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Toddlers' responsive imitation predicts preschool-age conscience.
Imitation has long been considered a mechanism for the development of conscience. Despite the central role of imitation in theories of moral internalization, the prediction from imitation to moral behavior has not been tested using an individual differences approach. In a longitudinal design, we examined whether individual differences in toddlers' responsive imitation predict preschool-age conscience. Mothers modeled actions for their children to imitate, and both matching behavior and motivation were observed at 14 and 22 months of age. We also measured preschool conscience by observing children's internalized conduct and guilt at ages 33 and 45 months. Imitation measures consistently predicted conscience variables. These relations were strengthened by aggregation across measures and times of assessment. Motivation and matching behavior each contributed independent variance in predicting preschool-age conscience. Results are consistent with the claim that responsive imitation reflects a general receptive stance to parents' guidance, and with both neopsychoanalytic and social cognitive views of imitation's importance in early moral development.
Behavioural and physiological reactivity to noise in the newborn.
OBJECTIVE: To assess the electromyographic (EMG) and behavioural reactivity of a group of newborn infants exposed to noisy stimulation of various intensity recorded in the Paediatric intensive care Unit (PICU). METHODS: The study was performed at the nursery of the Paediatrics Department (University of Padova) on a group of 21 healthy newborns (mean 39 weeks of gestation), assessed between 24 and 72 h after birth. The study involved taking EMG recordings of the corrugator supercilii muscle and assessing the infant's behaviour at the baseline (15 seconds before stimulation), during noisy stimulation (for 1-2 seconds) and during recovery (15 seconds in three subphases). The noises, previously recorded in PICU, had four different intensities and were administered in random order to all infants. Descriptive analysis and repeated-measures analysis of variance (anova) were performed on the EMG and behavioural data. RESULTS: The infants demonstrated a significant reaction to the noises both in the EMG recordings and in behavioural changes, especially during intense noisy stimulation. The reaction lasted longer than the stimulation period, preventing the infants from returning to the baseline condition. CONCLUSIONS: Exposure to high-intensity noise produced in PICU causes evident behavioural and physiological effects (EMG). This is a field of study that could have important repercussions, given the medium- and long-term effects of repeated noise stimulation.
Maternal psychological distress during pregnancy in relation to child development at age two.
Concern exists that a constellation of negative maternal emotions during pregnancy generates persistent negative consequences for child development. Maternal reports of anxiety, pregnancy-specific and nonspecific stress, and depressive symptoms were collected during mid-pregnancy and at 6 weeks and 24 months after birth in a sample of healthy women with low risk pregnancies. Developmental assessment and cardiac vagal tone monitoring were administered to 94 children at age 2. Higher levels of prenatal anxiety, nonspecific stress, and depressive symptoms were associated with more advanced motor development in children after postnatal control for each psychological measure; anxiety and depression were also significantly and positively associated with mental development. Mild to moderate levels of psychological distress may enhance fetal maturation in healthy populations.
The role of infant factors in postnatal depression and mother-infant interactions.
A large group of infants of primiparous women who were at high risk fo r postnatal depression (N=188) and a smaller group of those at low risk (N=43) were assessed in the neonatal period using the Neonatal Behavioural Assessment Scale. Poor motor scores and high irritability were strongly predictive of the onset of maternal depression by eight weeks postpartum. These effects obtained after taking account of both maternal mood in the neonatal period and maternal perceptions of infant temperament. Poor motor scores and high levels of infant irritability in the neonatal period also predicted less optimal infant behaviour in face-to-face interactions with the mother at two months postpartum. Neonatal behaviour did not predict the persistence of depression, nor did it predict the quality of maternal behaviour in interaction with the infant.
Crying patterns in preterm infants.
Healthy infants born at term cry most in the first three months of life, with a peak and increased crying in the evening during the second month. To determine whether the crying of preterm infants manifests similar features, the pattern of crying from 40 weeks gestational age through 24 weeks corrected age was described for 35 relatively healthy preterm infants born between 28 and 34 weeks gestational age. Despite their additional extra-uterine experience, they still cried significantly more after 40 weeks gestational age, with a peak and evening clustering at 6 weeks corrected age. The age of peak crying was not related to gestational age at birth, weight for gestational age, or a variety of perinatal and neurological indices. The results support the argument that the early-peak pattern is a robust maturational feature of early development and may be universal to human infancy.
