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Polygraphic studies of normal infants and infants at risk for the sudden infant death syndrome: heart rate and variability as a function of state.

Spontaneous heart rate and variability were examined as a function of age and state from birth to 6 months of age in 10 normal infants and 10 infants at risk for sudden infant death syndrome (SIDS). The risk group showed a higher heart rate at 3 months of age, particularly in the waking state. The risk infants' heart rate also increased more markedly during the first month after birth in both quiet and active sleep. Heart rate in both groups declined after 2 months in every state; however, the risk infants lagged in the 2- to 3-month decline seen with the normal infants. In the awake state, heart rate variability in the risk group did not follow the increase seen with the normals during the 1-week to 2-month age period.

Age Factors

[Calcium requirement in infants with intrauterine dystrophy (ID). Report II. Effect of differentiated diets with regard to quantity and quality of protein and fat on the calcium balance in infants with intrauterine dystrophy].

In the former report on he calcium requirement in Small-for Date (S-f-D) infants it was observed that the ability of calcium absorption of S-f-D infants is lowered in 1-st semester of life. From this point of view it seemed purposeful to study the influence of 3 modified cow's milk formulas (see table) on the calcium absorption in S-f-D infants. Modification of these diets in regard to cow's milk depended on: 1) partial replacement of cow's milk fat with soya oil. 2) change of the proportion between fat and protein. 3) partial replacement of milk casein with lactoalbumin . The infants were divided into 3 groups G, H and C according to the kind of diet. Observation in the first 2 groups lasted for the whole first year of life, C group of infants was observed only in 1-st half year of life. In the first month of life G and H infants were fed the same unmodified cow's milk formulas (diet S) 3-day balance-studies. Were carried out once a month. The data of these 3 groups of infants were compared with each other and the data of S-f-D infants fed unmodified cow's milk formulas (group S) described in he former report. In group S, calcium intake was the highest in 1-st and in 2-nd semester of life among all compared infant groups, but the difference was not statistically significant. The lowest (%) absorption was noted in group G infants (fig. 2, table III and IV). The difference was statistically significant in 1-st semester of life between group G and S and in 2-nd semester between G and S as well as G and H groups. Calcium retention mg/kg was also the lowest in group G infants, and the difference was statistically significant in 1-st and in 2-nd semester between G and S groups. The infants fed H formula in spite of the lowest indices of calcium absorption % and retention mg/kg in the first (see table) and the second month of life and in spite of the lowest intake of calcium among all compared infants groups cough up absorption (%) and retention (mg/kg b.w.) with groups S in 2 semester of life.(ABSTRACT TRUNCATED AT 400 WORDS)

Age Factors

[Calcium requirement in infants with intrauterine dystrophy. Report I. Indicators of calcium balance in infants with intrauterine dystrophy].

Observations of many investigators point at a lower amount of calcium in body composition of Small-for-Date infants (S-f-D). So far, only few investigations indicated that the calcium metabolism is disturbed in the postnatal life of S-f-D infants as well. Taking into consideration these data, the authors attempt to define calcium-requirement in S-f-D infants. In this report the cross-sectional observations of 30 infants are described . They were born after 37 weeks of gestation. The mean body weight was 2318 and it ranged between 1200-2760 g. Their body weight at birth was below 10 percentile according to Brzozowska . In these infants 3-days balance studies were carried out once a month. The calcium balance indices were compared with the indices of the Full-Size infants (FS) who were observed during the former years. The S-f-D and FS infants were fed similar diets based on unmodified cow's milk formulas. It was noted that the percentage absorption index in S-f-D infants was significantly lower than in the control group in 1-st and 2-nd trimester of life (table III, fig. 2). The S-f-D infants had a good appetite in first semester of life and they ate a big volume of milk formula and calcium in it. It seems that this is the reason that calcium retention in S-f-D infants in spite of lower ability of calcium retention, did not differ statistically from calcium retention in FS infants. The mean values were a little lower however. In the 2-nd half year of life statistically significant difference between any of the balance indices in S-f-D and FS infants was not found.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors

Postneonatal infant mortality in infants to a neonatal intensive care unit.

The postneonatal infant mortality (PNIM) of 2,205 infants admitted to a neonatal intensive care unit from January 1971 to December 1974 was 44 in 1,000 infants who survived to age 28 days. This rate is approximately ten times that of the general population. Congenital malformations (59%), infections (12%), sudden infant death syndrome (10%), and asphyxial brain damage (10%) were the most common causes of death. One third (26) of the infants remained in the hospital whereas two thirds (52) had been dismissed prior to death. All who remained in the hospital plus 36 who had been dismissed died of severe illnesses that were incompatible with prolonged survival. The remaining PNIM was 10 in 1,000 neonatal survivors. This rate is still twice that of the general population. These deaths occurred in infants who were apparently well at the time of dismissal and subsequent examinations. Sudden infant death syndrome and infections constituted the largest portion of this mortality. Factors contributing to mortality in this group were poor socioeconomic status and low birth weight. Maternal age, race, marital status, and neonatal illnesses including apnea were not significantly related. Factors that appear to be important in the birth of high-risk infants continued to be operative in the postneonatal period, and contribute to a high mortality in apparently normal infants dismissed from the neonatal intensive care unit.

Abnormalities, Multiple

Effect of intravenous L-alanine administration on plasma glucose, insulin and glucagon, blood pyruvate, lactate and beta-hydroxybutyrate concentrations in newborn infants. Study in term and preterm newborn infants.

