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PubMed1999

Randomized placebo-controlled trial of a 42-day tapering course of dexamethasone to reduce the duration of ventilator dependency in very low birth weight infants: outcome of study participants at 1-year adjusted age.

OBJECTIVE: Ventilator-dependent preterm infants are often treated with a prolonged tapering course of dexamethasone to decrease the risk and severity of chronic lung disease. The objective of this study was to assess the effect of this therapy on developmental outcome at 1 year of age. METHODS: Study participants were 118 very low birth weight infants who, at 15 to 25 days of life, were not weaning from assisted ventilation and were then enrolled in a randomized, placebo-controlled, double-blind trial of a 42-day tapering course of dexamethasone. Infants were examined at 1 year of age, adjusted for prematurity, by a pediatrician and a child psychologist. A physical and neurologic examination was performed, and the Bayley Scales of Infant Development were administered. All examiners were blind to treatment group. RESULTS: Groups were similar in terms of birth weight, gestational age, gender, and race. A higher percentage of dexamethasone recipients had major intracranial abnormalities diagnosed by ultrasonography (21% vs 11%). Group differences were not found for Bayley Mental Development Index (median [range] for dexamethasone-treated group, 94 [50-123]; for placebo group, 90 [28-117]) or Psychomotor Development Index Index (median [range]) for dexamethasone-treated group, 78 (50-109); for placebo-treated group, 81 [28-117]). More dexamethasone-treated infants had cerebral palsy (25% vs 7%) and abnormal neurologic examination findings (45% vs 16%). In stratified analyses, adjusted for major cranial ultrasound abnormalities, these associations persisted (OR values for cerebral palsy, 5.3; 95% CI: 1.3-21.4; OR values for neurologic abnormality 3.6; 95% CI: 1.2-11.0). CONCLUSIONS: A 42-day tapering course of dexamethasone was associated with an increased risk of cerebral palsy. Possible explanations include an adverse effect of this therapy on brain development and/or improved survival of infants who either already have neurologic injury or who are at increased risk for such injury.

Cerebral Palsy↗

PubMed1993

Identifying at-risk children for early intervention services: lessons from the Infant Health and Development Program.

A U.S. law mandates early intervention services for infants and young children who have, or are at risk for, developmental problems. Participating states must develop definitions for identifying infants and young children at risk for developmental problems. To assess the sensitivity, specificity, and positive predictive value of some commonly identified risk factors, we examined the definitions proposed by five states. Data on risk factors and 36-month developmental outcomes were obtained from follow-up participants in the Infant Health and Development Program, a multisite, collaborative prospective intervention program involving 985 low birth weight preterm infants. Few individual risk factors proposed by these states were associated with poor developmental outcomes. Characteristics with positive predictive values greater than 30% were highly specific but tended to involve few cases. Risk factors with positive predictive values greater than 50%, such as hypothyroidism, occurred infrequently (< 6%) in this sample. When state definitions for at-risk children were examined in composite, each definition yielded a positive predictive value of 25% to 35%, with poor specificities ranging from 12% to 40%. These data on low birth weight infants have implications for the design and funding of population-based early intervention programs, and suggest that more careful clinical and longitudinal research is necessary before appropriate definitions can be promulgated for identifying children in need of early intervention services.

Child, Preschool↗

PubMed1983

The maturation of visual acuity in neurologically normal and abnormal newborn infants.

The maturation of visual acuity was studied in 162 neurologically normal and 96 neurologically abnormal newborn infants. Ninety-five percent of the neurologically normal infants developed an acuity of 80 min arc by 35 weeks postmenstrual age (PMA) but only 50% developed an acuity of 40 min arc by 40 weeks PMA. Neurologically abnormal infants, and in particular those with periventricular haemorrhage (PVH), had a delay in the development of acuity. There was a close correlation between the development of 80 min arc acuity and the appearance of the first positivity of the flash visually evoked potential (VEP).

Cerebral Hemorrhage↗

PubMed1992

The moment of recognition. Rabbinic discourse, infancy, and psychoanalysis.

Professionals and educated laymen agree that the past 30 years have brought about a revolution in our understanding of infant development during the very first months of life. The inchoate "blooming buzzing confusion" once felt to characterize the neonate has given way to a well-documented realm of finely tuned perceptions and highly complex interactions. These shifts in our thinking are generally assumed to imply that periods chronologically more remote from our own are conceptually more remote from our modern achievements. But in fact, they are not. I here examine ancient and medieval rabbinic texts and find these "modern" issues discussed. The formulations of these texts, I suggest, sharpen the psychoanalytic focus on the role of the integrative function in very early development.