Developmental changes in response to heelstick in preterm infants: a prospective cohort study.
Twenty-eight preterm infants of 28 weeks gestational age were observed four times over eight weeks in order to determine changes in their pain response. Both routine and sham heelstick procedures were used. Physiological (heart rate and oxygen saturations) and behavioural parameters (three upper facial actions) were used as outcomes. The responses to real heelstick were significantly greater than to sham heelstick for heart rate and all facial actions except one at 28 weeks gestational age, but not for oxygen saturation. The magnitude of response to both real and sham heelstick increased over time. Thus, the older the infant, the more robust and recognisable the response. Since even the youngest infants showed a differential response to pain, professionals caring for such infants need to be able to recognize their more subtle pain responses.
Stepwise compared with rapid application of vacuum in ventouse extraction procedures.
OBJECTIVE: To compare a one-step (rapid) application of negative pressure (vacuum) with conventional stepwise application for ventouse extraction following a prolonged second stage of labour. DESIGN: Randomised controlled study. SETTING: Teaching Hospital. PARTICIPANTS: Forty-seven women were randomised to the rapid vacuum group and 47 to the stepwise group. MAIN OUTCOME MEASURES: Duration of ventouse procedure, effectiveness of methods of application, morbidity of mother and infant. RESULTS: There was no significant difference in frequency of detachment of the cup after rapid or stepwise application of vacuum. A reduction in mean duration of the ventouse procedure of 6 min was realised without significant difference in maternal or neonatal morbidity. CONCLUSION: Rapid application of vacuum significantly reduces the duration of a ventouse extraction procedure without compromise to efficiency and safety.
Epidurals and breastfeeding.
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Automated detection of videotaped neonatal seizures of epileptic origin.
PURPOSE: This study aimed at the development of a seizure-detection system by training neural networks with quantitative motion information extracted from short video segments of neonatal seizures of the myoclonic and focal clonic types and random infant movements. METHODS: The motion of the infants' body parts was quantified by temporal motion-strength signals extracted from video segments by motion-segmentation methods based on optical flow computation. The area of each frame occupied by the infants' moving body parts was segmented by clustering the motion parameters obtained by fitting an affine model to the pixel velocities. The motion of the infants' body parts also was quantified by temporal motion-trajectory signals extracted from video recordings by robust motion trackers based on block-motion models. These motion trackers were developed to adjust autonomously to illumination and contrast changes that may occur during the video-frame sequence. Video segments were represented by quantitative features obtained by analyzing motion-strength and motion-trajectory signals in both the time and frequency domains. Seizure recognition was performed by conventional feed-forward neural networks, quantum neural networks, and cosine radial basis function neural networks, which were trained to detect neonatal seizures of the myoclonic and focal clonic types and to distinguish them from random infant movements. RESULTS: The computational tools and procedures developed for automated seizure detection were evaluated on a set of 240 video segments of 54 patients exhibiting myoclonic seizures (80 segments), focal clonic seizures (80 segments), and random infant movements (80 segments). Regardless of the decision scheme used for interpreting the responses of the trained neural networks, all the neural network models exhibited sensitivity and specificity>90%. For one of the decision schemes proposed for interpreting the responses of the trained neural networks, the majority of the trained neural-network models exhibited sensitivity>90% and specificity>95%. In particular, cosine radial basis function neural networks achieved the performance targets of this phase of the project (i.e., sensitivity>95% and specificity>95%). CONCLUSIONS: The best among the motion segmentation and tracking methods developed in this study produced quantitative features that constitute a reliable basis for detecting neonatal seizures. The performance targets of this phase of the project were achieved by combining the quantitative features obtained by analyzing motion-strength signals with those produced by analyzing motion-trajectory signals. The computational procedures and tools developed in this study to perform off-line analysis of short video segments will be used in the next phase of this project, which involves the integration of these procedures and tools into a system that can process and analyze long video recordings of infants monitored for seizures in real time.
