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PubMed2000

Early postnatal (<96 hours) corticosteroids for preventing chronic lung disease in preterm infants.

BACKGROUND: Chronic lung disease (CLD) remains a major problem in neonatal intensive care units. Persistent inflammation in the lungs is the most likely underlying pathogenesis. Corticosteroids have been used to either prevent or treat CLD because of their potent anti-inflammatory effects. OBJECTIVES: To determine if postnatal corticosteroid treatment is of benefit in the prevention of chronic lung disease (CLD) in the preterm infant. This review examines the outcome of trials where preterm infants at risk of CLD were given postnatal steroids within 96 hours after birth. SEARCH STRATEGY: Randomised controlled trials of postnatal corticosteroid therapy were sought from the Oxford Database of Perinatal Trials, the Cochrane Controlled Trials Register, Medline, hand searching paediatric and perinatal journals, examining previous review articles and information received from practising neonatologists. SELECTION CRITERIA: Randomised controlled trials of postnatal corticosteroid treatment within 96 hours of birth (early) in high risk preterm infants were selected for this review. DATA COLLECTION AND ANALYSIS: Data regarding clinical outcomes including mortality, failure to extubate, pulmonary air leak, survival without chronic lung disease, CLD defined at 28 days postnatal age and 36 weeks post menstrual age, patent ductus arteriosus (PDA), severe intraventricular hemorrhage (IVH), infection, hyperglycaemia, hypertension, severe retinopathy of prematurity (ROP), necrotizing enterocolitis (NEC), gastrointestinal bleeding and longterm outcome were abstracted and analysed using Revman 4.0.4. MAIN RESULTS: Fifteen randomised controlled trials of early postnatal corticosteroid treatment of preterm babies at risk of developing CLD were identified. A meta-analysis of these trials demonstrates benefits as regards earlier extubation, decreased risks of CLD at both 28 days and 36 weeks, death or CLD at 28 days, and PDA. There was an almost significant reduction in the risk of pulmonary air leak and in death or CLD at 36 weeks in the babies treated with early corticosteroids. There were no differences in the rates of neonatal mortality, infection, severe ROP, severe IVH, NEC and pulmonary haemorrhage. Gastrointestinal bleeding and intestinal perforation were important adverse effects and the risks of hyperglycaemia and hypertension were also increased. Several adverse neurological effects were found at follow-up examinations of survivors treated with early steroids: abnormal neurological examination, cerebral palsy and developmental delay. REVIEWER'S CONCLUSIONS: The benefits of early postnatal corticosteroid treatment (< 96 hours) may not outweigh the known or potential adverse effects of this treatment. Gastrointestinal effects early in the neonatal period and neurological effects seen at follow-up mean that current use of early postnatal steroids needs to be reconsidered. There is a compelling need for the long term follow-up and reporting of late outcomes, especially neurologic and developmental outcomes, among surviving infants who participated in all randomized trials of early postnatal corticosteroid treatment. The role of inhaled steroids remains to be elucidated.

Anti-Inflammatory Agents↗
PubMed2000

Moderately early (7-14 days) postnatal corticosteroids for preventing chronic lung disease in preterm infants.

