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PubMedDate not supplied

Systematic literature review of modifiable risk factors for recurrent acute otitis media in childhood.

OBJECTIVE: Review evidence about modifiable risk factors for recurrent acute otitis media. SOURCE OF DATA: MEDLINE with no language restriction, from January 1966 to July 2005, using descriptors "acute otitis media/risk factors". Two hundred and fifty-seven articles were obtained. These included randomized clinical trials, cohorts, case-control and cross-sectional studies that contained analyses of modifiable risk factors for the development of recurrent acute otitis media as the main objective and with samples of individuals up to the age of 18 years. Except when relevant, the following were excluded: non-systematic reviews, reports of cases, series of cases, and medical society guidelines. SUMMARY OF DATA: Nine risk factors linked to the host and eight linked to the environment were identified. Of the first group, allergy, craniofacial abnormalities, gastroesophageal reflux and the presence of adenoids were classified as modifiable. In the second category, upper airway infections, day care center attendance, presence of siblings/family size, passive smoking, breastfeeding and use of pacifiers were included. Afterwards, the risk factors were classified in accordance with levels of evidence. CONCLUSIONS: The risk factors established for recurrent acute otitis media and capable of being modified were the use of pacifiers and care in daycare centers. The probable risk factors were privation of mother's milk, presence of siblings, craniofacial abnormalities, passive smoking and presence of adenoids. No modifiable factor was classified as unlikely. Among those that need further study are allergy, gastroesophageal reflux and passive smoking during gestation.

Acute Disease↗
PubMed1976

The relative efficacy of vestibular-proprioceptive stimulation and the upright position in enhancing visual pursuit in neonates.

48 healthy neonates born to multiparae were randomly assigned to view a moving stimulus either in the horizontal or the upright position, with or without added vestibular stimulation and with or without pacifier sucking. The infant was shown a moving black line inside a strictly controlled visual environment provided by an apparatus which permitted horizontal and upright positioning and displacement of the infant. Visual tracking was recorded by a concealed TV camera positioned at a constant distance and angle from the infants' eyes in both positions. Quality of tracking during each of 4 trials was scored on a 7-point scale. Results indicate that vestibularproprioceptive stimulation provided to the infant either horizontally or semivertically significantly enhanced his visual tracking, whereas the upright position did not. Pacifier sucking also improved his performace.

Eye Movements↗
PubMed2003

Sleep environment and the risk of sudden infant death syndrome in an urban population: the Chicago Infant Mortality Study.

OBJECTIVE: To examine risk factors for sudden infant death syndrome (SIDS) with the goal of reducing SIDS mortality among blacks, which continues to affect this group at twice the rate of whites. METHODS: We analyzed data from a population-based case-control study of 260 SIDS deaths that occurred in Chicago between 1993 and 1996 and an equal number of matched living controls to determine the association between SIDS and factors in the sleep environment and other variables related to infant care. RESULTS: The racial/ethnic composition of the study groups was 75.0% black; 13.1% Hispanic white; and 11.9% non-Hispanic white. Several factors related to the sleep environment during last sleep were associated with higher risk of SIDS: placement in the prone position (unadjusted odds ratio [OR]: 2.4; 95% confidence interval [CI]: 1.7-3.4), soft surface (OR: 5.1; 95% CI: 3.1-8.3), pillow use (OR: 2.5; 95% CI: 1.5-4.2), face and/or head covered with bedding (OR: 2.5; 95% CI: 1.3-4.6), bed sharing overall (OR: 2.7; 95% CI: 1.8-4.2), bed sharing with parent(s) alone (OR: 1.9; 95% CI: 1.2-3.1), and bed sharing in other combinations (OR: 5.4; 95% CI: 2.8-10.2). Pacifier use was associated with decreased risk (unadjusted OR: 0.3; 95% CI: 0.2-0.5), as was breastfeeding either ever (OR: 0.2; 95% CI: 0.1-0.3) or currently (OR: 0.2; 95% CI: 0.1-0.4). In a multivariate model, several factors remained significant: prone sleep position, soft surface, pillow use, bed sharing other than with parent(s) alone, and not using a pacifier. CONCLUSIONS: To lower further the SIDS rate among black and other racial/ethnic groups, prone sleeping, the use of soft bedding and pillows, and some types of bed sharing should be reduced.

