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At least 613 records · Page 34Linked to original sources
PubMed2004

Pain assessment in the neonate using the Bernese Pain Scale for Neonates.

BACKGROUND: Neonates who require treatment in the neonatal intensive care unit (NICU) are subjected to many invasive painful procedures. AIMS: Assessment of pain in preterm and term neonates with or without ventilation on continuous positive airway pressure using the Bernese Pain-Scale for Neonates (BPSN). The validity and the reliability of the BPSN was established. STUDY DESIGN AND SUBJECTS: Pain assessments (n=288) were performed by 6 health care workers in different situations of term and preterm neonates. Each neonate (n=12) was observed in four given situations (after feeding, while a foot was being warmed, while a routine capillary blood sample was taken and 15 min after the blood sample was taken). Pain assessments were made by two nurses at the bedside using the BPSN, the Visual-Analogue Scale (VAS) and the Premature Infant Pain Profile (PIPP). At the same time, a video sequence was made which was shown later to four different nurses to assess pain using the BPSN, the PIPP, and the VAS. RESULTS: The construct validity of the BPSN was very good (F=41.3, p<0.0001). Moreover, concurrent and convergent validity of the BPSN compared to VAS and PIPP was r=0.86, and r=0.91, p<0.0001, respectively. Finally, the study demonstrated high coefficients for interrater (r=0.86-0.97) and intrarater reliability (r=0.98-0.99). CONCLUSION: The BPSN was shown to be a valid and reliable tool for assessing pain in term and preterm neonates with and without ventilation.

Female↗
PubMed2004

The General Movements in children with Down syndrome.

OBJECTIVE: Aim of our study was to describe the character of General Movements (GMs) in children with Down Syndrome (DS). MATERIAL AND METHODS: GMs of 23 children with DS and of 30 healthy full-term infants were assessed from birth to 6th month corrected age. A qualitative and a semi-quantitative evaluation of GMs were achieved for each child. Data were graphically displayed to obtain growth curves of motor optimality scores. RESULTS: GMs in children with DS are characterised by low-low/moderate speed, large-large/moderate amplitude, partially creating impression of fluency, smoothness and complexity, abrupt beginning and end, few other concurrent gross movements. During the 6 months, all children showed an improvement of qualitative and semi-quantitative evaluation, but it was possible to observe great heterogeneity among children in the evolutionary course. GMs evaluation of children with no known motor problems was normal, showing only slight and transient abnormalities at first months. CONCLUSION: GMs character of children with DS could be related to central nervous system and peripheral abnormalities characterizing this syndrome. The evaluation of GMs in children with DS could be an early marker of motor impairment and help in early management decisions making.

Adult↗
PubMed2004

Pilot study of the systemic effects of three different screening methods used for retinopathy of prematurity.

PURPOSE: This pilot study compared the physiological and behavioural changes in premature infants undergoing three different methods of screening for retinopathy of prematurity (ROP). STUDY DESIGN: Prospective randomized cross-over pilot study. SUBJECTS AND METHODS: Fifteen premature infants requiring screening for ROP were recruited, and physiological and behavioural responses produced by three different methods of screening were compared. The screening methods employed a RetCam 120 and an indirect ophthalmoscope with and without an eyelid speculum. Physiological indices (change in pulse, mean blood pressure and oxygen saturation) and facial responses to pain (brow bulge, eye squeeze, nasolabial fold, mouth opening and the presence of cry) were recorded at five points: before, during and immediately after screening and 10 and 30 min after examination. RESULTS: Screening with the RetCam 120 and the indirect ophthalmoscope with a speculum both caused a greater change in pulse and mean blood pressure and an increase in facial responses to pain during and immediately after screening as compared to the indirect ophthalmoscope without the speculum. RetCam 120 screening caused greater desaturation than the other methods. CONCLUSIONS: Although this was a small sample which limits absolute conclusions, the study showed that screening using a RetCam or a speculum and indirect ophthalmoscope caused more stress to the infant, as indicated by physiological and behavioural changes, than simply screening using an indirect ophthalmoscope without a speculum. These effects should be considered when deciding on the appropriate screening method for examining particularly sick infants.

Face↗
PubMed2006

Is a nappy change stressful to neonates?

