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PubMed2002

Perinatal supply and metabolism of long-chain polyunsaturated fatty acids: importance for the early development of the nervous system.

The long-chain polyunsaturated fatty acids, arachidonic (AA) and docosahexaenoic acid (DHA), are essential structural lipid components of biomembranes. During pregnancy, long-chain polyunsaturated fatty acids (LC-PUFA) are preferentially transferred from mother to fetus across the placenta. This placental transfer is mediated by specific fatty acid binding and transfer proteins. After birth, preterm and full-term babies are capable of converting linoleic and alpha-linolenic acids into AA and DHA, respectively, as demonstrated by studies using stable isotopes, but the activity of this endogenous LC-PUFA synthesis is very low. Breast milk provides preformed LC-PUFA, and breast-fed infants have higher LC-PUFA levels in plasma and tissue phospholipids than infants fed conventional formulas. Supplementation of formulas with different sources of LC-PUFA can normalize LC-PUFA status in the recipient infants relative to reference groups fed human milk. Some, but not all, randomized, double-masked placebo-controlled clinical trials in preterm and healthy full-term infants demonstrated benefits of formula supplementation with DHA and AA for development of visual acuity up to 1 year of age and of complex neural and cognitive functions. From the available data, we conclude that LC-PUFA are conditionally essential substrates during early life that are related to the quality of growth and development. Therefore, a dietary supply during pregnancy, lactation, and early childhood that avoids the occurrence of LC-PUFA depletion is desirable, as was recently recommended by an expert consensus workshop of the Child Health Foundation.

Arachidonic Acid↗
PubMed2005

Neurobehavioral effects of treatment for opiate withdrawal.

A partially randomised, controlled trial was performed to test the hypothesis that opiate exposed infants treated with diluted tincture of opium (DTO) and phenobarbital would have better neurobehavioral scores than infants treated with DTO alone. Compared with those treated with DTO alone (n = 15), infants treated with DTO and phenobarbital (n = 17) were more interactive, had smoother movements, were easier to handle, and less stressed. Dual treatment results in improved neurobehavioral organisation during the first three weeks of life, which may indicate a more rapid recovery from opiate withdrawal.

Analgesics, Opioid↗
PubMed2005

Fetal homologue of infant crying.

Four behavioural states are recognised in the human fetus and are comparable to those of the neonate: 1F (quiet sleep), 2F (active state), 3F (quiet awake), and 4F (active awake). State 5, or crying, is not considered to have a fetal correlate. In a study assessing the effects of exposure to tobacco and cocaine during pregnancy on fetal response and habituation to vibroacoustic stimulation, what appears to be the fetal homologue of crying was observed. These behaviours were seen on ultrasound, and have been captured on video recordings and include: an initial exhalation movement associated with mouth opening and tongue depression, followed by a series of three augmented breaths, the last breath ending in an inspiratory pause followed by an expiration and settling. This is the first report/video documenting these behaviours and suggests the possibility of a state 5F.

Acoustic Stimulation↗
PubMed2006

Usefulness of an early neurofunctional assessment in predicting neurodevelopmental outcome in very low birthweight infants.

OBJECTIVE: To evaluate whether early neurofunctional assessment may be useful in predicting neurodevelopmental outcome in children of very low birth weight (VLBW). DESIGN: Observational longitudinal study. SETTINGS: Northern Italy. PATIENTS: A total of 250 VLBW children (129 boys, 121 girls) born consecutively 1996-1999. MAIN OUTCOME MEASURES: Neurodevelopment at 36 months of chronological age, classified in accordance with the classification of Tardieu and the International classification of functioning. RESULTS: Of the infants exhibiting normal neurodevelopment (n = 183) or major dysfunction (n = 17) at 3 months of corrected age, 72% and 94% respectively did not change their score during the study. Minor dysfunctions at 3 months of corrected age were transient in 17 (34%) children. After adjustment for neonatal variables, neurodevelopment at 3 months of corrected age remained predictive of dysfunction at 36 months (odds ratio = 4.33, 95% confidence interval 2.05 to 9.12). If the results for the normal and minor dysfunction groups were pooled, the predictive qualities of the 3 month neurofunctional assessment were: sensitivity 0.5, specificity 0.99, positive predictive value 0.94, negative predictive value 0.93. CONCLUSION: Early neurofunctional evaluation may be useful in predicting later neurodevelopmental outcome in VLBW children.

