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PubMed2004

Exposure to di-(2-ethylhexyl) phthalate among premature neonates in a neonatal intensive care unit.

OBJECTIVE: Premature neonates who spend time in a neonatal intensive care unit may be at increased risk of adverse health effects from exposure to di-(2-ethylhexyl) phthalate (DEHP) because of their increased risk of high exposure, their small body size, and their physical condition. DEHP, a reproductive toxicant in animals, is a major component in polyvinyl chloride (PVC) plastics, which are frequently used in medical tubing and blood storage bags. DEHP is not covalently bound to PVC, and it may be easily released from the PVC medical devices. The objective of this study was to determine whether premature infants who undergo medical procedures, such as blood transfusions, intravenous therapy, enteral and parenteral nutrition support, and dialysis, are at increased risk of exposure to DEHP than the general population. Because of their smaller size, children and especially premature and small infants may receive a larger dose of DEHP on a milligram per kilogram basis than adults when the same-size medical device is used for all ages. METHODS: Premature neonates who seemed to have the potential to be on intravenous infusion for >2 weeks and were expected to survive were eligible for enrollment in the study. We assessed exposure to DEHP in 6 premature newborns by measuring in 41 urine samples the levels of 3 DEHP metabolites: mono-(2-ethylhexyl) phthalate (mEHP), mono-(2-ethyl-5-hydroxyhexyl) phthalate (mEHHP), and mono-(2-ethyl-5-oxohexyl) phthalate (mEOHP). RESULTS: mEHHP and mEOHP were detected in all 41 urine samples, and mEHP was detected in 33. Because only 33 of the samples had detectable amounts for all 3 metabolites, statistical analyses were limited to those 33. The levels of all 3 DEHP metabolites varied widely, and the urinary mean and median concentrations of mEOHP and mEHHP were 1 order of magnitude higher than those for mEHP. Furthermore, the geometric mean urinary concentrations of mEOHP (1617 ng/mL), mEHHP (2003 ng/mL), and mEHP (100 ng/mL) in these 6 premature infants who underwent intensive therapeutic interventions were found to be severalfold higher than in the US general population (for mEHP, geometric mean in those 6 years and older was 3.43 ng/mL). CONCLUSIONS: This study provides the first quantitative evidence confirming that newborns who undergo intensive therapeutic medical interventions are exposed to higher concentrations of DEHP than the general population. Although the overall benefits of medical procedures using PVC devices outweigh the risks associated with exposure to DEHP, more research is needed to determine whether infants and children who undergo intensive therapeutic interventions using DEHP-containing devices are at higher risk for altered health outcomes than infants and children who undergo similar treatments but are not potentially exposed to DEHP.

Diethylhexyl Phthalate↗
PubMed1983

Effect of segmental epidural analgesia on neonatal serum bilirubin concentration and incidence of neonatal hyperbilirubinemia.

Neonatal serum bilirubin levels were determined at the ages of 12 hrs, 2 days, 3 days, 4 days and 5 days in 80 infants. Forty-three mothers had received segmental epidural analgesia at the height of Th 10-12 for pain relief during the first stage of labor. The analgesic agent used was 0.5% bupivacaine. The individual doses were of 4 ml. Thirty-seven mothers served as a control group. The groups were further divided into smaller groups according to whether oxytocin was used for induction or acceleration of labor--or not. The results showed no statistically significant differences in the neonatal serum bilirubin levels at different times between the epidural and the control groups, whether oxytocin was used or not. Nor did the incidence of neonatal hyperbilirubinemia cases differ between the groups.

Anesthesia, Epidural↗
PubMed2002

Neonatal sepsis: high antibiotic resistance of the bacterial pathogens in a neonatal intensive care unit in Karachi.

