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The inability of a temperature-sensitive pacifier to identify fevers in ill infants.

We assessed the utility and accuracy of a temperature-sensitive pacifier in screening for fever in ill children under 2 years of age. Of 189 candidates for study, 83 (42%) did not use pacifiers, and of the 106 who did, 25 (24%) could not sustain a suck for five minutes of direct observation. Among those 81 children who could sustain five minutes of sucking, only two of 20 children with rectal temperatures above 100 degrees F (37.8 degrees C) were correctly identified as febrile. Furthermore, seven of eight children with temperatures of 102 degrees F (38.9 degrees C) or greater were incorrectly identified as being afebrile. There were no false-positive fever assessments in afebrile infants. The temperature-sensitive pacifier tested in this study does not accurately identify fevers in most infants who are shown to have fevers by rectal temperature determination. The use of this pacifier for screening fever in ill infants cannot be recommended.

Fever↗

Sucking and breathing patterns during breast- and bottle-feeding in term neonates. Effects of nutrient delivery and composition.

We attempted to determine whether differences in milk composition or flow rate are the primary determinants in altering breathing pattern during nipple-feeding. In the first phase of the study, 15 neonates were studied during breast-feeding and bottle-feeding; in the second phase, 15 were evaluated during bottle-feeding of expressed human milk and formula. A reduction in inspiratory duration was observed with all feeding regimens. Moreover, significant prolongation in expiratory duration and reduction in breathing frequency were observed during bottle-feeding of formula and expressed human milk (compared with control); these effects were greater with formula feeding. Higher sucking frequency was observed during breast-feeding compared with bottle-feeding; no difference in suckling frequency or sucking pressure was observed between bottle-feeding of expressed human milk and formula. We conclude that most of the differences in sucking and breathing patterns between breast- and bottle-feeding can be attributed to nutrient delivery rather than nutrient composition.

Bottle Feeding↗

Symmetrical thalamic degeneration with calcifications of infancy.

We describe the clinical and radiographic features of three premature infants with symmetric thalamic calcification recognized by computed tomographic scan on days 6, 12, and 49 of life and contrast our findings with those reported in the literature. These lesions follow prepartum or intrapartum hypoxiaischemia and are clinically distinguished by prominent bulbar dysfunction, featuring weak or absent cry, poor feeding, and facial weakness. Neonatal thalamic calcification in premature infants may serve as a radiological marker of an acute, short-lived hypoxic-ischemic event. The presence of brain-stem dysfunction, particularly of lower cranial nerves in association with thalamic calcifications, constitutes a distinctive clinical-radiological entity and usually portends a poor outcome. The presence of these calcifications implies that injury was sustained to diencephalic and brain-stem structures at least 2 to 4 weeks prior to their appearance on computed tomographic scan.

Atrophy↗

The oral motor development of low-birth-weight infants who underwent orotracheal intubation during the neonatal period.

OBJECTIVE: To investigate the potential development of oral motor problems following prolonged orotracheal intubation in low-birth-weight infants. DESIGN: Prospective observational. SETTING: Tertiary-care hospital. PATIENTS: Fifty-one low-birth-weight infants and 10 full-term infants divided into three groups--group 1 with 15 low-birth-weight infants (< or = 1250 g) who had been intubated for more than 1 week; group 2 with 36 low-birth-weight infants who had been intubated for 1 week or less; and group 3 with 10 full-term control infants. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: Oral motor assessments of nutritive sucking were compared at corrected ages of term and 3 months. The results showed that low-birth-weight infants with prolonged intubation had significantly poorer sucking abilities at both term and 3 months. The number of days of oxygen use and the postnatal age (weeks) at which nipple feeding was begun were the most powerful predictors of sucking ability at term (P < .001), whereas the number of days of orotracheal intubation and gestational age at birth were the most powerful predictors of sucking ability at 3 months (P < .001).

Apgar Score↗

Imaging evaluation of artificial nipples during bottle feeding.

