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PubMed1998

Pain scores in infants: a modified infant pain scale versus visual analogue.

This study describes an observational system (modified infant pain scale, MIPS) with elements from a previously published observational scale and from assessments of video-recorded infant facial expressions. It was designed to allow rapid and repeated assessments of pain in infants after brief training by an observer without pediatric experience. Forty healthy term infants (17 +/- 7 weeks) undergoing elective surgery had simultaneous independent assessment of pain using two scales: a naive observer used the MIPS and an experienced pediatric nurse used a 10-cm unmarked horizontal visual analogue scale (VAS). This validation of the MIPS included its division during analysis into partial (P-MIPS, without data on sleep or vital signs) and total scores. Infants had a broad range of MIPS scores, and the two scales categorized infants as "comfortable" or "not comfortable" with a high degree of concordance. The MIPS was easily incorporated into an infant's physical examination. We recommend its use for two-point clinical pain assessment.

Female↗
PubMed2005

Maternal and infant characteristics associated with perinatal arterial stroke in the infant.

CONTEXT: Perinatal arterial ischemic stroke (PAS) is a common cause of hemiplegic cerebral palsy. Risk factors for this condition have not been clearly defined. OBJECTIVE: To determine maternal and infant characteristics associated with PAS. DESIGN, SETTING, AND PATIENTS: Case-control study nested within the cohort of all 199,176 infants born from 1997 through 2002 in the Kaiser Permanente Medical Care Program, a managed care organization providing care for more than 3 million residents of northern California. Case patients were confirmed by review of brain imaging and medical records (n = 40). Three controls per case were randomly selected from the study population. MAIN OUTCOME MEASURE: Association of maternal and infant complications with risk of PAS. RESULTS: The population prevalence of PAS was 20 per 100,000 live births. The majority (85%) of infants with PAS were delivered at term. The following prepartum and intrapartum factors were more common among case than control infants: primiparity (73% vs 44%, P = .002), fetal heart rate abnormality (46% vs 14%, P<.001), emergency cesarean delivery (35% vs 13%, P = .002), chorioamnionitis (27% vs 11%, P = .03), prolonged rupture of membranes (26% vs 7%, P = .002), prolonged second stage of labor (25% vs 4%, P<.001), vacuum extraction (24% vs 11%, P = .04), cord abnormality (22% vs 6%, P = .01), preeclampsia (19% vs 5%, P = .01), and oligohydramnios (14% vs 3%, P = .01). Risk factors independently associated with PAS on multivariate analysis were history of infertility (odds ratio [OR], 7.5; 95% confidence interval [CI], 1.3-45.0), preeclampsia (OR, 5.3; 95% CI, 1.3-22.0), prolonged rupture of membranes (OR, 3.8; 95% CI, 1.1-12.8), and chorioamnionitis (OR, 3.4; 95% CI, 1.1-10.5). The rate of PAS increased dramatically when multiple risk factors were present. CONCLUSIONS: Perinatal arterial ischemic stroke in infants is associated with several independent maternal risk factors. How these complications, along with their potential effects on the placenta and fetus, may play a role in causing perinatal stroke deserves further study.

Brain↗
PubMed1981

Circulating myelopoietic stem cells (CFUc): high levels in healthy pre-term infants and reduced levels in sick pre-term infants.

In healthy and diseased pre-term infants at birth, levels of circulating CFUc are 2,586 +/- 3,063 (s. d.) and 269 +/- 292 (s.d.) per 5 X 10(5) lymphoid cells, as compared to data from the literature of 5 CFUc per 5 X 10(5) mononuclear cells from the blood of adults [8]. Hypotrophic infants have the lowest concentration of CFUc in the blood, namely 78 +/- 105 (s.d.). In formerly sick infants recovering from their perinatal illness, blood CFUc levels increase to approach those from healthy infants of the same age. Our results provide evidence that blood CFUc levels in pre-term infants reflect the strong myelopoietic activity of fetal bone marrow and suggest a correlation to the clinical status of the infant.