OBJECTIVES: Infants in neonatal intensive care (NICU infants) are often cared for in a stressful environment that includes potentially painful or stressful interventions. The aim was to investigate whether NICU infants have different pattern of stress and pain responses than healthy newborns when challenged by a non-painful everyday care routine. METHODS: NICU infants born at 23-38 weeks gestation (n=39) were compared to healthy full-term newborns (n=30). Cortisol concentrations in saliva were determined before and 30 min after a standardised nappy change. The premature infant pain profile (PIPP) and the neonatal infant pain scale (NIPS) were evaluated before, during, directly after, 3 min after, and 30 min after the nappy change. The investigation was performed on two different occasions, first between postnatal days 2-7 and then between postnatal days 10-18. RESULTS: NICU infants had higher median baseline salivary cortisol levels compared to full-term newborns on both occasions (17.1 nmol/L vs. 6.2 nmol/L p<0.01 and 8.5 nmol/L vs. 2.4 nmol/L p<0.01, respectively). Salivary cortisol decreased in response to the second nappy change in NICU infants (p=0.01). NICU infants had higher PIPP scores during both nappy changes (p<0.001 for both occasions) and more sustained increases in PIPP and NIPS up to 30 min after the nappy changes compared to full-term newborns. CONCLUSIONS: NICU infants have higher baseline salivary cortisol than healthy full-term newborns. There is a change in baseline cortisol by age in both groups. Full-term infants as well as NICU infants show an increased pain response to a standardised nappy change.

Diapers, Infant↗
PubMed2005

Profile of fisting in term newborns.

BACKGROUND: Persistence of fisting of hands and cortical thumb is a predictor of abnormalities in development and dysfunction of the central nervous system, though this may be a normal finding in the immediate newborn period. AIM: To study the profile of fisting in early neonatal period. METHODS: Five hundred and fifty healthy term neonates were studied. Hand position was examined by a single observer between 24-48h of birth when the baby was awake and quiet. Complete fisting was defined as flexed fingers covering both proximal and distal palmer creases. If only the distal crease was covered, it was defined as incomplete fisting. Thumb position was observed as thumb by the side of the fingers, under the fingers and above the fingers. RESULTS: Of the total 550 babies, 338 (61.45%) had bilateral, 39 (7.09%) had right sided and 38 (6.91%) had left sided fisting and 135 (24.55%) had open hands. Of the 1100 hands, 669 hands (60.8%) had complete and 84 (7.63%) had incomplete fisting. "Cortical thumb" was found in 57% of fisted hands. There was no significant difference (p>0.05) in fisting according to the sex and weight of the babies. CONCLUSION: Fisting was a predominant hand posture among the babies (75.45%) but cortical thumb with bilateral fisting was seen in only 30% of babies.

Female↗
PubMed2005

Randomized controlled trial of music during kangaroo care on maternal state anxiety and preterm infants' responses.

The purpose of this randomized controlled trial was to investigate the influences of music during kangaroo care (KC) on maternal anxiety and preterm infants' responses. There are no experimental studies that explore the influences of combination of music and KC on psychophysiological responses in mother-infant dyads. Purposive sampling was used to recruit 30 hospitalized preterm infants body weight 1500 gm and over, gestational age 37 weeks and lower from two NICUs. Mother-infant dyads were randomly assigned to the treatment and the control group using permuted block randomization stratified on gender. There were 15 mother-infant dyads in each group. Subjects in the treatment dyads listened to their choice of a lullaby music during KC for 60 min/section/day for three consecutive days. Control dyads received routine incubator care. Using a repeated measures design with a pretest and three posttests, the responses of treatment dyads including maternal anxiety and infants' physiologic responses (heart rate, respiratory rate, and O2 saturation) as well as behavioural state were measured. The results revealed that there were no significant differences between the two groups on infants' physiologic responses and the values were all in the normal range. However, infants in the treatment group had more occurrence of quiet sleep states and less crying (p<0.05-0.01). Music during KC also resulted in significantly lower maternal anxiety in the treatment group (p<0.01). Maternal state anxiety improved daily, indicating a cumulative dose effect. The findings provide evidence for the use of music during KC as an empirically-based intervention for bahavioural state stability and maternal anxiety in mother-infant dyads.

Adult↗
PubMed2004

General movements: A window for early identification of children at high risk for developmental disorders.

