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A comparative study of the levonorgestrel-releasing intrauterine system Mirena versus the Copper T380A intrauterine device during lactation: breast-feeding performance, infant growth and infant development.

BACKGROUND: Mirena is a levonorgestrel-releasing intrauterine system (LNG-IUS) that provides highly effective and long-acting progestogen-only contraception. OBJECTIVE: The objective of this study was to analyze the possible effects of using LNG-20 microg IUS on breast-feeding performance, infant growth and infant development during the first postpartum year as compared with the Copper T380A intrauterine device (Cu T380A IUD). DESIGN: This study is a prospective, controlled and randomized trial. SETTING: The study was conducted at the Department of Obstetrics and Gynecology, Assiut University Hospital, Egypt. METHODS: Three hundred twenty lactating women asking for initiation of contraception during the early postpartum stage were assigned randomly into two groups, the LNG-20 microg IUS group (n=163) and the Cu T380A group (n=157). The insertions were done 6-8 weeks postpartum. Each participant was followed up at three monthly intervals after insertion and until the first birthday of her baby. During these visits, the breast-feeding pattern was assessed, certain infant physical growth parameters were measured and a set of infant development tests was performed. RESULTS: No pregnancy occurred in both groups. There were no significant differences in the net continuation rates between the two groups (89.3 for LNG-IUS vs. 90.9 for Cu T380A). The LNG-20 microg IUS group had comparable rates of breast-feeding continuation, complete weaning, full breast-feeding and partial breast-feeding, with the Cu-IUD group. No statistically significant differences were found between groups with regard to all infant physical growth parameters and various infant development tests. CONCLUSION: The findings of the current study confirm that the use of LNG-20 microg IUS during the first postpartum year in lactating women provides highly effective and acceptable contraception and does not negatively influence breast-feeding or the growth and development of breast-fed infants.

Adult↗

Feeding Infants and Toddlers Study: meal and snack intakes of Hispanic and non-Hispanic infants and toddlers.

OBJECTIVE: To describe meal and snack patterns of Hispanic and non-Hispanic infants and toddlers. DESIGN: A cross-sectional telephone survey in which mothers or other primary caregivers reported their infants' and toddlers' food and beverage intake for a 24-hour period. SUBJECTS/SETTING: Subjects were a subset of the national random sample of children aged 4-24 months who participated in the 2002 Feeding Infants and Toddlers Study. The Feeding Infants and Toddlers Study includes a stratified random sample of 3,022 infants and toddlers aged 4-24 months. Three hundred seventy-one Hispanic and 2,637 non-Hispanic children who had 24-hour dietary recalls are included in the subset. ANALYSES: Means+/-standard errors of daily intakes of energy, nutrients, and nutrient densities were calculated, as were percentages of children consuming foods at each eating occasion. RESULTS: Hispanic and non-Hispanic infants and toddlers, on average, were fed seven times per day. Overall, the percentages of children who ate snacks increased with age, and more than 80% of toddlers aged 12-24 months consumed afternoon snacks, with more than 90% of Hispanic children consuming an afternoon snack. In each age group, there were significant differences between ethnic groups in nutrient intakes by eating occasion. No significant difference was seen for energy across all meal occasions. At age 6-11 months, Hispanic children had a significantly lower intake of carbohydrate at dinner and lower intake of saturated fat at afternoon snacks compared with non-Hispanic children (P<.05). The main difference between Hispanic children's and non-Hispanic children's intakes by eating occasion is at age 12-24 months. Hispanics aged 12-24 months had significantly (P<.05) lower percentages of energy from fat and saturated fat and a significantly (P<.05) higher percentage of carbohydrate at lunch compared with non-Hispanic children. For dinner, Hispanic toddlers had significantly (P<.05) lower intakes of total fat and saturated fat compared with non-Hispanic toddlers at age 12-24 months. Overall fiber intake contributed 2 g/meal for both ethnic groups. Snacks contributed, on average, less than 1 g fiber, except Hispanic toddlers had significantly higher fiber intake at afternoon snacks (1.5 g) than non-Hispanic toddlers. Foods frequently consumed at meals and snacks were lacking in whole grains, vegetables, and fruits. Most nutrients were not significantly different between Hispanics and non-Hispanics for meals and snacks. CONCLUSIONS: Considering the sizeable contribution that snacks make toward overall energy, parents and caregivers should plan toddlers' snacks to complement meals by including additional fruits, vegetables, and whole grains that are culturally appropriate rather than fruit drinks, cookies, and crackers. This will increase fiber intake and limit fat and sugar intakes. To develop healthful eating patterns, introduce toddlers to foods eight to 10 times to increase food acceptance and the likelihood of establishing healthful eating patterns. Dietetics professionals need to consider cultural differences when developing meal and snack patterns for Hispanic and non-Hispanic infants and toddlers.