Female↗
PubMed2006

The Premature Infants in Need of Transfusion (PINT) study: a randomized, controlled trial of a restrictive (low) versus liberal (high) transfusion threshold for extremely low birth weight infants.

OBJECTIVE: To determine whether extremely low birth weight infants (ELBW) transfused at lower hemoglobin thresholds versus higher thresholds have different rates of survival or morbidity at discharge. STUDY DESIGN: Infants weighing <1000 g birth weight were randomly assigned within 48 hours of birth to a transfusion algorithm of either low or high hemoglobin transfusion thresholds. The composite primary outcome was death before home discharge or survival with any of either severe retinopathy, bronchopulmonary dysplasia, or brain injury on cranial ultrasound. Morbidity outcomes were assessed, blinded to allocation. RESULTS: Four hundred fifty-one infants were randomly assigned to low (n = 223) or high (n = 228) hemoglobin thresholds. Groups were similar, with mean birth weight of 770 g and gestational age of 26 weeks. Fewer infants received one or more transfusions in the low threshold group (89% low versus 95% high, P = .037). Rates of the primary outcome were 74.0% in the low threshold group and 69.7% in the high (P = .25; risk difference, 2.7%; 95% CI -3.7% to 9.2%). There were no statistically significant differences between groups in any secondary outcome. CONCLUSIONS: In extremely low birth weight infants, maintaining a higher hemoglobin level results in more infants receiving transfusions but confers little evidence of benefit.

Algorithms↗
PubMed1994

Prevention of iron deficiency and psychomotor decline in high-risk infants through use of iron-fortified infant formula: a randomized clinical trial.

OBJECTIVE: To determine the efficacy of iron-fortified infant formula in preventing developmental delays and abnormal behavior. DESIGN: Double-blind, randomized, controlled trial. SETTING: Urban hospital clinic. PARTICIPANTS: A total of 283 healthy, bottle-fed infants from very low income families. Children with prematurity, low birth weight, and major anomalies and those who had received more than 2 weeks of evaporated-milk feedings were excluded. The groups were similar for sociodemographic background variables. Fifty-eight infants (20.5%) dropped out before any outcome data were gathered; 225, 204, 186, and 154 remained at 6-, 9-, 12-, and 15-month assessments, respectively. INTERVENTION: Iron-fortified formula (12.8 mg iron per liter) versus regular formula (1.1 mg iron per liter). MAIN OUTCOME MEASURES: Iron status was measured on venous blood by determination of hemoglobin, serum iron and iron-binding capacity, serum ferritin, and free erythrocyte protoporphyrin values. The Bayley Scales of Infant Development (mental and psychomotor indexes) and two factors of the Infant Behavior Record (test affect and task orientation) were the outcomes of interest. RESULTS: All measures of iron status were significantly different between groups (p < 0.001). Psychomotor development patterns differed between groups (F3,520, 3.4; p = 0.02) with time. Mean values were similar at 6 months but differed at 9 and 12 months of age (p < 0.001), with a decline of 6.4 points in the regular-formula group. By 15 months of age the differences were no longer significant (p = 0.23). Mental development and behavior were not affected. CONCLUSIONS: Iron-fortified formula significantly reduced iron deficiency in a high-risk group of infants and prevented a decline in psychomotor development quotients. This effect may be transient, and its long-term significance needs further study.

Developmental Disabilities↗
PubMed2001

Maternal awareness of sudden infant death syndrome in North Queensland, Australia: an analysis of infant care practices.

