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PubMed2000

Parent-reported infant health and illness in a whole year birth cohort.

OBJECTIVE: To describe parent-reported infant health and illness experience at 8 weeks. SETTING: Coventry. STUDY DESIGN: Prospective whole year birth cohort. OUTCOME MEASURES: Period prevalences (birth to 8 weeks) and incidences, unadjusted and adjusted for differential cohort attrition, of parent-reported infant health outcomes. METHODS: Of 3891 live births in 1996, 2572 (66%) were recruited into the study. Data were collected by health visitors as part of routine child health surveillance, at 8 weeks using the Warwick Child Health and Morbidity Profile (WCHMP) incorporated into the Parent Held Record. Period prevalences and incidences of parent-reported health outcomes in the first 8 weeks of life were calculated with and without adjustment for the effects of different rates of cohort attrition by sociodemographic group. RESULTS: Data were collected on 2572 infants at recruitment. Health outcome data were available on 2072 (53% of all 1996 live births) infants at 8 weeks. There was differential attrition by social group between enrollment and 8 weeks. Nineteen (95% confidence intervals (CIs) 14,24)/1000 infants were reported as not very healthy/unhealthy, 12 (95% CIs 8,16)/1000 as having impaired health-related quality of life and 11 (95% CIs 7,15)/1000 impaired functional health. Chronic illness had a period prevalence rate of 19 (95% CIs 14,24)/1000. Sixty-six (95% CIs 55,77)/1000 had acute illnesses requiring medical attention and 43 (95% CIs 34,52)/1000 were admitted to hospital at least once. More minor illness than expected was reported in 87 (95% CIs 75,99)/1000. The incidence rate of accidents requiring medical attention was 16 (95% CIs 9,21)/1000. Behavioural problems had a prevalence rate of 78 (95% CIs 66,90)/1000. CONCLUSIONS: Infant health status data have traditionally been based on mortality, hospital admissions and specific diagnoses. This is the first report of health and illness experience during infancy in a whole year birth cohort based on a validated measure of parent-reported health status incorporated into the Parent Held Record and administered by the family health visitor as part of routine child health surveillance. These data give a more comprehensive picture of infant health and illness experience than traditional measures and provide the basis for infant health needs assessment.

Accidents↗
PubMed1998

Infertility and early parent-infant interactions.

Approximately 50% of infertile couples will become parents through pregnancy or adoption, but they experience major difficulties while working towards this goal. Infertility treatments are associated with physical pain and psychological distress, and adoption procedures are prolonged and emotionally stressful. The extent to which these stressors alter the parenting of these couples is not known. The purpose of this study, therefore, was to examine the early parent-infant interactions in infertile couples who become parents through pregnancy or adoption. Two groups of infertile couples (30 who achieved pregnancy and 21 who adopted) and a group of 19 couples without fertility problems were observed interacting with their infants twice, 7 to 21 days after the infant's arrival and a week later, at a time when both parents were at home. Their babies were between 9 days and 5 months of age. Behaviours of the mother, father and infant were recorded every 10 seconds, beginning when the baby was picked up and ending when the baby was put down asleep or 1 1/2 hours had passed. Repeated measures ANOVAs were used to compare the three groups over the observations. There were no differences between fertile and infertile biological parents. Adopted infants showed more alertness, less sleeping, more smiles, and more looking than biological infants. Adoptive mothers spent less time as the sole interactor. Adoptive parents spent more time in playing with their infants and held and touched them less than did biological parents. Infertility, therefore, does not appear to affect early parenting. In general, the amounts of behaviours exhibited by infertile biological parents were very close to those of fertile parents. Differences in the behaviours of adoptive as compared to biological parents can best be explained as responses to the behaviours of their older infants, rather than as evidence of different parenting styles.

Adoption↗
PubMed2000

Effects of infant and caregiving conditions on an infant's focused exploration of toys.

An infant's exploration of toys, in the context of the mother's regulating actions, is a setting for cognitive and social development. The aim of this study was to examine the contribution of infant and caregiving conditions to the quantity of focused exploration of toys for 8-month-old infants. Infant biological conditions were gender and birth weight, including a range of both prematurely and term-born infants. The infant behavioural condition was responsiveness to care. Caregiving conditions included mother's education, the supportive, stimulating and sustaining quality of the home environment, and the attention-directing and -supporting behaviour of the mother during play. The direct and indirect effects of these conditions on focused toy exploration were modelled using multiple regression. The sample of 79 mother-infant dyads included 43 full-term infants and 36 premature infants. The mother's attention-directing behaviour was a significant negative predictor of focused toy exploration. Infant birth weight did not have a significant direct effect on focused toy exploration. Birth weight did not interact significantly with responsiveness to care or with any of the caregiving environment conditions to affect focused toy exploration. Further study of infant responses to the mother's attention-regulating and emotion-regulating behaviour during play is recommended to better understand how the caregiving environment supports or thwarts focused toy exploration.

