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PubMed1985

Continuous microbiological and pathological study of 70 sudden and unexpected infant deaths: toxigenic intestinal clostridium botulinum infection in 9 cases of sudden infant death syndrome.

As part of a programme to exclude infection as the cause of death in infants who died suddenly and unexpectedly necropsies were carried out on 70 such infants. In 11 cases (15%), a pathological diagnosis could be made at necropsy; in 9 of these, causative bacteria or viruses were found. The 59 cases in which the cause of death could not be found had histological features characteristic of sudden infant death syndrome (SIDS). Botulinum toxin was found in 9 SIDS cases (15%). 8 of these infants had botulinum toxin and organisms of different types (A, B, C, F, G) in the contents of the ileojejunum or colon. 4 of them also had toxin in the serum. No botulinum toxin or organisms were found in the 11 infants who died of identified causes or 18 other infants who died in hospital of known causes.

Botulinum Toxins↗
PubMed2003

Autonomic responses to sighs in healthy infants and in victims of sudden infant death.

OBJECTIVE: Sigh, defined as an isolated breath with an increased tidal volume, can be associated with abrupt changes in heart rate (HR) or blood oxygenation. Sigh may be followed by a central apnea. As impairment of autonomic control was postulated in future SIDS victims, we hypothesized that their autonomic responses to sighs were different from those of healthy control infants. METHODS: Sighs followed by central apnea were studied in the sleep recordings of 18 infants who eventually died of SIDS and of 18 control infants. The infants of the two groups were matched for sex, gestational age, postnatal age, weight at birth and sleep position during sleep recording. HR autoregressive power spectral analysis was performed on RR intervals preceding and following sighs. RESULTS: In all infants, most sighs followed by an apnea were found in NREM sleep. Compared to the control infants, the future SIDS victims were characterized by a greater sympathovagal balance and a lower parasympathetic tonus before the sighs. Following the sighs, no more differences were found in NREM sleep. CONCLUSION: Based on the present findings, it can be postulated that sighs contribute to reset autonomic tonus during NREM sleep.

Electroencephalography↗
PubMed2004

The effect of postnatal depression on mother-infant interaction, infant response to the Still-face perturbation, and performance on an Instrumental Learning task.

A representative community sample of primiparous depressed women and a nondepressed control group were assessed while in interaction with their infants at 2 months postpartum. At 3 months, infants were assessed on the Still-face perturbation of face to face interaction, and a subsample completed an Instrumental Learning paradigm. Compared to nondepressed women, depressed mothers' interactions were both less contingent and less affectively attuned to infant behavior. Postnatal depression did not adversely affect the infant's performance in either the Still-face perturbation or the Instrumental Learning assessment. Maternal responsiveness in interactions at 2 months predicted the infant's performance in the Instrumental Learning assessment but not in the Still-face perturbation. The implications of these findings for theories of infant cognitive and emotional development are discussed.

Adult↗
PubMed1999

Risk of previous very low birth weight and very preterm infants among women delivering a very low birth weight and very preterm infant.

OBJECTIVE: To examine the relationship of the birth of a very low birth weight (VLBW, < 1500 gm) and very preterm (VPT, < or = 32 week) infant to previous occurrences of VLBW-VPT infants among women who had two to five pregnancies. STUDY DESIGN: This was a case-control study using data from the 1988 National Maternal and Infant Health Survey (NMIHS). A case was defined as a singleton live birth weighing 500 to 1499 gm with a gestational age of < or = 32 weeks. Control infants were defined as singleton births weighing > 2500 gm with gestational ages of > or = 38 weeks. RESULTS: There were 128 non-black cases and 864 non-black controls, and 241 black cases and 1205 black controls available for analysis. Logistic regression was used to adjust for a history of previous stillbirth, mother's birth weight, pre-pregnancy weight, pregnancy interval, and sociodemographic risk factors. The adjusted odds ratio for the occurrence of a previous VLBW-VPT birth for non-black cases versus controls was 21.24 (6.87, 65.7) and for black cases versus controls, 6.87 (3.82, 12.34). CONCLUSION: These results confirm the substantial risk of previous VLBW-VPT infants among women giving birth to such an infant, independent of sociodemographic factors and other prior pregnancy outcomes.