Analysis of Variance↗
PubMedDate not supplied

[School girls' perception and knowledge about breastfeeding].

OBJECTIVE: To compare two groups of school age girls from different social strata were compared in terms of their perception and knowledge about breastfeeding. METHODS: A structured questionnaire was applied to all 346 4th to 8th grade girls attending two schools, a private one, whose students belonged to the upper class (School A), and a public one, whose students belonged to the lower class (School B). RESULTS: About 90% of the girls reported having been breastfed and more than 98% had seen a mother breastfeeding. Only 14% of girls from School A and 26% from School B (p = 0.01) exclusively offered their breast or their breast and a bottle when playing with dolls. More than 80% of the girls stated that they would like to have a normal delivery and to breast-feed their child for more than 6 months, but 46% of the girls from School A and 32% from School B stated that they would be ashamed to breastfeed in public. About 90% of the girls considered human milk to be the best food for the baby, but only a small portion of them recognized other more specific advantages. Less than 1/3 would choose exclusive breastfeeding and about 60% would offer a pacifier to the baby. CONCLUSION: Girls from both social strata are aware of the fact that breastfeeding is the best diet for a newborn baby, but are not aware of its specific advantages. Exclusive breastfeeding is not incorporated into the knowledge of most of these girls, since most of them consider offering water, tea, juices and a pacifier to be adequate practices. Teaching about breastfeeding at school should emphasize these concepts.

Adolescent↗
PubMedDate not supplied

[Interobserver agreement in the radiological diagnosis of lower respiratory tract infections in children].

OBJECTIVE: To evaluate the inter-observer agreement of radiological diagnosis of lower respiratory tract infections in children. METHODS: Chest X-rays from 60 children younger than 5 years of age were evaluated by three physicians: a pediatric radiologist (PR), a pediatric pulmonologist (PP) and an experienced emergency pediatrician (EP). All children had sought an emergency room due to acute respiratory infections with apparent lower respiratory tract involvement. Observers were blinded to the original diagnostic conclusions, but clinical and laboratory data from the initial medical evaluation were provided with each film. Variables were grouped into five categories: a) film quality; b) site of abnormality; c) radiological patterns; d) other radiographic images; e) diagnosis. Inter-observer agreement was assessed using Kappa statistics, accepting prevalence-bias-adjusted values (PABAK). compare the prevalence of breastfeeding and exclusive breastfeeding during the first six months of life among pacifier and non-pacifier users. RESULTS: Kappa values for each of the three observer pairs (RP vs. PP, RP vs. EP, and PP vs. PE) were 0.41, 0.43, and 0.39, respectively. The overall inter-observer agreement was moderate (0.41). Agreement on other variables was as follows: regular for "film quality" (0.30); moderate for "site of abnormality" (0.48); fair for "radiological patterns" (0.29); moderate for "other radiographic images" (0,43); and moderate for "diagnosis" (0.33). The overall intra-observer agreement was "moderate" (0.54), which is below the agreement values reported by other studies on chest X-ray variability. CONCLUSIONS: Inter-observer variability is an intrinsic characteristic of the interpretation of chest X-rays, and the diagnosis of lower respiratory tract infections in children remains a challenge. Most of our results were similar to those previously reported.

Child, Preschool↗
PubMedDate not supplied

Feeding habits and severe early childhood caries in Brazilian preschool children.

PURPOSE: The objective of this study was to analyze the association between the feeding practice and presence or absence of SECC (Severe Early Childhood Caries) in Brazilian preschool children. METHODS: This cross-sectional study was conducted with male and female preschool children, aged 36 to 71 months, randomly selected from a low-income population. A 24-hour recall diary was used to assess data about infant feeding practices and dietary habits. The data were statistically analyzed using the chi-square test with a significance level of 5%. RESULTS: SECC was observed in 36% of the children examined. Infant feeding practices showed the association between SECC and night-time breast-feeding (P = .02) or breast-feeding (P = .0004) in children older than 12 months of age. The use of a bottle at night as a substitute for the pacifier and its use on demand during the day were also correlated with SECC (P < .0001). CONCLUSIONS: It was concluded that night-time breast-feeding in children older than 12 months of age, the use of a bottle at night as a substitute for the pacifier, and use of the bottle on demand during the day are feeding practices correlated with the etiology of SECC.