Adult↗
PubMed2001

Living and coping with excessive infantile crying.

AIM: The aim of the study was to elicit from parents how they lived and coped with a baby who cries excessively. It sought to identify factors which made coping more difficult, as well as interventions perceived by parents to be effective in improving the situation. BACKGROUND: The excessive crying of a baby can be one of the most trying aspects of parenthood. Although there have been many studies into the cause and treatment of the problem, these have produced little convincing evidence and even less agreement among investigators. In the light of this an alternative approach is to provide effective support to enhance coping until the crying abates. DESIGN: This study was based in pragmatic ethnography and followed an adapted grounded theory approach. A total of 25 adults from 14 families participated, recounting their experiences with 20 babies who either were currently crying excessively or had done so previously while less than 1 year old. Data was collected by a factual questionnaire and tape-recorded focused interviews conducted in the family home augmented by periods of participant observation. OUTCOMES: Almost every aspect of family life was disrupted, resulting in strained relationships, feelings of guilt, and concerns about losing control. Repeated attempts had to be made to establish a diagnosis and to find a cure. Such attempts failed, leading to a repeated cycle of hope and disappointment. The greatest potential to effect a positive impact lay in the supportive role of health visitors. They needed to visit frequently; stay for a prolonged period; demonstrate engagement with the family and its difficulties; and impart specific messages with conviction and sincerity. CONCLUSION: A specific, vital role was found for the health visitor in supporting parents through this problem, and aspects of the role were identified in which further study is indicated.

Activities of Daily Living↗
PubMed2002

Effects of sponge bathing on vagal tone and behavioural responses in premature infants.

The purpose of this study was to evaluate the effects of sponge bathing on physiological (vagal tone, heart rate, heart period, oxygen saturation) and behavioural responses in newly born premature infants in the intensive care unit of a university hospital in South Korea. A convenience sample was taken of 40 infants who were between 27 and 36 weeks gestational age at birth and free of congenital defects. The infants' physiological parameters were recorded 10 min before, during and after bathing. To determine behavioural status, tools were modified from the instruments used in a previous study by Scafidi et al. (1990). Analysis of the results showed that the premature infants reacted to sponge bathing with decreases in vagal tone and heart period and increases in heart rate. Oxygen saturation did not demonstrate any remarkable alteration during bathing. Also, there were no significant differences in behavioural signs, motor activity and behavioural distress. Results of this study indicated that nurses in a neonatal intensive care unit should decide according to a premature infant's physiological state whether or not to give a sponge bath.

Analysis of Variance↗
PubMed2001

The effect of age of introduction to lumpy solids on foods eaten and reported feeding difficulties at 6 and 15 months.

AIM: The study aimed to document the dietary patterns of infants and determine the development of feeding difficulties as perceived by the mother according to the age at which lumpy solids were introduced into the diet. STUDY DESIGN: Information was collected from a geographically representative population of 9360 mothers of infants born in 1991/92, part of the Avon Longitudinal Study of Pregnancy and Childhood (ALSPAC). Self-completion questionnaires enquiring about the foods and drinks consumed by the infant and any difficulties experienced by the mothers in feeding her child at both 6 months and 15 months of age were collected. METHODS: Infants were divided into three groups based on the age at which they were first introduced to 'lumpy' solids: 10.7% were introduced before 6 months of age, 71.7% were introduced between 6 and 9 months and 17.6% were introduced after 10 months of age. The foods eaten by those introduced before 6 months and after 10 months were compared to those introduced between 6 and 9 months. Behaviours and problems as reported by the mother were also assessed. RESULTS: Those infants who were introduced to lumpy solids at the earliest ages consumed a greater variety of family foods at the age of 6 months, while those introduced at 10 months or later had been given fewer solids of all types by 6 months of age and at 15 months were significantly less likely to be having family foods when compared to those introduced between 6 and 9 months. At each age, those introduced late (10 months or older) to lumps were more difficult to feed and had more definite likes and dislikes. CONCLUSIONS: A significant difference was observed in the variety of foods given to infants at both 6 and 15 months according to the age at which they began to have lumps in their food, and feeding difficulties were more likely to occur when lumps were introduced at or after 10 months of age.

Diet Surveys↗
PubMed2000

Medicalizing normality? Management of irritability in babies.