BACKGROUND: Corticosteroids have been used late in the neonatal period to treat chronic lung disease (CLD) in preterm babies and early to try to prevent it. CLD is likely to be the result of persisting inflammation in the lung and the use of powerful anti-inflammatory drugs like dexamethasone has some rationale. Early use tends to be associated with increased adverse effects so that studies of moderately early treatment (7-14 days postnatal) might have the dual benefits of fewer side effects and onset of action before chronic inflammation is established. OBJECTIVES: To determine if moderately early (7-14 days) postnatal corticosteroid treatment vs control (placebo or nothing) is of benefit in the prevention and/or treatment of early chronic lung disease in the preterm infant. SEARCH STRATEGY: Randomised controlled trials of postnatal corticosteroid therapy were sought from the Oxford Database of Perinatal Trials, Cochrane Database of Controlled Trials, Medline, hand searching paediatric and perinatal journals, examining previous review articles and information received from practising neonatologists. SELECTION CRITERIA: Randomised controlled trials of postnatal corticosteroid treatment from 7-14 days of birth in high risk preterm infants were selected for this review. DATA COLLECTION AND ANALYSIS: Data regarding clinical outcomes including mortality up to 28 days and before discharge, failure to extubate, mortality and / or chronic lung disease at 28 days and 36 weeks, CLD at 28 days and 36 weeks, infection, hyperglycaemia, hypertension, severe retinopathy of prematurity (ROP), pneumothorax, necrotizing enterocolitis (NEC), gastrointestinal bleeding, severe intraventricular hemorrhage (IVH), hypertrophic cardiomyopathy, late rescue with dexamethasone and abnormal neurological examination at follow-up were abstracted and analysed using Revman 4.0.4. MAIN RESULTS: Moderately early steroid treatment (vs placebo or nothing) reduced mortality by 28 days, chronic lung disease at 28 days and 36 weeks, and death or chronic lung disease at 28 days or 36 weeks. Earlier extubation was facilitated. There was no significant effect on the rates of pneumothorax, severe ROP, and NEC. Adverse effects included hypertension, hyperglycaemia, gastrointestinal bleeding, hypertrophic cardiomyopathy and infection. Steroid-treated infants were less likely to need late rescue with dexamethasone. There was only one small study of longterm follow-up and it did not show any increase in adverse neurological outcome. REVIEWER'S CONCLUSIONS: Moderately early corticosteroid therapy (started at 7-14 days) reduces neonatal mortality and CLD, but at the cost of important short term adverse effects. No reliable evidence concerning long term effects is provided by the trials included in this review. In view of the evidence of an important increase in cerebral palsy and other adverse neurodevelopmental outcomes from trials in which postnatal steroid was begun either earlier or later than 7-14 days, there are reasonable grounds for extending this concern to moderately early initiation of steroid therapy. More research is urgently needed, including long term follow-up of survivors included in previous and any future trials, before the benefits and risks of postnatal steroid treatment, including initiation at 7-14 days, can be reliably assessed.

Anti-Inflammatory Agents↗
PubMed1993

Parent-infant cosleeping: the appropriate context for the study of infant sleep and implications for sudden infant death syndrome (SIDS) research.

Nearly all laboratory research on human infant sleep assumes that solitary sleeping is the normal and desirable environment. Yet solitary sleeping in infancy is a very recent custom limited to Western industrialized societies, and most of the world's people still practice parent-infant cosleeping. A hypothesis is presented that cosleeping provides a sensory-rich environment which is the more appropriate environment in which to study normal infant sleep. In addition, two preliminary, in-laboratory, polygraphic investigations of mother-infant cosleeping are reported in normal infants within the peak age range for sudden infant death syndrome (SIDS). Five mother-infant pairs coslept for 1 night in the first study; in the second, three additional pairs slept separately for 2 nights and coslept the third consecutive night. The results suggest that cosleeping is associated with enhanced infant arousals and striking temporal overlap in infant and maternal arousals. Infant sleep also showed subtle alterations with cosleeping, as manifested in increased overlap with corresponding maternal sleep stages and decreased amount of Stage 3-4. These are the first in-laboratory investigations of parent-infant cosleeping. The implications of the hypothesis and preliminary results for research on the normal development of infant sleep and on SIDS are discussed.

Adult↗
PubMed1994

Iron, zinc, copper and selenium status of breast-fed infants and infants fed trace element fortified milk-based infant formula.

Infants were fed cow's milk-based formulas containing 4 mg of iron/l from 1.5 to 6 months of age and their hematological status was compared to infants receiving the same formula but with 7 mg of iron/l and with breast-fed infants. One formula with 4 mg of iron/l contained iron as ferrous sulfate, in another, part of the iron was provided as bovine lactoferrin. We also studied the effect of selenium (10 micrograms/l) and copper (0.4 mg/l) supplementation on selenium and copper status. There were no significant differences in hematological indices among the groups at 6 months of age; all infants had satisfactory iron status. Serum transferrin receptor levels, a potential novel indicator of iron status, were highest in breast-fed infants, suggesting a cellular need for iron, and lowest in infants receiving formula with 7 mg of iron/l. Selenium status, as assessed by serum glutathione peroxidase activity, was similar at 6 months of age in breast-fed infants and infants fed formula fortified with selenium but lower in infants fed unfortified formula. The lowest levels of glutathione peroxidase activity were found in infants fed the highest concentration of iron (7 mg/l). Serum copper concentrations were similar in all groups, but the lowest levels were found in infants fed the highest concentration of iron. These results suggest that 4 mg of iron/l is adequate for infants up to 6 months of age and that higher levels may have some negative effects.

