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Neurophysiologic evaluation of auditory recognition memory in healthy newborn infants and infants of diabetic mothers.

OBJECTIVES: We evaluated the integrity of neural pathways for auditory recognition memory in normal newborn infants (n = 32) and infants of diabetic mothers (IDMs, n = 25). IDMs are at risk for fetal metabolic abnormalities that potentially damage recognition memory pathways. We hypothesized that newborn IDMs would have recognition memory deficits that would be correlated with later cognitive development. STUDY DESIGN: Recognition memory was assessed with event-related potentials (ERPs). Neonatal ERPs elicited by the maternal voice were compared with those elicited by a stranger's voice. The Bayley Scales of Infant Development were administered at 1 year of age. RESULTS: Infants in both the control and IDM groups demonstrated recognition of the maternal voice, but their ERP patterns differed. Both groups demonstrated increased amplitude and latency for the "P2" peak elicited by the maternal voice compared with the stranger's voice. In the control group the stranger's voice also elicited a negative slow wave, which was attenuated in the IDMs. The negative slow wave correlated significantly with the 1-year Mental Developmental Index. CONCLUSIONS: The presence of a specific neonatal ERP pattern indicated better 1-year cognitive development in infants in the control and IDM groups. ERPs from IDMs demonstrated subtle evidence of recognition memory impairments.

Analysis of Variance↗

Postnatal depression, anxiety and unsettled infant behaviour.

OBJECTIVE: This study compares maternal mood, marital satisfaction and infant temperament in 128 mothers admitted to the residential care unit of a parentcraft hospital and 58 mothers in a demographically matched group. METHOD: Mothers were recruited from the residential care unit of a parentcraft hospital (Tresillian Family Care Centres) and a comparison group from a private obstetric practice in the same demographic area. Both groups completed self-report questionnaires on depression, anxiety and marital adjustment, while mothers in the residential care group also received a structured diagnostic interview for depression (CIDI). RESULTS: Sixty-two per cent of mothers in the residential care group met diagnostic criteria for a major depressive episode occurring since childbirth and a further 13% met DSM-IV research criteria for minor depression. The residential care group also scored significantly higher on both state and trait anxiety and rated their infants as significantly more temperamentally difficult than did the comparison group. CONCLUSIONS: This study replicates a previous Australian finding of a high incidence of maternal mood disorders in mothers admitted to parentcraft hospitals. Acknowledgement of the close association between maternal mood state and unsettled infant behaviour facilitates an integrated multidisciplinary approach offering appropriate management for both mothers and infants. Residential care units may be ideally suited to provide such early intervention strategies in a non-stigmatizing environment, but provision of adequate staff support, mental health consultation, education and skills in managing mental health problems in these settings is important.

Adult↗

Norwegian families: transition to parenthood.

Our purpose in conducting this study was to explore relationships among family dynamics, parent-fetal attachment, and infant temperament in 230 mother-father pairs from the third trimester of pregnancy to when their infant was 7 to 9 months old. Mothers reported increased role conflict during this time, as well as more role conflict than their partners. First-time parents (n = 133) perceived more positive family dynamics than second-time parents (n = 97), as well as greater parent-fetal attachment. Maternal-fetal attachment was greater than paternal-fetal attachment. Health care providers can provide support for new parents as they negotiate new role relationships.

Adult↗

Effectiveness of casein hydrolysate feedings in infants with colic.

This study found that two casein hydrolysate formulas varying in composition were equally effective in managing colicky symptoms associated with protein sensitivity. Both hydrolysate formulas were associated with a significant, comparable reduction in crying duration and intensity from baseline in 15 of 22 infants with complete data. Subsequent challenge data suggest that the population studied were infants experiencing colicky symptoms due to protein sensitivity. A greater proportion of infants showed a positive reaction (> or = 1.5 h of crying/d) to the protein challenges than the placebo challenge, and crying was rated as more intense during whey and milk protein challenges.

Caseins↗

Influence of incubator humidity on sleep and behaviour of neonates kept at stable body temperature.