Detection of children with a developmental disorder, such as cerebral palsy, at an early age is notoriously difficult. Recently, a new form of neuromotor assessment of young infants was developed, based on the assessment of the quality of general movements (GMs). GMs are movements of the fetus and young infant in which all parts of the body participate. The technique of GM assessment is presented and the features of normal, mildly abnormal, and definitely abnormal GMs discussed. Essential to GM assessment is the Gestalt evaluation of movement complexity and variation. The quality of GMs at 2 to 4 months postterm (so-called fidgety GM age) has been found to have the highest predictive value. The presence of definitely abnormal GMs at this age--that is, GMs devoid of complexity and variation--puts a child at very high risk for cerebral palsy. This implies that definitely abnormal GMs at fidgety age are an indication for early physiotherapeutic intervention.

Age Factors↗
PubMed2006

Early gross motor development of preterm infants according to the Alberta Infant Motor Scale.

OBJECTIVE: To systematically examine gross motor development in the first 18 months of life of preterm infants. STUDY DESIGN: A total of 800 preterm infants (356 boys), ages between 1 and 18 months and corrected for degree of prematurity, were assessed with the use of the Alberta Infant Motor Scale. RESULTS: Comparison of the mean Alberta Infant Motor Scale scores of the preterm infants with the norm-referenced values derived from term infants revealed that as a group, the preterm infants scored significantly lower at all age levels, even with full correction for degree of prematurity. CONCLUSIONS: In general, preterm infants exhibit different gross motor developmental trajectories compared with term infants in the first 18 months of life. The gross motor developmental profile of preterm infants may reflect a variant of typical gross motor development, which seems most likely to be specific for this population. As a consequence, adjusted norms should be used for proper evaluation and clinical decision-making in relation to preterm infants.

Analysis of Variance↗
PubMed2006

Exposure to marijuana during pregnancy alters neurobehavior in the early neonatal period.

OBJECTIVE: To assess the neurobehavior of full-term neonates of adolescent mothers exposed to marijuana during pregnancy. STUDY DESIGN: This prospective cross-sectional study included full-term infants within 24 to 72 hours of life born to adolescent mothers at a single center in Brazil. Data on sociodemographic and obstetrical and neonatal characteristics were collected. The mothers underwent the Composite International Diagnostic Interview, and the infants were assessed with the Neonatal Intensive Care Unit Network Neurobehavioral Scale (NNNS). Maternal hair and neonatal meconium were analyzed. Neonates exposed in utero to tobacco, alcohol, cocaine, and/or any other drugs except marijuana were excluded. RESULTS: Of 3685 infants born in the study hospital, 928 (25%) were born to adolescent mothers. Of these, 561 infants met the inclusion criteria and were studied. Marijuana exposure was detected in 26 infants (4.6%). Infants exposed (E) or not exposed (NE) to marijuana differed in the following NNNS variables: arousal (E, 4.05 +/- 1.19 vs NE, 3.68 +/- 0.70), regulation (E, 5.75 +/- 0.62 vs NE, 6.04 +/- 0.72), and excitability (E, 3.27 +/- 1.40 vs NE, 2.40 +/- 1.57). After controlling for confounding variables, the effect of marijuana exposure on these scores remained significant. CONCLUSIONS: Marijuana exposure during pregnancy alters the neurobehavioral performance of term newborn infants of adolescent mothers.

Adolescent↗
PubMed2006

Together or apart? A behavioural and physiological investigation of sleeping arrangements for twin babies.

OBJECTIVE: the pros and cons of co-bedding for healthy twin babies on the postnatal ward and in the home are issues with which midwives need to be familiar; however, little objective research has been conducted on which to base policies and recommendations. In this two-part study, I explore the behaviour and physiology of twin babies sleeping separately and together. DESIGN, SETTING AND PARTICIPANTS: in part one, 10 twin baby pairs aged between 1 and 3 months were videoed sleeping together at home in head to head and side by side configurations. In part two, 14 twin pairs under 3 months of age participated in a two-condition trial with behavioural and physiological monitoring while sleeping together and apart in the sleep lab. FINDINGS: in part one, sleep variables were unaffected by co-bedding configuration. Babies positioned side by side were observed to occasionally impinge on, but not obstruct, one another's airways, with an arm across the other's face. In part two, no difference was found in their duration of sleep, frequency of waking, core temperature or head covering in the two conditions; co-bedded twins showed synchronous sleep states. CONCLUSIONS: the co-bedding of term twin babies less than 3 months of age does not seem to be associated with the negative attributes that concern some parents. There may also be advantages of sleep synchrony and ease of care. These results can be used by health professionals in formulating guidance for parents of twins.