Blood Urea Nitrogen↗
PubMed1994

Sudden infant death syndrome and infant mortality in aboriginal and non-aboriginal infants.

The aim of this study was to investigate sudden infant death syndrome (SIDS) in the context of total infant mortality for Aboriginal and non-Aboriginal infants. Deaths for infants born in Western Australia from 1980 to 1988 inclusive were ascertained from a total population data base. Infant mortality rates and rates by period and cause of death were calculated for both populations. Aboriginal infants had a mortality rate three times that for non-Aboriginal infants (23.6 cf. 7.9 per 1000 live births) and both populations showed a similar rate of decline in mortality over the study period. There were differences in the proportion of deaths occurring neonatally and postneonatally in the two populations. In terms of SIDS, 21% of the deaths in Aboriginal infants occurred neonatally compared with 7% for non-Aboriginal infants. The overall cause of infant death distribution differed significantly between the two populations (P < 0.001). During the study period, Aboriginal infants showed a significant increase in deaths due to SIDS and a significant decrease in those due to birth defects and low birthweight. These results suggest it would be useful to review the pathology and diagnosis of sudden unexplained death in infancy.

Cause of Death↗
PubMed2002

Excessively crying infant in the family: mother-infant, father-infant and mother-father interaction.

METHOD: We studied mother-infant, father-infant and mother-father interaction in 32 families with an excessively crying infant and in 30 control families. The group with excessive criers was divided further into subgroups of severe colic (n=13) and moderate colic (n=19). The three dyads of the family were video-recorded when the infants were an average of 5 weeks old. The assessment was carried out during the infant's feeding, nappy change and discussion between the parents. During the assessment, only four infants were crying. The Parent Child Early Relational Assessment Scale and the Beavers Scale were used. RESULTS: The main findings suggest that both parents of colicky infants had less optimal parent-child interaction compared with the control parents. The problems in the interaction were most pronounced between the fathers and infants in the severe colic group. The father-infant interaction was less optimal in 13 items of 65 (20%) in the severe colic group, in one item of 65 (2%) in the moderate colic group and in none of the items in the control group. The mother-infant interaction was less optimal in six items out of 65 (9%) in the severe colic group, in three items out of 65 (5%) in the moderate colic, and in none of the items in the control group. Severely colicky infants were also less competent in interacting with their parents. In addition, interaction between the parents was more often dysfunctional in the severe colic group. CONCLUSIONS: The problems in early family interaction may threaten the well-being of families with excessively crying infants and they therefore deserve special attention from the health care professionals.

Adult↗
PubMed1981

Effect on serum calcium of a alpha-hydroxy-vitamin D3 supplementation in infants of low birth weight, infants with perinatal asphyxia, and infants of diabetic mothers.

Thirty infants of low birth weight, 35 infants with perinatal asphyxia, and 16 infants of diabetic mothers were investigated for early neonatal hypocalcaemia. The infants were randomized into a group prophylactically given 1 alpha-hydroxy-vitamin D3, 0.05 or 0.10 micrograms/kg i.v. on the first 3 days of life, and an untreated control group. In infants of low birth weight and infants of diabetic mothers there were no differences in serum ion-Ca concentrations on days 2, 3, 5, and 7 between the treated and untreated groups. In infants with perinatal asphyxia, however, serum ion-Ca concentrations on days 5 and 7 were significantly higher in the treated than in the untreated group, while on days 2 and 3 the differences were not statistically significant. The hypocalcaemia in asphyctic infants was not correlated to bicarbonate treatment, but infants with severe signs of asphyxia had lower serum ion-Ca concentrations than infants with only mild or no signs. Hypocalcaemia in asphyctic infants might be explained by a decreased concentration of 1 alpha, 25-dihydroxy-vitamin D3 following reduced 1 alpha-hydroxylation in the kidney as a consequence of anoxia during perinatal asphyxia.

Asphyxia Neonatorum↗
PubMed2000

Inositol for respiratory distress syndrome in preterm infants.