OBJECTIVE: To study the bacterial pathogens causing neonatal sepsis and their sensitivity pattern so that guidelines can be prepared for empirical antibiotic therapy. SETTING: The study was conducted in the neonatal intensive care unit (NICU) at PNS Shifa (Naval Hospital), Karachi during January 1997 to June 1999. METHODS: Blood specimens for culture were drawn from 520 newborns admitted in a NICU with sepsis. The specimens were inoculated into brain heart infusion broth. Subcultures were performed on days 1, 2, 3, 5, 7 and 10. The isolates were identified by standard biochemical tests. Antibiotic resistance pattern of the isolates was studied by Modified Kirby Baur disc diffusion technique. RESULTS: A total of 212 organisms were isolated. These included Staphylococcus aureus (n = 65), Klebsiella pneumoniae (n = 73), Acinetobacter baumannii (n = 23), Escherichia coli (n = 22), Enterobacter cloacae (n = 18), Citrobacter diversus (n = 5), Pseudomonas aeruginosa (n = 4) and group B Streptococcus (n = 2). On antibiotic sensitivity testing, 61.54% of Staphylococcus aureus isolates were found to be methicillin resistant. Susceptibility to the other common drugs was also quite low while 89.23% of these were susceptible to amikacin and 100% to vancomycin. More than 90% gram negative rods were resistant to ampicillin and co-trimoxazole. Resistance to gentamicin was as high as 90.4% for Klebsiella pneumoniae; 60.87% for Acinetobacter baumannii. Resistance to the third generation cephalosporins and the quinolone tested (ciprofloxacin) varied between 25-75%. Majority of the isolates were susceptible to meropenem and amikacin. CONCLUSION: In view of the isolation of highly antibiotic resistant organisms, vancomycin in combination with amikacin or a carbapenem is the drug of choice for empirically treating neonatal sepsis.

Anti-Bacterial Agents↗
PubMed2004

Neonatal sepsis in the neonatal intensive care unit: characteristics of early versus late onset.

Neonatal sepsis is a major cause of death in newborns despite sophisticated neonatal intensive care. This retrospective study reviewed the clinical characteristics of cases of culture-proven sepsis in a neonatal intensive care unit from January 1992 to December 2001. Patients were divided into those with onset of sepsis in the first 7 days of life (early-onset group) and those with onset after the seventh day of life (late-onset group). A total of 270 cases with 325 episodes of sepsis and 353 isolated pathogens were identified and included in the study. The male-to-female ratio was 1.4. The majority of cases of sepsis occurred in low birth weight (75.9%) and premature babies (76.7%). Late onset occurred in 71.9% of cases. Patients with late onset had a lower mortality rate than those with early onset (11.3% vs 28.9%). Coagulase-negative staphylococci (20.1%) was the most common organism isolated, but infection with Pseudomonas aeruginosa was associated with the highest morality rate (55.0%). Late-onset sepsis was significantly more common in very low birth weight and premature infants. The most frequently encountered pathogens in the early-onset group were group B streptococci (GBS) and Escherichia coli, while in the late-onset group, the organisms were coagulase-negative staphylococci and Enterobacteriaceae, including E. coli, Klebsiella pneumoniae, and Acinetobacter baumannii. GBS infection resulted in the highest mortality when the onset of sepsis was within the first 24 hours of life.

Age Factors↗
PubMed2003

[Neonatal mortality associated with transfer of low birth weight newborns. Assessment of a neonatal care unit of Dakar].

The aim of this study is to assess mortality rate of low birth weight newborns admitted to a neonatal care unit of Dakar after transfer. This retrospective study include all newborns weighing less than 2500 g transferred to Abass Ndao neonatal care unit between January 1st,1998 and December 31, 1999. Maternal, newborns and transfer related parameters were studied. Data of 180 new-borns were recorded from a sample of 247 babies transferred. The mean weight of these babies were 1452.5 +/- 432 g. An ambulance was used for transport in only 10% of cases. The median time of admission after birth was 3 hours. Median delay of admission and methods of transfer, maternal age and parity, apgar score at 1st and 5th minute were comparable between the newborns deceased and survivors (p > 0.05). To reduce mortality associated with newborns transfer, we insist on a better organisation of neonatal transport in under developed countries by promoting obstetricians and paediatricians collaboration and prevention of low birth weight.

Adolescent↗
PubMed2006

Phototherapy and exchange transfusion for neonatal hyperbilirubinaemia: neonatal academic hospitals' consensus guidelines for South African hospitals and primary care facilities.

The purpose of this document is to address the current lack of consensus regarding the management of hyperbilirubinaemia in neonates in South Africa. If left untreated, severe neonatal hyperbilirubinaemia may cause kernicterus and ultimately death and the severity of neonatal jaundice is often underestimated clinically. However, if phototherapy is instituted timely and at the correct intensity an exchange transfusion can usually be avoided. The literature describing intervention thresholds for phototherapy and exchange transfusion in both term and preterm infants is therefore reviewed and specific intervention thresholds that can be used throughout South Africa are proposed and presented graphically. A simplified version for use in a primary care setting is also presented. All academic heads of neonatology departments throughout South Africa were consulted in the process of drawing up this document and consensus was achieved.