Age Distribution↗
PubMed2005

[Profile of breastfeeding in children under 2 years old in the city of Itupeva, SP, Brazil].

The objective of this study was to estimate the frequency of breastfeeding and to identify variables associated with median breastfeeding length. It is a cross-sectional population-based study carried out in a representative sample of 261 children under 2 years old randomly selected in the urban area of Itupeva city, SP, Brazil. The breastfeeding patterns recommended by WHO were used. The frequency and the median length of breastfeeding were estimated by life tables technique. The Wilcoxon test was used to identify association between breastfeeding and the categorical variables (p<0.05) in the bivariate analysis. For the multivariate analysis, the variables associated with the breastfeeding length (Wilcoxon test; p<0.10) were inserted in a Cox Regression model. Almost 100% of the children have initiated breastfeeding and 41.0% were in breastfeeding at the moment of the interview. The median length of breastfeeding was 7.2 months and exclusive breastfeeding was only 28 days. It was observed association between the breastfeeding length and the following variables: father's schooling, mother's marital status, number of children, sequence of birth, bottle-feeding and pacifier use. The Cox regression model selected as significant variables: sequence of birth (HR=1.68; IC95%=1.03-2.73), bottle-feeding use (HR=15.20; IC95%=3.69-62.01) and pacifier use (HR=2.84; IC95%=1.95-4.19). The current pattern of breastfeeding in Itupeva is still far from the WHO recommendations; therefore, encouragement and support to breastfeeding need to be intensified. Variables influencing breastfeeding should be considered in the attempt to increase breastfeeding. Health workers should dedicate all their efforts to increase the exclusive breastfeeding period in children under 6 months of age and increase the total breastfeeding period.

Brazil↗
PubMed1990

Evaluation of beneficial effects of nonnutritive sucking in preterm infants.

The effects of nonnutritive sucking (NNS) were studied in 40 preterm infants weighing less than or equal to 1800 g and of less than or equal to 35 weeks gestation by using a pacifier. The provision of NNS accelerated the maturation of sucking resulting in a faster transition from gavage to oral feedings. Treated infants (20) were ready for bottle feeds 1.54 days earlier, took their bottle feeds 1.5 min/30 ml faster and were transferred out of the nursery on an average .5 days earlier than the control infants. No adverse effects due to NNS were observed throughout the period of study. This resulted in an earlier union with their mother, less maternal deprivation and decreased work load on the nursery staff. Used judiciously this simple and safe modality of providing a pacifier for NNS during tube feeding may be useful in the management of preterm infants.

Body Weight↗
PubMed1989

Lack of improved growth outcome related to nonnutritive sucking in very low birth weight premature infants fed a controlled nutrient intake: a randomized prospective study.

The effect of nonnutritive sucking during gavage feeding on nutritional outcome and gastrointestinal transit time was evaluated in 18 premature appropriate for gestational age infants whose birth weights were less than or equal to 1,400 g and gestational ages were less than or equal to 30 weeks. Infants were randomized to a treatment (nonnutritive sucking infants received a pacifier for 30 minutes with each feeding, 12 times per day until they reached a weight of 1,500 g, eight times per day thereafter) or control (no pacifier) group. The nine nonnutritive sucking (five girls, four boys) and nine control (five girls, four boys) infants were treated for 14 days. Infants were without medical complications and were fed a single premature formula by intermittent gastric gavage at exactly 120 kcal/kg/d throughout the study period. Weight gain, linear growth, subscapular and triceps skinfold, and arm circumference accretions were assessed weekly. Serum proteins (albumin, prealbumin, retinol-binding protein, and transferrin) were measured weekly. Gastrointestinal transit times were measured weekly using carmine red markers. In contrast to previous studies, these data indicate no apparent effect of nonnutritive sucking on growth outcome, serum proteins, or gastrointestinal transit time in growing, very low birth weight infants when nutrient intake was controlled. In a subgroup of eight boys (four nonnutritive sucking, four control), energy and fat excretions were determined from 72-hour fecal collections and energy expenditure was estimated from six-hour cumulative heart rate measurements. Neither excretion of fat and calories nor estimated energy expenditure was affected significantly by nonnutritive sucking in this subgroup of baby boys. Fat excretion correlated well (r = .987) with energy excretion.