OBJECTIVE: The aims of this project were to identify the scources and quality of the health advice provided to parents with irritable infants; to assess the efficacy of a residential programme in the diagnosis and management of irritable infants; and to assess the intermediate term outcome for such infants and their mothers. METHODOLOGY: All mother-infant pairs admitted during a 3 month period to a residential setting with the primary concern of infant irritability were asked to participate in the study. Pre-admission and 3 month post-discharge health-care advice, investigations and treatment details were collected. Maternal mood at admission and 3 months post-discharge was measured using the Edinburgh Postnatal Depression Scale (EPDS). On admission, infant medication for proposed cause of excess irritability was ceased, with parental consent, if it was appropriate and following full medical assessment. Individual case plans were designed by the admitting child health nurse in consultation with the mother. These included education as to normal infant behaviour, settling techniques, and establishment of routine; family issues were also explored. RESULTS: Fifty-one consecutive mother-infant pairs consented to participate and formed the cohort, 48 (94%) were available for follow-up interview 3 months post-discharge. The average age on admission was 13 weeks (range 4-28 weeks), 32 (62.7%) were male, 34 (66.7%) were first born and 45 (88.2%) lived with both their parents. A multiplicity of health professionals had been involved in the pre-admission care, and 48 of the infants had been or were currently on medication for gastro-oesophageal reflux disease and or colic. At the end of admission, diagnoses made were predominantly behavioural (22) and feeding problems (20). Nine infants were felt to have an organic cause for their irritability. Maternal mood improved significantly on EPDS from the time of admission (45 (86.2%) of mothers with scores > or = 12, mean score 16.5) to post-admission follow up (9 (18. 8%) with scores > or = 12, mean score 7.2). CONCLUSIONS: There is evidence that a proportion of babies with 'normal' irritability are being incorrectly diagnosed as having an organic disorder exposing them inappropriately to medication, which may be harmful, and potentially creating lifelong problems for these infants and their families.

Colic↗
PubMed2001

The sleep and settle questionnaire for parents of infants: psychometric properties.

OBJECTIVE: To determine the psychometric properties of a parent-report questionnaire (Sleep and Settle Questionnaire (SSQ)) assessing: (i) the infant's sleep and settling behaviour, and (ii) the parent's level of concern with such behaviours. METHODOLOGY: Test-retest reliability was determined by administering the SSQ to 20 mothers on two occasions, 7-14 days apart. Validity was determined by comparing SSQ responses between mothers with 6-week-old infants who, on a semistructured questionnaire, reported no sleep or settling difficulties (n = 56-60) with those who reported they were experiencing difficulties (n = 133). Further comparison was made with a sample of mothers (n = 34-36) attending a community class on sleep and settling difficulties with infants. Sensitivity to change was determined by comparing mothers' SSQ responses at 6-weeks and 6-months postpartum. RESULTS: The SSQ was found to have low test-retest reliability on items referring to the infants' sleep and settling behaviour, but moderate reliability for the extent that such behaviour bothered the parent. Comparison across the different samples showed good discriminant and concurrent validity. CONCLUSIONS: Parental reports on the SSQ indicates that over a short period (1-2 weeks) the infants' sleep and settling behaviour can change considerably, but that the extent to which such behaviour bothers the parent is more stable. Good validity demonstrates the SSQ is sensitive to differing infant behaviour. It is recommended as both a clinical and research instrument, and could be used to complement assessments focusing on the parent's psychosocial adjustment in the early postpartum period.

Female↗
PubMed2000

Parental presence during anaesthesia induction for outpatient surgery of the infant.

We conducted a randomized controlled trial of parental presence during anaesthesia induction for outpatient surgery in 73 infants (aged 1-12 months). Effects of parental presence on infant and parental outcomes, including anxiety, health care attitudes and satisfaction with the anaesthesia and surgery experience were evaluated. Results demonstrated that parental presence had no impact on infant behavioural distress during induction. In addition, parents who were present demonstrated comparable anxiety levels and health care attitudes before and after surgery, as well as comparable levels of satisfaction with the surgical experience compared to parents who were absent during induction. We discuss reasons for the lack of treatment effects from parental presence, and new directions for future research to identify subgroups of children who may most benefit from the opportunity to have parents involved in the perioperative period.

Ambulatory Surgical Procedures↗
PubMed2000

The stepping response in early infancy.