Case-Control Studies↗
PubMed2000

Gestational age- and birthweight-specific declines in infant mortality in Canada, 1985-94. Fetal and Infant Health Study Group of the Canadian Perinatal Surveillance System.

We studied infant mortality rates in Canada within specific gestational age and birthweight categories after using probabilistic techniques to link information in Statistics Canada's live births data base (1985-94) with that in the death data base (1985-95). Gestational age- and birthweight-specific mortality rates in 1992-94 were contrasted with those in 1985-87 with changes expressed in terms of relative risks with 95% confidence intervals [CI]. Statistically significant reductions in infant mortality were observed beginning at 24-25 weeks of gestation and extended across the gestational age range to post-term births. Crude infant mortality rates, infant mortality rates among those > or = 500 g and among those > or = 1000 g decreased by 22%, 25% and 26%, respectively, from 1985-87 to 1992-94. The magnitude of the reductions in infant mortality rates ranged from 14% [95% CI 7, 21%] at 24-25 weeks of gestation to 40% [95% CI 31, 47%] at 28-31 weeks. Almost all reductions in gestational age- and birthweight-specific infant mortality between 1985-87 and 1992-94 were due to approximately equal reductions in neonatal and post-neonatal mortality. Live births > or = 42 weeks of gestation did not follow this rule; post-neonatal mortality rates among such live births decreased significantly by 51% [95% CI 26, 68%], although neonatal mortality rates showed no significant change. The mortality reductions observed across the gestational age and birthweight range are probably a consequence of specific clinical interventions complementing improvements in fetal growth. Temporal changes in the outcome of post-term pregnancies need to be carefully examined, especially in relation to recent changes in the obstetric management of such pregnancies.

Adult↗
PubMed2000

Heart weight in infants--a comparison between sudden infant death syndrome and other causes of death.

UNLABELLED: Heart and body weights were compared with regard to heart pathology and cause of death in well-defined groups of infants under 1 y of age. In the period 1980 to 1998, out of 468 infants autopsied at the Department of Forensic Medicine in Stockholm, Sweden, 331 died of sudden infant death syndrome (SIDS), while 137 died of other causes. Physical violence was the known cause of death in 30 infants and cardiovascular malformations in another 19. Inflammatory alterations of the myocardium were found in 74 cases (16%): in 17 cases (3.6%) myocarditis was interpreted as the main cause of death; in 45 (10%) it was interpreted as contributing to SIDS and in 12 cases (2.5%) it was observed but judged not to be a contributory cause of death in non-SIDS victims. Two of these infants died as a result of physical violence. Body weight was the best predictor for heart weight as analysed by multiple regression, including age, sex, body weight, length, BMI and birth weight. An equation for estimating heart weight from body weight gave an accuracy within the range 0.75-1.25 in 89.2% and 85.0% of the SIDS and non-SIDS groups, respectively. CONCLUSION: Body weight is the best predictor for estimating heart weight. No evidence supported the notion that heart weight, body weight or birth weight of SIDS victims differs from non-SIDS, although heart weight in infants with cardiovascular malformations deviated from observations in the other groups.

Body Weight↗
PubMed1990

Correlations between cardiorespiratory measures in normal infants and victims of sudden infant death syndrome.

Coordination between physiological measures (i.e., the tendency for measures to co-vary with each other) develops with maturation in the infant. We hypothesized that correlations between cardiorespiratory measures would increase with maturation in normal infants and that infants destined to die of sudden infant death syndrome (SIDS) would show lower correlations than those of age-matched controls. Twenty-two recordings of electrocardiogram and respiratory movements were obtained from infants who subsequently succumbed to SIDS and compared with 66 recordings from control infants. Each 1-min epoch of data was sleep-state classified. Median heart and respiratory rate, respiratory variability, and median extent of three types of heart rate variation were determined for each epoch, and the minute-by-minute correlations between seven pairs of parameters were determined for quiet sleep, rapid eye movement sleep, and waking in each recording. Most cardiorespiratory measures showed correlations that increased with age; the correlation coefficients for these measures tended to be lower in SIDS victims than in controls prior to 2 weeks of age. The correlations between heart rate and heart rate variability became lower with maturation; correlations between these measures tended to be higher in the SIDS victims. In all analyses showing significant maturational trends, the SIDS victims showed "less mature" correlations than those of the controls.