Child, Preschool↗

Accuracy of ultrasonic detection of the uterus in normal newborn infants: implications for infants with ambiguous genitalia.

Every year approximately one in 5000 babies is born with ambiguous genitalia, a condition that requires immediate sex assignment if possible. We investigated whether transabdominal ultrasonography with the use of a linear array high-resolution 7.5-MHz transducer would enhance the accuracy of detecting the uterus in the newborn. One hundred mothers who delivered normal, term infants (> 36 weeks and > 2500 g) gave their informed consent for the investigation. Each infant was placed in an unmarked bassinet, external genitalia were covered, and ultrasound examinations were performed by the same examiner (R.S.) who was blinded to the sex of the infant. The neonatal uterus was identified in 47 of 50 female infants (94% sensitivity) and the absence of a uterus was correctly predicted in 49 of 50 male infants (specificity 98%). The average length of the neonatal uteri 1 day after birth was 3.2 +/- 0.5 cm and the total volume was 3.5 +/- 0.9 cm3. An endometrial strip could be identified in 98% of neonatal uteri. We conclude that the use of the high-resolution 7.5-MHz transducer available in commercial ultrasound equipment is an accurate method for the detection of the neonatal uterus. Infants born with ambiguous genitalia who have a uterus will almost always be assigned the female sex. Infants with ambiguous genitalia but without a uterus will have male pseudohermaphroditism.

Cervix Uteri↗

Infants' perception of dynamic affective expressions: do infants distinguish specific expressions?

Seven-month-old infants' perception of positive (happy, interested) and negative (angry, sad) affective expressions was investigated using a preferential looking procedure (n = 20 in each of 6 conditions). The infants saw two videotaped facial expressions and heard a single vocal expression concordant with one of the facial expressions. The voice on the soundtrack was played 5 s out of synchrony with the ongoing affective visual display. Infants participated in one of six conditions (all possible pairs of the four expressive events). Infants' visual fixations to the affectively concordant and affectively discordant displays were recorded. Infants looked longer at the affectively concordant displays than at the affectively discordant displays in all conditions except the happy/sad and interested/sad conditions. For these two comparisons, facial discrimination was demonstrated by the infants' preferential looking at happy and interested expressions compared to the sad expression. Thus, 7-month-old infants discriminate among happy, interested, angry, and sad expressions, demonstrating differentiation among specific, dynamic expressions. The results are discussed in terms of the information specifying facial and vocal affect and the possible role of familiarity in learning to differentiate among affective expressions during infancy.

Affect↗

Effects of infant sociability and the caretaking environment on infant cognitive performance.

40 middle-class mothers and their 12-month-old infants participated in an examination of the extent to which infant sociability and infant home experiences were correlated with cognitive capacity. Results indicated that the measures of the home environment (including Caldwell's Home Observation for Measurement of the Environment [HOME] inventory) were not correlated with the measures of cognitive competence (Bayley Mental Development Index [MDI], Ordinal Scales of Psychological Development) except among firstborns. Measures of the home environment were, however, correlated with measures of infant sociability (assessed inside and outside the test situation): sociable infants had sociable mothers. The infants' reactions to strange adults clearly influenced their performance in testing situations. Strong relationships were found between both measures of sociability and both measures of cognitive competence. The sociable friendly infants received higher scores on both cognitive tests than the less sociable babies did.

Cognition↗

Effect of Gaviscon Infant on gastro-oesophageal reflux in infants assessed by combined intraluminal impedance/pH.