Bible↗

PubMedDate not supplied

Prenatal drug exposure: effects on neonatal and infant growth and development.

There is no question that the number of women using and abusing drugs other than opiates far exceeds the number who are addicted to narcotics. Data on four groups of drug-addicted pregnant women and their newborns are presented and compared to a drug-free control group. Group I women (N = 51) conceived while on heroin and were converted to low-dose methadone maintenance; Group II women were addicted to multiple licit or illicit nonnarcotic drugs (N = 22); Group III women abused a combination of pentazocine and tripelennamine (T's and blues) during pregnancy (N = 13); and Group IV women (N = 9) abused phencyclidine (PCP) throughout pregnancy. Group V women (N = 27) were selected from the clinic population of Prentice Women's Hospital and Maternity Center and had no history or evidence of substance use or abuse. Opiate-exposed newborns in Groups I and III were significantly smaller than control infants for all growth parameters, though by nine months of age they had caught up in weight and length to control infants. Head circumference remained significantly smaller than controls through two years of age. All four groups of drug-exposed infants exhibited abnormal neurobehavior in the newborn period, but mental and psychomotor development as evaluated with the Bayley Scales of Infant Development was comparable to control infants' development through two years of age.

Child Development↗

PubMed2001

Differential patterns of development: the interaction of birth weight, temperament, and maternal behavior.

A short-term longitudinal study of 83 families compared patterns of development between full-term small for gestational age (SGA) and normal birth weight (NBW) infants. Data were collected on infant temperament and maternal interaction at 3 and 6 months, and infant developmental outcomes at 6 months in order to investigate relationships between infant and maternal behavior, and developmental outcomes as a function of birth weight. Findings revealed few differences between SGA and NBW groups. However, the relations between infant temperament and maternal behavior varied as a function of birth weight and home environment. Specifically, more positive home environments were associated with higher ratings of maternal behavior and lower levels of infant negative reactivity for SGA but not for NBW infants. In addition, higher negative reactivity was related to lower performance on both the mental and psychomotor scales of the Bayley Scales of Infant Development (BSID), with stronger associations reported for SGA infants than for NBW infants.

Birth Weight↗

PubMed1984

Primitive reflex profile: a quantitation of primitive reflexes in infancy.

This report describes quantitative standardization data on nine primitive reflexes for a cohort of 381 normal infants evaluated longitudinally at each visit between birth and two years of age. Normality was confirmed by the use of the Bayley Scales of Infant Development at one year of age. The standardization of this new examination technique complements the traditional infant neurological examination and may allow primitive reflexes to become a useful adjunct to the prediction of motor disability in early infancy.

Brain Damage, Chronic↗

PubMed2005

Circulating interferon-gamma and white matter brain damage in preterm infants.

The fetal inflammatory response has been suggested as causal in neonatal morbidity. Serial levels of circulating cytokines were evaluated in 74 infants with a mean gestational age (GA) of 27.1 wk. Pro-inflammatory [tumor necrosis factor-alpha (TNF-alpha), interferon-gamma (IFN-gamma), IL-1 beta, IL-2, IL-6, IL-8, IL-12] [corrected] and modulatory (IL-4, IL-10) cytokines were analyzed from cord blood, and at 6, 24 [corrected] and 72 h postnatal age. Measure of cytokine burden over time was assessed by calculating the area under curve (AUC) for analyzed levels (0-72 h). Premature rupture of membranes (PROM) was associated with higher levels of IL-2 at birth and at 6 h, of IFN-gamma at 6 and 24 h postnatal age and of TNF-alpha at 6 and 24 h. Levels of IFN-gamma at 6, 24, and 72 h were increased in infants developing white matter brain damage (WMD) compared with those without WMD. Infants with arterial hypotension requiring dopamine treatment had an increase in IL-6 with a peak at 6 h of age. Severe intraventricular hemorrhage (IVH) was associated with increase in AUC [(IL-6) and (IL-8), odds ratio (OR) 2.8 and 13.2 respectively], whereas white matter brain damage (WMD) [corrected] was associated with increase in AUC (IFN-gamma; OR, 26.0) [corrected] A fetal immune response with increased postnatal levels of IFN-gamma was associated with development of WMD. PROM was associated with a T-helper 1 cytokine response with increased levels of IFN-gamma. Type of inflammatory response appears of importance for subsequent morbidity.

Area Under Curve↗

PubMed2004

Respiratory development in preterm infants.