UNLABELLED: The influence of incubator air humidity (via passive humidification through use of a water reservoir or via active humidification to 2 and 4 kPa) on sleep and behavioural changes was investigated in 13 neonates. The thermal environment of the incubator was servocontrolled via an interactive device tracking the skin temperature changes of the neonates. Using this servocontrolled skin temperature derivative heating programme, it is believed that an increase in air moisture content (reducing evaporative skin cooling) can be counterbalanced by a fall in neutral air temperature, so as to keep the body thermally constant. This procedure permits the experimental evaluation of the specific effect of air humidity on the thermal equilibrium air temperature and the thermal comfort of neonates without eliciting thermoregulatory mechanisms. Under the experimental conditions, in order to keep body temperature stable an increase in water vapour partial pressure from 1.72 (water reservoir) to 3.99 kPa (produced by a nebulizer) is counterbalanced by a decrease in air temperature of 1.49 degrees C. Within this humidity range, the air temperature must be lowered by 0.05 degrees C when the vapour pressure is increased by 0.08 kPa. The magnitude of this deviation depends on the humidity range and is probably a result of changes in the wetted skin area. CONCLUSION: When body temperature is kept constant, changes in air humidity do not modify sleep, body motility and respiratory and heart rates in neonates.

Body Temperature↗

Olfaction and human neonatal behaviour: clinical implications.

About 1-2% of the human genome is allocated to production of receptors for the olfactory epithelium--a hint as to the possible importance of this chemical sense, which includes two anatomically distinct systems: the main olfactory system with sensory cells located in the upper part of the nasal cavity, and the vomero-nasal organ with sensory cells on the nasal septum. In adults, individual odours may influence mate preferences and a growing body of evidence indicates that naturally occurring odours play an important role in the mediation of the infant's behaviour. Even foetal olfactory learning seems to occur and breast odours from the mother exert a pheromone-like effect at the newborn's first attempt to locate the nipple. Newborns are generally responsive to breast odours produced by lactating women. Olfactory recognition may be implicated in the early stages of the mother-infant attachment process, when the newborns learn to recognize the own mother's unique odour signature--a process possibly facilitated by the high norepinephrine release and the arousal of the locus coeruleus at birth. New knowledge about human odour physiology may have diagnostic and therapeutic implications--the initiation and stabilization of breastfeeding and termination of apnoeic spells are mentioned as examples.

Adult↗

Heart rate variability in the neonate and infant: analytical methods, physiological and clinical observations.

Naturally occurring oscillations in heart rate have long been considered to reflect the modulating influences of the autonomic nervous system. Individual reports of heart rate variability in healthy and sick neonates and infants have provided valuable information as to pathophysiological changes in autonomic cardiovascular control. It is evident that prematurity and poor health are reflected in attenuated heart rate variability. However, at present, there are few standard criteria for the analysis of heart rate variability, preventing precise comparisons among the various studies. Until recommendations for standardized analytical methods are made, clinical application of heart rate variability in neonatal and infant prognosis and therapy remains premature.

Asphyxia Neonatorum↗

Concurrent validity of the Neurobehavioural Assessment for Pre-term Infants (NAPI) at term age.

BACKGROUND: Accurate measurement of neonatal neurological integrity is critical for early identification of pre-term and full-term infants at-risk for developmental disability. The Neurobehavioural Assessment for Pre-term Infants (NAPI) was developed to measure the progression of neurobehavioural development in pre-term infants born between 32 weeks post-conceptional age (PCA) and term. This instrument has many unique advantages; however, criterion validity is unknown and results are subsequently difficult to interpret. OBJECTIVES: This study examined the concurrent validity of the NAPI against a criterion instrument, the Einstein Neonatal Neurobehavioural Assessment Scale (ENNAS), which measures similar constructs and has demonstrated excellent reliability and validity. METHODS: A sample of 41 pre-term and full-term infants (40 +/- 2 weeks) was assessed with the NAPI and ENNAS on the same day. RESULTS: The findings demonstrated that correlations between similar NAPI clusters and ENNAS clusters ranged from 0.35-0.65 and correlations between many similar individual NAPI and ENNAS items ranged from 0.40-0.60. Two NAPI clusters also discriminated between normal, abnormal and suspect performance on the ENNAS. CONCLUSION: The NAPI has many unique advantages as a tool. It examines neonates serially, has established weekly normative data and requires minimal infant handling. This study provides new validation of the NAPI instrument.