Bilirubin↗
PubMed1991

[Neonatal conjunctivitis in a nursery and a neonatal unit].

After Credé prophylaxis was abandoned at our hospital in 1984 scrupulous clinical surveillance of all neonates for conjunctivitis, and bacterial cultures from purulent eye discharge, have become routine. During the two-year period 1 March 1987 to 28 February 1989, testing for Chlamydia trachomatis (EIA-technique) was added in all infants with clinical conjunctivitis. During the period concerned there were 332 cases of conjunctivitis among 4,520 live born infants, an incidence of 7.3%. The incidence was higher for infants staying in the nursery (8.2%) than for those admitted to the neonatal unit (3.5%) (p less than 0.01). 90% of the infections were diagnosed during the first week of life. 468 isolates were identified by routine bacteriological investigation, 452 gram-positives (96.6%), and 16 gram-negatives (3.4%). The following strains were found: Staphylococcus aureus 171 (51.5% of the patients), Staphylococcus epidermidis 153 (46.1%), Streptococcus viridans 106 (31.9%), diphteroids 11 (3.3%), beta-hemolytic streptococci seven (2.1%), Streptococcus pneumoniae two (0.6%), enterococci two (0.6%), Hemophilus influenzae six (1.8%), Escherichia coli five (1.5%), Proteus two (0.6%) and Branhamella catarrhalis one (0.3%). Not a single case of gonococcal ophthalmia was diagnosed. Positive tests for Chlamydia were found in 13 infants (3.9% of all infants with conjunctivitis), an incidence of 0.3% for the whole population of live born infants. Six of the chlamydia infections (46%) occurred within the first week of life. Expenses for chlamydia testing were estimated to be NOK 1,020 per positive test. Preventing conjunctivitis in our nursery and neonatal unit calls for strategies to protect newborn infants from colonization with pathogenic bacteria, especially S. aureus.(ABSTRACT TRUNCATED AT 250 WORDS)

Conjunctivitis, Bacterial↗
PubMed1981

[A 5-year review of neonatal intensive care at the kinderklinik der stadt wien - glanzing, neonatal intensive care centre (author's transl)].

This study deals with clinical results obtained at the neonatal intensive care unit of the Kinderklinik der Stadt Wien - Glanzing since its inception in 1974. An analysis of our newborn cases-admitted from 14 obstetric departments in Vienna and some obstetric departments in Lower Austria and Burgenland soon after birth-points to the fact that prematurity is still the most important risk factor in neonatal mortality. The results show that the prognosis of high-risk newborn infants depends very much on condition in the delivery room following primary resuscitation, the neonatal mortality increases with immaturity, hyaline membrane disease is the most important indication for artificial ventilation of premature infants, 30% of all patients requiring artificial ventilation are fullterm infants; 45% of them suffer from cerebral respiratory dysfunction, the mortality rate in mechanically-ventilated infants could not be significantly decreased over the past years. The consequences are discussed.

Austria↗
PubMed1995

[How sick is the neonatal intensive care patient? Limited prognostic significance of the Neonatal Therapeutic Intervention Scoring System for mortality and for psychomotor development in the first year of life].

OBJECTIVE: To study the Neonatal therapeutic intervention scoring system (NTISS-score) as a prognostic indicator for mortality and psychomotor development in newborns admitted to an intensive care unit. DESIGN: Retrospective. SETTING: Neonatal intensive care unit, Sophia Hospital, Zwolle, the Netherlands. METHOD: The medical files of all neonates (n = 152) admitted for intensive care in 1991 were studied. The NTISS scores at admission were compared of infants with birthweights < 1500 g and > or = 1500 g and in these groups of infants who died and infants who survived and of infants with normal and with abnormal psychomotor development in the first year of life regardless of their birthweight (data of 110 children were available from outpatient clinic control or reports from paediatricians). RESULTS: 22 infants died. There was no significant correlation between NTISS score and birthweight or gestational age (r = -0.07 and -0.03 respectively). In the group of very low birthweight infants, the NTISS score was significantly higher of the infants who died (25.9; SD: 4.3) than of those who survived (15.9; 5.0). The NTISS score did not differ between infants with normal and with abnormal psychomotor development. CONCLUSION: The NTISS score at admission only correlates with mortality in infants with birthweights < 1500 g. There is no correlation with mortality in infants with birthweights > or = 1500 g, with gestational age or with psychomotor development in the first year of life.

