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PubMedDate not supplied

Hyperbilirubinemia in neonates associated with total parenteral nutrition.

To identify the factors responsible for total parenteral nutrition (TPN) associated jaundice in the neonate, 77 newborns who had been started on TPN during the past 12 years had their charts reviewed. Forty-four (57%) of these infants developed jaundice during the 1st month of life. The incidence of jaundice was significantly higher in the presence of those diseases which were associated with impaired intestinal passage such as congenital duodenal atresia, jejunal atresia, etc, and those with an abnormal rotation of the gut such as diaphragmatic hernia, gastroschisis, etc. Thirty-two (42%) of these 77 infants had accompanying infectious signs, and 28 (88%) of those 32 infants with infectious signs developed jaundice. This incidence was significantly higher than that (36%) among those who had no infectious signs. Of the possible etiologic factors other than infection, neither the length of intrauterine life nor birth weight showed significant correlation with the incidence of jaundice. The incidence of jaundice tended to be higher in infants started on TPN at a younger age. There was no significant correlation between the incidence of jaundice and the duration of TPN or fasting period. Infants receiving 110 cal/kg/day or more during TPN developed jaundice significantly more frequently than those receiving fewer calories. No definite correlation was obtained between the incidence of jaundice and the amount of amino acids administered.

Humans↗

PubMed1992

Dexamethasone and hypertension in preterm infants.

The magnitude and duration of the effect of dexamethasone on systolic blood pressure has been examined in 13 very preterm infants (median gestational age 25 weeks). All had chronic lung disease (CLD). To exclude any effect of CLD on blood pressure each infant acted as his or her own control. Systolic blood pressure increased in all infants (P less than 0.01) and remained elevated for at least 48h following cessation of therapy. The median maximum increase in blood pressure was 24 mmHg (range 13-49 mmHg) and occurred on day 4 (median, range 2-10) of treatment. One infant developed hypertensive encephalopathy. These results demonstrate the need to monitor infants with CLD throughout steroid therapy and preferably for some days after it has ceased.

Chronic Disease↗

PubMed1992

Comparison of enteral and intramuscular vitamin A supplementation in preterm infants.

Vitamin A deficiency associated with preterm delivery is not readily reversible using the recommended supplement of 1500 IU per day. It has been reported that 2000 IU of intramuscular vitamin A administered on alternate days for 28 days will correct the deficiency. The objective of this study was to compare this regime with the practice in our nursery of giving 5000 IU of vitamin A per day with the early introduction of feeds. The vitamin A status of ten preterm infants (mean gestation 30.5 weeks) who received intramuscular vitamin supplementation was compared with that of nine infants (mean gestation 30.7 weeks) given enteral vitamin A. Vitamin A status was evaluated on the 32nd day of life using plasma retinol and retinol-binding protein (RBP) concentrations and a modified relative dose response (RDR) test. Plasma retinol and RBP concentrations were similar in the two groups shortly after birth revealing vitamin A deficiency. By the 32nd day of life, plasma retinol and RBP concentrations had risen significantly in both groups and in 70% the modified RDR was normal. Differences between the groups were not observed irrespective of the method of vitamin A administration. None of the infants developed clinical or biochemical vitamin A toxicity. In most preterm infants who tolerate feeds, vitamin A deficiency can be corrected safely by supplementing the feeds with 5000 IU of vitamin A per day.

Enteral Nutrition↗

PubMed1992

Neuropsychologic abnormalities in children with congenital central hypoventilation syndrome.