OBJECTIVES: To determine whether real-time ultrasonography can be used to directly visualize artificial nipples in vivo while an infant is sucking, to compare deformation differences of the artificial nipple with the human nipple during sucking, and to compare the suck mechanism used by the infant with four types of artificial nipples. DESIGN: Nonrandomized clinical study with a control group. SETTING: University-affiliated teaching hospital in Iowa City, Iowa. PARTICIPANTS: A volunteer sample of 35 healthy infants 6 to 12 weeks of age. INTERVENTION: None. MEASUREMENTS/MAIN RESULTS: Images produced by real-time ultrasound of infants during sucking using artificial nipples were measured to determine the percentage lengthening, the percentage lateral compression, and the percentage flattening of nipples. These results were compared with data obtained from studies using breast-fed infants. None of the artificial nipples lengthened like the human nipple. One artificial nipple was significantly more compressible than the human nipple and the remaining three artificial nipples. CONCLUSION: Real-time ultrasonography can be used to visualize artificial nipples in vivo during sucking.

Bottle Feeding↗

The Pointer syndrome: a new syndrome with skeletal abnormalities, camptodactyly, facial anomalies, and feeding difficulties.

We describe a brother and sister with a unique combination of skeletal findings including camptodactyly (phalangeal dislocations), facial anomalies, neonatal respiratory problems, and feeding problems due to poor suck. Metaphyseal splaying, osteopenia, endosteal bone apposition, campomelia, and multiple fractures characterize the other skeletal abnormalities. The parents are first cousins once removed and are unaffected. These cases appear to represent a previously undescribed autosomal recessive disorder.

Abnormalities, Multiple↗

Morphological changes in the masseter muscle and its motoneurons during postnatal development.

BACKGROUND: It has been suggested that the morphological properties of the masseter muscle are changed by the masticatory activity pattern. In the rat, the activity pattern of the muscle alters from sucking to biting around 3 weeks after birth. The working hypothesis in this study is that the unique alteration in masticatory activity has an important influence on the development of the masseter muscle and its motoneurons. METHODS: We examined the morphological changes in the muscle fibers of the superficial masseter muscle and its motoneurons from 2 days to 280 days after birth in the rat. The change in masseter muscle activity sucking and biting was confirmed by electromyography. To label motoneurons innervating the muscle, horseradish peroxidase was injected into the muscle. The muscle and lower brain stem were sliced and processed histochemically to measure the diameters of muscle fibers and its motoneurons in the trigeminal motor nucleus. In addition, composition of myosin heavy chain (MHC) isoforms of the muscles were analyzed using gradient sodium dodecyl sulphate-polyacrylamide gel electrophoresis. RESULTS: There was a rapid growth in both types of muscle fibers (fast-twitch oxidative glycolytic muscle fibers and fast-twitch glycolytic fibers) for 42 days after birth, and then a gradual growth lasting until 280 days after birth. Particularly, rapid growth of the muscle fibers was seen between 21 days and 42 days after birth. A large amount of neonatal type MHC disappeared between 21 days and 42 days after birth. In the motoneuron, there was a rapid growth of motoneurons by 42 days after birth but no significant growth was seen thereafter. CONCLUSIONS: These results suggest that the alteration of mastication activity from sucking to biting has a significant influence on morphological development of both types of muscle fibers, but not on that of motoneurons innervating the masseter muscle.

Animals↗

A mixture model for sucking patterns of breast-fed infants.

Previous studies of sucking patterns have mainly been on bottle-fed babies and have assumed that the babies' sucks occur within bursts separated by gaps of predetermined minimum length which is fixed over the feed. This study considers babies that are breast-fed, a more complex and natural process than bottle-feeding, and develops a more sophisticated model for the pattern of bursts and gaps which allows the parameters of the process to vary over the feed. We consider data from four breast feeds of each of 32 babies. We develop a two-component mixture model based on an underlying Markov chain model for the switching between bursts and gaps. We use the model to provide summary statistics for each feed and give estimates of the normal range of each of the model's parameters.

Breast Feeding↗

Perinatal stimulation facilitates suckling onset in newborn rats.

The fetus' experience of birth derives from a sequence of stimulation provided by the mother's labor contractions, her licking and handling, and the contrasting environmental conditions of the uterus and outside world. In the present investigation, Day 21 fetal rats were externalized from the dam's body; subjects in one uterine horn were compressed by simulated uterine contractions while control subjects in the opposite horn were not compressed. All pups were Cesarean-delivered, stroked, and exposed to a thermal environment simulating either room (21 degrees C), nest (33 degrees C), or intrauterine (36 degrees C) temperature. After 1-hr exposure to the experimental temperature, all pups were maintained at 33 degrees C and tested for their suckling response to an anesthetized dam. When newborns were tested at 120 min postpartum, simulated contractions increased the probability of nipple attachment in pups exposed to 21 degrees C relative to noncompressed littermates maintained at the same temperature. Atypically warm postpartum conditions (nestlike or intrauterine) obviated the effects of compression by increasing suckling above the levels seen in noncompressed newborns exposed to the cool condition. Thus, compressions facilitate the achievement of suckling under thermal conditions resembling those typically encountered by the newborn rat.