OBJECTIVES: To assess awareness of sudden infant death syndrome (SIDS) and risk reducing recommendations in a sample of mothers in North Queensland, Australia, and to examine their infant care practices. METHOD: Interviews conducted with 195 women using a standardized questionnaire between October 1997 and January 1998. RESULTS: 191 questionnaires analyzed; 134 (70.2%) Caucasian and 57 (29.8%) indigenous women. Four women with previous SIDS experience were excluded from the analysis. Eight (4.2%) had never heard of SIDS. Twenty-nine (15.2%) had heard of SIDS and 154 (80.6%) had heard of SIDS and could list risk recommendations to reduce its incidence. Multivariate analysis identified ethnicity as the only significant predictor of maternal knowledge. Indigenous mothers knew less about SIDS: adjusted odds ratio (OR) = 5.4; 95% confidence interval (CI) = [2.1-14.0]. Avoidance of prone sleeping was the most frequently identified recommendation (n = 132), with no smoking in pregnancy (n = 48) and breastfeeding (n = 40) identified least frequently. There were 80.2% of mothers who put their infant in non-prone positions to sleep. Only 48 (25%) women identified smoking in pregnancy, and 93 (48.6%) smoking in the infant's environment as risk factors. Indigenous women were more likely to smoke in their pregnancy (P = 0.004), bed share with their infant (P = 0.0001), and have smokers in the home. CONCLUSION: There is a high level of awareness of SIDS and the main associated risk factor of infant prone sleeping, but the link between SIDS and smoking requires further emphasis. Future campaigns should ensure the SIDS message is delivered more effectively to the indigenous communities.

Adult↗
PubMed1985

Neuronal development in the medullary reticular formation in sudden infant death syndrome and premature infants.

Morphological and morphometrical development of the neurons in the medullary reticular formation was observed in control, sudden infant death syndrome (SIDS) and prematurely born infants, using Golgi stains. With increasing gestational age, in controls dendrites became long, spines increased and the distribution of spines assumed a mature pattern. The number of spines reached a peak at 34 to 36 weeks gestation and after birth it decreased rapidly. Term and prematurely born SIDS infants showed a persistence of reticular dendritic spines. On the other hand, ventilator-dependent prematurely born infants had decreased numbers of dendritic spines with thin dendrites and long, thin spines. Persistence of reticular dendritic spines in SIDS infants may suggest incomplete development to the mature, higher level of respiratory control. Spine abnormalities in the ventilator-dependent prematurely born infants may indicate secondary neuronal changes in the reticular formation.

Dendrites↗
PubMed2000

Treatment of infant colic with amino acid-based infant formula: a preliminary study.

Infant colic, a common disorder of infancy, is characterized by excessive crying and fussing. In this preliminary study we examined whether Neocate, an amino acid-based formula, would be accepted by formula-fed infants with colic, 3-7 wk of age, and whether Neocate would improve their symptoms. Six infants with colic were studied using Barr-type infant behavior diaries for 3-6 d on their current formula and then for 5-17 d on Neocate exclusively. All infants tolerated Neocate well and all improved, usually within 1-2 d. The total time spent crying and fussing was reduced by an average of 45%, representing a decrease of 1.0 to 5.2 h daily. After colic symptoms improved, infants were challenged with oral doses of 75 mg of bovine IgG at a 1 mg/ml concentration in order to assess its potential role in colic. Bovine IgG challenges resulted in increased crying and fussing behavior, suggesting that this protein may be etiologically important.

Administration, Oral↗
PubMed2001

Early discharge of preterm infants followed by domiciliary nursing care: parents' anxiety, assessment of infant health and breastfeeding.

UNLABELLED: The aim of this study was to evaluate the effect of early discharge of preterm infants, followed by domiciliary nursing care, on the parents' anxiety, their assessment of infant health and breastfeeding. Seventy-five families including 88 preterm infants who were physiologically stable but in need of further special care, such as gavage feeding, were allocated to an early discharge group (EDG) that was offered home visits (n = 40), or to a control group offered standard neonatal care (CG) (n = 35). Seventy families (37 in the EDG and 33 in the CG) completed the study to the 1-y follow-up. Data were collected by means of questionnaires on three occasions: in the EDG, at hospital discharge, on completion of the domiciliary care programme and after 1 y, and in the CG at the corresponding points in time, which were during hospitalization, at hospital discharge and after 1 y. No statistical differences were observed between the groups in emotional well-being, except that mothers in the EDG had a lower level of situational anxiety at the time of hospital discharge compared with CG mothers whose infants remained in hospital. One year after the birth, the EDG mothers said they had felt better prepared to take responsibility for the care of their babies after completion of the domiciliary care programme, in contrast to CG mothers. However, no statistical differences were observed in the recollection of anxiety, confidence in handling the baby and periods of mental imbalance. No statistical difference was observed in breastfeeding rates between the groups. Fathers in the EDG group tended to perceive their babies as being healthier, compared with CG fathers. CONCLUSION: Early discharge of preterm infants followed by domiciliary nursing care did not seem to have any major effect on the parents' anxiety and their assessment of infant health.