We hypothesized that intellectual, neurodevelopmental, and visual-motor tests would be able to characterize the scope and nature of central nervous system involvement in children with congenital central hypoventilation syndrome. Age-appropriate intellectual (Brazelton Neonatal Behavioral Assessment, Bayley Scales of Infant Development, Wechsler Preschool and Primary Scale of Intelligence-Revised and Wechsler Intelligence Scale for Children--Revised), neurodevelopmental (Halsted-Reitan neuropsychologic battery), and visual-motor (Beery visual-motor integration test) tests were given to 17 children with congenital central hypoventilation syndrome (age 0.1 to 14.3 years). We found a broad range in IQ and developmental quotient, from greater than the 85th percentile to less than the 5th percentile, with discrepancies noted between verbal and performance measures. Multiple asymmetries and deficiencies of motor performance, not consistently related to handedness, were also found. Significant eye-hand coordination deficits were uncommon, but general performance was well below average. Full, verbal, and performance IQs and developmental quotients greater than or equal to 70 and less than 70 were compared by chi-square analysis with other associated conditions, including hours of ventilatory support, duration of initial hospitalization, growth, pulmonary hypertension, seizures, brain atrophy, central and peripheral hearing deficits, and ophthalmologic abnormalities; no statistically significant associations were found. These results lend support to the hypothesis that congenital central hypoventilation syndrome is a diffuse central nervous system process. However, the effects of transient hypoxia and associated conditions on neurodevelopmental test results cannot be excluded with certainty.

Adolescent↗

PubMed1991

Intellectual development in children with congenital hypothyroidism in relation to recommended thyroxine treatment.

The relationship between the treatment serum thyroxine level and intellectual development at 2 and 6 years was investigated in 46 Norwegian children with congenital hypothyroidism identified by neonatal screening. The level of serum thyroxine during the first 2 years was positively correlated with the Mental Development Index at 2 years of age (Bayley Scales of Infant Development) and the Verbal IQ at 6 years of age (Wechsler Preschool and Primary Scale of Intelligence). Children with a mean serum thyroxine level greater than 180 nmol/L (14 micrograms/dl) during the first year had a significantly higher Mental Development Index at 2 years and Verbal IQ at 6 years than children with serum thyroxine values less than 129 nmol/L (10 micrograms/dl). Boys had a lower Mental Development Index at 2 years of age than girls (86.9 vs 105.1; p less than 0.001) and a higher frequency of elevated serum levels of thyroid-stimulating hormone during the first year (p = 0.001). No signs of toxic effects of a high hormone level at the time of IQ assessment were detected. However, high serum levels of thyroxine at ages 2 to 4 years in girls were related to lower Performance IQ at age 6 years. The results demonstrate that the serum level of thyroxine is of importance in relation to intellectual development. Thyroxine levels above the upper reference range during the first 2 years were related to best intellectual development at 2 and 6 years.

Analysis of Variance↗

PubMed1997

Neurodevelopmental outcome of young children with extrahepatic biliary atresia 1 year after liver transplantation.

STUDY DESIGN: Forty children < 2 years of age receiving extrahepatic liver transplantation were tested with the Bayley Scales of Infant Development before transplantation and again at 3 and 12 months after transplantation. Neurodevelopmental status 1 year after transplantation was organized by a descriptive statistic of normal, suspect, or delayed. Disease and transplantation variables were investigated for association with delayed neurodevelopmental outcome. RESULTS: Before transplantation mental development was in the low-average range (92 +/- 13.2) with psychomotor development 1 SD below the norm (82.5 +/- 13). Three months after transplantation both mental (80.1 +/- 12.6) and psychomotor (69 +/- 16.1) scores dropped 1 SD, but 1 year after transplantation mental and psychomotor scores recovered to the pretransplantation level of functioning. One year after transplantation 35% of the study group was diagnosed as developmentally delayed. Delayed development was associated with decreased weight (p < 0.04), low albumin (p < 0.02), length of hospital stay (p < 0.04), and age at transplantation (p < 0.05). CONCLUSION: Young children undergoing liver transplantation are at risk for developmental delay. Aggressive nutritional support before transplantation and timing of transplantation before malnutrition develops may reduce developmental delays.

Age Factors↗

PubMed2006

Impact of gestational age on the clinical presentation and surgical outcome of necrotizing enterocolitis.

