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PubMed1993

Improving the quality of survival for infants of birthweight < 1000 g born in non-level-III centres in Victoria. The Victorian Infant Collaborative Study Group.

OBJECTIVE: To compare between eras the early care of extremely low birthweight (birthweight < 1000 g) infants born in non-level-III centres, that is, centres without a neonatal intensive care nursery, in Victoria, to identify changes associated with the improved quality of survival over time. DESIGN AND SETTING: The early care and outcome for infants of birthweight 500 to 999 g born in a non-level-III centre in Victoria were compared between two distinct eras, 1979-1980 and 1985-1987. PATIENTS AND OUTCOMES: Mortality data to two years of age were available for all infants liveborn in non-level-III centres in the two eras (1979-1980, n = 106; 1985-1987, n = 129). In 1979-1980, 47 of 52 infants transferred to a level-III centre were transported by the Newborn Emergency Transport Service (NETS); in 1985-1987, all 49 infants transferred were transported by NETS. Data concerning the immediate care after birth and during transport to a level-III centre were available for all infants transferred by NETS. All survivors were assessed for sensorineural impairments and disabilities at two years of age, corrected for prematurity. RESULTS: In both eras, 18 children born outside and transferred to a level-III centre survived to two years of age. Survivors in both eras had almost identical mean birthweights and gestational ages. There were trends for more survivors to be referred by paediatricians--1979-1980, 61%; 1985-1987, 83%; odds ratio (OR), 2.94; 95% confidence interval (CI), 0.7-12.4--and for quicker referral times to NETS in 1985-1987 (1979-1980, median 34.5 minutes after birth; 1985-1987, median 21.5 minutes after birth; z = 1.91, P = 0.056). It was possible only during 1985-1987 to monitor transcutaneous PO2 during transport. Durations of transport were similar in both eras. However, only in 1985-1987 was it possible in survivors to reduce significantly the inspired oxygen concentration during transport (median reductions in inspired oxygen, 1979-1980 3.5%; 1985-1987 20%; P = 0.028). Neurological impairment rates were substantially lower in survivors transported in the latter era (1979-1980 72% impaired; 1985-1987 22% impaired; OR 0.14, 95% CI 0.04-0.52). Of the neurological impairments, fewer had severe developmental delay alone (1979-1980 22%; 1985-1987 0%; OR 0.09, 95% CI 0.018-0.46), and the rate of blindness was lower, but the latter difference was not quite statistically significant (1979-1980 28%; 1985-1987 6%; OR 0.21, 95% CI 0.037-1.19). Over all, neurological disabilities were significantly reduced in the latter era (z = 2.93, P < 0.005). CONCLUSIONS: More active management of extremely low birthweight infants before transfer to a level-III centre, including prompt referral and transcutaneous PO2 monitoring during transport, may be important in improving the sensorineural outcome of survivors.

Blood Gas Monitoring, Transcutaneous↗
PubMed2002

Infant mortality and low birth weight among black and white infants--United States, 1980-2000.

Despite substantial reductions in U.S. infant mortality during the past several decades, black-white disparities in infant mortality rates persist. One of the Healthy People 2010 national objectives for maternal and infant health is to reduce deaths among infants aged < 1 year to < or = 4.5 per 1,000 live births among all racial/ethnic groups (objective 16-1c). Important determinants of racial/ethnic differences in infant mortality are low birth weight (LBW), defined as < 2500 grams, and very low birth weight (VLBW), defined as < 1500 grams. High birth weight-specific mortality rates (BWSMRs) occur at these low birth weights. Healthy People 2010 goals include reducing LBW to 5% and VLBW to 0.9% of live births (objectives 16-10a and 16-10b, respectively). To assess progress toward meeting these national objectives, CDC analyzed birth and death certificate data from the National Center for Health Statistics. This report describes trends in mortality and birth weight among black and white infants, which indicate persistent black-white disparities and underscore the need for prevention strategies that reduce preterm delivery and specific medical conditions that lead to infant death.

