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PubMed1983

Infant response to facelike patterns under fixed-trial and infant-control procedures.

10-week-old infants were shown 4 facelike patterns that differed along 2 dimensions: number of elements and the extent to which the elements were organized to resemble the human face. The purpose was to determine whether the stimulus dimension to which infants respond is different with fixed-trial than with infant-control methodologies. Each infant was tested under 1 of 3 experimental conditions: fixed trials (trials and intervals of fixed, predetermined durations), offset control (trial termination controlled by the behavior of the infant), or onset-offset control (trial initiation and termination both controlled by the infant's behavior). Although the relationship was linear with fixed trials and offset control but was curvilinear with onset-offset control, infants responded to number, rather than organization, of elements in all 3 conditions. Furthermore, no specific methodological advantages were demonstrated for infant-control procedures.

Attention↗
PubMed1982

Adult physiological response to infant cries: effects of temperament of infant, parental status, and gender.

This article describes research on adult physiological and self-report response to audiotapes of infants' cries. 3 groups were studied: nonparents, primiparous parents, and multiparous parents. The tapes consisted of cries ordered (difficult, average, easy) according to sound spectrographic features and infant temperament ratings. While nonparents and multiparous parents showed the expected order in arousal levels (difficult infant cries highest, easy infant cries lowest), primiparous parents had highest levels to average infant cries. Overall, primiparous parents had highest levels of arousal, nonparents next, and multiparous parents least. There were no gender differences in arousal. Difficult infant cries received higher irritation and spoiled ratings; were rated as more grating, arousing, piercing, etc.; were less similar to own infants' cries; and were said to be caused more frequently by frustration, etc., rather than routine physical discomfort. Fathers had higher irritation and spoiled ratings, and lower care for ratings, than mothers. The relationship of these data to own infant temperament ratings was also assessed.

Adult↗
PubMed2002

Infant colic: empirical evidence of the absence of an association with source of early infant nutrition.

BACKGROUND: The etiology of infant colic remains unknown, despite an abundance of research on the topic. OBJECTIVE: To determine whether breastfeeding has a protective effect in colic's development. DESIGN: A prospective cohort study of 856 mother-infant dyads. Eligible participants included English-speaking adult residents of a region in Ontario, who gave birth, at term, to a live singleton whose birth weight was appropriate for gestational age. Self-administered questionnaires, mailed to mothers at 1 and 6 weeks post partum, requested information on several infant and maternal factors, including source of infant nutrition (exclusively breastfed, complementary fed, and exclusively formula fed). Cases of colic were identified by applying modified Wessel criteria to data recorded in the Barr Baby Day Diary or by interpreting responses to the Ames Cry Score. MAIN OUTCOME MEASURES: Prevalence of colic among breastfed, formula-fed, and complementary-fed infants; and adjusted odds ratios (AORs) reflecting the prevalence of colic among formula- and complementary-fed infants relative to those who were breastfed. RESULTS: Of 856 mothers, 733 (86%) completed the first questionnaire and 617 (72%) completed the second questionnaire. Overall, the prevalence of colic at 6 weeks was 24%. No association was seen between the source of infant nutrition and colic's development. In multivariate analyses, higher levels of maternal trait anxiety (AOR, 1.22; 95% confidence interval [CI], 0.96-1.54), maternal alcohol consumption at 6 weeks (AOR, 1.57; 95% CI, 1.03-2.40), and shift work during pregnancy (AOR, 1.27; 95% CI, 0.73-2.21) were associated with an increased likelihood of colic, after controlling for feeding method, maternal age, and parity. In these same analyses, being married or having a common-law partner (AOR, 0.30; 95% CI, 0.10-0.87) and being employed full-time during pregnancy (AOR, 0.60; 95% CI, 0.32-1.14) were associated with a reduced likelihood of colic. CONCLUSIONS: Breastfeeding did not have a protective effect on the development of colic. Although colic was statistically associated with several variables, including preexisting maternal anxiety, much of colic's etiology remains unexplained.

Adult↗
PubMed2001

Is there a link between infant botulism and sudden infant death? Bacteriological results obtained in central Germany.