Energy Metabolism↗
PubMedDate not supplied

Effect of nonnutritive sucking on behavioral state in preterm infants before feeding.

To describe the effect of nonnutritive sucking (NNS) on behavioral state (BSt) in preterm infants before feedings 24 preterm infants were randomly assigned and studied before each of their first 16 bottle feedings. Twelve received NNS by pacifier for 5 minutes; 12 did not receive a pacifier. BSt was measured with a 12-category scale for 30 seconds before the 5-minute period (BSt1) and for 30 seconds after (BSt2). Sleep states decreased for both groups. BSts considered more optimal for feeding increased more during NNS (86 vs. 46). Restless states were three times less frequent after NNS (23 vs. 68). Differences between groups were nonsignificant at BSt1, but were significant at BSt2, p less than .001. In the absence of self-regulatory feeding policies based on early hunger cues, NNS for 5 minutes prefeeding is simple, brief, and suitable for implementation in busy neonatal intensive care units. Nonnutritive sucking was an effective modulator of behavioral state for this sample.

Child Behavior↗
PubMed1985

Anticipatory guidance: a modest intervention in the nursery.

Although the importance of anticipatory guidance in the care of children is well recognized, pediatricians devote only about 10% of the average well child visit to parent education. The reluctance to engage more extensively in preventive interventions may relate to the paucity of evidence that such efforts are effective. This study was designed to test whether a modest anticipatory intervention, easily adaptable to other settings, could favorably influence maternal behavior. Mothers of newborn infants in a municipal hospital were assigned in alternate 2-week periods to an intervention program (n = 49) or a control group (n = 54). The intervention in the nursery consisted of a short group meeting, reinforced by a handout, advocating delayed introduction of solid foods and juices, and the use only of safe pacifiers. The mothers were interviewed at all visits to the general pediatric clinic using a standard format questionnaire. The two groups of mothers were demographically comparable but differed significantly in both the foods they introduced and the pacifiers they used for their babies. As an unexpected benefit, intervention mothers tended to view their babies as healthier than did control mothers. The implications of these findings are discussed.

Adolescent↗
PubMedDate not supplied

[Allergy to latex evaluated at an allergology clinic].

Natural rubber latex allergy is responsible for a wide spectrum of clinical symptoms ranging from rhinoconjunctivitis to severe anaphylaxis both in adults and children. The aim of this study was to investigate the prevalence and clinical significance of latex sensitization in children evaluated for allergic disease. Four hundred fifty three consecutive children evaluated for allergic disease in a university outpatient allergy clinic were screened. A detailed clinical history with particular attention to the past surgical history and the use of natural dummies or pacifiers was obtained. Skin prick tests (SPT) for the more important inhalants and foods were performed on all children. In patients with positive latex SPT, latex challenge and RAST as well as patch test with latex were also done. Ten out 326 atopic children (3%) presented positive skin test to latex, but only five (1.5%) also had a positive clinical history to latex exposure. Latex challenge was positive in 3/9 positive latex SPT children. None of the non-atopic children had positive skin test to latex or symptoms to latex exposure. A history of previous surgery was found in 5/10 positive latex SPT children, in 63/316 negative latex SPT atopic children (p < 0.05) and in 23/127 non-atopic children. The use of natural dummies or pacifiers was similar in atopic (positive or negative latex SPT) and non-atopic children. RAST to latex was positive in 5/10 positive latex SPT children. Latex SPT sensitivity was demonstrated in a moderate proportion of atopic children (3%) even if only half of these patients had a positive clinical history to latex exposure. Latex challenge was positive in 3 out 9 latex SPT positive children. SPT to latex is a safe and simple method to detect sensitive patients and should be included in the routine PT series of inhalant allergens.

Adult↗
PubMedDate not supplied

An analysis of malocclusion in children with otitis media.