Arrhythmias, Cardiac↗
PubMed2001

Diagnoses and interactive patterns of infants referred to a community-based infant mental health clinic.

OBJECTIVES: To describe the distribution of symptoms and diagnoses in a community-based infant mental health clinic and to compare play and feeding interactions of referred and nonreferred infants. METHOD: The Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood (DC 0-3) was used to diagnose 113 referred infants (60% were boys). Thirty additional dyads were matched with 30 nonreferred dyads. Feeding, play interactions, and home environment were compared. RESULTS: Two peaks of referral were found: 0 to 6 and 12 to 18 months. The main reasons for referral were eating problems, sleep problems, aggressive behavior, irritability, and maternal depression. The most common DC 0-3 diagnosis was a combination of primary infant disorder, parent-child relationship disorder, and parental psychopathology. Mothers of referred children provided lower levels of sensitivity, support, and structuring of the interaction, and less optimal home environment. The dyadic relationship showed a lower degree of mutuality and higher negative exchanges. Feeding interactions elicited more negative interactions than play. CONCLUSIONS: Infants referred by community health workers showed less optimal mother-infant interactions and had less optimal environment, compared with nonreferred dyads. Symptoms of emotional distress in infancy are best apprehended when assessed in multi-institutional contexts and formulated in a multiaxial approach.

Affective Symptoms↗
PubMed1985

Comparative growth and biochemical response of very low birthweight infants fed own mother's milk, a premature infant formula, or one of two standard formulas.

Very low birthweight (VLBW) infants weighing less than 1,600 g at birth were fed their own mother's milk (OMM) or randomly assigned to receive one of three formulas: a "humanized" formula (SF), a partially modified casein-predominant cow's milk formula (CF), or a premature formula (PF). All infants were fed at 120 kcal/kg/day where possible. PF infants had significantly greater weight increments (28.0 g/day) than those on OMM (19.4 g/day), SF (18.9 g/day), and CF (18.2 g/day). Those on PF also had greater increments of length, head circumference, and skin-fold thickness than those on the other two formulas and greater length increments than those on OMM. Dynamic skinfold measurements suggested that no infants accumulated excessive amounts of interstitial fluid. Infants on the two standard formulas had significantly greater base deficits, whereas those on CF also had higher urea values. Those on OMM had lower phosphate and higher alkaline phosphatase values than the other groups. Thus VLBW infants fed a premature formula had better growth and fewer biochemical problems than those on standard formulas, whereas supplementation of OMM may be necessary to ensure optimal growth and bone mineralization.

Alkaline Phosphatase↗
PubMed1994

Potential aluminium toxicity in infants fed special infant formula.

Aluminium was measured in samples of plasma and samples of feed obtained from 74 infants with normal renal function established on various feeds (breast, whey-based, fortified whey-based, preterm, soy, and casein hydrolysate). All infants were bolus fed, and blood samples were collected midway between feeds. Aluminium was measured using electrothermal atomization and atomic absorption spectrometry. Mean aluminium concentrations in milks were as follows: breast, 9.2 micrograms/L [95% confidence interval (CI), 5.6-12.7]; whey-based, 165 micrograms/L (95% CI, 151-180); fortified, 161 micrograms/L (95% CI, 143-180); preterm, 300 micrograms/L (95% CI, 272-328); soy, 534 micrograms/L (95% CI, 470-598); casein hydrolysate, 773 micrograms/L (95% CI, 632-914). Mean plasma aluminium concentrations in infants receiving different milks were as follows: breast, 8.6 micrograms/L (95% CI, 5.6-10.6); whey-based, 9.2 micrograms/L (95% CI, 7.4-11.0); fortified, 10.3 micrograms/L (95% CI, 8.3-12.3); preterm, 9.7 micrograms/L (95% CI, 5.3-17.1); soy, 12.5 micrograms/L (95% CI, 5.0-20.0); casein hydrolysate, 15.2 micrograms/L (95% CI, 10.7-19.8). Mean plasma aluminium concentration was significantly different in infants fed casein hydrolysate formulae than in those fed breast milk (difference, 6.7 micrograms/L; 95% CI, 2.8-10.5; p = 0.028). We conclude that infants may be at risk from aluminium toxicity when consuming formula containing > 300 micrograms/L--in particular, casein hydrolysate formulae. We speculate that the aluminium compounds found in breast milk are more bioavailable than those found in other milks and that some constituents of infant formula affect aluminium absorption from the gut lumen.