UNLABELLED: Despite the fact that botulism was described in Germany for the first time by Kerner in 1820, the disease is almost forgotten in this country. Only about 10-20 cases of classical botulism (intoxication) are recorded every year, including 1-2 cases of clinical infant botulism. As we assumed a high incidence of botulism to be connected with cases of sudden infant death (SID), we undertook the research work presented here. From every case of unexpected infant death up to 12 months of age, standardised specimens (blood, liver and intestine) were taken at autopsy. They were tested for the presence of botulinum neurotoxin (BoNT) and/or bacterial forms of Clostridium botulinum with subsequent BoNT neutralisation tests by the international standard mouse bioassay. Age, sex, pathological findings and season were recorded. Over a 5-year period, 75 samples including 57 SID cases were tested. Free toxin was found in nine and bacterial forms were detected in six samples. Toxin neutralisation revealed the definite presence of BoNT/BoNT producing bacteria (mainly type E), whereas another 11 toxin tests were inconclusive. According to international literature, these 15 cases are to be interpreted as infant botulism. CONCLUSION: the results show a remarkable incidence of infant botulism without any known previous medical history, partly hidden as sudden infant death. We propose to systematically search for botulism in connection with sudden infant death.

Animals↗
PubMed1983

Respiratory frequency during sleep in siblings of sudden infant death syndrome victims. A comparison with control, normal infants.

The present study was carried out on 76 polygraphic recordings performed on 38 siblings of sudden infant death syndrome victims and on 38 control (2 days to 18 weeks old) infants. Each sibling corresponded to a control infant according to gender, gestational age at birth and postnatal age criteria. We found that in siblings as in controls, respiratory frequency (RF) was higher in active sleep (AS) compared to quiet sleep (QS) state (P less than 0.05 for 11-18 week siblings, p less than 0.01 for the other groups). During the transitional sleep (TS), RF was on an intermediate level (AS greater than TS greater than QS). There were no significant differences between RF of siblings compared to controls, except that RF during QS in 6-10 week control infants was higher than in siblings of the same age (P less than 0.05). We found a wide variability between RF of different individuals within all the age groups of siblings and of controls (P less than 0.001). However, a high correlation was usually noted between RF found in different sleep states: some infants (siblings or controls) breathed more rapidly and others more slowly in all states studied. In siblings, as previously described in other groups of normal infants, RF seems to be an individual characteristic. In addition, the present work shows that according to RF criterion, healthy siblings are similar to normal infants.

Circadian Rhythm↗
PubMed1994

Ethnic differences in infant care practices and in the incidence of sudden infant death syndrome in Birmingham.

Certain infant care practices have consistently been shown to play an important role in the aetiology of the sudden infant death syndrome (SIDS). In the UK, the incidence of SIDS amongst Asians is less than half that of whites. We conducted a questionnaire-based survey of 374 multiparous mothers from a multiracial community in Birmingham. We found that the majority of Asian infants slept in the parental bedroom at night, 94% compared to 61% of whites, whilst 33% of white infants slept alone compared to 4% of Asians. Three times as many white mothers as Asians placed infants prone (31% vs. 11%). We, therefore, observed marked differences in the infant care practices of Asians compared to whites in the UK, which may partly account for the low incidence of SIDS amongst infants of Asian origin.

Adult↗
PubMed1995

Maturation of the auditory brainstem in low risk-preterm infants: a comparison with age-matched full term infants up to 6 years.

Whether preterm birth has a significant effect on the maturation of the human brain remains an equivocal issue. Since experience plays a crucial role in the development of the brain, it is conceivable that extra-uterine preterm exposure could exert some effects on the maturation of the developing human brain. The present study compared the post-term maturation of the central components of brainstem auditory evoked response (BAER) in low risk preterm infants with that of age-matched full term infants up to 6 years. The preterm infants demonstrated similar maturational profiles to those of the term infants in both interpeak intervals and amplitude measures. No systematic, statistically significant differences were found between the preterm and term infants in any of the BAER variables although the I-V interval tended to be slightly shortened in the prematurely born infants. These results suggest that preterm birth or earlier exposure to sound environment extra utero is unlikely to lead to significant neurophysiological consequence in the developing auditory brainstem of low risk infants.

Aging↗
PubMed1986

Pneumograms in infants who subsequently died of sudden infant death syndrome.