OBJECTIVE: This study examined the development of respiration during the preterm and early post-term periods and the effects of other biological and environmental variables, including sleep state, on this development. STUDY DESIGN: Weekly 2-hour sleep observations and respiration recordings were obtained on 134 preterm infants from the time they were no longer critical until hospital discharge; a follow-up observation was conducted 1 to 3 months later. RESULTS: All respiratory variables, except length of respiratory pauses in quiet sleep, decreased although the rate of this decrease slowed after term for four variables. Respiratory variables, except variability of respiratory pauses lengths and periodic respiration, differed by sleep state. Covariates, except methylxanthine treatment, had minor effects. Four variables showed hospital-related differences, but cisapride treatment helped to explain the differences in three variables. CONCLUSIONS: Much development of respiration occurs in the early weeks after birth and reflects both neural maturation and effects of other biological and environmental factors, especially medications.

Child Development↗

PubMedDate not supplied

Recent trends in infant mortality in developed countries.

"This paper examines the progress of infant mortality in the primary developed countries after 1960. A strong decrease of the phenomenon was measured everywhere although its intensity was independent of the starting levels. The most rapid decline occurred in Japan and several countries in southern and northwestern Europe. The slowest decline occurred in the Soviet Union. In some countries, such as Romania, Czechoslovakia and the United States, short term fluctuations interposed themselves on the declining trend. The differences in mortality between the two sexes were generally reduced in those populations with low infant mortality, while the opposite happened in the case of most of the others." (SUMMARY IN FRE AND ITA)

Age Factors↗

PubMed1985

Is this child developing properly? A practical tool for monitoring.

The developmental picture of a child can be appreciated only by regular comparison of the child's progress with normal milestones for age in an organized and systematic manner. The Kansas Infant Development Screen (KIDS) chart is a useful instrument for this very important element of well-child visits. It is simple to use and easily interpreted by health care providers and parents.

Aging↗

PubMedDate not supplied

Implications of kangaroo care for growth and development in preterm infants.

OBJECTIVE: To review research on kangaroo care with implications for growth and development in preterm infants. DATA SOURCES: Nursing, medical, and child development research literature was searched through PubMed through 2003 using the search terms kangaroo Care, skin-to-skin, growth/development, and premature infants. STUDY SELECTION: Randomized controlled trials, pretest-posttest designs, and other comparative studies of kangaroo care were reviewed. Reports exploring parent perspectives were examined for attachment and parent-infant interaction findings. Theory and research regarding growth in preterm infants were explored. DATA EXTRACTION: Research on topics of kangaroo care, skin-to-skin contact, preterm infant growth, preterm infant weight gain, and failure to thrive was evaluated. DATA SYNTHESIS: Research on kangaroo care reports physiologic safety for preterm infants and increased attachment for parents. Attachment promotes nurturing behaviors that support growth and development. Weight gain as a benefit of kangaroo care remains in question. CONCLUSIONS: Kangaroo care is safe for preterm infants and may have important benefits for growth and development. Suggestions are made for future research on effects of KC on preterm infants.

Body Temperature Regulation↗

PubMed1992

Skin temperature and heart rate rhythms in infants of extreme prematurity.

Nine preterm infants of 26 to 29 weeks' gestational age and 792 to 1200 g birth weight spent six to 17 weeks in our neonatal medical unit. Hourly recordings of skin temperature and heart rate were carried out. The first five to 15 weeks were spent in the intensive care ward, in continuous light, due to various medical conditions. After recovery they were moved to a nursery for one to nine weeks, with 12 hourly periods of light and darkness. Four infants developed circadian rhythms in temperature and three in heart rate in light-dark periods, the remainder failing to do so. Some infants take longer than others to develop circadian rhythms but the reasons for this are not clear. It is suggested that earlier exposure to a light-dark environment may synchronize the 'body clock' to a 24 hour period in more preterm infants.

Circadian Rhythm↗

PubMed1989

Pre-irradiation chemotherapy for infants and children with medulloblastoma: a preliminary report.

From March, 1984, through June, 1987, 21 newly diagnosed children with high-risk medulloblastoma (Chang Stage T3 to T4) were treated on a 9-week postoperative, pre-irradiation chemotherapy regimen consisting of vincristine and cisplatin. The children over 2 years old then received radiation therapy. Six infants (aged 6 to 18 months) were maintained on chemotherapy consisting of MOP (nitrogen mustard, vincristine, and procarbazine) until the age of 2 years, at which time they were referred for irradiation. Of 13 children with measurable disease following surgery, five showed a definite response on computerized tomography scans to vincristine and cisplatin (one complete response and four partial responses) and five others showed clear marginal responses. Four of the six infants were disease-free at 19, 32, 35, and 57 months from diagnosis. One infant developed progressive disease at the completion of the vincristine and cisplatin course, and a second infant had progression during MOP administration. Three of the 21 children developed hearing loss within the speech frequencies during cisplatin treatments, but there were no other major toxicities. Fifteen children remained disease-free with a median follow-up period of 35 months (range 19 to 57 months). Chemotherapy given between surgery and radiotherapy may allow for the direct evaluation of a specific drug regimen and permit the postponement of radiation therapy in infants. Pre-irradiation vincristine and cisplatin was well tolerated and effective in shrinking the tumor in most children with medulloblastoma. Such chemotherapy regimens have the potential for extending long-term survival in high-risk children.