Black or African American↗
PubMed2002

The impact of missing birth weight in deceased versus surviving fetuses and infants in the comparison of birth weight-specific feto-infant mortality.

Birth weight-specific is preferred to crude feto-infant mortality in epidemiologic studies comparing rates across jurisdictions, because it can help limit the bias arising from regional differences in the completeness of reporting of vital events and in classification of live versus stillbirth among extremely small and immature infants. The potential impact of missing birth weight information in deceased versus surviving fetuses and infants in the comparison of birth weight-specific feto-infant mortality has been seldom examined, however. The authors investigated this issue, using data collected from two nationwide surveys of all pregnancy outcomes occurring 15 17 May 1989 and 12 16 February 1996, respectively, in Taiwan and the 1989 and 1996 linked birth and infant death records in Canada (excluding Ontario and Newfoundland). The proportions with missing birth weight information in Taiwan in 1989 were 25.0%, 15.4%, 0%, and 0.6%, respectively, for stillbirths, neonatal deaths, post-neonatal deaths, and survivors, and in 1996 were 100%, 5.0%, 0%, and 0.2%. The proportions with missing birth weight information in Canada in 1989 were 5.8%, 2.6%, 1.2%, and 0.6%, respectively, for fetal deaths, neonatal deaths, post-neonatal deaths, and survivors, and in 1996 were 5.0%, 2.4%, 1.1%, and 0.6%. Infant and (especially) fetal death rates were substantially higher in Taiwan than in Canada among births with missing birth weight. The authors concluded that differences in missing birth weight information between deaths and survivors can bias comparisons of birth weight-specific feto-infant mortality.

Bias↗
PubMed1979

Neurologic abnormalities in near miss for sudden infant death syndrome infants.

As part of the Sudden Death Research Project at Stanford University School of Medicine, we have performed systematic neurologic examination of 41 near miss infants, 7 normal siblings of babies who died a sudden infant death, and 21 normal control infants. Many infants were examined longitudinally until 2 years of age. We found that near miss infants under 3 months of age had consistent abnormalities of muscle tone, particularly shoulder hypotonia. These abnormalities disappeared with maturation, but only 60% of older infants who had suffered near miss episodes of neurologically and developmentally normal. In addition, only one of the seven apparently normal siblings had an entirely normal neurologic examination when first seen. Thus, infants who present with near miss episodes may have an underlying central nervous system abnormality or may acquire some abnormality as a result of the episode.

California↗
PubMed1981

Vitamin A and vitamin E concentration of the milk from mothers of pre-term infants and milk of mothers of full term infants.

The vitamin E, vitamin A and beta carotene concentrations of milk, from eight mothers delivering premature infants and ten mothers delivering full term infants were determined and compared. Milk samples were collected three times per day on days 3, 9, 15, 21, 27 and 33 postpartum. Dietary records were kept on days 2-3, 14-15, and 32-33. There was no significant difference in vitamin E, vitamin A and beta carotene levels between the two groups. The mean retinol concentration was higher in the milk of mothers of premature infants on all days except day three. The highest mean carotene and retinol concentrations in the milk of mothers of full terms infants were on day three: but the peak occurred in the preterm group on day nine and did not drop as rapidly as the milk retinol of the full term group. The milk of mothers of fullterm infants, day 3 vitamin E concentration was significantly higher than days, 15, 21, 27 and 33 postpartum. There were no significant differences in the dietary intake of the full term and preterm groups. The amount of vitamin E in the milk was not affected by dietary vitamin E intake of the subjects regardless of gestational age of the infant. More research is needed to determine the exact quantity of vitamin A and E ingested by the premature infants if breastfed by their respective mothers.

Adult↗
PubMed1999

Hepatitis B maternal screening, infant vaccination, and infant prophylaxis practices in North Carolina.