BACKGROUND: Gaviscon Infant (GI) has been recommended for gastro-oesophageal reflux (GOR) in infants. Its efficacy has not been examined with a physiologically appropriate denominator to define the degree of GOR. AIM: To investigate the influence of Gaviscon Infant on GOR in infants using combined pH and intraluminal impedance measurement. METHODS: Twenty infants (mean age 163.5 days, range 34-319 days) exclusively bottle fed, with symptoms clinically suggestive of GOR, underwent 24 hour studies of intra-oesophageal 6 channel impedance and dual channel pH monitoring, during which six random administrations (3+3) of Gaviscon Infant (625 mg in 225 ml milk) or placebo (mannitol and Solvito N, 625 mg in 225 ml milk) were given in a double blind fashion. Impedance/pH reflux data were recorded and analysed blind by one observer. RESULTS: The median number of reflux events/hour (1.58 v 1.68), acid reflux events/hour (0.26 v 0.43), minimum distal or proximal pH, total acid clearance time per hour (time with pH below pH 4), and total reflux duration per hour were not significantly different after GI than after placebo. Reflux height was marginally lower after GI (median 66.6% v 77.3% oesophageal length) compared with placebo. CONCLUSIONS: Results showed a marginal but significant difference between Gaviscon Infant and placebo in average reflux height, and raises questions regarding any perceived clinical benefit of its use.

Alginates↗

Neutrophil survival is prolonged in the airways of healthy infants and infants with RSV bronchiolitis.

Large numbers of neutrophils in the airway of infants infected by respiratory syncytial virus (RSV) are recruited by chemokines, such as interleukin-8, and specific inflammatory molecules can delay apoptosis increasing their longevity. The aim of this study was to investigate whether airway secretions in RSV bronchiolitis contain factors that influence neutrophil apoptosis. Nasal lavage fluid (NLF) was obtained from 24 infants with RSV bronchiolitis (31 infant controls and 12 adults). Neutrophils isolated from healthy adult volunteers were incubated with the NLF in Dulbecco modified Eagle medium (DMEM) for 24 h, and apoptosis and necrosis were quantified using Hoechst 33342 and propidium iodide viability dyes. The presence of putative factors that delay neutrophil apoptosis was investigated using inhibitors to leukotriene-B4, lipopolysaccharide and the IL-8 receptor CXCR2, and blocking antibodies to granulocyte-monocyte colony-stimulating factor. Characterisation of NLF involved tests of thermal instability, proteolysis, deoxyribonuclease digestion and molecular filtration. NLF from infants with RSV bronchiolitis and controls significantly delayed neutrophil apoptosis, whereas NLF from healthy adults did not. None of these inhibitor molecules blocked this delay in apoptosis but activity was heat liable and >3 kDa. The study showed that nasal lavage fluid from infants significantly delays neutrophil apoptosis. The speculation is that the prolonged survival of neutrophils in the infant airway contributes to the characteristic accumulation of neutrophils in the airways of infants with respiratory infections.

Adult↗

Nutritional status of infants aged 4 to 18 months on macrobiotic diets and matched omnivorous control infants: a population-based mixed-longitudinal study. I. Weaning pattern, energy and nutrient intake.

Information on food intake during weaning was collected as part of a mixed-longitudinal study on the nutritional status and growth of the 1985 Dutch birth cohort of infants on macrobiotic diets (n = 53) and a matched control group on omnivorous diets (m = 57). Weighed food records over 3d, including breast-milk, were obtained on 49 macrobiotic and 57 control infants at 2-monthly intervals between the ages of 6 and 16 months. Intake of energy and nutrients was calculated using the Dutch food composition table which was supplemented by our own analyses of 50 macrobiotic foods. Ninety-six per cent of the macrobiotic infants and 74 per cent of the control infants had been breast-fed, but breast-feeding continued longer in the macrobiotic group (13.6 vs 6.6 months, P less than 0.001). In the macrobiotic group, complementary feeding started at 4.8 months with water-based cereal porridges, followed later by vegetables, sesame seeds and pulses. Fruits were rarely given and products of animal origin were avoided. For all age groups combined, the intake of energy, protein, fat, calcium, riboflavin and vitamin B12 was significantly lower in the macrobiotic infants, whereas their intake of polysaccharides, fibre, iron and thiamin was higher than that of the control infants. The macrobiotic weaning diet tended to be bulky with a low energy density (2.4 kJ/g, controls: 3.4 kJ/g, P less than 0.05) and a high fibre content. Protein intake of the macrobiotic infants was only 80 per cent of the Dutch recommended daily intakes at the age of 6-8 months, and at 8 months, 69 per cent of this was derived from plant sources. Calcium intake was 280 mg/d; correction for calcium derived from hard tap-water raised the calcium intake to 308 mg in the macrobiotic age group of 14 months. The evidence of biochemical deficiencies of iron, riboflavin, vitamin B12, vitamin D and calcium is discussed. It is suggested that the macrobiotic diet should be supplemented with fat, fatty fish and dairy products.