Awareness↗

Attachment linked predictors of women's emotional and cognitive responses to infant distress.

The purpose of this study was to examine associations among women's emotional and cognitive responses to infant fear and anger and to identify attachment linked predictors of these responses. Four hundred and forty Caucasian and African American undergraduate college women viewed video clips of two crying infants, one displaying anger and the other displaying fear. They identified what the infants were feeling, made causal attributions about the cause of crying, rated their own emotional reactions to the crying infants, and reported on the extent to which their parents met their emotional needs in childhood and their current adult attachment patterns. Emotional and cognitive responses to infant fear and anger were interrelated. Consistent with prediction, a history of parental emotional rejection and adult attachment anxiety and avoidance correlated negatively with accurate identification of emotions and positively with negative attributions, amusement, and neutral responses to infant distress. Adult attachment security moderated the effects of early parental rejection on emotional and cognitive responses to infant distress, and these results varied based on race and parent gender. Results are discussed from an attachment theory perspective.

Adolescent↗

The relationship between pacifier use, bottle feeding and breast feeding.

OBJECTIVE: To investigate the influence of pacifier use and the introduction of formula milk on breast feeding. METHODS: The mothers of 356 healthy newborn infants who initiated breast feeding while in-patients were interviewed within 3 days of birth and later at 2 and 6 months postpartum. Information regarding previous birth, breast-feeding frequency, pacifier use and the adoption of formula milk were obtained. The data were analyzed using chi2 and Kruskal-Wallis tests. RESULTS: At the end of the second month, 264 (74%) of the mothers were still breast feeding; by the end of the sixth month this had fallen to 236 (66%). Among the 356 mothers, 152 had at least one previous infant, and 132 (86.8%) of them had breast fed a previous infant. Of the women who breast fed their previous infant for more than 2 months, 112 (84.8%) breast fed the current child until the end of the second month and 104 (78.7%) until the end of the sixth month after delivery. Of all investigated patients, 204 were primiparous (57.3%). Of these, 152 (74.5%) breast fed until the end of the second month, and 132 (64.7%) until the end of the sixth month after delivery. Amongthe 204 primiparae, 92 (45%) gave formula to their newborn infants. Forty-four of these 92 mothers (47.8%) had discontinued breast feeding by the end of the second month. Among the 356 newborn infants, 220 used pacifiers at the end of the second month. Within this group, 72 (33%) of the infants did not breast feed, while 148 (67%) did breast feed. Of all investigated mothers, 136 did not give pacifiers to their infants and only eight of these mothers (6%) had stopped breast feeding at the end of the second month. CONCLUSIONS: We found an inverse correlation between pacifier usage and breast feeding. Breast feeding was most common among multiparous mothers.

Breast Feeding↗

Potential contribution of maternal zinc supplementation during pregnancy to maternal and child survival.

Mild-to-moderate zinc deficiency may be relatively common worldwide, but the public health importance of this degree of zinc deficiency is not well defined. The purpose of this review was to provide a conceptual framework for evaluating the public health importance of maternal zinc deficiency as it relates to fetal growth and development, complications of pregnancy, labor and delivery, and maternal and infant health. The mechanisms through which zinc deficiency could influence health outcomes are well described. The results of experimental studies conducted in animal models have motivated concern about the potential health effects of mild-to-moderate maternal zinc deficiency. Observational studies in human populations have produced strong associations between poor maternal zinc status and various indicators of poor pregnancy outcome, but supplementation trials have not produced strong, or even consistent results. Supplementation trials are needed to define the public health importance of maternal zinc deficiency worldwide.

Brain↗

Development, behaviour and temperament: a prospective study of infants conceived through in-vitro fertilization.