Ten term and eleven preterm newborn infants with appropriate weights for their gestational age were infused for one minute with L-alanine (150 mg/kg) at the age of 29 to 76 hours (mean 48 hours) and circulating levels of glucose, lactate, pyruvate, D-betahydroxybutyrate (D-BOHB), insulin and glucagon were monitored. Plasma glucose concentrations increased from 2.7 +/- 0.16 (mean +/- S.E.M.) to 3.7 +/- 0.2 mmol/l after 50 min (p less than 0.01) in term infants. In preterm infants, after an initial decrease of the glucose level from 3.1 +/- 0.16 to 2.6 +/- 0.16 mmol/l (p less than 0.05), it returned to the baseline level at 50 min: 3.0 +/- 0.2 mmol/l. The blood concentration of D-BOHB decreased in term infants from 192 +/- 37 to 112 + 6 micrometer/l (p less than 0.01) after 40 min. In preterms, its decrease was not significant (p greater than 0.05). Plasma glucagon level rose from 53 +/- 5 to 70 +/- 8 pmol/l after ten minutes (p less than 0.01) in terms infants and from 61 +/- 6 to 75 +/- 9 after 20 min (p less than 0.01) in preterm infants. There were no significant changes in plasma insulin concentrations in either group. Forty minutes after L-alanine infusion, I/G ratios were lower in preterm infants (1.26 +/- 0.14) than in term infants (1.71 +/- 0.25) (p less than 0.01). There was no relationship between the glycemic responses to L-alanine and the basal levels of D-BOHB. The data suggest that the glycemic effect of L-alanine infusion and circulating glucagon depends upon a specific stage in maturation. The antiketogenic effect of L-alanine infusion is observed in term infants as in adults.

Alanine

Care of infants with near-miss sudden infant death syndrome.

The purpose of this study was to evaluate the effectiveness of home management of life-threatening apnea in infants with near-miss sudden infant death syndrome (SIDS). A total of 84 infants were monitored with apnea monitors for an average of seven months (range 1 to 27). A group of 27 infants had episodes of apnea requiring resuscitation during home monitoring, all of whom were successfully resuscitated by their parents on at least one occasion using bag and mask resuscitation, and 17 infants required more than one resuscitation. Subsequent resuscitation was unsuccessful with four infants. Infants who experienced more than ten episodes of prolonged sleep apnea (apnea longer than 20 seconds) during home monitoring had a significantly increased risk of requiring resuscitation than other infants being studied. With the use of home monitoring of these infants and parents trained in cardiopulmonary resuscitation, the survival rate was 93.4%.

Apnea

The sudden infant death syndrome and infant botulism.

Fecal and serum specimens taken from 30 cases of sudden infant death and from eight cases of nonsudden infant death that were diagnosed at a single facility in King County, Wash., were examined for the presence of Clostridium botulinum organisms and toxin. Organisms, but not toxin, were recovered from a fecal specimen in one case of sudden infant death, results that parallel those from studies previously reported by investigators in California. Studies made in our laboratory of a nonfatal case of infant botulism revealed that an estimated 366,000 mouse minimal lethal doses of toxin were excreted in feces collected by purging the infant. Organisms and toxin were excreted for at least 15 days after the infant was hospitalized. Observations made in our laboratory of atypical responses in mice to both fecal and serum extracts, coupled with recently described experiments in which mice were used as an animal model for infant botulism in humans, provide a biologically plausible foundation for the hypothesis that C. botulinum may be implicated etiologically in some sudden infant deaths. Additional microbiologic, physiologic, and toxicologic data are needed to adequately test this hypothesis.

Botulinum Toxins

Serum dehydroepiandrosterone sulfate in premature infants and infants with intrauterine growth retardation.

Serum dehydroepiandrosterone sulfate (DHAS) was measured by radioimmunoassay in blood samples obtained in 128 ill newborn infants. Serial sampling was carried out in 40 infants. There were wide ranges found in the values in all gestational age groups, and there were not significant differences in the first day of life between DHAS levels in less than 30 week gestation prematures, 6819 +/- 4631 (SD) ng/ml, and near term or term infants, 4307 +/- 1498 ng/ml. Mean DHAS concentrations did not decline over the first three weeks of life in prematures less than 36 weeks gestation. In six infants, age 35-73 days, and 29-34 weeks gestation at birth, the DHAS concentration was 1068 +/- 138 ng/ml. High concentrations were frequent in prematures less than 33 weeks gestation and could be correlated to epiodes of severe clinical stress. There were no significant differences in serum DHAS levels, on the first day of life, between infants with no hyaline membrane disease, nonfatal hyaline membrane disease and fatal hyaline membrane disease. Intrauterine growth retarded (IUGR) infants, who were greater than 35 weeks gestation, had significantly lower (P less than .032) DHAS levels in the first day of life than normally grown infants. The results show that there is a persistence during the postnatal period of the prominent delta5-3beta-hydroxysteroid production by the adrenal cortex characteristic of the fetus. Low concentrations of serum DHAS in IUGR infants suggest that the fetal zone of the neonatal adrenal cortex is a major source of circulating DHAS in the newborn period.

Dehydroepiandrosterone

Blind ratings of mother-infant interaction in home movies of prepsychotic and normal infants.

Home movies of infants later diagnosed as having early childhood psychoses were compared with movies of normal control infants. A scale of attachment indicators measured mother-infant dyadic avoidance and reciprocity in the first 6 months of the infant's life. Three judges blind to diagnosis saw a general trend to dampened interaction for prepsychotic infants and their mothers. Prepsychotic and normal infants were not significantly different in touching and eye gaze behaviors, whereas mothers of prepsychotic infants exhibited less adequate eye gaze and touching than mothers of normal infants.

Eye