Aging↗

Maternal employment in a family context: effects on infant-mother and infant-father attachments.

The relation between resumption of full-time employment by mothers of infants under 6 months of age, and subsequent infant-mother and infant-father attachments, was examined in this study. Attachment classifications and ratings of reunion behavior with mother and with father in Ainsworth's Strange Situation at 12 months were obtained for 57 nonemployed-mother families and 40 employed-mother families. No relation emerged between maternal work status and the quality of infants' attachments to their mothers, indicating that early resumption of employment may not impede the development of secure infant-mother attachment. A significantly higher proportion of insecure attachments to fathers in employed-mother families was found for sons but not for daughters. Joint examination of the infants' attachments to both parents revealed a trend suggesting that in employed-mother families, boys were more likely to be insecurely attached to both parents than were girls in employed-mother families or infants of either sex in nonemployed-mother families. These patterns are discussed in light of differences in maternal and paternal sex-typing behavior and of evidence suggesting boys' vulnerability to psychosocial stress.

Child Development↗

The relationship between quality of infant-mother attachment and infant competence in initial encounters with peers.

18-month-old infants and their mothers were observed in the Ainsworth strange situation (SS) in order that security of attachment might be assessed. Infant dyads were created for observation in unstructured peer interaction according to their SS classification (security of attachment). Focus was on the subgroups within the securely attached (B) category. Results indicated a relationship between quality of infant-mother attachment and infant peer competence. The B1 and B2 infants engaged in more frequent and more sophisticated interaction with peers than did the B3 and B4 infants, who intensely sought proximity and contact with their mothers in the peer session just as in the SS. The B1 and B2 infants engaged in more distal interaction with their mothers and were more sociable with the peers' mothers and with the stranger in the SS. Implications of individual differences in quality of attachment for the development of social competence and social relationships are discussed.

Female↗

Infant wariness toward strangers reconsidered: infants' and mothers' reactions to unfamiliar persons.

In this study, the interpretation of infants' responses to approaching strangers as "wariness" or "fear" was questioned by comparing infants' behaviors toward strangers with adults' behaviours toward strangers. 24 8-month-old infants and their mothers were observed in a standard laboratory situation. Both infants and mothers were approached by female strangers with a fast, 12-sec approach and a slow, 40-sec approach. Mothers' and infants' behaviors were coded at 4 distances during each approach. Behaviors coded were smile, alert face, quizzical look, frown, looks at mother/infant, looks at stranger, and averts gaze. Mothers showed significantly more behaviors typically labeled "wary" than did infants, particularly as the proximity of the stranger increased. These findings suggest that wary responses toward strangers are not unique to infants and may be more characteristic of the situation than of the developmental level of the individual.

Arousal↗

Febrile infants at low risk for serious bacterial infection--an appraisal of the Rochester criteria and implications for management. Febrile Infant Collaborative Study Group.