Aging↗
PubMed1994

Heel blood sampling in preterm infants: which technique?

Preterm infants undergoing heel blood sampling were randomly allocated to specimen collection by heel puncture (Autolet II Clinisafe) or incision (Tenderfoot 'preemie'). A total of 187 procedures was observed in 47 infants. No significant difference was found in the infants' behavioural response, increase in heart rate, or in the frequency of specimen haemolysis. Collection times for small to medium sized samples were similar, but for large samples (> 1 ml) the Tenderfoot method was superior and fewer repeat procedures were necessary. Tenderfoot has the added advantage of improved safety, but it is too costly for routine use.

Blood Specimen Collection↗
PubMed1995

Can topical lignocaine reduce behavioural response to heel prick?

In a randomised, double blind, controlled study the ability of 5% lignocaine ointment to reduce the behavioural response to heel lance in 30 healthy neonates was assessed. Five per cent lignocaine ointment applied to the heel under an occlusive dressing for one hour before heel prick did not reduce the infants' behavioural response to the heel prick procedure.

Administration, Topical↗
PubMed1998

Randomised controlled trial of low dose fentanyl infusion in preterm infants with hyaline membrane disease.

AIM: To evaluate the effects of low dose fentanyl infusion analgesia on behavioural and neuroendocrine stress response and short term outcome in premature infants ventilated for hyaline membrane disease. METHODS: Twenty seven ventilated preterm infants were randomly assigned to receive a mean fentanyl infusion of 1.1 (0.08 SE) micrograms/kg/h for 75 (5) hours, and 28 untreated infants were considered a control group. A behavioural sedation score was used to assess the infants' behaviour. Urinary metanephrine and the normetanephrine:creatinine molar ratio were determined at 0, 24, 48 and 72 hours. Outcome data and ventilatory indexes were recorded for each infant. RESULTS: The fentanyl group showed significantly lower behavioural stress scores and O2 desaturations than controls and lower urinary concentrations of metanephrine and normetanephrine at 24, 48, 72 hours. The two groups showed no significant difference in ventilatory variables or short term outcome. CONCLUSIONS: A short course of low dose fentanyl infusion reduces behavioural sedation scores, O2 desaturations and neuroendocrine stress response in preterm ventilated infants.

Analgesics, Opioid↗
PubMed2000

Skin conductance and the stress response from heel stick in preterm infants.

AIM: To evaluate whether spontaneous skin conductance activity is an objective method for measuring the stress response to painful stimuli in premature infants. The number and amplitude of the waves and the baseline increase with the activity of the sympathetic nervous system. METHODS: In 20 preterm infants of gestational age >/= 29 weeks, behavioural state and spontaneous skin conductance activity variables were measured for three minutes before, during, and for three minutes after heel stick. RESULTS: The number of waves (p < 0.001), the amplitude of the waves (p = 0.001), and the level of the behavioural state (p < 0.001) increased during heel stick, and then decreased to levels found before the procedure. The baseline increased both during (p < 0.001) and after heel stick (p < 0.001), compared with levels before. CONCLUSION: Spontaneous skin conductance activity reflects the stress response to heel stick in premature infants from at least 29 weeks of gestational age.

Female↗
PubMed1999

Influences on infant speech processing: toward a new synthesis.