Child Development↗
PubMed1993

Score for Neonatal Acute Physiology: a physiologic severity index for neonatal intensive care.

The substantial variation in birth weight-adjusted mortality among neonatal intensive care units (NICUs) may reflect differences in population illness severity. Development of an illness severity measure is essential for comparisons of outcomes. The Score for Neonatal Acute Physiology (SNAP) was developed and validated prospectively on 1643 admissions (114 deaths) in three NICUs. SNAP scores the worst physiologic derangements in each organ system in the first 24 hours. SNAP showed little correlation with birth weight and was highly predictive of neonatal mortality even within narrow birth weight strata. It was capable of separating patients into groups with 2 to 20 times higher mortality risk. It also correlated highly with other indicators of severity including nursing workload (r = .59), therapeutic intensity (r = .78), physician estimates of mortality risk (r = .65), and length of stay (R2 = .59). SNAP is an important new tool for NICU research.

Birth Weight↗
PubMed2001

Human fetal and neonatal movement patterns: Gender differences and fetal-to-neonatal continuity.

Longitudinal quantification of leg movements per minute for human subjects during both fetal and neonatal periods was accomplished from videotapings conducted antenatally (ultrasonography 30, 34, and 37 weeks gestational age) and postnatally (birth and 6 weeks of age). Fetal/neonatal subjects displayed decreasing numbers of leg movements per minute during antenatal development (30 to 37 weeks), followed by increasing numbers of leg movements per minute during postnatal development (birth to 6 weeks of age). Male subjects displayed greater numbers of leg movements per minute than female subjects during both antenatal and postnatal development. Fetal-to-neonatal continuity for numbers of leg movements per minute was found for comparisons between fetal (37 weeks gestational age) and neonatal (during sleep states at birth) measures, and females displayed a stronger and different movement continuity pattern than males. These results indicate a differential time course for neurobehavioral development of male and female fetuses/neonates, and the findings have implications for the clinical assessment of fetal neurobehavioral development and well-being.

Embryonic and Fetal Development↗
PubMed1981

Neonatal imprinting and hepatic cytochrome P-450. II. Partial purification of a sex-dependent and neonatally imprinted form(s) of cytochrome P-450.

A new form of cytochrome P-450 was partially purified from hepatic microsomes of neonatally imprinted rats (adult male and adult male castrated at four weeks of age). This new form of cytochrome P-450 appears to have an apparent molecular weight of approximately 50,000 daltons as judged by sodium dodecyl sulfate polyacrylamide gel electrophoresis. It appears that this form of cytochrome P-450 is either absent or present in low concentrations in cytochrome P-450 preparations isolated from neonatally nonimprinted rats (adult female and adult male castrated at birth). Reconstitution of testosterone hydroxylase and benzphetamine N-demethylase activities of this partially purified cytochrome P-450 revealed that the presence of testosterone 16 alpha-hydroxylase activity, an imprintable microsomal enzyme, was in parallel with the imprinting status of the animals; a significantly higher activity was detected in the neonatally imprinted than that of the nonimprinted animals. This was in contrast to the nonimprintable benzphetamine N-demethylase, testosterone 7 alpha- and 6 beta-hydroxylase activities which exhibited no correlation with the imprinting status of the animals. We have prepared antisera from rabbits using the partially purified cytochrome P-450 preparations from adult male rats as antigens. These antisera inhibited microsomal testosterone 16 alpha- and 7 alpha-hydroxylase activities in a concentration-dependent manner, without impairing 6 beta-hydroxylase activity. These data suggest that the partially purified cytochrome P-450 from adult male rats consists of both imprintable (16 alpha-) and nonimprintable (7 alpha-) testosterone hydroxylase activities.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed2005

Outcome of 60 neonates who had ARED flow prenatally compared with a matched control group of appropriate-for-gestational age preterm neonates.