OBJECTIVES: To determine if the Advisory Committee on Immunization Practices hepatitis B screening, vaccination, and prophylaxis recommendations were being followed in North Carolina, and to establish a baseline hepatitis B seroprevalence rate. DESIGN: A survey of mother and infant birthing facility medical records. SETTING: Four birthing facilities selected from each of the 7 districts in North Carolina (a total of 28 facilities). PARTICIPANTS: A probability proportional to size survey design was used to select 4763 mother-infant record pairs. All records came from the 1996 birth cohort. MAIN OUTCOME MEASURES: Maternal hepatitis B screening status, infant vaccination status, infants prophylaxis status, hepatitis B seroprevalence rate, demographic and clinical predictors for maternal infection, failure to receive prenatal care or for whom status was unknown, failure to screen, and failure to vaccinate. RESULTS: Ninety-two percent of pregnant women were screened for hepatitis B surface antigen. Eighty-six percent of infants received dose 1 of the hepatitis B vaccine. Four of the 9 infants with mothers who were hepatitis B surface antigen-positive did not receive both vaccine and hepatitis B immune globulin. The hepatitis B seroprevalence rate was 0.2%. Mothers who were not screened for infection were 3.4 times more likely to have infants who were not vaccinated. White mothers were twice as likely not to have their child vaccinated as mothers of other races. CONCLUSIONS: Not all infants with hepatitis B-infected mothers were receiving vaccine and hepatitis B immune globulin as recommended. Seroprevalence of hepatitis B infection may be lower in North Carolina than in other states. Hepatitis B laboratory test results should be included in every mother's medical record.

Birthing Centers↗
PubMed1981

Iron deficiency in one-year-old infants: comparison of results of a therapeutic trial in infants with anemia or low-normal hemoglobin values.

The purpose of this study was to determine the Hgb response to a therapeutic trial of iron in infants with anemia compared to those with low-normal hemoglobin values. Hgb was determined in 1.128 one-year-old infants. The 278 infants (25%) who had an Hgb less than 11.5 gm/dl were given a three-month oral course of ferrous sulfate (3 mg iron/kg/day); the regimen was satisfactorily completed by 188 infants. Of the 75 infants whose initial capillary Hgb was in the anemic range (Hgb less than 11.0 gm/dl), 45% had an increase in venous Hgb greater than or equal to 1.0 gm/dl. Of the 113 infants with initial capillary values in the low-normal range (11.0 to 11.4 gm/dl), 28% had greater than or equal to 1.0 gm/dl Hgb response. Despite the lower rate of response in the low-normal group, almost half of the infants with a greater than or equal to 1 gm/dl response would have been missed by using the generally accepted cutoff value of 11 gm/dl for a therapeutic trial. Because of the low cost and simplicity of a therapeutic trial, we favor including the low-normal Hgb group for a therapeutic trial of iron in order to avoid missing iron-responsive individuals among groups of infants with a similarly high prevalence of iron deficiency anemia.

Adult↗
PubMed2002

Infant photometry: are mean adult isoluminance values a sufficient approximation to individual infant values?

Individual differences in isoluminance values were studied in infants and adults using a motion nulling paradigm. Two luminance-modulated sinusoidal grating components (spatial frequency=0.25 cpd, temporal frequency=5.6 Hz, speed=22.4 deg/s) were superimposed and moved in opposite directions across a color video screen. The contrasts of the two components were traded off to determine motion nulls. Two conditions were used: red/black vs. green/black, and red/black vs. blue/black grating components. An eye movement based response measure was used for infant subjects, and an average of 308 trials per infant were obtained. As observed in earlier studies, the mean motion null values for infants and adults were highly similar in each condition. The standard errors of motion null values for individual subjects were very small. Individual differences among infants were also small, and were clearly measurable only in the red/black vs. blue/black condition. The close similarity of mean null values, combined with the small individual differences among infants, supports the idea that under the right circumstances mean adult isoluminance values can be used as a sufficient approximation to individual infant isoluminance values in studies of infant color vision. These circumstances are discussed and evaluated in detail.

Adult↗
PubMed1997

Accommodation in mean f0 during mother-infant and father-infant vocal interactions: a longitudinal case study.