The development, behaviour and temperament of 65 singleton infants conceived through in-vitro fertilization (IVF) and 63 matched controls were compared at 1 year postpartum. Primiparous women were recruited during pregnancy and their infants' development was assessed at 1 year. In addition, test-taking behaviour was evaluated by an examiner using the Bayley behaviour rating scale and mothers completed a behaviour problem checklist and temperament scale. Mental, motor, speech and social development were appropriate for age, with no significant group differences. While receptive language development was in the normal range, IVF infants scored lower than control infants. Across both groups, mothers reported low levels of behaviour difficulty and mean temperament ratings were in the general population range. There were no group differences in observed test-taking behaviour. However, IVF mothers rated their children at a higher level of behaviour difficulty and more reactive than the ratings given by control mothers. Overall, singleton children conceived through IVF demonstrate appropriate general development at 1 year of age. The higher reported behaviour difficulty experienced by IVF mothers may reflect their concerns about the well-being and adjustment of their child during the first year.

Adult↗

Relationships and parenthood in couples after assisted reproduction and in spontaneous primiparous couples: a prospective long-term follow-up study.

BACKGROUND: The aim of this study was to analyse relationships and parenthood in primiparous IVF couples and spontaneous primiparous couples. METHOD: In total, 110 consecutive IVF couples were studied. The control group was matched for women's age and selected out of the total spontaneous pregnant population in the study area. Questionnaires and semi-structured telephone interviews were used to gain information about sociodemographic data, couples' relationships, and the children's health, temperament and behaviour. Obstetrical variables concerning the course and outcome of pregnancy and delivery as well as the health status of the new-borns were obtained from standardized antenatal care and delivery files. RESULTS: There were no differences concerning gestational age, mode of delivery or neonatal health between the two groups. The IVF couples were more stable over time-from pregnancy until the child was 1 year old-in their relationship, while the control group experienced a decrease in marital satisfaction. The children in the IVF group were assessed by their parents as being more regular/habitual, sensitive and manageable than the control children. CONCLUSION: The differences present between the groups were in favour of the IVF families, and the effects of the infertility crisis were not notable when the children were 1 year old.

Adult↗

Serendipitous insights involving nonhuman primates.

Serendipity is discussed as a form of controlled chaos, a phenomenon in a class with synchronicity and other actions affecting research in terms of theory versus observation (e.g., "optional stopping"). Serendipity is a fundamental aspect of basic research, a profitable and normal outcome in the context of "informed observation." The serendipitous finding fits into the following pattern: it is unanticipated, anomalous, and strategic. All observations that have meaning must fit into some context in the observer's mind or suggest a revolutionary new context. It is critically important to maintain access to the resources provided by established primate centers and similar laboratories to capitalize in a timely way on serendipitous findings and to benefit from valuable discoveries made in more directly targeted development investments. Examples are given of serendipitous insights gained in experimentation and observation relative to nonhuman primate research, including both broad and narrow topics. Genomics, which uses comparison-based strategies and capitalizes on the DNA sequences of genetic information, presents what might seem the basis for endless serendipity because nonhuman primates are likely to share most genes present in the human genome. Other topics discussed include infant behavior, birth periodicity, leprosy, cystic fibrosis, environmental enrichment, endocrinology, drug development, and the rapidly expanding study of infectious diseases and pathogen-based bioterrorism.

Animals↗

The Neurobehavioral Assessment Scale as an instrument for early long-term prognosis and intervention in major disability in high-risk infants.

Evaluated the hypothesis that more effective prognosis is achieved by assessing the modifiability of infants' reactions than by evaluating the presence or absence of normal/abnormal reactions. To evaluate this hypothesis the Neurobehavioral Assessment Scale (NAS) was developed. The NAS assesses the extent to which infants can change their responses in functional contexts. The NAS was administered to 102 high-risk infants repeatedly over the first 16 months of life. Analysis confirmed that the modifiability of performance was predictive of outcome significantly earlier in development than scoring the same items in terms of their normalcy or abnormalcy.

Adaptation, Psychological↗