OBJECTIVE: Prospective studies were conducted to test the hypothesis that infants unlikely to have serious bacterial infections (SBI) can be accurately identified by low risk criteria. METHODS: Febrile infants (rectal T > or = 38 degrees C) < or = 60 days of age were considered at low risk for SBI if they met the following criteria: 1) appear well; 2) were previously healthy; 3) have no focal infection; 4) have WBC count 5.0-15.0 x 10(9) cells/L (5000-15,000/mm3), band form count < or = 1.5 x 10(9) cells/L (< or = 1500/mm3), < or = 10 WBC per high power field on microscopic examination of spun urine sediment, and < or = 5 WBC per high power field on microscopic examination of a stool smear (if diarrhea). The recommended evaluation included the culture of specimens of blood, cerebrospinal fluid, and urine for bacteria. Outcomes were determined. The negative predictive values of the low risk criteria for SBI and bacteremia were calculated. RESULTS: Of 1057 eligible infants, 931 were well appearing, and, of these, 437 met the remaining low risk criteria. Five low risk infants had SBI including two infants with bacteremia. The negative predictive value of the low risk criteria was 98.9% (95% confidence interval, 97.2% to 99.6%) for SBI, and 99.5% (95% confidence interval, 98.2% to 99.9%) for bacteremia. CONCLUSIONS: These data confirm the ability of the low risk criteria to identify infants unlikely to have SBI. Infants who meet the low risk criteria can be carefully observed without administering antimicrobial agents.

Anti-Bacterial Agents↗

Reducing infant mortality in rural America: evaluation of the Rural Infant Care Program.

The Rural Infant Care Program (RICP), initiated in 1979, was developed to improve perinatal health care in ten rural sites with histories of high infant mortality rates. Time-series regression models indicate that neonatal mortality rates were reduced, following program initiation, by 2.6 per 1,000 live births (p = .0002); black neonatal mortality rates were reduced by an estimated 4.5 per 1,000 (p = .0004). Three sets of comparison areas exhibited no significant changes in rates. Postneonatal mortality rates did not increase in the target areas following initiation of RICP, indicating that deaths were not merely being postponed. Nine of ten individual sites showed reductions in infant mortality following program initiation. Birthweight-specific mortality data indicated that the decline was due mainly to reductions in neonatal mortality among low-birthweight infants. No reductions in the incidence of low birthweight were observed in the target areas. Substantial gaps in the delivery of prenatal care remained due to the continuing poverty of the population and the resultant lack of financial coverage for health services. We conclude that improved perinatal medical care can reduce infant mortality in poor rural areas to average levels experienced in the United States, and that the high rates still observed in some rural counties are unnecessary.

Black or African American↗

Initial laboratory evaluation of infants with 'presumed near-miss' sudden infant death syndrome.

We reviewed the cases of 201 infants hospitalized for "presumed near-miss" sudden infant death syndrome over a recent five-year period to determine the value of routine initial laboratory investigations in establishing diagnosis or altering therapy. A total of 1,278 measurements were performed on 163 patients aged 3 days to 6 months; 276 (22%) of the results were outside the normal limits for age. The most common abnormalities were hyperchloremia (58% of infants tested), hypermagnesemia (43%), hypobicarbonatemia (33%), and hyperkalemia (27%). There were no instances of polycythemia, hypochloremia, hypokalemia, hyperbicarbonatemia, or uremia. Only six (0.5%) of the abnormal values in four patients were useful in diagnosing or treating the apneic episodes. Infants with respiratory symptoms at the time of presentation had a statistically greater incidence of abnormal values than patients who were asymptomatic. Because of the low yield of useful information, we conclude that the use of a routine battery of laboratory investigations in the initial evaluation of infants with presumed near-miss sudden infant death syndrome should be questioned.

Electrolytes↗

Infant sleep apnea profile: preterm vs. term infants.

By means of polygraphic sleep recording, the sleep apnea profile with respect to the number and duration of inactive, obstructive and mixed apneic episodes as well as periodic breathing has been investigated in infants born preterm at 40, 52 and 64 weeks conceptional age and compared to that of term infants. At 40 weeks preterm infants showed significantly more apnea and periodic breathing compared to term infants. The difference was essentially due to obstructive and mixed apnea in non-REM sleep. There was a sharp decrease in all apneic variables--inactive, obstructive and mixed apnea as well as of periodic breathing--at 52 weeks conceptional age in infants that were previously preterm. Both groups exhibited a rather identical sleep apnea profile at 64 weeks. Two prospectively studied infants in the preterm group later became SIDS victims. One of them might have been identified as being at risk on the basis of his apnea profile compared to the normative data now available.