Aluminum↗
PubMed1996

Plasma amino acid concentrations in healthy, full-term infants fed hydrolysate infant formula.

The effect of feeding hydrolysate infant formula (HF) on protein and amino acid metabolism was investigated in healthy, full-term infants who were either breast-fed (BF, n = 10) or received conventional formula (CF, n = 10) or HF based on soy and beef collagen (n = 10) with equal total protein equivalent contents. There were no differences between groups for gain in weight, length, and head and chest circumferences throughout the study. Plasma concentrations of total proteins, albumin, urea nitrogen, uric acid, and creatinine as well as total amino acid and total essential amino acid concentrations did not differ at the ages of 2, 4, and 8 weeks. In contrast, significant differences were seen in concentrations of five free amino acids. Arginine concentrations were significantly higher at the age of 4 weeks in the infants fed HF than in the other groups (71 +/- 12 versus 27 +/- 6 and 30 +/- 4, mumol/L, mean +/- SEM, HF versus BF and CF, p < 0.01). Plasma histidine concentrations were also higher in infants receiving HF (4 weeks: 217 +/- 33 versus 91 +/- 18, HF versus BF, p < 0.01; 8 weeks: 218 +/- 33 versus 105 +/- 20, HF versus CF, p < 0.01). The most pronounced feeding-related differences were seen in plasma glycine concentrations (2 weeks: 653 +/- 89 versus 345 +/- 55, HF versus BF, p < 0.01; 8 weeks: 613 +/- 74 versus 385 +/- 56 and 312 +/- 46, HF versus BF and CF, p < 0.01), with the mean value exceeding the upper limit of the normal range in infants fed HF. Although the biological importance of the differences observed remains to be clarified, further investigations on amino acid metabolism are needed to establish the final nutritional safety of feeding hydrolysate infant formulae.

Amino Acids↗
PubMed1985

Effects on plasma glucose concentration of light-for-date infants and infants of diabetic mothers of feeds supplemented with a glucose polymer.

Serial plasma glucose estimations were performed in 44 light-for-date infants and 17 infants of diabetic mothers fed 2, 3 or 4-hourly with feeds containing 10% additional carbohydrate in the form of a glucose polymer (Caloreen). In the infants fed 2 and 3-hourly, plasma glucose was higher following the high carbohydrate feeds, particularly immediately before the next feed was due. Given 4-hourly, the high carbohydrate feed had little effect in most light-for-date infants, and in one light-for-date infant and two infants of diabetic mothers the plasma glucose was lower at the end of 4 hours than following normal formula. It is concluded that the addition of glucose polymer to feeds given 2 and 3 hourly has a potentially useful effect in neonates at risk of developing hypoglycaemia, but it cannot be used to increase the feed interval to 4 hours.

Blood Glucose↗
PubMedDate not supplied

The effects of infant feeding decisions on infant growth.

ISSUES AND PURPOSE: To determine the effects of feeding decisions on infant growth in the first 6 months of life. DESIGN AND METHODS: Growth measurements were collected twice during the first 6 months of infancy as part of a larger investigation of infant feeding practices (N = 52). RESULTS: Infants who received solid foods before the age of 4 to 6 months weighed less than those who received solid foods after 4 to 6 months. There were no differences in growth measurements between formula-fed and breast-fed infants, although breast-fed infants weighed more at birth. PRACTICE IMPLICATIONS: Emphasize the importance of feeding breast milk (preferably) or formula only for the first 6 months. Advise parents to withhold fruit juices until the infant is at least 6 months old.

Breast Feeding↗
PubMed2003

Factors relating to the infant's last sleep environment in sudden infant death syndrome in the Republic of Ireland.