PURPOSE: The purpose of this study was to examine the occlusion of children younger than 6 years with a diagnosis of otitis media. METHODS: The study consisted of 112 children diagnosed with otitis media by their pediatrician. Parents were surveyed regarding their child's history of pacifier use, thumb/finger-sucking habit, mouthbreathing habit, method of feeding, day care attendance, snoring, allergies, asthma, upper respiratory infections, otitis media in the family, and the number of people who smoke in the home. The children's occlusions were examined. RESULTS: In this study, 52% of the population presented with some type of malocclusion, with anterior open bite (17%) and an overbite measuring greater than 70% (17%) being the most prominent. This study showed that the following factors were common in children with otitis media: bottle feeding, smoking in the home, day care attendance, upper respiratory infection, history of otitis media with a sibling, pacifier habit, snoring, and mouthbreathing habit. CONCLUSION: A logistic regression analysis showed no significant association between malocclusion and factors related to otitis media.

Asthma↗
PubMed2006

Breastfeeding or breast milk for procedural pain in neonates.

BACKGROUND: Physiological changes brought about by pain may contribute to the development of morbidity in neonates. Clinical studies have shown reduction in the changes in physiological parameters and pain score measurements following pre-emptive analgesic administration in situations where the neonate is experiencing pain or stress. Nonpharmacological measures (such as holding, swaddling, breastfeeding) and pharmacological measures (such as acetaminophen, sucrose and opioids) have been used for this purpose. OBJECTIVES: The primary objective of this review was to evaluate the effectiveness of breastfeeding or supplemental breast milk in reducing procedural pain in neonates. The secondary objective was to conduct subgroup analyses based on the type of control intervention, type of painful procedure, gestational age and the amount of supplemental breast milk given. SEARCH STRATEGY: A literature search was performed using MEDLINE (1966 - Feb 2006), EMBASE (1980 - Feb 2006), CINAHL (1982 - Feb 2006), Cochrane Central Register of Controlled Trials (Issue 4, 2005 of Cochrane Library), abstracts from the annual meetings of the Society for Pediatric Research (1994 - 2006) and major pediatric pain conference proceedings. No language restrictions were applied. SELECTION CRITERIA: Randomized or quasi-randomized controlled trials of breastfeeding or supplemental breast milk versus no treatment/other measures in neonates were eligible for inclusion in this review. The study must have reported on either physiologic markers of pain or validated pain scores. DATA COLLECTION AND ANALYSIS: The methodological quality of the trials was assessed using the information provided in the studies and by personal communication with the authors. Data on relevant outcomes were extracted and the effect size was estimated and reported as relative risk (RR), risk difference (RD) and weighted mean difference (MD) as appropriate. MAIN RESULTS: Eleven eligible studies were identified. Marked heterogeneity in terms of control intervention and pain assessment measures were noted among the studies. Neonates in the breastfeeding group had statistically significantly less increase in the heart rate, reduced proportion of crying time and reduced duration of crying compared to swaddled group or pacifier group. Neonates in the breastfeeding group had a significant reduction in duration of crying compared to fasting (no intervention) group, but there was no significant difference when compared to glucose group. Premature Infant Pain Profile scores were significantly different between the breastfeeding group when compared to placebo group and the group positioned in mother's arms. However, these scores were not statistically significantly different in the breastfeeding group when compared to the no treatment group and the glucose group. Douleur Aigue Nouveau-ne scores were significantly different in the breastfeeding group when compared to the placebo group and the group positioned in mother's arms, but not when compared to the glucose group. Neonates in the supplemental breast milk group had significantly less increase in the heart rate and Neonatal Facial Coding Score compared to the placebo group. The differences in the duration of crying time and oxygen saturation change between supplemental breast milk group and the placebo group were not statistically significant. Neonates in the supplemental breast milk group had significantly higher increase in the heart rate changes and duration of crying time compared to glucose/sucrose group. No study was identified that has evaluated safety/effectiveness of repeated administration of breastfeeding or supplemental breast milk for pain relief. AUTHORS' CONCLUSIONS: If available, breastfeeding or breast milk should be used to alleviate procedural pain in neonates undergoing a single painful procedure compared to placebo, positioning or no intervention. Administration of glucose/sucrose had similar effectiveness as breastfeeding for reducing pain. The effectiveness of breast milk for repeated painful procedures is not established and further research is needed. These studies should include various control interventions including glucose/ sucrose and should target preterm neonates.

Breast Feeding↗
PubMed2003

Sudden infant deaths: stress, arousal and SIDS.