To comprehend and produce language, we must be able to recognize the sound patterns of our language and the rules for how these sounds "map on" to meaning. Human infants are born with a remarkable array of perceptual sensitivities that allow them to detect the basic properties that are common to the world's languages. During the first year of life, these sensitivities undergo modification reflecting an exquisite tuning to just that phonological information that is needed to map sound to meaning in the native language. We review this transition from language-general to language-specific perceptual sensitivity that occurs during the first year of life and consider whether the changes propel the child into word learning. To account for the broad-based initial sensitivities and subsequent reorganizations, we offer an integrated transactional framework based on the notion of a specialized perceptual-motor system that has evolved to serve human speech, but which functions in concert with other developing abilities. In so doing, we highlight the links between infant speech perception, babbling, and word learning.

Association↗
PubMed1999

Measurement of upper esophageal sphincter tone and relaxation during swallowing in premature infants.

Upper esophageal sphincter (UES) motor function has not been previously evaluated in premature infants. The motor patterns associated with tonic activity and swallow-related relaxation of the UES were recorded for 1 h after completion of gavage feeding in 11 healthy preterm neonates (postmenstrual age 33-37 wk) with a micromanometric assembly, which included a sleeve sensor specifically adapted for UES recordings. A clearly defined UES high-pressure zone was observed in all premature infants studied. Resting UES pressure ranged from 2.3 to 26.2 mmHg and was higher during periods of irritability and apparent discomfort. During dry swallows, UES pressure relaxed from a resting pressure of 28.2 +/- 4.0 mmHg to a nadir of 1.1 +/- 3.3 mmHg. The mean UES relaxation interval (the time from relaxation onset to relaxation offset) was 0. 31 +/- 0.11 s. We conclude that in premature infants >/=33 wk postmenstrual age the motor mechanisms regulating UES resting pressure and the onset of UES relaxation are well developed.

Deglutition↗
PubMed2004

Parental judgements of infant pain: importance of perceived cognitive abilities, behavioural cues and contextual cues.

BACKGROUND: Despite blatant indications, such as behavioural and contextual cues, infant pain is often undermanaged by adult caretakers. The belief that infants are limited in their abilities to comprehend the meaning of an experience or recall that experience has been used to minimize or deny the need for intervention in this vulnerable population. OBJECTIVES: This investigation explored parental beliefs regarding the impact of infant cognitive capabilities, behavioural cues and contextual cues to their pain judgments. Particular interest was focused on their beliefs regarding the general cognitive capabilities of infants of different ages. METHODS: Forty-nine parents viewed videotapes of healthy infants, aged two, four, six, 12 and 18 months, receiving routine immunization injections and provided judgements of the severity of pain on a 100 mm Visual Analogue Scale. Upon completion of their pain judgements for each of the five age groups (two infants per age group; 10 infants total), parents completed questionnaires regarding their beliefs about the capabilities of infants in that age group and then reported the importance of the various cues utilized to formulate their pain judgements. RESULTS: Parents attributed substantial pain to infants in all age groups, almost twice the amount they hypothesized an adult undergoing a similar injection would experience. The cues rated as most important for judgements were similar for infants of varying ages. Overall, facial expressions, sounds and body movements were consistently reported to be most important. Parents acknowledged the development of memory and understanding of pain throughout infancy. However, these beliefs were not deemed by parents as important to their pain ratings, nor were their importance ratings directly related to the pain ratings. CONCLUSION: Parents judged that infants undergoing a routine immunization were experiencing clinically significant levels of pain. However, despite generally acknowledging a developing trajectory for memory and understanding across the five age groups, parents did not indicate that a child's ability to remember and understand pain were essential features of their pain judgements. The results indicated that memory and understanding did not influence parental judgements of infant pain demonstrating the validity of the parents' self-assessments.

Adult↗
PubMed1999

Effect of repeated doses of sucrose during heel stick procedure in preterm neonates.