Anxiety↗
PubMed1996

Palm olein in infant formula: absorption of fat and minerals by normal infants.

Palm olein, a low-melting fraction of palm oil, and soy oil can be combined to obtain fat blends with proportions of palmitic and oleic acids similar to those of human milk. We compared the absorption of fat and calcium by infants fed a formula containing a blend of palm olein (53%) and soy oil (47%) (Formula PO/S) with that by infants fed a formula containing a blend of soy oil (60%) and coconut oil (40%) (Formula S/C). In a randomized crossover design, one study was performed with each formula in each of 11 normal infants ranging in age from 27 to 161 d. Six of the infants were admitted for 72-h metabolic balance studies. In the other five infants, feces (with some admixture of urine) were collected at home for 96 h by using acid-washed cloth diapers. Mean (+/- SD) absorption of fat was 90.6 +/- 1.6% of intake when Formula PO/S was fed and 95.2 +/- 1.1% of intake when Formula S/C was fed; the difference was significant (P < 0.001). The difference in excretion of fat by infants fed the two formulas was explained by the difference in excretion of palmitic acid. Absorption of calcium averaged 39.0 +/- 8.3% of intake with Formula PO/S and 48.4 +/- 10.3% with Formula S/C; the difference was significant (P < 0.01). We conclude that fat is less well absorbed from a mixture of 53% palm olein and 47% soy oil than from a mixture of 60% soy oil and 40% coconut oil, and that absorption of calcium is less from a formula containing palm olein, presumably because of the formation of insoluble calcium soaps of unabsorbed palmitic acid.

Absorption↗
PubMed2001

An infant formula free of glycomacropeptide prevents hyperthreoninemia in formula-fed preterm infants.

BACKGROUND: Hyperthreoninemia is a well-known phenomenon in infants fed a whey protein-predominant formula. Sweet whey is commonly used for the production of these whey-predominant infant milk formulas. Sweet whey contains not only whey proteins but also the threonine-rich glycomacropeptide (GMP). In the current study, an experimental formula based on acid whey without GMP and a formula based on sweet whey with GMP (threonine content 17.2% higher than in the experimental formula) but otherwise with identical composition were tested with particular respect to threonine metabolism. METHODS: Fourteen preterm infants appropriate for gestational age were enrolled in this randomized cross-over study. After a feeding period of at least 7 days, the nutrition of each infant was switched to the other formula for the second feeding period. At the end of each feeding period, the concentrations of creatinine and amino acids in the plasma and in the urine were measured. RESULTS: In the plasma, the threonine concentration was significantly lower in the group fed the experimental GMP-free formula than in the group fed the sweet whey formula (P < 0.001). Renal excretion of all essential amino acids was generally very low and less than 2% of the intake, indicating that the kidneys had no marked homeostatic function with respect to plasma amino acid. The plasma concentrations of the threonine metabolites glycine and serine, and that of urea were not influenced by diet. CONCLUSION: Feeding a whey protein-predominant bovine milk produced from acid whey protein reduces significantly the hyperthreoninemia commonly found in formula-fed preterm infants. Thus, acid whey formulas should be recommended for feeding preterm infants.

Amino Acids↗
PubMed1995

The intergenerational relationship between mother's birthweight, infant birthweight and infant mortality in black and white mothers.