Animals↗

Significance of the secretion of human prolactin and gonadotropin for puerperal lactational infertility.

The causes of puerperal infertility in lactating women are poorly understood. The controlling centres may be either the hypothalamic-pituitary axis or the ovary (or both). We studied the secretory dynamics of prolactin and gonadotropins in healthy, normal, lactating and non-lactating women after administering either gonadoliberin to assess pituitary responsiveness or human menopausal gonadotropins to assess ovarian responsiveness during the puerperium. A reciprocal relationship was observed between the secretion of gonadotropins and the secretion of prolactin after the nipples of mothers who were breast-feeding had been stimulated for 30 min. The absence of a short-loop negative feedback control by prolactin for gonadotropin secretion was not confirmed because cyclic secretion of gonadotropin was not necessarily impaired by hyperprolactinaemia. Hyperprolactinaemia did, however, appear to impair the function of the corpus luteum in women suffering from non-puerperal galactorrhoea. We postulate a multifactorial mechanism for puerperal infertility based initially on the peripheral concentration of prolactin and gonadotropins and, in some poorly defined way, on the cerebral concentration of catecholamines.

Amenorrhea↗

Lactation: some cardiovascular and metabolic consequences, and the mechanisms of lactose and ion secretion into milk.

Lactation causes increases in mammary blood flow, gastrointestinal blood flow and cardiac output in the rat, and the suckling-induced release of lactogenic anterior pituitary hormones probably causes these changes, directly or indirectly. Metabolic requirements of lactation in women are similar to those in other animals not artificially selected for a high milk yield but the physiological control of the relationship between milk secretion and nutrient availability is not well understood. The unusual composition of the aqueous phase of human milk (rich in lactose but poor in sodium and potassium ions) can be explained by the same basic mechanisms for secretion of lactose and ions as operate in other animals but with quantitative differences.

Animals↗

Maternal nutrition and lactation.

The present recommended dietary interpretation of the effects of both maternal nutritional status and diet on the yield and composition of milk is complicated by disparities between the methods of sampling, collection of samples and analysis in these studies. The effect of breast-feeding on the growth of the neonate and the desirable period during which unsupplemented breast-feeding can be safely given are discussed. Well coordinated studies worldwide on the effect of lactation on maternal and infant health and on the nutrient requirements of infants are urgently needed in view of recent developments regarding the true protein value of breast milk. The let-down reflex must be considered. Three main strategies, including supplementary feeding of the mother, for improving breast-feeding potential among mothers who want to suckle their infants are outlined.

Breast Feeding↗

Effects of 12 days of artificial rearing on morphology of hypoglossal motoneurons innervating tongue retrusors in rat.

The purpose of this study was to examine the influence of reduced tongue activity by artificial rearing on the morphology of motoneurons innervating the extrinsic tongue retrusors. Artificially reared rat pups were fed via gastric cannula from postnatal day 3 to postnatal day 14. Artificially reared animals and dam-reared controls had cholera toxin (subunit B) conjugate of horseradish peroxidase injected into the styloglossus to label motoneurons innervating hyoglossus and styloglossus on postnatal day 13 and postnatal day 59. Following perfusion on postnatal days 14 and 60, serial transverse sections treated with tetramethyl benzidine and counterstained neutral red were used to analyze motoneuron morphology. The shorter diameter of hyoglossus motoneurons increased with age for the dam-reared but not the artificially reared group. There was a tendency for a similar pattern for styloglossus motoneurons across the two rearing groups. The changes in form factor reflected the changes in shorter diameter for both motoneuron pools. Therefore, reducing suckling activity during normal postnatal development leads to diminished motoneuron somal growth in rats. This may also be the case in premature infants necessarily fed artificially.

Animals↗

Suckling stimulus suppresses messenger RNA for tyrosine hydroxylase in arcuate neurons during lactation.