BACKGROUND: Inositol is an essential nutrient required by human cells in culture for growth and survival. Inositol promotes maturation of several components of surfactant and may play a critical role in fetal and early neonatal life. OBJECTIVES: To assess the effectiveness/safety of supplementary inositol in preterm infants with RDS in reducing adverse neonatal outcomes. SEARCH STRATEGY: Medline, Embase, and Reference Update Databases were searched in August 1997 using key words: inositol and infant-newborn and random allocation or controlled trial or randomized trial (RCT). The reference lists of identified RCTs, personal files and Science Citation Index were searched. Unpublished additional information was obtained from the authors of one RCT published in abstract form. SELECTION CRITERIA: All randomized controlled trials of inositol supplementation to preterm infants with a control group that received a placebo or no intervention were included. Outcomes of interest were bronchopulmonary dysplasia (BPD), death, BPD or death, retinopathy of prematurity (ROP), intraventricular hemorrhage (IVH), necrotizing enterocolitis (NEC), and sepsis. DATA COLLECTION AND ANALYSIS: Data on neonatal outcomes were abstracted independently by the two researchers and any discrepancy was resolved through consensus. Revman was used for analysis of the data. MAIN RESULTS: Four reports of three RCTs were identified. One report was a duplicate publication. The outcome of death or bronchopulmonary dysplasia was reported in two trials, and was found to be significantly reduced (RR 0.56, 95% CI 0.42, 0.77; RD -0.215, 95% CI -0.323, -0.107). The outcome of death was reported in two trials and was found to be significantly reduced (RR 0.48, 95% CI 0.28, 0.80; RD -0.131, 95% CI -0.218, -0.043). Retinopathy of prematurity, stage 4 or needing therapy, was reported in two trials, and was found to be significantly reduced (RR 0.09, 95% CI 0.01, 0.67; RD -0.078, 95% CI -0.128, -0.027). Intraventricular hemorrhage, grade III-IV, was significantly decreased (RR 0.55, 95% CI 0.32, 0.95; RD -0.090, 95% CI -0.170, -0.010). Neither sepsis nor necrotizing enterocolitis outcomes were increased. When a secondary analysis was done excluding a study published in abstract form, the results differed only in that there was a significant reduction in retinopathy of prematurity, any stage (RR 0.53, 95% CI 0.29, 0.97; RD -0.082, 95% CI -0.159,-0.005). REVIEWER'S CONCLUSIONS: Inositol supplementation results in statistically significant and clinically important reductions in important short-term adverse neonatal outcomes. A multi-center RCT of appropriate size is justified to confirm these findings.

Dietary Supplements↗
PubMed1995

Maternal directiveness and infant compliance at one year of age: a comparison between mothers and their developmentally-delayed infants and mothers and their nondelayed infants.

Maternal directiveness and infant compliance at one year of age were observed in social interactions between mothers and their handicapped and nonhandicapped infants. Eleven nondelayed, typically developing infants, and nine developmentally delayed infants, matched for chronological age, were observed in a free play situation with their mothers. Mothers of the delayed infants attempted to direct their children's play significantly more than those with nondelayed infants, and they engaged more frequently in social play involving physical contact with their infants. Nondelayed infants complied with their mothers' directives more than the developmentally delayed infants. Further study of infant capabilities and maternal affect and behaviors with this age group is suggested.

Cooperative Behavior↗
PubMed1988

Infants at risk for sudden infant death syndrome (SIDS): differential prediction for three siblings of SIDS infants.

The outcome for three siblings of SIDS (SSIDS) infants was predicted, using as a risk model the sleep and respiratory characteristics of a SIDS victim studied extensively during the neonatal period. The SIDS infant had shown unstable state organization and deviant respiration patterns, including a deficit of brief apneic pauses. Like the SIDS infant, the SSIDS infants and a group of 16 normal infants were observed in the home for 7-hr periods when they were 2, 3, 4, and 5 weeks old. Two of the infants showed normal sleep and respiratory characteristics, and they were predicted to develop without respiratory dysfunction. In contrast, the third infant showed a pattern of deviancies similar to the SIDS infant; and at 4 months, she had prolonged apneic episodes, requiring resuscitation on two occasions. The findings are consistent with the notion of subtle central nervous system (CNS) dysfunction in SIDS risk infants from the time of birth.