OBJECTIVE: To describe the course and outcome of fetuses with absent or reversed end-diastolic (ARED) flow in the umbilical artery (UA) and to examine the influence of prematurity according to gestational age at delivery. METHODS: Sixty pregnancies complicated by ARED flow in the UA were monitored by repeat Doppler measurements of arterial and venous vessels, non-stress tests (cardiotocogram (CTG)) and maternal investigations, and were delivered between 24 and 34 weeks. Fetal outcome was investigated and compared to a control group of appropriate-for-gestational age (AGA) preterm neonates, matched for gestational age. Mortality, birth weight, Apgar scores, postnatal cord arterial pH and need for ventilation were all recorded, as were cases of respiratory distress syndrome, bronchopulmonary dysplasia, persistent ductus arteriosus, necrotizing enterocolitis, intraventricular hemorrhage, periventricular leukomalacia, abnormal neurological findings and those requiring surgical intervention. Additionally, the group of fetuses with ARED flow was divided into three subgroups of different degrees of prematurity (delivery between 24 + 0 and 28 + 6 weeks, delivery between 29 + 0 and 31 + 6 weeks, and delivery after 32 weeks) and compared according to the above parameters. RESULTS: Pre- or postnatal death occurred in 16 cases. Comparing the 44 (61%) that were born alive with the AGA neonates, significant differences were found in birth weight (P < 0.001), arterial pH value (P < 0.001), bronchopulmonary dysplasia (P = 0.002) and intestinal complications (P < 0.01). Prematurity-related complications were: need for ventilation (P = 0.001), respiratory distress syndrome (P < 0.0001), periventricular leukomalacia (P = 0.002) and pathological neurological testing (P = 0.005). CONCLUSIONS: Neonates displaying ARED flow before birth are growth restricted, acidemic at delivery and are at high risk of developing bronchopulmonary dysplasia and intestinal complications. While perinatal mortality seems to be related to abnormal fetal Doppler velocimetry, age at delivery has a significant impact on short-term morbidity. After 32 weeks, morbidity is low and delivery should be considered. It could be speculated from our data that prolongation of pregnancy with Doppler velocimetry monitoring could help to reduce morbidity, although prolongation remains limited in most cases.

Birth Weight↗
PubMed1991

Erythropoietic progenitor cells from premature neonates studied using a validated serum-deprived medium. Evidence that peripheral blood BFU-E from premature neonates are increased in number and are highly dependent upon burst promoting activity for in vitro growth.

We have examined a serum-deprived culture system in order to verify that it is suitable for the study of burst forming unit erythroid (BFU-E) progenitor cells from premature neonates. Optimum growth of BFU-E from premature neonates was observed with each media constituent using the same concentration as that previously described for adult subjects. Growth of immature BFU-E from premature neonates were highly dependent upon a source of Burst Promoting Activity and mature BFU-E derived colonies emerged at day 12 compared to day 14 in adults. Our preliminary results with the validated medium suggest that premature infants have increased peripheral blood concentrations of BFU-E compared to healthy adult controls.

Adult↗
PubMed1991

Possible essentially of docosahexaenoic acid in Japanese monkey neonates: occurrence in colostrum and low biosynthetic capacity in neonate brains.

The importance of mother's milk as a source of docosahexaenoic acid (DHA) in Japanese monkey neonates was investigated. The DHA content in monkey colostrum total lipids was 2.2%, similar to or slightly higher than in humans. A comparison of the biosynthetic capacity of brain microsomes from monkeys of different age (up to 10 years) showed that chain elongation/desaturation of linolenic acid and eicosapentaenoic acid in neonates was significantly less pronounced than in adults. In particular, the formation of DHA, which is the product of delta 4 desaturase, was negligible. These results suggest that milk is an important source of DHA in Japanese monkey neonates.

Aging↗
PubMed2002

A neonate with mitral stenosis due to accessory mitral valve, ventricular septal defect, and patent ductus arteriosus: changes in echocardiographical findings during the neonatal period.