Beds↗
PubMed2005

Do pregnancy and childbirth adversities predict infant crying and colic? Findings and recommendations.

Bouts of unexplained crying in 1- to 3-month-old infants are a common problem for parents and health services. One proposed explanation has linked the crying to preceding adversities, such as maternal stress and cigarette smoking during pregnancy and complications during childbirth. In the first part of this review, we argue that studies of these links have methodological shortcomings, and make recommendations about the safeguards needed to overcome these shortcomings. In part two, we present a study that assesses the relations between adversity indices and validated measures of crying in two separate cohorts of infants. Four indices of childbirth adversity predicted infant crying separately and cumulatively in cohort 1, but not in cohort 2. We conclude that there is a need for further research that includes replication and other safeguards. Infant crying is a highly emotional issue for many parents. Before researchers add to their burden by claiming that maternal prenatal anxiety, cigarette smoking, or labour medication, contribute to their baby's crying, we need to be sure of our grounds.

Adult↗
PubMed2006

Pain assessment: current status and challenges.

Neonatal pain assessment has received much attention over the past decade. Behavioural indicators of pain include facial action, body movement and tone, cry, state/sleep, and consolability. Physiological indicators of pain include increased heart rate, respiratory rate, and blood pressure, as well as decreased heart rate variability and oxygen desaturation. Pain assessment in neonates is difficult in neurologically compromised, chemically paralyzed, and non-responsive infants. Multiple pain assessment tools are summarized. Pain assessment and management protocols are delineated.

Biomarkers↗
PubMedDate not supplied

From the big bang to the brain.

Current research on the capacities of the infant has lead to a better understanding of developmental processes underlying cognition and motor skill acquisition. ASHA's Eighth Annual Research Symposium on Infant-Toddler Development, in November 1998, included a presentation on developmental cognitive science by Dr. Andrew Meltzoff and a presentation on motor skill acquisition by Dr. Esther Thelen. The theoretical constructs and data presented served to broaden our current perspectives on infant abilities. The data reported by Meltzoff and Thelen challenged several long-standing theories of infant cognition and motor development. Alternative theoretical models were used to describe skill acquisition during the first several years of life. Our response will include a brief summary of each investigator's presentation, discuss their findings with respect to research in the area of infant speech physiology and production, and provide possible future directions and challenges for individuals conducting developmental research.

Cognition↗
PubMed2001

Polygraphic investigation of 24-h waking distribution in infants.

An evening forbidden zone for sleep has been shown for adults. This research was aimed to ascertain the prevalence of waking in the evening in early development. Twelve infants, aged between 2 weeks and 11 months 3 weeks, were each recorded once over a 24-h period. Recordings included EEG, EOG, EMG, respiration, ECG, and behavioural observation. Four states were defined by combining behavioural and electrophysiological data. Wakefulness was defined by the presence of eyes open, eye movements and additionally body movements, and irregular respiration. In infants younger than 12 months and a half, a greater amount of wakefulness was observed in the time interval between 17 and 20. Older infants show uniform high amount of wakefulness during daytime. Our data corroborate the hypothesis that evening hours are those most frequently characterised by the behavioural waking state, suggesting that a forbidden zone for sleep exists in development and that its time placement corresponds to the one observed in the adult.

Electrocardiography↗
PubMed1999

The response of crying newborns to sucrose: is it a "sweetness" effect?

Intraoral sucrose (and other sweet carbohydrates) induce rapid and sustained calming in crying newborns and transiently increase mouthing and hand-mouth contact ("sucrose effects"). To investigate whether these effects are due to the sweetness of sucrose, 60 crying newborns were randomized to receive 250 microL of 24% sucrose solution, 0.12% of aspartame solution of equivalent sweetness (to adults), or 24% polycose, a soluble carbohydrate that is only very slightly sweet (to adults), as well as water in a mixed parallel crossover design. Relative to water, sucrose persistently reduced crying, and transiently increased mouthing and hand-mouth contact, as previously demonstrated. Aspartame also reduced crying, and transiently increased mouthing and hand-mouth contact, virtually mimicking the time course and the magnitude of the effects obtained in response to sucrose. By contrast, polycose solution had no specific effects on crying, mouthing, or hand-mouth contact. The results imply that the responses of crying newborns to intraoral sucrose are neither specific to sucrose nor to the general class of carbohydrates, and that these effects are more appropriately understood as "sweetness" effects.

Administration, Oral↗