Arousal↗
PubMed2006

Unexplained infant and child death: a review of sudden infant death syndrome, sudden unexplained infant death, and child maltreatment fatalities including shaken baby syndrome.

PURPOSE OF REVIEW: This review will examine the most recent published literature on Sudden Infant Death, Sudden Unexplained Infant Death, infant and child death due to maltreatment, and Shaken Baby Syndrome. RECENT FINDINGS: New recommendations from the American Academy of Pediatrics about the evaluation and prevention of possible Sudden Infant Death Syndrome cases were published this year, with a focus not only on the Back to Sleep campaign, but other factors that may contribute to the risk of Sudden Infant Death Syndrome. Additionally, the controversial issue of bed sharing is addressed, with advice given not to bed share in the first 3 months of life. The possibility of a second sudden infant death within a family is discussed. Attention is also paid to the importance of considering inflicted injury in the differential diagnosis of every unexplained infant or child death, and the recent literature on child maltreatment deaths is reviewed. SUMMARY: The grieving family who has lost an infant should receive immediate attention and support, and a multidisciplinary investigation team should be involved as soon as possible so that a full investigation can take place. Investigation of unexplained infant or child death should always involve a thorough interview with all adults involved, as well as a proper scene investigation and post-mortem examination.

Biomechanical Phenomena↗
PubMed1987

Need of hospital care for newborn infants. A population analysis of preterm infants and infants with respiratory disturbances.

In a prospective study of a total population the hospital resources required for the care of preterm infants and infants with respiratory disturbances (RD) were analyzed. 5.2% of all the infants were preterm and 7.6% developed RD. For the care of preterm infants the requirements were 63.8 beds per 1,000 annual preterm births of which 8.3 beds were attributable to the care of RD in these infants. Full term infants needed 0.88 hospital beds per 1,000 annual full term births for respiratory care. The number of days on ventilator for preterms was calculated to 2,044 per 1,000 annual preterm births. For preterm infants the mode of delivery was not found to affect the length of hospitalization. For the total population the average need of hospital days for full term infants because of RD was 0.29 days after vaginal delivery compared with 0.78 days after elective Caesarean section.

Health Services Needs and Demand↗
PubMed1982

Effects of obstructive sleep apneas on transcutaneous oxygen pressure in control infants, siblings of sudden infant death syndrome victims, and near miss infants: comparison with the effects of central sleep apneas.

In order to investigate the effects of obstructive sleep apneas upon transcutaneous PO2 75 polysomnograms, recorded during night sessions in 25 control infants, 25 siblings, and 25 near miss for sudden infant death syndrome (SIDS) infants were studied. These observations were compared with the decreases in transcutaneous PO2 measured during central sleep apneas in the same infants. During a total of 707.6 hours of sleep, 33 obstructive apneas and 1,650 central apneas were recorded. Obstructive apneas were seen in three control infants (three episodes), one sibling (five episodes), and six near miss for SIDS infants (25 episodes). The obstructive apneas tended to be short (less than 10 seconds). Comparatively, the central apneas were equally distributed in the three groups of infants, and only the near miss children presented apneas that lasted as long as 19 seconds. The decrease in transcutaneous PO2 was proportional to the duration of both types of apnea, but for a given duration the decrease in transcutaneous PO2 was significantly greater for the obstructive apneas than for the central apneas (with a mean difference of 7.59 +/- 0.53% PO2. It is concluded that the hypoxic effects of the obstructive apneas might have important clinical implications in infants, such as the near miss for SIDS.

Female↗
PubMed1983

Relationship between infant death and maternal age. Comparison of sudden infant death incidence with other causes of infant mortality.

The high incidence of sudden infant death syndrome in infants born to teenage mothers prompted us to search for epidemiologic clues that might relate to SIDS causation. The death rate for SIDS was compared with that of other major causes of infant mortality in two maternal age groups (younger than 20 years and 30 to 34 years). In the neonatal period, a significantly greater overall mortality occurred in infants born to the younger mothers. This difference was primarily related to an excess of low-birth-weight infants dying from diseases of early infancy. "Weight-specific" mortality, however, was similar for the two groups. In the postneonatal period, when most SIDS occurs, the incidence was 5.2 per 1000 among infants of teenage mothers, compared with 1.0 in infants of the older mothers. A similar maternal-age-related incidence was observed for death from infections, accidents, and "other causes." By contrast, death from congenital anomalies was unrelated to maternal age in both periods. We conclude that many postneonatal deaths are influenced by environmental factors, including the age and maturity of the mother.