OBJECTIVE: This investigation tests the hypothesis that the clinical presentation and the outcome of necrotizing enterocolitis (NEC) vary with gestational age (GA). METHODS: All infants admitted to our center between October 1991 and September 2003 were evaluated weekly to identify confirmed cases of NEC. Based upon GA, these infants were divided into five groups: Extremely premature (EP, 23 to 26 weeks), very premature (VP, 27 to 29 weeks), moderately premature (MP, 30 to 34 weeks), near-term (NT, 35 to 36 weeks), and term (T, 37 to 42 weeks). RESULTS: A total of 202 infants developed NEC. The most common sign of NEC among EP infants was ileus (77%), followed by abdominal distention (71%), emesis (58%), pneumoperitoneum (54%), fixed intestinal loop (52%), gasless abdomen (42%) and bloody stools (17%). Intramural gas was detected in 100% of T but was present in only 29% of EP infants (P < 0.0001). Similarly, portal venous gas was common in T but infrequent in the EP infants (47 vs 10%, P < 0.0001). Despite a higher peritoneal drain insertion rate (31 vs 5%, P < 0.001) and a higher mortality rate (33 vs 10%, P = 0.05) in EP compared to T infants, other clinical outcomes were not different. CONCLUSIONS: The clinical presentation of NEC is different in EP compared to more mature infants; however, outcome among NEC survivors is similar across all GA. Reliance solely on observation of intramural or on portal venous gas in EP infants may lead to a delay or failure in the diagnosis.

Enterocolitis, Necrotizing↗

PubMed1998

Semantic development of African-American children prenatally exposed to cocaine.

Semantic content categories were described for the single word, multiple word, and verb relation utterances of 22 African-American 2-year-olds during a 90-min laboratory session. Half of the toddlers had been exposed prenatally to cocaine and half were unexposed, as documented by biological assay in the newborn period. The exposed and unexposed groups were carefully matched on demographic, medical, and proximal caregiving variables. Children's spontaneous utterances were transcribed from audio- and videotapes during the laboratory session and scored for semantic features by a team of reliable coders who were masked to child exposure status. General productive language features (utterance length, verbosity, and intelligibility) were also assessed. To evaluate general language and cognitive skills, the toddlers were evaluated with the Sequenced Inventory of Communicative Development-Revised (SICD-R) and the Bayley Scales of Infant Development (BSID). Although exposed and nonexposed toddlers exhibited similar sequences of semantic development, the exposed toddlers were more restricted and delayed in their semantic representations. No significant group differences were observed, however, for structural features of language (e.g., utterance length, distribution of utterance types) or for children's general language and cognitive functioning as assessed by standardized assessments (i.e., SICD-R, BSID). Thus, a history of prenatal cocaine exposure and associated risk factors (e.g., prenatal exposure to alcohol, diminished birth weight) are related to delays in early semantic development. Proposed diagnostic and treatment strategies are discussed.

Black or African American↗

PubMed2002

Intestinal flora during the first months of life: new perspectives.

Increasing awareness that the human intestinal flora is a major factor in health and disease has led to different strategies to manipulate the flora to promote health. The complex microflora of the adult is difficult to change in the long term. There is greater impact of diet on the infant microflora. Manipulation of the flora particularly with probiotics has shown promising results in the prevention and treatment of diarrhoea and allergy. Before attempting to change the flora of the infant population in general, a greater understanding of the gut bacterial colonisation process is required. The critical stages of gut colonisation are after birth and during weaning. Lactic acid bacteria dominate the flora of the breast-fed infant. The formula-fed infant has a more diverse flora. The faeces of the breast-fed infant contain mainly acetic and lactic acid whereas the formula fed-infant has mainly acetic and propionic acid. Butyric acid is not a significant component in either group. The formula-fed infant also has higher faecal ammonia and other potentially harmful bacterial products. The composition of the microflora diversifies shortly before and particularly after weaning. The flora of the formula-fed infant develops more quickly than that of the breast-fed infant. Before embarking on any strategy to change the flora, the following questions should be considered: Should we retain a breast-fed style flora with limited ability to ferment complex carbohydrates? Can pro- and prebiotics achieve a flora with adult characteristics but with more lactic acid bacteria in weaned infants? Are there any health risks associated with such manipulations of the flora?

Bacteria↗

PubMedDate not supplied

You go this way and I'll go that way: developmental changes in infants' detection of correlations among static and dynamic features in motion events.