Changes in breastfeeding practices in Norwegian maternity wards: national surveys 1973, 1982 and 1991.
Total breastfeeding rates in Norway increased from < 30% at 12 weeks in 1968 to > 80% in 1991. Concomitant changes in routines related to breastfeeding in all Norwegian maternity wards were examined in 1973, 1982 and 1991. Head midwives responding to identical survey questionnaires described "usual practices" in their wards. The considerable changes over these 18 years reflected international recommendations such as those summarized in WHO/UNICEF's 1989 Joint Statement and "Ten steps to successful breastfeeding". Undisturbed and prolonged contact between mother and baby became more common, as did more respect for the needs of the nursing couple, and more individualized care. In responses to open-ended questions, many respondents expressed a positive attitude towards these changes, while "clusters" of negative attitudes were also seen. As research on inborn infant behaviour and mother-infant interaction proceeds, the present survey suggests areas where further information may benefit both mothers and health workers.
Infant fussing and crying patterns in the first year in an urban community in Denmark.
Infant crying amounts and patterns in 590 1- to 12-month-old infants in an urban community in Denmark were studied using the Crying Patterns Questionnaire. The impact of the crying on parents and the primary health services was also assessed. The results showed that Danish mothers leave their infants to "cry out" substantially less than mothers in the UK and North America. Despite this difference, mean crying amounts, crying patterns and the incidence of persistent crying were similar to those reported in earlier western studies. The findings support the view that the infant crying peak in the first 3 months is due to normal maturational and developmental processes.
An assessment of behavioural characteristics in infants who died of sudden infant death syndrome using the Early Infancy Temperament Questionnaire.
An assessment of the behavioural peculiarities of infants dying of sudden infant death syndrome (SIDS) was carried out using the Early Infancy Temperament Questionnaire (EITQ). Thirty-six infants (25 boys and 11 girls aged 1-4 months) in whom the diagnosis of SIDS was confirmed by full necropsy and who died in St Petersburg from 1990 to 1992 entered the study, and the families were approached contemporaneously. A control group consisted of an equal number of age, sex, geographic distribution and date of birth matched live infants from the same city. The infants who died of SIDS had significantly lower estimates of activity in comparison with the babies from the control group. Behavioural defects may be a contributory factor and a sign of increased risk in some babies presenting with SIDS.
Effectiveness of individualized neurodevelopmental care in the newborn intensive care unit (NICU).
The individual infant's neurodevelopmental process provides an integrative framework for the delivery of medical care needed to assure the infant's survival and quality of outcome. The infant's neurobehavioral functioning and expression provides an opportunity for caregivers to estimate the individual infant's current strengths, vulnerabilities and threshold to disorganization, as well as to identify the infant's strategies in collaborating in his or her best progression. This perspective supports caregivers in seeing themselves in a relationship with the infant, and in considering opportunities to enhance the infant's strengths and reduce apparent stressors in collaboration with the infant and the family. The results of several randomized studies supporting the effectiveness of such a neurodevelopment approach to NICU care will be presented, and suggest implications for staff education and nursery-wide implementation.
Attractiveness of amniotic fluid odor: evidence of prenatal olfactory learning?
Human infants are responsive to maternal odors beginning shortly after birth. In several non-human mammals, the fetus is capable of olfactory learning and in some species neonates are attracted to the odor of amniotic fluid (AF). The present study examined the responses of newborn babies to AF in a biologically relevant context, i.e. during their initial attempt to locate the mother's nipple/areola. We observed newborns' spontaneous choice between a breast with the nipple/areola moistened with AF and an untreated breast; 23 of 30 infants chose the AF-treated breast. All babies had been washed before the observations, and only 12/30 sucked their hands/fingers prior to approaching the nipple/ areola. In a previous study with unwashed newborns, the corresponding proportion was 27/30 (p < 0.001). We tentatively suggest that the observed attraction to AF odor may reflect fetal exposure to that substance (i.e. prenatal olfactory learning). Because of the salience of biological odors for neonates, products that eliminate or mask such cues should be avoided during the perinatal period.