Postnatally, the stepping response can be elicited right after birth, but soon diminishes and disappears by about 2-3 months of age. It is still not clear if the disappearance of the response is caused by gradual maturation of the central nervous system, environmental factors, or biomechanical factors such as added body weight and/or increased muscle mass of the legs. This clinical study assessed the stepping response in a group of healthy infants (n = 58) at the age of 6 weeks: 37 born preterm and corrected for gestational age. Quantitative measures of stepping response were obtained together with the qualitative measures of behavioural state and the distribution of active and passive muscle power of the legs. Mechanical factors were studied by dividing the infants according to their birth weight status, and calculating the ponderal index (PI), leg volume (LV), and weight gain of each group. Preterm infants show more stepping responses, more muscle power discrepancies, and different leg volumes than their full-term counterparts. In addition, our results reported significant relationship between gestational age and relative birth weight on the manifestation of stepping response. Within the preterm group the responses lingered longer in infants with shorter gestational ages and in those with lower birth weight status. Consequently, this study suggests that environmental experience and the time of birth of the infants play a more significant role than maturation and mechanical factors in the manifestation of the infantile stepping response.

Body Mass Index↗
PubMedDate not supplied

Pacifier use and sleep position in 2 to 4 month old infants.

UNLABELLED: Much interest has been raised in optimal infant care practices which can be preventive against sudden infant death syndrome (SIDS). In particular, avoiding prone sleep and the use of a pacifier were reported to be associated with a reduced risk for SIDS. It was suggested that potential beneficial effect resulted from the use of a pacifier might be ascribed at least in part to the prevention of an infant to be put prone to sleep and/or to turn down prone in sleep. To explore this hypothesis, the study aimed to analyse potential interaction between the habitual sleep position and the regular use of a pacifier in 2-4-month-old infants, age known for the peak incidence of SIDS. 192 randomly selected clinically healthy infants born in St. Petersburg in 1997-1998 entered the survey. The mothers were asked to complete the questionnaires addressing infant, maternal, and demographic major characteristics as well as sleep routine and other child care practices with particular emphasis on the use of a pacifier. Of 181 infants for whom the mothers were able to define typical position the baby was put to sleep and/or found, 174 (96.1%) were usually put to sleep non-prone: 103 on the back, and 71 on the side. In 51 of 181 cases (28.2%) the babies habitually changed their position in sleep. Of 174 babies usually put to sleep non-prone, 6 (3.5%) usually turned to front. Putting baby to sleep on the side compared with on the back bore the risk to turn to front equal to 3.01 (95% CI: 0.42-34.0). There was no difference in any infant, maternal, and demographic characteristic between the groups of the babies usually put to sleep prone and non-prone. Of 192 infants, 117 (60.9%) were usually left to sleep with a pacifier, and there was no significant association between the use of a pacifier and optional prone or non-prone position the baby was usually put to sleep. Likewise, the use of a pacifier did not significantly influence infant's position when found. CONCLUSION: In clinically healthy 2-to-4-month-old babies, the use of a pacifier does not have major influence on the choice of sleep position and infant's propensity to spontaneously modify it during sleep.

Female↗
PubMedDate not supplied

Environmental characteristics and sleep in two-month-old infants.

The study aimed at assessing possible relationship between the quality of infant environment and maternal reported behavioural features during sleep in 2-month-old infants. It comprised 115 randomly selected, apparently healthy infants (50 boys, 65 girls) from community setting who were singletons born at term with normal birth weight in St. Petersburg in 2001-2002. Quality of infant care was estimated using the "PROCESS" (Paediatric Review of Children's Environment Support and Stimulation) inventory enabling to measure infant's developmental stimulation and organisation. Infant's behaviour during sleep was assessed using an adapted version of the Children's Sleep Habits Questionnaire (CSHQ). The babies facing more developmental stimulation and from more organised environment less often fell asleep in parents bed (P = 0.036). Infants from more organised environment were more often put to sleep at the same time at night, more often were ready to go to sleep at bedtime and less often struggled at bed; it was more common with them to have right amount of sleep and to have about a same amount of sleep each day; less often they moved a lot during sleep and woke up in sleep. These associations remained significant after adjustment has been made for each of such potential confounders as infant's gender, weight at birth and at study, gestational age, Apgar score at 1 and 5 minutes, birth order, maternal age and education, maternal marital status, infant's feeding at birth and at study, as well as to their simultaneous effects. Lower environmental organisation and developmental stimulation may be associated with specific disadvantageous infant behavioural features during sleep. Infants with parentally reported sleep problems should be carefully considered for possible flaws in the quality of environment.

Apgar Score↗
PubMedDate not supplied

[Measures for the assessment of pain in neonates as well as a comparison between the Bernese Pain Scale for Neonates (BPSN) with the Premature Infant Pain Profile (PIPP)].