Reports that infants imitate the vocal pitch characteristics of adult caregivers (e.g. Lewis, 1936/1951) include Lieberman's (1967; Lieberman, Ryalls & Rabson, 1982) claim that infants differentially adjust their vocal pitch or fundamental frequency (f0) towards that of their caregivers, resulting in higher mean pitch when interacting with mothers than when interacting with fathers. However, a recent cross-sectional study of infants at ages 0:8 to 0:9 and 1:0 failed to find evidence of differential pitch adjustment toward male and female caregivers (Siegel, Cooper, Morgan & Brennessie-Sarshad, 1990). A more sensitive test of Lieberman's claims would be to use a longitudinal design, with spontaneous recording sessions repeated over many months. The current study presents data from a longitudinal case study of an infant recorded at ages 0:3, 0:7, 0:10, 1:3 and 1:5 interacting with each of her parents in spontaneous play sessions and in isolated play. The infant in our study did not demonstrate significant adjustment of her vocal pitch in the direction of either parent. However, we did find evidence for consistent adjustment by the parents, in accord with the literature on infant-directed speech and mother-infant dyadic interactions, which suggest that the parents adjusted their behavior to suit the infant more than vice versa.

Adult↗
PubMed1989

Infant preference for both male and female infant-directed talk: a developmental study of attentional and affective responsiveness.

This research increases our understanding of infants' preference for "motherese" by demonstrating that this preference extends to infant-directed talk (IDT) delivered by males as well as females and that infants show both more attentional responsiveness and more affective responsiveness to IDT than to adult-directed talk (ADT). Infants aged 4-5.5 and 7.5-9 months were shown video recordings of male and female adults reciting identical scripts in either IDT or ADT. Attentional preference was measured by the amount of time the infants watched in each condition, and affective responsiveness was measured by two trained raters. Overall, it was found that infants of both ages show greater attentional and affective responsiveness to IDT than to ADT when spoken by either a male or a female. The younger group was also found to be more responsive, on both measures, than the older group. Of perhaps greater significance, it was shown that the behaviour infants displayed in response to IDT makes them more attractive to naive adult judges. This suggests that IDT may facilitate and maintain positive adult-infant interactions.

Affect↗
PubMed2005

Maternal reflective functioning, mother-infant affective communication, and infant attachment: exploring the link between mental states and observed caregiving behavior in the intergenerational transmission of attachment.

This study examines the link between mental representations and maternal behavior within the intergenerational transmission of attachment. Maternal reflective functioning was hypothesized to predict the quality of mother-infant affective communication based on the AMBIANCE measure. Each of these measures was also considered as a predictor of the quality of infant attachment. The subjects were 45 mothers and their 10-14-month-old infants. Results supported each of the study's major hypotheses. The AMBIANCE measure and the reflective functioning measure had a strong negative correlation. Thus, the level of disruption in mother-infant affective communication was inversely related to the level of maternal reflective functioning. The AMBIANCE measure was also shown to be a very good predictor of infant attachment. Mothers with high AMBIANCE scores were more likely to have infants classified as disorganized or resistant, whereas mothers with low AMBIANCE scores were more likely to have infants classified as secure. A linear regression analysis indicated that maternal behavior mediates the impact of maternal reflective functioning upon infant attachment. Implications for attachment theory and early intervention are explored.

Adult↗
PubMed2005

Mother-infant interactions and infant development are altered by maternal iron deficiency anemia.

The aim of this study was to determine whether iron deficiency anemia (IDA) in young South African mothers alters mother-infant interactions and the infant's development. The study was a prospective, randomized, controlled intervention trial with 3 groups of mothers: nonanemic controls and anemic mothers administered either placebo (25 mg ascorbic acid and 10 microg folate) or daily iron treatment (125 mg FeSO(4) plus ascorbate and folate). Mothers of full-term, normal birth weight infants (n = 81) were followed from 10 wk to 9 mo postpartum. Maternal iron status, socioeconomic level, mother-infant interaction [Parent/Caregiver Involvement Scale (PCIS scale)], and infant development (Griffiths scale) were assessed. At baseline, anemic mothers tended (P < 0.10) to be less responsive to, and more controlling of, their infants. Infants of anemic mothers were developmentally delayed at 10 wk in hand-eye movement and overall quotient. Despite normalization of maternal iron status with supplementation in some mothers, the developmental delays were not diminished at 9 mo. At 9 mo, anemic mothers were significantly more "negative" towards their babies, engaged less in goal setting, and were less "responsive" than control mothers. In contrast, the behavior of anemic mothers given iron treatment toward their children was similar to that of the control mothers on all 11 scales of the PCIS. In conclusion, IDA altered mother-child interactions at both 10 wk and 9 mo postpartum. Additionally, infants whose mothers were anemic in the early postpartum scored worse on developmental tests at 10 wk and 9 mo of age.