The prevalence of the Sudden Infant Death Syndrome (SIDS) has dropped in most countries following the development of education campaigns on the avoidance of preventable risk factors for SIDS. These include factors in the infant's micro environment, such as prenatal passive smoking, administration of sedative drugs, prone sleep, high ambient temperature or sleeping with the face covered. Sleep laboratory studies have shown that these risk conditions contribute to the development of respiratory and autonomic disorders and reduce the child's arousability. The opposite effects were seen when studying factors protective from SIDS, such as breastfeeding or the use of a pacifier. In victims of SIDS, similar breathing, autonomic and arousal characteristics were recorded days or weeks before their death. It is concluded that in some infants, already immature control mechanisms can be aggravated by environmental factors.

Arousal↗
PubMed2006

Sudden infant death syndrome: risk factors for infants found face down differ from other SIDS cases.

OBJECTIVE: To test the hypothesis that infants with sudden infant death syndrome (SIDS) found face down (FD) would have SIDS risk factors different from those found in other positions (non-face-down position, NFD). STUDY DESIGN: We used the New Zealand Cot Death Study data, a 3-year, nationwide (1987 to 1990), case-control study. Odds ratios (univariate and multivariate) for FD (n = 154) and NFD SIDS (n = 239) were estimated separately, and statistical differences between the two groups were assessed. RESULTS: Of 12 risk factors for SIDS, there were 8 with a statistically significant difference between FD and NFD infants. After adjustment for the potential confounders, younger infant age, Maori ethnicity, low birth weight, prone sleep position, use of a sheepskin, and pillow use were all associated with a greater risk of SIDS in the FD than the NFD group. Sleeping during the nighttime, maternal smoking, and bed-sharing were associated with a risk of SIDS only in the NFD group. Pacifier use was associated with a decreased risk for SIDS only in the NFD group, whereas being found with the head covered was associated with a decreased risk for SIDS for the FD group. CONCLUSIONS: Infants with SIDS in the FD position appear to be a distinct subgroup of SIDS. These differences in risk factors provide clues to mechanisms of death in both SIDS subtypes.

Analysis of Variance↗
PubMed2006

Non-pharmacological pain relief.

The delivery of humane neonatal care demands that attention is given to interventions that reduce pain effectively. Painful procedures are common for neonatal patients and a growing body of research suggests that simple non-pharmacological methods are effective in reducing the signs of pain. Both oral sucrose and pacifiers reduce pain scores during procedures, and other simple measures, including facilitated tucking and skin-to-skin contact, might also be effective. Organising care to reduce exposure to painful procedures and also optimising the devices used for procedures might reduce the experience of pain. There is some evidence of long-term improvement in pain sensitivity following pain reduction programmes. Further research is needed to understand the detail of how and when to best apply these interventions; the long-term outcomes of policies that give routine prominence to pain reduction on the neonatal intensive care unit also need to be investigated. The absence of long-term effect should not impede the introduction of these simple, low-cost humane measures.

Analgesia↗
PubMed2002

Sudden infant deaths: from epidemiology to physiology.

The incidence of sudden infant death syndrome (SIDS) has dropped significantly in most countries following the development of education campaigns on the avoidance of risk factors for SIDS. However, questions have been raised about the physiological mechanism responsible for the effects of these environmental risk factors. Since 1985, a series of prospective, multicentric studies have been developed to address these questions; over 20,000 infants were recorded during one night in a sleep laboratory and among these, 40 infants eventually died of SIDS. In this review, the following methods were employed: sleep recordings and analysis, monitoring procedure, data analysis of sleep stages, cardiorespiratory and oxygen saturation, scoring of arousals, spectral analysis of the heart rate and the determination of arousal thresholds, and statistical analysis and the results including sleep apneas, arousals and heart rate and autonomic controls in both future SIDS victims and normal infants were introduced separately. In addition, the physiological effect of prenatal risk factors (maternal smoking during gestation) and postnatal risk factors (administration of sedative drugs, prone sleeping position, ambient temperature, sleeping with the face covered by a bed sheet, pacifiers and breastfeeding) in normal infants were analyzed. In conclusion, the physiological studies undertaken on the basis of epidemiological findings provide some clues about the physiological mechanisms linked with SIDS. Although the description of the mechanisms responsible for SIDS is still far from complete, it appears to involve both arousal responses and cardiac autonomic controls during sleep-wake processes.

Autonomic Nervous System↗