The relationship between the birthweight of white and black mothers and the outcomes of their infants were examined using the 1988 National Maternal and Infant Health Survey. White and black women who were low birthweight themselves were at increased risk of delivering very low birthweight (VLBW), moderately low birthweight (MLBW), extremely preterm and small size for gestational age (SGA) infants. Adjustment for the confounding effects of prepregnant weight and height reduced the risks of all these outcomes slightly, and more substantially reduced the maternal birthweight associated risk of moderately low birthweight among white mothers. There was little effect of maternal birthweight on infant birthweight-specific infant mortality in white mothers; however, black mothers who weighed less than 4 lbs at birth were at significantly increased risk of delivering a normal birthweight infant who subsequently died. Although the risks for the various outcomes associated with low maternal birthweight were not consistently higher in black mothers compared with white mothers, adjustment for prepregnant weight and height had a greater effect in white mothers than in black mothers. We suggest that interventions to reduce the risks for adverse pregnancy outcomes associated with low maternal birthweight should attempt to optimise prepregnant weight and foster child health and growth.

Adult↗
PubMed1999

An illustrative example of infant and child death review in South Dakota: "the 1998 annual report of the Regional Infant and Child Mortality Review Committee".

Local, regional, or state infant and child death review teams provide an excellent mechanism for identifying risk factors for infant and childhood deaths along with establishing a conduit for effecting preventive measures to reduce the number of deaths in these particularly vulnerable age groups. In 1997, a predecessor of the current Regional Infant and Child Mortality Review Committee was established in Minnehaha County as South Dakota's first non-Indian review committee for infant and childhood deaths. The 1998 Review Committee's annual report to the public is presented in this paper as an illustration of what can be expected from such a committee along with the specific public health concerns identified and their potential remedies. Especially noted in the committee's 1998 report is an alarming increase in Sudden Infant Death Syndrome (SIDS) death in the region and the educational role the Back to Sleep Campaign can play in the prevention of SIDS. The annual report serves as an example to illustrate how local review mechanisms can identify community strategies that may promote the health and well being of infants and children in their review areas.

Adolescent↗
PubMedDate not supplied

A generally neglected threat in infant nutrition: incorrect preparation of infant formulae.

Breast milk is the most appropriate food for infants. At least 4-6 months of breast feeding is sufficient for all babies if appropriate growth is monitored monthly. However, for those infants unable to breast-feed sufficiently or at all, formula can be given as an alternative. However, serious health problems such as hypernatremic dehydration, malnutrition, and obesity may develop if powdered formula is not appropriately prepared. In the present study, our aim was to investigate whether or not mothers of formula-fed babies in Ozkanlar (Izmir, Turkey) district prepared powdered infant formula appropriately. For this purpose, we visited all (328) families with infants younger than 12 months of age. Forty-two (13%) of these 328 infants were still fed formula. The mothers of the infants were asked to prepare formula for two different meals, and duplicate samples from each prepared formula were taken for the measurement of dry matter. Fifty percent of the mothers diluted formula with 10% more or 10% less water for the second meal as compared with the first meal. Four (10%) mothers diluted formula with 10% or less of the required water, while 27 (64%) prepared formula with 10% or more of the required water. It is concluded that mothers must be informed about the preparation of formula when formula is prescribed for their babies.

Body Weight↗
PubMed2002

Nutrition education and infant growth in rural Indian infants: narrowing the gender gap?

Growth faltering and malnutrition are highly prevalent in most South Asian countries. Among the serious consequences of malnutrition are increased risks of morbidity and mortality in children as well as deficits in physical stature and lowered cognitive measures. Childhood malnutrition in poor households has been well documented in India, with the highest rates observed in those aged 12-23 months. Countrywide National Family Health Survey II (NFHS II) data show mean underweight prevalence increases from 11.9% among infants under six months of age to 58.4% at 12-23 months of age. This paper discusses the results of an analysis of a longitudinal community-based study of infant growth feeding and care practices in rural south India, for which data have been collected since 1997 and completed in May 2001. In 1998 an intervention began in which a monthly visit for nutrition counselling was made by a trained worker. Mothers were counselled about the need for exclusive breastfeeding for four to six months, choice of appropriate complementary foods, and feeding frequency. Infants enrolled in the study prior to 1998, did not receive this intervention in the first year of life. Using bivariate analysis and regression modelling, weight velocity and feeding practices for intervention and non-intervention infants, controlling for a range of socio-economic and demographic factors for infants aged 6 to 10 months, are compared. Both descriptive and multivariate analyses show a statistically significant positive association between intervention and weight velocity for female infants. The intervention group as a whole had improved feeding practices such as avoidance of feeding bottle and increased variety of foods. The implication of this association, in a culture where discrimination against females exists, is promising for the development of low-cost educational interventions to improve nutritional status without the need to provide supplementary food.

