infant Development (BSID), Makrides et al 1995 &1996). The Portland study showed no effect of supplementation on development at one year (BSID) or at three years (Stanford Binet IQ test). The Portland study showed no effect of supplementation on language development at one year (McArthur Communicative Development Inventory, Janowsky et al 1995) or at three years (Peabody Picture Vocabulary Test, Scott et al 1997). Growth was measured in a small number of infants in the studies of Makrides et al (1995 & 1996) and Austed et al (1997). There was no suggestion that LCPUFA supplementation reduced the growth of term infants. REVIEWER'S CONCLUSIONS: At present there is little evidence from randomised trials of LCPUFA supplementation to support the hypothesis that LCPUFA supplementation confers any benefit on visual or cognitive development. There are no data from the randomised trials presently available to indicate that LCPUFA supplements influence the growth of term infants.

Dietary Supplements↗