AIM: To identify risk factors for sudden infant death syndrome (SIDS) in the sleeping environment of Irish infants. METHODS: A five year population based case-control study with parental interviews conducted for each case and three controls matched for age, place of birth, and last sleep period. A total of 203 SIDS cases and 622 control infants born 1994-98 were studied. RESULTS: In a multivariate analysis, co-sleeping significantly increased the risk of SIDS both as a usual practice (adjusted OR 4.31; 95% CI 1.07 to 17.37) and during the last sleep period (adjusted OR 16.47; 95% CI 3.73 to 72.75). The associated risk was dependent on maternal smoking (OR 21.84; 95% CI 2.27 to 209.89), and was not significant for infants who were > or =20 weeks of age (OR 2.63; 95% CI 0.49 to 70.10) or placed back in their own cot/bed to sleep (OR 1.07; 95% CI 0.21 to 5.41). The use of pillows, duvets, and bedding with tog value > or =10 were not significant risk factors when adjusted for the effects of confounding variables, including maternal smoking and social disadvantage. However, the prone sleeping position remains a significant SIDS risk factor, and among infants using soothers, the absence of soother use during the last sleep period also significantly increased the SIDS risk (OR 5.83; CI 2.37 to 14.36). CONCLUSION: Co-sleeping should be avoided in infants who are <20 weeks of age, or whose mothers smoked during pregnancy. The prone position remains a factor in some SIDS deaths, and the relation between soother use and SIDS is a complex variable requiring further study.

Beds↗
PubMed2004

Nitric oxide levels in preterm and term infants and in premature infants with bacteremia.

OBJECTIVE: To determine the serum nitric oxide levels in healthy neonates and in infants with bacteremia. METHODS: We performed a prospective study in a tertiary neonatal intensive care unit. The serum nitric oxide levels were measured in all infants at birth (basal) and in the infected neonates also on the first 2 days of bacteremia. RESULTS: Thirty-three neonates (10 term, 23 preterm) were included. Eleven preterm infants (mean gestational age 27 weeks) had bacteremia. The main blood culture isolates included coagulase-negative staphylococci (n=4), Klebsiella pneumoniae (n=3), and Escherichia coli (n=3). The serum nitric oxide levels increased during infection in 10 infants (p <0.008). The mean nitric oxide level before infection was 44 microM and during infection 96 microM (p=0.008). In the healthy babies, the mean nitric oxide level was 26 microM in those with a gestational age <27 weeks, 44 microM in those born between 28 and 36 weeks of gestation, and 63 microM in term infants. CONCLUSIONS: Bacteremic preterm infants produce significantly higher amounts of nitric oxide. The basal nitric oxide levels at birth may be correlated with gestational age.

Bacteremia↗
PubMed1986

Cerebrospinal fluid and plasma beta-endorphin concentrations in prolonged infant apnea (near-miss sudden infant death syndrome).

Elaboration of beta-endorphins (beta-ED) is implicated in the modulation of respiratory control in infants. Therefore, beta-ED concentrations were measured in paired samples of CSF and plasma in three groups of infants. Group 1 and group 3 were used as controls. Group 2 infants suffered prolonged apnea of infancy (near-miss sudden infant death syndrome) and were successfully resuscitated. Age and weight (mean +/- SEM) in groups 1, 2 and 3 were 8.5 +/- 3 months and 7.2 +/- 1.4 kg, 3.8 +/- 0.7 months and 5.2 +/- 0.6 kg, and 3.4 +/- 0.9 months and 3.4 +/- 0.7 kg, respectively. CSF beta-ED concentrations were found to be significantly elevated in group 2, 67.8 +/- 4.7 pg/ml, when compared to group 1, 29.8 +/- 3.1 pg/ml, and group 3, 46.5 +/- 7.2 pg/ml (p less than 0.01). No correlation was observed with plasma and CSF concentrations in all three groups. beta-ED may play a role in the pathophysiology of prolonged infant apnea (near-miss sudden infant death syndrome).

Apnea↗
PubMed2002

The contribution of prone sleeping position to the racial disparity in sudden infant death syndrome: the Chicago Infant Mortality Study.