Electroencephalography↗

Sudden infant death and chronic infant disorders: the N.E.S.T. model versus the lethal Cot-death syndrome hoax.

The Cot-death Syndrome is an out-moded model which is bizarre and unique in medical history for it enables a certificate of cause of death to be issued only if no medical cause can be found. It rewards incompetence. Apart from being a placebo for bereaved parents and a lucrative source of research funds it is unsupportable, lethal nonsense and it must be discarded. There are studies which prove that most infant death and chronic infant illnesses are linked and are primarily associated with environmental stress. The infant death problem is not a medical problem except where the stress trauma is of medical origin. The N.E.S.T. (Non-disease Environmental Stress Trauma) perspective provides a model which has elements of causation, prediction and prevention. It requires that intense investigation be carried out in an unbiased manner that is not hindered by a convenience syndrome barrier to truth. Unfortunately twenty years of adherence to the medical profession's Cot-death Syndrome hoax has meant that the evidence pin-pointing specific, causative environmental stress factors has been denigrated and disregarded. This has permitted the asthma convenience syndrome to thrive. Still-birth or infant death that is not due to disease or inherited causation can only be caused by environment stress trauma. Identifying and preventing such stress trauma is the key to healthy birth and to avoiding infant death and chronic infant disorders.

Environment↗

Sudden infant death syndrome in infants of substance-abusing mothers.

A population-based study was performed to determine whether substance abuse during the perinatal period may be a risk factor for sudden infant death syndrome (SIDS). The incidence of SIDS was studied in 2143 infants of substance-abusing mothers (ISAM) born in Los Angeles County during 1986 and 1987 who were reported to the Los Angeles County Department of Health Services because of a history of drug exposure or positive urine test results in the mother, infant, or both. By comparing the ISAM birth reports with records of autopsy-proven SIDS in Los Angeles County, we found 19 SIDS cases in the population of 2143 ISAM, a SIDS rate of 8.87 cases per 1000 ISAM (95% confidence interval 5.3 to 13.8). This was significantly higher than the SIDS rate for the non-ISAM general population: 396 SIDS deaths among 325,372 live births, an incidence rate of 1.22 cases per 1000 births, p less than 0.00001. The age of ISAM at death was 99 +/- 63 (mean +/- SD) days compared with 91 +/- 52 days for the non-ISAM population (not significant). The incidence of SIDS was significantly greater in male infants, during the winter months, in black infants, and in non-Hispanic white infants in the non-ISAM population. Such differences were not observed in the ISAM group. A greater incidence of symptomatic apnea was reported before SIDS for the ISAM than for the non-ISAM population (22% vs 5.4%, p = 0.022). We conclude that ISAM have a higher incidence of SIDS than the non-ISAM general population. However, it was not possible to separate maternal substance abuse from other confounding variables that may also have had an impact on SIDS risk in the ISAM group.

Age Factors↗

Arousal responses in near-miss sudden infant death syndrome and in normal infants.

Hypercarbic and hypoxic arousal responses were measured in 22 normal and 11 near-miss sudden infant death syndrome infants during natural sleep. End-tidal PCO2, (PACO2), transcutaneous PO2, electrocardiogram and heart rate, and thoracic and abdominal circumference were continuously recorded. The essential behavioral criteria for arousal were eye opening and crying. For each hypercarbic arousal test, step increases in FICO2 were made until arousal occurred or until PACO2 reached 65 mm Hg. For each hypoxic arousal, step decreases in FIO2 were made until arousal occurred or until FIO2 = 0.15 had been maintained for 20 minutes. The hypercarbic arousal threshold was significantly higher in near-miss SIDS than in normal infants, 54.9 +/- 2.3 vs 48.4 +/- 1.4, respectively ((P less than 0.05). An arousal response to hypoxia occurred in only 9% of near-miss SIDS infants compared to 70% of normal infants (P less than 0.01). The level of respiratory chemostimulation required to produce an arousal response from sleep is significantly greater in near-miss SIDS than in normal infants. We speculate that deficient arousal responsiveness, especially to hypoxia, may prevent potential SIDS victims from responding appropriately to apneic asphyxia.

Arousal↗