Victims of sudden infant death syndrome (SIDS) have occasionally been reported to have had prolonged apnea or an increased frequency of short apnea prior to their deaths. To examine the extent of these abnormalities, we compared pneumograms obtained in 17 infants who subsequently died of SIDS (10 with history of apnea) with those of 34 age- and sex-matched controls. The recordings were analyzed by a computer program that avoided observer bias. SIDS infants had significantly greater mean heart rate (P less than 0.05) and periodic breathing during quiet time (P less than 0.003) than control infants had. The apnea in SIDS infants tended to be more periodic than in control infants (P less than 0.002). In addition, the incidence of bradycardia was greater in SIDS (three infants) than in controls (none) (P less than 0.03). These differences suggest a disturbance of autonomic function prior to death in some victims of SIDS.

Apnea↗
PubMed2000

[Mothers' behavior regarding infant sleep position: effects of the last public campaign to prevent sudden infant death syndrome].

BACKGROUND: To define infant care practices in maternity units and those subsequently adopted at home. Using these data, we evaluated the acceptance and application of recommendations issued by the previous public education campaign on infant sleeping position as related to sudden infant death syndrome. PATIENTS AND METHODS: A survey was carried out in two maternity units (Port-Royal and Créteil) and in one pediatric consultation unit (affiliated with Port-Royal maternity). RESULTS: The mixed position (side or back) is used equally with, respectively, 47% at Port-Royal and 45% at Créteil. The supine sleeping position (French public health recommendations) is used by 12% of the mothers at Port-Royal and by 40% at Créteil. It appears that hospital nurseries play an important role in determining the mother's preference for the sleeping position (64% at Port-Royal and 54% at Créteil), but it does not adequately explain all mothers' responses. However, as the infants mature (> two months old), the more spontaneously they changed their sleeping position. All the infants placed in a side sleeping position moved to a supine sleeping position during the night. Upon awakening, infants were found mostly in the supine position (in contrast to the national public education campaign). CONCLUSION: Our results show that mothers and hospital nurseries were distressed in terms of ensuring the supine sleeping position of the infant. New choices of sleeping positions were initiated by mothers. For example, they used the side position after feedings essentially in the case of reflux or during the daytime. The supine position was used when the mothers were assured that any problems had been avoided or only during the night.

Adult↗
PubMed2002

Validity of the Test of Infant Motor Performance for prediction of 6-, 9- and 12-month scores on the Alberta Infant Motor Scale.

The Test of Infant Motor Performance (TIMP) is a test of functional movement in infants from 32 weeks' post-conceptional age to 4 months postterm. The purpose of this study was to assess in 96 infants (44 females, 52 males) with varying risk, the relation between measures on the TIMP at 7, 30, 60, and 90 days after term age and percentile ranks (PR) on the Alberta Infant Motor Scale (AIMS). Correlation between scores on the TIMP and the AIMS was highest for TIMP tests at 90 days and AIMS testing at 6 months (r=0.67, p=0.0001), but all comparisons were statistically significant except those between the TIMP at 7 days and AIMS PR at 9 months. In a multiple regression analysis combining a perinatal risk score and 7-day TIMP measures to predict 12-month AIMS PR, risk, but not TIMP, predicted outcome (21% of variance explained). At older ages TIMP measures made increasing contributions to prediction of 12-month AIMS PR (30% of variance explained by 90-day TIMP). The best TIMP score to maximize specificity and correctly identify 84% of the infants above versus below the 10th PR at 6 months was a cut-off point of 1 SD below the mean. The same cut-off point correctly identified 88% of the infants at 12 months. A cut-off of -0.5 SD, however, maximized sensitivity at 92%. A negative test result, i.e. score above -0.5 SD at 3 months, carried only a 2% probability of a poor 12-month outcome. We conclude that TIMP scores significantly predict AIMS PR 6 to 12 months later, but the TIMP at 3 months of age has the greatest degree of validity for predicting motor performance on the AIMS at 12 months and can be used clinically to identify infants likely to benefit from intervention.

Ankle↗
PubMed2006

Nasal continuous positive airway pressure from high flow cannula versus Infant Flow for Preterm infants.