BACKGROUND: Rates of sudden infant death syndrome (SIDS) are over twice as high among African Americans compared with Caucasians. Little is known, however, about the relationship between prone sleeping, other sleep environment factors, and the risk of SIDS in the United States and how differences in risk factors may account for disparities in mortality. OBJECTIVE: To assess the contribution of prone sleeping position and other potential risk factors to SIDS risk in a primarily high-risk, urban African American population. DESIGN, SETTING, AND POPULATION: Case-control study consisting of 260 infants ages birth to 1 year who died of SIDS between November 1993 and April 1996. The control group consists of an equal number of infants matched on race, age, and birth weight. Prospectively collected data from the death scene investigation and a follow-up home interview for case infants were compared with equivalent questions for living control participants to identify risk factors for SIDS. MAIN OUTCOME MEASURES: Risk of SIDS related to prone sleeping position adjusting for potential confounding variables and other risk factors for SIDS, and comparisons by race-ethnicity. RESULTS: Three quarters of the SIDS infants were African American. There was more than a twofold increased risk of SIDS associated with being placed prone for last sleep compared with the nonprone positions (odds ratio [OR]: 2.4; 95% confidence interval [CI]: 1.6-3.7). This OR increased after adjusting for potential confounding variables and other sleep environment factors (OR: 4.0; 95% CI: 1.8-8.8). Differences were found for African Americans compared with others (OR: 1.8; 95% CI: 1.2-2.6 and OR: 10.3, 95% CI: 10.3 [3.2-33.8, respectively]). The population attributable risk was 31%. Fewer case mothers (46%) than control mothers (64%) reported being advised about sleep position in the hospital after delivery. Of those advised, a similar proportion of case mothers as control mothers were incorrectly told or recalled being told to use the prone position, but prone was recommended in a higher proportion of black mothers (cases and controls combined) compared with nonblack mothers. CONCLUSIONS: Prone sleeping was found to be a significant risk factor for SIDS in this primarily African American urban sample, and approximately one third of the SIDS deaths could be attributed to this factor. Greater and more effective educational outreach must be extended to African American families and the health personnel serving them to reduce prone prevalence during sleep, which appears, in part, to contribute to the higher rates of SIDS among African American infants.

Adolescent↗
PubMed2005

A population-based study to determine the performance of the Cognitive Adaptive Test/Clinical Linguistic and Auditory Milestone Scale to Predict the Mental Developmental Index at 18 Months on the Bayley Scales of Infant Development-II in very preterm infants.

OBJECTIVES: To determine optimal ages to perform the Cognitive Adaptive Test/Clinical Linguistic and Auditory Milestone Scale (CAT/CLAMS) and optimal "cutoff" score of the CAT/CLAMS to screen very preterm infants (<31 weeks) for severe cognitive-adaptive delay and to ascertain the sensitivity, specificity and likelihood ratios using optimal cutoff scores compared with the Mental Developmental Index (MDI) of the Bayley Scales of Infant Development II. METHODS: A population-based cohort of very preterm infants who were born to mothers who resided in Nova Scotia or Prince Edward Island were evaluated at 4, 8, 12, and 18 months' corrected gestational age, which included a CAT/CLAMS by a physician. At 18 months' corrected gestational age, each child was assessed using the Bayley Scales of Infant Development II, the "gold standard" for developmental delay in young infants. The results of each CAT/CLAMS was compared with the 18-month MDI to identify significant developmental delay (MDI <70). RESULTS: Optimal scores on the CAT/CLAMS to identify correctly MDI <70 were determined by using the kappa statistic for chance independent agreement. Sensitivities and specificities for optimal cutoff scores were as follows: 4-month score <109 (88% and 37%), 8-month score <98 (75% and 82%), 12-month score <81 (63% and 99%), and 18-month score <83 (88% and 98%). CONCLUSION: Sensitivity and specificity of the CAT/CLAMS are high in very preterm infants at identifying major developmental delay at 12 and 18 months. For follow-up programs without psychology services, the CAT/CLAMS at 12 and 18 months is a reasonable screening tool to determine which children need expedited psychology referral for cognitive delay.

Child Development↗