Tyrosine hydroxylase (TH) mRNA in tuberoinfundibular dopamine (TIDA) neurons is suppressed during lactation but rebounds upon pup removal. A time course of TH mRNA changes after pup removal revealed three phases: (1) a nuclear phase (evident 1.5 hours after pup removal, maximal at 3 hours) with TH mRNA appearing in 1 or 2 nuclear loci with little or no change in cytoplasmic mRNA; (2) a cytoplasmic phase (noted 6 hours after pup removal, peaked 12-24 hours) with a significant increase in total TH mRNA levels mainly in the cytoplasm; and (3) a stabilization phase (24-48 hours after pup removal) when nuclear signals were low and cytoplasmic RNA showed a slight decline with extension of RNA clusters into the cell dendrites. In rats whose pups could suckle only on one side, TH was up-regulated only on the side contralateral to nipple blockade. These data indicate that after suckling terminates, TH up-regulation is evident at 1.5 hours, but 6 hours is needed before the cells transport sufficient mRNA into the cytoplasm. The rapid signaling of TH up-regulation stems from the fact that the TIDA neurons respond to neural signals from termination of suckling.

Animals↗

Response of the three main types of glial cells of cortex and corpus callosum in rats handled during suckling or exposed to enriched, control and impoverished environments following weaning.

The cell populations of the occipital cortex were examined in young rats subjected to different sensory experiences. In one series recently weaned animals were reared in enriched, impoverished or control environments. The enriched environment was obtained by keeping the animals among "toys" and other rats; the impoverished environment, by rearing the animals one per cage in a darkened, quiet room; and the control environment, by housing the animals three per cage under usual animal room conditions. Six recently weaned rats were kept in each environment for 30 days and ten, for 80 days. In a second series suckling rats were handled daily. Handling consisted of touching, holding and rubbing rat pups for 15 minutes per day during the first ten days after birth; twelve rats were studied, six handled and six unhandled controls. In the two series, the animals were sacrificed under anesthesia by perfusion with mixed aldehydes. Semithin epon sections of occipital cortex were stained with toluidine blue; neurons and the three main types of glia were enumerated. In addition, the thickness of the cortex was measured and the glial cells of corpus callosum counted in the animals exposed to the three environments for 80 days. Under the influence of the enriched environment, the occipital cortex enlarged, the number of oligodendrocytes increased over the controls by 27-33% in the 30- and 80-day groups and the number of astrocytes, by 13% in the 80-day group. Within the cortex, only certain layers showed the increase in glial numbers. In the corpus callosum, however, the numbers of glial cells did not differ from those in controls. In the animals exposed to the impoverished environment, neither the size of the cortex nor the number of oligodendrocytes and astrocytes differed from controls. The animals subjected to handling also showed evidence of cortical enlargement, but the only significant change in glial cells was a 12% increase in astrocytes. It is concluded that handling and enrichment produce changes in anatomical indices of neural function including depth of cortex and numbers of glial cells. The glial response was specific to the type.of manipulation since astrocytes were predominantly affected by handling and oligodendrocytes, by enrichment. The effect of handling on astrocytes may be attributed to the stimulation being applied at a time of astrocyte proliferation, whereas the effect of enriched environment on oligodendrocytes occurred at a time of active production of these cells. The differences in cell numbers were explained by changes in the rate of cell population growth; since the impoverished did not differ from the control animals, the changes probably consisted of growth acceleration in the enriched animals rather than diminution in the impoverished ones.

Animals↗

Gastric saline infusion reduces ultrasonic vocalizations and brown fat activity in suckling rat pups.

Under standard conditions involving isolation and cooling, it has been documented that intraoral infusion of milk and injection of the intestinal peptide cholecystokinin (CCK) result in an attenuation in ultrasonic vocalizations (USV) emitted by infant rat pups. One of the most effective stimuli in inhibiting ingestion in suckling rat pups is gastric distension, but the effect of gastric distension on USV production has not been reported. In this experiment, we subjected infant rats to intragastric infusion of isotonic saline (2% body weight) to produce a natural level of gastric distension and hydration. We found that this stimulus resulted in a powerful reduction in USV emissions in isolated 10-day-old rats. In a subsequent experiment, we found that gastric saline infusion also diminished brown adipose tissue (BAT) thermogenesis. There were different time courses of the gastric saline infusion effects on BAT thermogenesis and on USV emissions, however, suggesting that these processes may be independently regulated. We hypothesize that this stimulus induces a transient activation of the parasympathetic nervous system, which overrides the sympathetic control of BAT and USV production.

Adipose Tissue, Brown↗