Four experiments utilizing the habituation procedure examined 10- to 18-month-olds' ability to detect and encode correlations among features in a motion event (N = 136). Infants were habituated to two events in which objects-with distinct parts and a distinct body-moved across a screen along a rectilinear or curvilinear motion path. Infants were then tested with one familiar event and three events in which one feature of the object (parts, body, or motion path) was presented in a novel combination with the other features. The results of the experiments revealed that 10-month-olds process independently static features in an event, but do not process correlations among dynamic features; whereas 14-month-olds detect the correlation between an object's parts and its motion trajectory, but only when the movement of parts is correlated with the motion of the object. Further, the data show that 18-month-olds detect correlations between all three features when the parts of the object move, but they detect only the relation between parts and motion path when the parts do not move. It is proposed that infants develop representations for the static and dynamic properties of objects through a sensitive perceptual system that detects individual features, whole objects, and movement properties, and a domain-general associative learning mechanism that encodes independent features and correlations among features.

Child Development↗

PubMed1986

Positive-pressure ventilation at moderately high frequency in newborn infants with respiratory distress syndrome (IRDS).

In 24 seriously ill newborn infants with respiratory distress syndrome (IRDS) and ensuing respiratory failure, high-frequency positive-pressure ventilation was administered. The mean gestational age of the infants was 32 +/- 3 weeks. In the infant ventilator employed, the compressible volume had been reduced in order to give higher flow rates but lower intratracheal pressures. The ventilation frequency was kept constant at 60-66 per min and the insufflation period at 32-35% of the ventilatory cycle. A positive end-expiratory pressure (PEEP) of 0.2-0.6 kPa was used. Arterial PCO2 was maintained at 4.0-5.3 kPa and PO2 at 8.5-10.5 kPa by adjusting the gas flow through the patient circuit, the peak tubing pressure, the PEEP and the oxygen concentration in inspired gas. High-frequency positive-pressure ventilation improved oxygenation and gave adequate alveolar ventilation in all infants, in most cases at a low peak pressure. Only one infant developed pneumothorax during intermittent positive pressure ventilation, and in no infant did bronchopulmonary dysplasia or retrolental fibroplasia occur. One infant died from intracranial hemorrhage during the ventilation period, giving a survival rate of 96%.

Female↗

PubMed1997

Neurodevelopmental outcome in babies with a low Apgar score from Zimbabwe.

The early identification of neurological dysfunction in the neonatal period, the predictive value of single items of the neonatal neurological examination (NNE) adapted from Prechtl and the developmental outcome at 1 year of age in infants with a low Apgar score in Zimbabwe were studied. One hundred and sixty-five infants were examined with the NNE and 142 with the Bayley Scale of Infant Development (BSID) at 1 year of age. Twenty-three infants had cerebral palsy, ten had a motor delay or developmental delay, and four were mentally retarded. The NNE proved to be a sensitive instrument for detecting neurodevelopmental abnormality. Logistic regression analysis was used to investigate the relationship between the BSID and nine selected predictors from the NNE. This resulted in a correct classification of 94%. However, the number of false negatives was high. By using only the variability of movements and fixation as predictors the number of false negatives was reduced to one.

Apgar Score↗

PubMed1980

Hydrocolpos with peritonitis in the newborn.

Two cases of hydrocolpos are described presenting soon after birth. One infant who died on the first day had an intrauterine peritonitis caused by compression of the caecum on the pelvic brim. The other surviving infant developed a caecal perforation secondary to Hirschsprung's disease. Neither infant had rectal atresia, which is the commonest cause of intestinal obstruction in these infants. The association of hydrocolpos with polydactyly in one of these cases may represent an autosomal recessive trait.

Female↗

PubMed1992

Short-term outcome in infants with birth weights less than 1750 g born to mothers with HELLP syndrome.