Body Weight↗
PubMed1981

Serum thymic hormone activity and cell-mediated immunity in healthy neonates, preterm infants, and small-for-gestational age infants.

Groups of healthy, small-for-gestational age (SGA) and preterm appropriate-for-gestational age (AGA) infants were studied at birth, 1 month, 3 months, and 12 months of age. Serum thymic hormone (TH) activity was assayed, the number of T lymphocytes in the peripheral blood was counted, and in vitro lymphocyte stimulation responses to phytohemagglutinin (PHA) were evaluated. TH activity was decreased in 1-month-old SGA infants. T cells were reduced in all low birth weight infants; the number reverted to normal by 3 months of age in preterm AGA infants, whereas it remained low for at least 12 months in the SGA group. Lymphocyte stimulation response was decreased in low birth weight infants; the extent of depression paralleled reduction in T lymphocyte number. These observations indicate that cell-mediated immunity is impaired in low birth weight newborns and reduced TH activity may be one of the pathogenetic factors involved. Persistent depression of immunocompetence may underlie the increased susceptibility of SGA infants to infection-related morbidity and mortality.

Adult↗
PubMed1982

Sudden infant death syndrome in infants with bronchopulmonary dysplasia.

The association between bronchopulmonary dysplasia and sudden infant death syndrome was studied retrospectively in low-birth-weight infants discharged from the neonatal program at Harvard Medical School. The incidence of sudden infant death syndrome was seven times greater in infants with bronchopulmonary dysplasia when compared with a group of control infants without bronchopulmonary dysplasia. Confounding factors, including birth weight, sex, multiple birth, socioeconomic status, and apnea were evaluated. The results indicate that there is an association between bronchopulmonary dysplasia and sudden infant death syndrome.

Apnea↗
PubMed1995

Epidemiology of sudden infant death syndrome (SIDS) for Kentucky infants born in 1990: maternal, prenatal, and perinatal risk factors.

Using state vital statistics data for infants born to Kentucky residents in 1990, a nonconcurrent prospective study design was used to evaluate various risk factors for infant mortality from Sudden Infant Death Syndrome (SIDS). For comparison, an identical analysis was performed for infant mortality from all causes combined, including SIDS. The following factors were considered as potential risks: infant low birthweight, maternal age at delivery, maternal education, maternal cigarette and alcohol use during pregnancy, prenatal care, maternal race, method of delivery, premature birth, sex of the child, and multiple (twin or more) birth. A categorical analysis was used to calculate an adjusted relative risk for each potentially significant (p < 0.10) risk factor. Potentially significant adjusted relative risks for SIDS are maternal age under 20 (1.73, p < or = 0.08), maternal years of education (0.80 for one year, p < 0.01), maternal cigarette use (1.92 for one pack per day, p < 0.01), Cesarean delivery (2.09, p < or = 0.01), and premature birth (1.76, p < or = 0.08). Potentially significant adjusted relative risks for infant death from all causes are low birthweight (5.93, p < 0.01), maternal age over 35 (1.54, p < or = 0.05), maternal years of education (0.94 for one year, p < or = 0.02), marginal prenatal care (1.47, p < or = 0.01), premature birth (1.47, p < 0.01), and female sex (0.82, p < or = 0.05). Given this data, there may be unique risk factors for SIDS. The implications of these findings are discussed.

Adult↗