Anemia, Iron-Deficiency↗
PubMed1986

Clinical comparison of the visual parameters in infants with intrauterine growth retardation vs. infants with normal birth weight.

We measured vision function in a number of 7-month-old infants with intrauterine growth retardation (IUGR) and compared these findings to those for 7-month-old infants of normal birth weight. The IUGR infants had an average visual acuity of 6/162 (20/540) and an average spherical refractive error of 1.49 D hyperopia. The normal birth weight infants had an average visual acuity of 6/118.8 (20/396) and an average spherical refractive error of 0.94 D hyperopia. However, the differences between the infant groups for visual acuity and refractive error were not statistically significant. Anisometropia, astigmatism, and strabismus were infrequent for both infant groups. The results of this study suggest that IUGR infants have visual abilities resembling those of normal birth weight infants.

Astigmatism↗
PubMed1986

Postheparin plasma lipoprotein and hepatic lipase activities in hyperinsulinemic infants of diabetic mothers and in large-for-date infants at birth.

To study postheparin plasma lipase activities in nonfed newborn infants immediately after birth and to investigate the possible influence of fetal hyperinsulinemia on lipoprotein lipase activity, we measured lipoprotein and hepatic lipase activities in 55 macrosomic newborn infants: group I consisted of 21 infants born to mothers with insulin-dependent diabetes. The infants were hyperinsulinemic at birth and had hypoglycemia and poor lipolysis at the age of 2 h. Group II consisted of 18 infants born to mothers with gestational diabetes. Group III consisted of 16 large-for-date infants born to nondiabetic mothers. The mean postheparin plasma lipoprotein lipase activities at 2 h of age were similar (mean 36 mumol free fatty acids/ml/h; SEM 15) in groups I-III. Lipoprotein lipase activity correlated negatively with cord-serum triglycerides (range 0.13-1.2 mmol/liter) but did not correlate with serum insulin (range 5.4-524 microU/ml) or C-peptide (range 0.6-21.0 micrograms/liter). Hepatic lipase activity was somewhat higher in group I (mean 68 mumol free fatty acids/ml/h; SEM 23) than in groups II and III (mean 55 mumol free fatty acids/ml/h; SEM 14). Hemoglobin Alc was the only important factor explaining the difference in hepatic lipase activities between groups. Lipoproteins and apolipoproteins A-I, A-II, and B were similar in all three groups. We conclude that in large-for-date infants lipoprotein lipase is active at birth without exogenous fat induction, and that these infants are capable of hydrolyzing fat, their main source of energy, immediately after birth. In addition, we conclude that postheparin plasma lipoprotein lipase activity is not affected by fetal hyperinsulinemia.

Apolipoprotein A-I↗
PubMed2003

Adaptation of a cardiac monitor for collection of infant sleep data and development of a computer program to categorize infant sleep state.

This article describes the adaptation of a cardiac Holter monitor to more conveniently collect and store infant sleep data. The cardiac monitor was first adapted to connect to a sleep mattress, then refined until readable infant sleep signal data were produced. System data were compared to data collected by a live observer of infant sleep (kappa = 0.84). The IRB-approved testing used newborn infants, conducted with parental consent. Development of a rule-based computer program was designed to categorize the physiologic data into infant sleep wake states. The cardiac monitor was found to be lightweight, portable, battery powered, nonintrusive, and safe for collecting infant sleep data. Preliminary assessment of the validity of the program in scoring infant sleep was compared to hand scored data (kappa = 0.76). Refinement of the system and software program is ongoing and expected to greatly facilitate the study of infant state behavior.