Adolescent↗
PubMed2005

Palatal development of preterm and low birthweight infants compared to term infants - What do we know? Part 2: The palate of the preterm/low birthweight infant.

BACKGROUND: Well-designed clinical studies on the palatal development in preterm and low birthweight infants are desirable because the literature is characterized by contradictory results. It could be shown that knowledge about 'normal' palatal development is still weak as well (Part 1). The objective of this review is therefore to contribute a fundamental analysis of methodologies, confounding factors, and outcomes of studies on palatal development in preterm and low birthweight infants. METHODS: An electronic literature search as well as hand searches were performed based on Cochrane search strategies including sources of more than a century in English, German, and French. Original data were recalculated from studies which primarily dealt with both preterm and term infants. The extracted data, especially those from non-English paper sources, were provided unfiltered for comparison. RESULTS: Seventy-eight out of 155 included articles were analyzed for palatal morphology of preterm infants. Intubation, feeding tubes, feeding mode, tube characteristics, restriction of oral functions, kind of diet, cranial form and birthweight were seen as causes contributing to altered palatal morphology. Changes associated with intubation concern length, depth, width, asymmetry, crossbite, and contour of the palate. The phenomenon 'grooving' has also been described as a complication associated with oral intubation. However, this phenomenon suffers from lack of a clear-cut definition. Head flattening, pressure from the oral tube, pathologic or impaired tongue function, and broadening of the alveolar ridges adjacent to the tube have been raised as causes of 'grooving'. Metrically, the palates of intubated preterm infants remain narrower, which has been examined up to the age of the late mixed dentition. CONCLUSION: There is no evidence that would justify the exclusion of any of the raised causes contributing to palatal alteration. Thus, early orthodontic and logopedic control of formerly orally intubated preterm infants is recommended, as opposed to non-intubated infants. From the orthodontic point of view, nasal intubation should be favored. The role that palatal protection plates and pressure-dispersing pads for the head have in palatal development remains unclear.

Humans↗
PubMed1989

[Cause of death statistics and death certificate documentation of stillborn infants and infants. II: Preventable errors in filling out death certificates for stillborn infants and for infants dying before 1 year of age].

The analysis of 311 death certificates of stillbirths and dead persons under one year revealed a lot of mistakes both in the diagnostic and nondiagnostic part of the form. All mistakes are mentioned and discussed. 90% of the death certificates had been written out by obstetricians and pediatrists, but also pathologists made many mistakes. It is recommended to perform a training referring hereto for obstetricians, pediatrists, neonatologists, pathologists and specialists in forensic medicine on the one hand and to combine the various rules printed in the pocket- and handbook of ICD and in the interpretations of LEOPOLD and HUNGER on the other.

Cause of Death↗
PubMed1992

Sudden infant death syndrome in Washington State: why are Native American infants at greater risk than white infants?

Washington State reports one of the highest rates of sudden infant death syndrome (SIDS) in the United States; within the state, Native Americans have the highest rate of any racial group. To explore this apparent genetic predisposition, we conducted a population-based retrospective cohort study. Using the state's linked birth and death certificate file for 1984 to 1988, we compared infants whose mothers were coded as "American Indian" with infants whose mothers were coded as "white." Native American infants were more than three times more likely than white infants to die of SIDS (crude relative risk = 3.25; 95% confidence interval = 2.41 to 4.38). However, this elevated risk diminished after adjustment for differences between Native American and white mothers in age, marital status, parity, and smoking status during pregnancy (adjusted relative risk = 1.82; 95% confidence interval = 1.28 to 2.58). The high SIDS rate of Washington's Native Americans appears to be due to the high prevalence of SIDS risk factors among Native American mothers, rather than to a genetic predisposition in the infants. Because many of these maternal factors are related to socioeconomic status, it is likely that programs to improve the overall health of Native Americans might lessen both the impact of SIDS and that of other causes of infant morbidity and death.

Adolescent↗