The purpose of this randomized clinical trial was to test the efficacy of repeated versus single dose sucrose to decrease pain from routine heel stick procedures in preterm neonates. Infants (n = 48) in the first week of life with a mean gestational age of 31 weeks received 0.05 ml of 24% sucrose solution or sterile water by mouth (1) 2 min prior to actual lancing of the heel; (2) just prior to lancing, and (3) 2 min after lancing. The single-dose group received sucrose for the first dose and water for the second and third dose; the repeated-dose group received sucrose three times, and the placebo group received only water. The Premature Infant Pain Profile (PIPP) scores were obtained for five 30-second blocks from lancing. Both sucrose groups had lower PIPP scores (single sucrose pain scores, 6.8-8.2, p = 0.07; repeated sucrose pain scores, 5.3-6. 2, p < 0.01) than water (pain scores 7.9-9.1), and in the last block, the repeated dose had lower scores than the single dose (6.2 vs. 8. 2, p < 0.05).

Analgesics↗
PubMedDate not supplied

Relationship between rhythmic behavior and canonical babbling in infant vocal development.

The onset of canonical babbling (CB) is a landmark event in infants' vocal development for spoken language. Previous research has suggested that the onset of CB coincides with the peak period of rhythmic activities. To examine this phenomenon in detail, 28 Japanese infants (14 girls, 14 boys) were observed longitudinally from the age of 5 to 9 months. In the experimental sessions, an audible or an inaudible rattle was placed into a hand of each tested infant. Then the number of times that the infant shook the rattle was counted. In the observational sessions, infants' spontaneous rhythmic activities under natural conditions were observed. The result shows that rhythmic activities reached their peak around the onset of CB. When the infants began to babble, they shook whichever rattle was in their hand, regardless of its audibility. After this period, they shook the audible rattles more frequently than the inaudible ones. These findings suggest that, around the onset of CB, infants learn to control their motor activities based on auditory feedback.

Child, Preschool↗
PubMedDate not supplied

Cry characteristics of 172 healthy 1-to 7-day-old infants.

A total of 1,836 cry signals from 172 healthy babies, 1-7 days old, were analysed with sound spectrography. The mean values for the 8-15 cries from each infant were calculated and used for the statistical analyses. The mean duration of the cry signals was 1.4 +/- 0.6 s. The mean fundamental frequency was 496 +/- 95 cps (Hz). Fifty percent of the mean fundamental frequencies in the 8-15 cries analysed from each baby varied between 450 and 520 Hz. Of the children, 93% had cries with a mean fundamental frequency below 600 Hz. The mean value of the highest point of the fundamental frequency was 583 +/- 151 Hz and of the lowest point 398 +/- 75 Hz. The melody type had mainly a rising-falling contour, though the difference between the highest and the lowest point was often rather small. There were no significant differences noted in the cry characteristics according to gender, the age of the infants or the gestational age when they were born.

Age Factors↗
PubMed2004

Neurological examination in healthy term infants aged 3-10 weeks.

OBJECTIVES: The neurodevelopmental progress of newborn term infants is checked routinely at around 6 weeks of postnatal age. The maturation of neurological signs in this age range however has not been systematically studied and normative data are not available. The aim of this study was to document any changes in posture, tone, reflexes, behaviour and movements in low-risk full-term infants between 3 and 10 weeks of postnatal age. STUDY DESIGN: We performed a structured neurological examination previously standardised in full-term newborns in the first 48 h after birth. In the current study, a total of 76 examinations were performed between 3 and 10 weeks of age in low-risk full-term infants. RESULTS: The results of the examinations were divided according to postnatal age. In most items, the scores changed with time, with a definite shift in their distribution occurring around 6 weeks. At this age, a reduction in flexor tone of the limbs was observed, together with an increase in active neck tone. Visual orientation in contrast had already improved by 3 weeks when all infants were able to follow a target in a full circle compared to newborns that are often only able to follow a target in an arc. CONCLUSIONS: Our results suggest that 6 weeks post-term birth is an important milestone for changes in neurological signs, particularly those related to muscle tone and posture, probably reflecting maturation of the nervous system. These findings provide important guidelines for the interpretation of the neurological examination performed at this age.

Child Development↗