OBJECTIVE: To compare the feasibility of continuous positive airway pressure (CPAP) support generated by high flow nasal cannula with conventional CPAP for prevention of reintubation among preterm infants with a birth weight of <or=1,250 g. STUDY DESIGN: Preterm infants were randomized to CPAP generated via high flow cannula or the Infant Flow Nasal CPAP System (VIASYS, Conshohocken, PA, USA) at extubation. Primary outcome was incidence of reintubation within 7 days. Secondary outcomes included change in oxygen use and frequency of apnea and bradycardias postextubation. RESULTS: Forty neonates were randomized. Twelve of 20 infants randomized to high flow cannula CPAP were reintubated compared to three of 20 using Infant Flow (P=0.003). The high flow cannula group had increased oxygen use and more apneas and bradycardias postextubation. CONCLUSIONS: CPAP delivered by high flow nasal cannula failed to maintain extubation status among preterm infants <or=1,250 g as effectively as Infant Flow CPAP.

Apnea↗
PubMed1997

The effect of mode of delivery on neonatal mortality in very low birthweight infants born in Victoria, Australia: Caesarean section is associated with increased survival in breech-presenting, but not vertex-presenting, infants.

To determine whether the improved survival of very low birthweight (VLBW) infants (< 1500 g) born in Australia can be attributed to currently high rates of Caesarean section, we examined the associations between neonatal mortality and Caesarean section in singleton liveborn VLBW infants (500-1499 g) born during 1986-93 in Victoria, Australia, using data from the Victorian Perinatal Collection Unit. The infants included in this study had completed > 23 weeks of gestation, had no life-threatening malformations and had not been delivered by a repeat Caesarean without a trial of labour (n = 2763). For infants weighing 500-749 g, 750-999 g, 1000-1249 g and 1250-1499 g, the neonatal mortality rates were 56.1%, 25.7%, 13.0% and 4.3% respectively, and the Caesarean section rates were 33.1%, 42.3%, 54.8% and 55.8%. Nearly half of these births (n = 1269) were associated with one or more obstetric indications for Caesarean section (non-breech malpresentation, fetal distress, prolapsed cord, placenta praevia, pre-eclampsia and hypertension). Overall, the odds ratio (OR) for neonatal death associated with Caesarean section was 0.92 [95% confidence interval 0.60-1.41], after adjustment for gestational age, birthweight, year of birth, type of hospital, presence or absence of labour, presentation and obstetric indications for Caesarean section. However, when the vertex-presenting (n = 1702) and breech-presenting (n = 746) infants were considered separately, the adjusted ORs for neonatal death were 1.98 [0.96-4.10] and 0.52 [0.29-0.96] respectively. For those infants without obstetric indications for Caesarean section, the adjusted ORs for neonatal death in vertex-presenting (n = 950) and breech-presenting (n = 446) infants were 3.80 [1.11-13.0] and 0.47 [0.23-0.6]. These recent population-based data support the view that Caesarean section does not enhance the neonatal survival of VLBW babies when obstetric complications are absent.

Birth Weight↗
PubMed2003

Mother-infant interaction in premature infants at three months after nursery discharge.

Both the immature and disorganized behaviour of the premature infant and the psychosocial or socioeconomic factors which adversely affect a mother's responsiveness to her premature infant can jeopardize the mother-infant relationship. At three months after infant hospital discharge, the interactions of 50 premature infants (< or = 32 weeks) and their mothers were videotaped and coded using the Nursing Child Assessment Feeding Scale. The relationship between data derived from the feeding interaction and maternal psychosocial and infant perinatal variables collected at one month after birth and at three months after discharge from hospital were examined. Results showed that the mothers' use of coping strategies both in hospital and at home were important factors in explaining mother-infant interaction.

Adaptation, Psychological↗
PubMed1996

Adjustment of birth weight standards for maternal and infant characteristics improves the prediction of outcome in the small-for-gestational-age infant.

OBJECTIVE: Birth weight is a function of gestational age. Various maternal and infant characteristics also affect birth weight. This study sought to adjust for these factors to better define abnormal growth. STUDY DESIGN: Maternal and infant characteristics from normal pregnancies were correlated with birth weight. A formula was developed and applied to a second group in which we compared perinatal outcomes in normally grown infants with those who were small for gestational age. We compared outcomes between small-for-gestational-age infants defined by the formula with those defined by conventional tables. RESULTS: Infants defined by the formula as small-for-gestational-age were more likely to have morbidity and mortality than those who were normally grown (p < 0.001). Small-for-gestational-age infants defined by the formula had more deaths and adverse outcomes than those defined by gestational age. CONCLUSION: Adjusting birth weight standards for maternal and infant characteristics may improve the prediction of adverse outcomes.