A female neonate with mitral stenosis due to accessory mitral valve with ventricular septal defect and patent ductus arteriosus is described. She was referred to our hospital because of neonatal asphyxia. Asphyxia was improved by ventilator support, but rapid deterioration of respiration with pulmonary congestion and hemorrhage appeared 8 days after birth. Echocardiography revealed an accessory mitral valve attached to the anterior mitral leaflet with a perimembranous ventricular septal defect and patent ductus arteriosus. Although there were no echocardiographical findings indicating mitral stenosis on admission, the mitral stenosis blood flow patterns were detected by color and pulsed Doppler examination performed on the eighth day after admission. Transaortic resection of accessory mitral valve tissue was performed with patch closure of the ventricular septal defect and ligation of the ductus arteriosus 35 days after birth. After operation, pulmonary congestion and hemorrhage were improved. Postoperative echocardiography showed complete resection of the accessory mitral valve and no mitral insufficiency. We concluded that the combination of the accessory mitral valve and left-to-right shunt due to ventricular septal defect or patent ducturs arteriosus might have led to a critical hemodynamic condition due to relative mitral stenosis in the neonatal period with the decrease in pulmonary vascular resistance.

Cardiac Surgical Procedures↗
PubMed2000

The stressed neonatal kidney: from pathophysiology to clinical management of neonatal vasomotor nephropathy.

The healthy term, and particularly the premature infant, is born with a very low glomerular filtration rate (GFR), controlled by a delicate balance of intrarenal vasoconstrictor and vasodilator forces. Vasoactive disturbances can easily further reduce the already low GFR. The newborn infant is thus prone to develop vasomotor nephropathy (VMNP) or acute renal failure (ARF). The main causes for ARF at this young age are prerenal mechanisms, and include hypotension, hypovolemia, hypoxemia perinatal asphyxia, and neonatal septicemia. Other causes include the administration of angiotensin converting enzyme inhibitors, indomethacin and tolazoline. The most-important factors governing the ultimate renal prognosis are the severity of the underlying disorder, the rapidity of an accurate diagnosis, prompt treatment, and avoidance of severe iatrogenic complications. The immediate treatment is of particular importance in VMNP, i.e., prerenal ischemic ARF, and consists of correcting abnormalities in fluid homeostasis and reduction of the complications of the acute azotemic state (uremia, hyperkalemia, acidosis, and hypertension). In severe and prolonged (established) ARF, temporary dialysis therapy may be indicated. Prerenal ARF with oliguria or anuria warrants immediate volume resuscitation. Special attention should be given to infants with congestive heart failure (CHF). The sick neonate with persistent oliguria and CHF should be treated with intravenous dopamine. Furosemide (FM) is the second line of therapy for babies with indomethacin-induced ARF. In most other conditions, the therapeutic effect of FM is limited to a transient increase in urine flow, without improving basic renal function. The special conditions of the maturing kidney have to be appreciated in order to protect babies from undue renal injury. With the increasing knowledge of the mechanisms governing the development of ARF, progress has been made in the development of new treatment modalities. For example theophylline, calcium antagonists, ATP-MgCl2, thyroxine, and a variety of cytokines may in the near future be used to prevent or ameliorate VMNP and/or recently established ARF. With a combination of time-honored and new therapeutic strategies, there may well be a brighter future for neonates with vasomotor, prerenal, ischemic ARF.

Humans↗
PubMed2005

Neonatal ethanol exposure but not neonatal cocaine selectively reduces specific isolation-induced vocalization waveforms in rats.

This study was designed to examine the interaction of neonatal ethanol and cocaine exposure on isolation induced ultrasonic vocalizations using an oral gavage method of drug administration. There were 5 neonatal treatment groups including 3.0 g/kg ethanol, 20 mg/kg cocaine, both 3.0 g/kg ethanol and 20 mg/kg cocaine, an intubated control and a nonintubated control. Drug was administered twice daily from postnatal days (PND) 4 - 10. On PND 14, subjects were tested for a 6 min test to assess the rate and type of ultrasonic vocalizations displayed. As previously reported using an intragastric "artificial rearing" administration procedure, pups exposed to ethanol displayed reductions in the number of ultrasonic vocalizations across the test session. Pups exposed to both drugs showed similar deficits to those pups receiving ethanol alone. In contrast, cocaine had no effect on this outcome measure. Sonographic analysis of the vocalizations revealed that ethanol's effects appeared to be selective to certain waveforms rather than a general reduction across all wave types and again, cocaine had no impact on the proportion of the various wave types. These findings provide further support that neonatal ethanol exposure can have significant effects on maternal/infant communication and may play a role in many of the long-term effects associated with ethanol exposure during development.

Animals↗