BACKGROUND: Neonate's expression of pain lacks the ability to report pain. Several pain measures exist to assess acute pain in term and preterm neonates. The aim of the present study is to compare them with respect to their validity and reliability. METHOD: Review of the literature and a description of the measures most often cited. Additionally, the validity of the Bernese Pain Scale for Neonates (BPSN) was assessed in a department of neonatology of a university hospital. PATIENTS: Assessments of pain (n = 48) in term and preterm neonates with and without respiratory support. RESULTS: Existing pain measures are using behavioural indicators of pain (eg, facial expression, body posture, movements, and vigilance) as well as physiological indicators of pain (eg, changes in heart rate, respiratory rate, blood pressure, oxygen saturation). The used measures and their feasibility in everyday practice, the study population and the method of validation were presented. The BPSN differentiates pain from nonpain (F = 41.27, p < 0.0001) and the interrater- as well as the intrarater-reliability was high (r = 0.87 - 0.98 and r = 0.98 - 0.99, respectively). CONCLUSIONS: Assessment of acute pain in neonates should take into account the way of validation that has been performed especially with respect to the study population. The BSN is a pain measure with good validity and reliability for the assessment of pain in term and preterm neonates.

Arousal↗
PubMed1997

The effect of behavioural states on cerebral oxygenation during endotracheal suctioning of preterm babies.

Near infrared spectroscopy (NIRS) was used to investigate the effect of behavioural states on changes of oxygenated (O2Hb), deoxygenated haemoglobin (HHb) and total haemoglobin (tHb), during endotracheal suctioning. In an open prospective design, NIRS measurements have been done during 20 suctioning episodes in 13 preterm neonates. Heart rate, arterial oxygen saturation, and carbon dioxide tension were monitored continuously. Behavioural state (BS) observations were made and documented as well. The statistical analysis showed that in patients who were active, with crying periods during suctioning (behavioural states 4-5), changes of oxygenated (p < 0.005) and deoxygenated haemoglobin (p < 0.05), as well as of arterial oxygen saturation (p < 0.05) and heart rate (p < 0.05) were significantly greater than in patients who were quiet with predominant behavioural state 1, 2 and 3. These results underline the influence of behavioural states on the physiological answers to endotracheal suctioning. NIRS proved to be a valuable tool to evaluate possible harmful effects of different suctioning techniques.

Cerebrovascular Circulation↗
PubMed1995

The effect of behavioural states on visual evoked responses in preterm and full-term newborns.

There is no general agreement about the influence of the behavioural states on the visual evoked responses. In the present study visual evoked potentials (VEP) were recorded in 6 preterm and 6 full-term newborns in the different behavioural states. A significant increase in the amplitude was observed from sleep to awake states in both preterm and full-term infants. The results supply information in favour of the utility of the behavioural assessment when VEP are recorded. It reduces the variability of the results providing for more reliable normative data.

Evoked Potentials, Visual↗
PubMed2005

Transplantation of umbilical-cord blood in babies with infantile Krabbe's disease.

BACKGROUND: Infantile Krabbe's disease produces progressive neurologic deterioration and death in early childhood. We hypothesized that transplantation of umbilical-cord blood from unrelated donors before the development of symptoms would favorably alter the natural history of the disease among newborns in whom the disease was diagnosed because of a family history. We compared the outcomes among these newborns with the outcomes among infants who underwent transplantation after the development of symptoms and with the outcomes in an untreated cohort of affected children. METHODS: Eleven asymptomatic newborns (age range, 12 to 44 days) and 14 symptomatic infants (age range, 142 to 352 days) with infantile Krabbe's disease underwent transplantation of umbilical-cord blood from unrelated donors after myeloablative chemotherapy. Engraftment, survival, and neurodevelopmental function were evaluated longitudinally for four months to six years. RESULTS: The rates of donor-cell engraftment and survival were 100 percent and 100 percent, respectively, among the asymptomatic newborns (median follow-up, 3.0 years) and 100 percent and 43 percent, respectively, among the symptomatic infants (median follow-up, 3.4 years). Surviving patients showed durable engraftment of donor-derived hematopoietic cells with restoration of normal blood galactocerebrosidase levels. Infants who underwent transplantation before the development of symptoms showed progressive central myelination and continued gains in developmental skills, and most had age-appropriate cognitive function and receptive language skills, but a few had mild-to-moderate delays in expressive language and mild-to-severe delays in gross motor function. Children who underwent transplantation after the onset of symptoms had minimal neurologic improvement. CONCLUSIONS: Transplantation of umbilical-cord blood from unrelated donors in newborns with infantile Krabbe's disease favorably altered the natural history of the disease. Transplantation in babies after symptoms had developed did not result in substantive neurologic improvement.

Brain↗