Premature infants born to mothers with HELLP syndrome were reported to have a less favourable outcome compared to infants with uncomplicated maternal history. We investigated the short term outcome in 21 premature infants with birth weights less than 1750 g born to mothers with HELLP syndrome. Median birth weight was 1050 g (range 420 g-1750 g), corresponding gestational age 29 weeks (range 26-35 weeks). Mechanical ventilation for RDS was necessary in 15 infants. Intracranial hemorrhage was diagnosed in 2 infants, 1 of the surviving infants developed bronchopulmonary dysplasia. Acute renal failure was observed in 3 infants immediately after birth. Mortality was attributed to progressive respiratory failure in 2 patients (b.w. 420 g and 490 g) and persisting acute renal failure in 1 patient (b.w. 520 g) Leucocytopenia (less than 9000/mm3) was observed in 13 infants and thrombocytopenia (less than 115000/mm3) was noted in 4 infants during the first day. Eighteen infants survived. We conclude, that the short term outcome in infants born to mothers with HELLP syndrome is not as poor, as previously reported.

Birth Weight↗

PubMed2005

[Neurodevelopment of full-term small-for-gestational age infants in the second month of life].

The objective of the present study was to assess and to compare the neurodevelopment of full-term adequate (AGA) or small-for-gestational age (SGA) infants in the second month of life. Sixty-seven infants were evaluated: 43 AGA and 24 SGA, making use of the Bayley Scales of Infant Development. The SGA group Index Score (IS) was significantly lower in Mental and Motor Scales. Considering the body proportionality (Asymmetric, Symmetric-SGA and Control group) there was difference in Motor Scale (p=0.003) with lower scores in the Symmetric-SGA group. Comparing to the Control group IS percentiles, in Mental Scale there was difference between Asymmetric X Symmetric-SGA; in Motor Scale, there was difference between the Asymmetric X Control (p=0.039) and Symmetric-SGA X Control (p=0.007) groups; there was no difference between Asymmetric and Symmetric-SGA although both exhibited lower scores than the Control group.

Anthropometry↗

PubMedDate not supplied

Neonatal drug exposure: assessing a specific population and services provided by visiting nurses.

Historically, community health nurses have provided nursing services to infants who were exposed to licit and illicit drugs in utero and their mothers. The charts of 145 infants whose mothers had a history of drug and alcohol abuse and who were referred to a visiting nurse agency between 1988 and 1994 were reviewed for this study. Of the infants who were reported to have been exposed to drugs in utero, 69% were exposed to cocaine, 11% to heroin, and 6% to marijuana. The average age of the mothers was 26 years; 83.4% were single; 82.1% received Aid for Families of Dependent Children (AFDC); 92.4% were on Medicaid; and 95.9% were involved with child protective services. The most frequent nursing problems identified were (a) maternal-child attachment, (b) sleep patterns, (c) infant feeding, and (d) infant development. Nursing interventions included nutritional management, physical assessment, monitoring growth and development, and education in parenting skills. Fifty percent of the infants increased their weight by at least one percentile and 31% increased two percentiles. Resolution of nursing problems occurred in 50% of the cases.

Adult↗

PubMed1983

Improving adolescent parenting through participant modeling and self-evaluation.

This article describes how nurses can promote adolescent parenting by providing opportunities for young mothers to view and practice appropriate behavior to foster their infants' development. The importance of utilizing such an intervention in the context of an ongoing caring environment is stressed as a key element. The program was developed with consideration of the adolescent's developmental stage and parenting characteristics. Participant modeling and self-evaluation were utilized as effective means of fostering behavioral change. Content for the films was drawn from the findings of the Harvard Preschool Study, the work of Badger, the research of Wachs, Uzgiris, and Hunt, and the nursing child assessment training materials developed by Barnard at the University of Washington. Timing and sites for class sessions have been suggested. The reader is encouraged to study the literature on phases of transition, organization, reorganization, and adaptation when considering the timing for developmental intervention. The goal of this program is to foster competent, curious children and competent, supportive parents who will assume full responsibility for the health care decisions relating to their child. As young parents develop their decision-making skills, the health provider role should move from a protective/collaborative stance to one of a resource for health care maintenance and problems.

Adolescent↗

PubMed1982

Infant botulism--the first five years.

In 1976 physicians in California reported the presence of botulism in infancy. Over a period of a few days infants developed generalized weakness and lost autonomic functions. The severity of infant botulism has varied from feeding difficulties to paralysis. No toxin was found in the infants' food, but it was detected in the stool along with C. botulinum spores and organism. This suggested that infants consumed the spores, which germinated into organisms, which produced the toxin.

Animals↗