Adolescent↗

PubMed1997

Small changes of dietary (n-6) and (n-3)/fatty acid content ration alter phosphatidylethanolamine and phosphatidylcholine fatty acid composition during development of neuronal and glial cells in rats.

It has been suggested that the fat composition of infant formula should provide arachidonic acid [20:4(n-6)] and docosahexaenoic acid [22:6(n-3)] or increased alpha-linolenic acid [18:3(n-3)] to optimize the (n-3) and (n-6) fatty acid content of brain during infant development. This experiment examined the effects of feeding increased levels of 18:3(n-3), 20:4(n-6) and 22:6(n-3) on brain development in neonatal rats. Diets varying in (n-6) and (n-3) fatty acid content with or without 20:4(n-6) or 22:6(n-3), at levels proposed for infant formula, were fed to nursing dams from parturition and subsequently to weaned pups until 6 wk of age. Neuronal and glial cells were isolated from the frontal region, cerebellum and hippocampus of the brain. Fatty acid analyses of ethanolamine- and choline-phosphoglycerides indicated that small changes in the dietary (n-6)/(n-3) ratio significantly altered neuronal and glial membrane fatty acid composition. Brain regions and cell types varied in amount and rate of 20:4(n-6) and 22:6(n-3) accretion. Fatty acid composition of individual phosphoglycerides was distinct and exhibited changes with age. Inclusion of both 20:4(n-6) and 22:6(n-3) in the diet resulted in alteration of brain fatty acid composition reflecting the fatty acid composition of the diet. If analogous developmental changes occur in human brain, then these results imply that addition of 20:4(n-6) and 22:6(n-3) or a reduced 18:2(n-6):18:3(n-3) ratio in infant formula may result in fatty acid profiles of neuronal and glial cells in formula-fed infants similar to those observed in breast-fed infants.

Aging↗

PubMed1980

The effect of treatment on mental and psychomotor development of marasmic infants according to age of admission.

The mental and psychomotor development of severely malnourished infants were examined during nutritional and psychological treatment. There was a significant difference between younger and older infants in their response to the treatment. The older infants had a remarkable reduction of their psychomotor development at admission and showed a considerable recovery throughout treatment. The younger infants became more affected during hospitalisation. The bodyweight deficit had mostly recovered by the end of the treatment.

Age Factors↗

PubMed1988

Operant conditioning of vocalization rate of infants with Down syndrome.

Reinforcement control over vocalization rates of infants with Down syndrome was evaluated; elicitation of vocalizations by social stimulation was controlled. Parents of three infants (2.7, 5, and 8.2 months old) provided social reinforcement under two schedules: continuous reinforcement for vocalization (CRF) and differential reinforcement of other-than-vocalization (DRO). All infants produced systematically higher vocalization rates during CRF, even though the amount of social stimulation during DRO was equal to or greater than the amount provided during CRF. The results replicated findings with normally developing infants and support a contingent-stimulation model of intervention for infant vocal communication.

Behavior Therapy↗

PubMed1980

Maternal stimulation and infant exploratory competence: cross-sectional, correlational, and experimental analyses.

Research on maternal influence on infant development is criticized on the basis of its limited ability to make strong causal claims. 2 observational studies are then presented; 1 details, cross-sectionally, developmental changes in strategies of maternal stimulation and infant exploration and the interrelationship of these domains of parent and child behavior; the other tests, experimentally, the hypothesis that maternal stimulation fosters infant exploratory competence. Results of the first study reveal: (1) a linear increase in mother's verbal attention-focusing behavior and a curvilinear trend in physical attention-focusing strategies between 9 and 18 months; (2) linear increases in a variety of measures of infant exploration; and (3) positive associations between naturalistically observed maternal stimulation and infant exploratory competence. The experimental study demonstrates that infant exploratory skill, as measured both naturalistically and during a semistructured, free-play assessment, is positively influenced by the enhancement of maternal stimulation. These latter results are discussed in terms of infant stimulation programs.

Exploratory Behavior↗