Adult↗
PubMed2002

The effects of labor on infant mortality among small-for-gestational-age infants in the USA.

OBJECTIVE: To determine whether the presence of labor affects infant mortality among small-for-gestational-age (SGA) infants. METHODS: Data were derived from the United States national linked birth/infant death data sets for 1995-97. Singleton SGA live births in cephalic presentation delivered at 24-42 weeks' gestation were included. Mortality rates for SGA infants exposed and unexposed to labor were compared, and relative risks (RR) were derived using multivariable logistic regression models, after adjusting for potential confounding factors. RESULTS: Of 986 405 SGA infants, 87.4% were exposed to labor. Infants exposed to labor at 24-31 weeks had greater risks of dying during the early neonatal period (RR 1.79-1.86). Decreased risks of late and postneonatal death were observed at all gestational ages in the presence of labor. CONCLUSIONS: Exposure to labor is associated with an increased risk of early neonatal death among SGA infants, especially at gestational ages below 32 weeks. Future randomized trials are warranted to determine the optimal obstetric management of these high-risk infants.

Female↗
PubMed1988

Cardiac and respiratory patterns in normal infants and victims of the sudden infant death syndrome.

Victims of the sudden infant death syndrome (SIDS) have higher overall heart rates prior to death than do control infants (1). The objective of this study was to partition these heart rate differences by state and to identify any state-dependent differences in heart rate variability and respiratory rate and variability. Twenty-two recordings of electrocardiogram (ECG) and respiration from 16 infants who subsequently died of SIDS were compared with 66 recordings of age-matched control infants. Median cardiac and respiratory rate and variability were computed for each sleep state in each recording, and one-way analysis of variance tests were performed for each variable for infants less than 1 month and for infants greater than 1 month of age. Heart rate was higher in SIDS victims less than 1 month of age than in age-matched controls during all sleep-waking states. SIDS victims greater than 1 month showed higher heart rates during rapid eye movement sleep only. Heart rate variability was also diminished during waking in victims less than 1 month, but much of this difference could be attributed to increased heart rate. These results suggest that, as a group, SIDS victims differ physiologically from control infants and that these differences may be especially prominent during particular sleep-waking states.

Electrocardiography↗
PubMed2001

The black infant's susceptibility to sudden infant death syndrome and respiratory infection in late infancy.

Between 2 and 11 months of age, the risk of sudden infant death syndrome (SIDS) declines more slowly in black infants than in infants of other races. This phenomenon might also be a feature of certain non-SIDS causes of death. Identifying these causes may through analogy provide support for the theory that SIDS is a disease of the central nervous system, an unusual consequence of respiratory infection, or a form of suffocation. We used logistic regression analysis on details of infant deaths in the United States, 1985-1991, to examine the difference between the rates of decline with increasing age in the mortality rates of black infants and infants of other races. We defined slower rate of decline in black infants as a positive difference. The magnitude and direction (positive) of the difference for deaths due to respiratory infection were similar to those for SIDS. It is unlikely that this difference in the rates of decline for respiratory infection can be explained by diagnostic cross-misclassification between respiratory infection and SIDS. SIDS appears to be a disease of the respiratory system caused by infection that affects that system's control centers.

Black or African American↗
PubMed1991

Gastroesophageal reflux in infants with a history of near-miss sudden infant death.

From January 1984 through August 1986, 130 infants were referred to our department with a history of apnea, hypotonia, and cyanosis or pallor, suggesting near-miss sudden infant death syndrome. Protocol consisted of medical history, clinical examination, overnight polygraphic recording, and cardiologic, gastrointestinal, metabolic, neurologic, and toxicologic workups. In 49 of these infants who needed vigorous stimulation or mouth to mouth resuscitation, the event occurred shortly after feeding. Combined, continuous esophageal pH monitoring and polygraphic recording in these 49 infants showed pathologic gastroesophageal reflux (GER) in 34 patients. An abnormal overnight polygraphic recording was observed in 8 of 34 infants with pathologic GER. Other investigations led to etiologic diagnoses in 42 of the remaining infants. Severe GER was frequently found in children with apnea after feeding but clearly is not the only mechanism involved. Infants with a history of apnea after a feeding should be investigated for GER and appropriately treated.

Apnea↗