Diagnosis, Computer-Assisted↗
PubMed2002

Pitch characteristics of infant-directed speech affect infants' ability to discriminate vowels.

"Baby talk" or speech directed to prelinguistic infants is high in pitch and has exaggerated pitch contours (up/down patterns of pitch change) across languages and cultures. Using an acoustic model, we predicted that the large pitch contours of infant-directed speech should improve infants' ability to discriminate vowels. On the other hand, the same model predicted that high pitch would not benefit, and might actually impair, infants' ability to discriminate vowels. We then confirmed these predictions experimentally. We conclude that the exaggerated pitch contours of infant-directed speech aid infants' acquisition of vowel categories but that the high pitch of infant-directed speech must serve another function, such as attracting infants' attention or aiding emotional communication.

Attention↗
PubMed2006

Infant immunisation with a pneumococcal conjugate vaccine: from the age of two months, for all infants.

(1) In France, before widespread infant immunisation with the 7-valent pneumococcal conjugate vaccine, there were about 13 deaths a year and about 145 cases of pneumococcal meningitis, often with serious sequelae. The peak incidence of pneumococcal meningitis occurs at approximately 5 months of age. (2) About 65% of the pneumococcal serotypes that cause meningitis in French children are covered by the 7-valent vaccine. (3) Several trials have yielded similar results: vaccination during infancy reduces the risk of invasive pneumococcal infection due to serotypes covered by the vaccine by 80% to 90%, leading to a relative reduction of 60% to 70% in the risk of invasive pneumococcal infections due to all serotypes. (4) In the United States, since the introduction of routine vaccination for all infants under 2 years of age, infant mortality due to invasive pneumococcal infections has fallen, with roughly one death prevented per 200 000 infants. Infant vaccination also appears to reduce the circulation of vaccine serotypes among unvaccinated subjects, especially those over 50 years of age. There is some evidence of replacement by non-vaccine serotypes, but the magnitude of occurrence is small. (5) The efficacy of the 7-valent pneumococcal conjugate vaccine in the prevention of acute otitis media in infants has been tested in several clinical trials: it is minimal to non-existent. (6) The adverse effects of the 7-valent pneumococcal conjugate vaccine are similar to those of other commonly used vaccines, and include fever, rash, urticaria, reactions at the injection site, and agitation. Serious allergic reactions have occurred: at least one spontaneous report of one serious allergic reaction per 500 000 vaccinated children. (7) There is consensus on the vaccination schedule: 3 intramuscular injections given at least 4 weeks apart, plus a booster at 12-15 months, if vaccination is started at 2 months of age. (8) In France, routine vaccination would prevent about a dozen deaths, several dozen cases of meningitis, and a few hundred hospital admissions per year, at a cost of at least one serious allergic reaction. (9) The risk-benefit balance is very favourable in infants who are at a high risk of invasive pneumococcal infection. It is also positive in other infants, and should therefore be routinely offered from the age of 2 months. Epidemiological monitoring must continue.

Clinical Trials as Topic↗
PubMed1990

Infant proneness-to-distress temperament, maternal personality, and mother-infant attachment: associations and goodness of fit.

66 mother-infant pairs were examined when the infants were 9 and 13 months. The purpose of this report was to examine relations between infant proneness-to-distress temperament, maternal personality characteristics, and mother-infant attachment. There were no main-effect relations between infant proneness-to-distress temperament as assessed at 9 months and infant attachment classification at 13 months. This was true whether security of attachment (A and C vs. B) or proposed temperament (A1-B2 vs. B3-C2) groupings of attachment classifications were examined. Infant proneness-to-distress temperament, however, was associated with maternal behavior and personality. Furthermore, security of attachment could be predicted by an interaction between maternal personality and infant proneness-to-distress. The importance of considering goodness-of-fit relations in predicting attachment security is discussed.

Affect↗