Breastfeeding and infant-mother interaction.
The prevalence of breastfeeding varies very much throughout the world. In some countries, such as in Scandinavia, it is extremely high, whereas it is rather low in many industrialized countries such as northern Italy. In urban areas of many developing countries the prevalence is extremely low, although it may be high in rural areas. For instance, in rural Guinea-Bissau in West Africa it is reported to be 100% at 3 mo of age, and this high prevalence may be explained by the fact that infants who have not been breastfed die before this age. In Sweden the prevalence at 2 mo of age was around 95% in 1945 (including infants fed by milk-mothers) but then gradually dropped until 1972, when it was as low as 20%. However, during the following 10-y period the prevalence gradually increased to around 80%. The main reasons for the decline most probably were that infant formulae, then considered to be safe, became available, that an increasing number of women started to work outside their homes, making formula feeding part of the feminist movement, and finally that no real attempts were made to promote breastfeeding in the maternity wards and well-baby clinics. The reverse trend started in 1972, when the attitude towards breastfeeding changed completely. Well-educated mothers became aware of the new discoveries of the importance of breastfeeding from immunological and nutritional points of view, and organized campaigns. Within a few years, the Swedish parliament passed a law which guaranteed all mothers paid leave from their work (80% of their salary) for 9 mo after childbirth, which has now been increased to 12 mo. The WHO/UNICEF code from 1980, which regulates the marketing of infant formula, has also probably played an important role. After a plateau for the prevalence of breastfeeding between 1982 and 1990, a further increase has taken place, particularly between 6 and 9 mo of age. Whereas the first phase in the increase of the prevalence of breastfeeding was, to a certain extent, the result of the concern of well-educated mothers, the second phase (1990-1998) may, at least partly, be explained by the fact that Swedish maternity wards then implemented the suggestion, launched by WHO/UNICEF, to create "baby-friendly" maternity hospitals with the aim of enabling all women to practise exclusive breastfeeding immediately after birth. Methods to stimulate lactation and proper nutritional suckling behaviour of the newborn were then developed.
Can cry in the newborn be used as an assessment of pain?
UNLABELLED: Pain in the neonate is a complex subject. The assessment of pain should be simple and clinically usable. So far, the scales that have been used to assess pain are too time consuming and complex. The analysis of cry in a simple manner, as described in this issue of Acta Paediatrica by Bellieni et al., could be used in a simple and effective way at the bedside. CONCLUSION: Since sick and premature newborns are not studied, the scale needs further confirmation.
Development and validation of the ABC pain scale for healthy full-term babies.
AIM: We developed and validated a pain scale (ABC scale) for term babies based on acoustic features of crying. METHODS: The scale consisted of three different cry parameters: (a) pitch of the first cry; (b) rhythmicity of the crying bout; (c) constancy of crying intensity. These parameters were previously found to distinguish between medium and high levels of pain measured by spectral analysis of crying. We validated the scale using healthy term babies undergoing routine heel prick. Concurrent validity was assessed comparing pain values obtained with our scale with those obtained with another pain scale; this relationship was also used to assess the sensitivity of the scale. To assess specificity we compared the ABC scores during a painful event (heel prick) with two non-painful events (preliminary phase of prick in the same group of babies, and heel prick with analgesia in another group). RESULTS: Specificity: (a) analgesic/non-analgesic comparison, p < 0.0001; (b) pain/sham comparison, p < 0.0001). Sensitivity: a high correlation between scores of the ABC scale and the Douleur Aigue du Nouveau-Né scale indicates good sensitivity. Concurrent validity: Spearman rho = 0.91. Internal consistency: Cronbach's alpha = 0.76. Inter-rater reliability: Cohen's kappa for multiple raters = 0.83. Intra-rater reliability: Cohen's kappa = 0.85. Practicality: All nurses who used it scored the scale as "good". CONCLUSION: The ABC scale proved to be simple and reliable for assessing pain in healthy, non-intubated term newborns.