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PubMed1999

[Significance of research with infants for operationalized psychodynamic diagnosis (OPD) during the first year of life].

The early development of the infant and of the infant-parent relationship contains complex processes. These processes are built on the relational competency of the infant and of the parents and are characterized by fast changes and affective integration. The developmental process can easily be disturbed. Early disturbances can have severe consequences for further development. The process of early diagnostic in infant psychiatry faces many difficulties: the fast changes during early development, the strong connection between individual and interactional processes, and the uncertainty of differentiating between normality and pathology during this early age. The operationalized psychodynamic diagnostic can better deal with this developmental phase than traditional classification systems, which only address the individual phenomenology, because in the OPD there is a special axis for the relational level. Modern theories and research results on early development and on the early parent-infant triad offer a favorable background for such a classification of relations.

Child Development↗
PubMed1999

Association between prenatal exposure to methylmercury and developmental outcomes in Seychellois children: effect modification by social and environmental factors.

UNLABELLED: The Seychelles Child Development Study (SCDS) is testing the hypothesis that prenatal exposure to low doses of MeHg from maternal consumption of fish is associated with the child's developmental outcomes. No deleterious relationships between exposure to MeHg and cognitive functions have been identified in the primary analysis of the main cohort through 66 months of age. We performed secondary analyses to determine if effect modification (EM) from social and environmental factors was affecting associations between MeHg and outcomes. METHODS: MeHg exposure was determined by analysis of maternal hair growing during pregnancy. Children in our Main Study cohort were evaluated at 6.5 months (N = 740) for visual recognition memory and visual attention using the Fagan Infantest, at 19 months (N = 738) and 29 months (N = 736) with the Bayley Scales of Infant Development (BSID). Interactions between MeHg and Caregiver Intelligence, Family Income and Home Environment were examined by multiple regression analysis. RESULTS: The median prenatal MeHg exposure was 5.9 ppm (Range 0.5-26.7 ppm). No EM occurred for preferential looking or visual attention at 6.5 months, for the BSID Psychomotor Scale at either 19 or 29 months, or for activity level at 29 months as measured by the BSID Infant Behavior Record. Interactions between MeHg level and both caregiver intelligence and family income were statistically significant for the BSID Mental Scale at 19 months but not at 29 months. These showed enhancement of MDI scores with increasing maternal MeHg in higher caregiver IQ groups at several levels of family income. CONCLUSIONS: In Seychellois children, consistent major EM by social or environmental factors were not identified. The small EM by caregiver intelligence and social factors at 19 months is consistent with the enhanced performance we reported when this cohort was examined at 66 months.

Attention↗
PubMed1999

Pain, nociception and the developing infant.

The study of paediatric pain and the provision of safe but reliable analgesia for all age groups has become a central issue in paediatric anaesthesia. For the practising paediatric anaesthetist, this represents a major challenge: the developing infant is not a single discrete entity but one that changes constantly with increasing maturity of individual organs. Recent developments in both basic and clinical sciences has given valuable insights into this process, giving the clinician a firm basis to provide analgesia at all ages. This review looks at some of the most interesting recent developments in this field.

Analgesia↗
PubMed1999

Caring for critically ill infants: strategies to promote physiological stability and improve developmental outcomes.

Promoting organization and delivering developmentally supportive care leads to improved outcomes for infants and their families. Critical care nurses must function as catalysts to expand the thinking of caregivers from a dimension consisting primarily of physiology to one that embraces the emotional and cognitive growth and well-being of the patient, the patient's family, and staff members. For critically ill infants, developmentally supportive care that is relationship based and that promotes the balance of organized neurobehavioral and physiological function is an avenue to achieve that end. Beneficial or adverse outcomes of nursing care used during this critical period can persist long after an infant is discharged from the intensive care setting.

Child Development↗
PubMed2000

The effect of epoch length and smoothing on infant sleep and waking state architecture for term infants at 42 to 46 weeks postconceptional age.

STUDY OBJECTIVES: Epoch lengths from 20 seconds to 1 minute, and smoothing strategies from zero to three minutes are encountered in the infant sleep and waking literature. The present study systematically examined the impact of various epoch lengths and smoothing strategies on infant sleep state architecture. DESIGN: Overnight polysomnographic recordings were visually assessed by epoch as wake or as each of four sleep state parameters: electroencephalographic patterns, respiration, body movement, and eye movement. From these findings, sleep and waking states were assigned for each of six combinations of epoch length (30-second or 1-minute) and smoothing window length (none, 3-epoch, or 5-epoch). SETTING: N/A. PARTICIPANTS: Subjects were 91 term infants, 42-46 weeks postconceptional age, from the Collaborative Home Infant Monitoring Evaluation (CHIME) study. INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: A greater epoch length resulted in more active and less quiet sleep as a percentage of total study; however, the size of the smoothing window did not affect the percentage of sleep/waking states. In general, the greater the epoch length and the greater the smoothing window length, the fewer the number of, the greater the mean duration of, and the greater the longest continuous episode of sleep/waking states. Analysis of significant interactions indicated that a 1-minute epoch length relative to a 30-second epoch length resulted in increasingly longer episodes of quiet and especially active sleep with a greater smoothing window length. CONCLUSIONS: Smoothing strategy significantly altered sleep state architecture in infants and may explain part of the variability in infant sleep state findings between laboratories.

Gestational Age↗
PubMed2000

Music modulates behaviour of premature infants following heel lance.

The physiological and behavioural effects of music during recovery from heel lance were examined in 14 preterm infants at 29 to 36 weeks post-conceptual age (PCA). Infants were tested on 2 occasions: during a music condition and during a no-music control condition. Each condition was videotaped during 3 periods: baseline, heel lance, and recovery. Infants were divided into 2 age groups for data analyses: less than and greater than 31 weeks PCA. Mixed model ANOVAs showed that heel lance elicited a stress response (i.e., increased heart rate, decreased oxygen saturation, increased state-of-arousal, and increased facial actions indicative of pain) in both age groups. The stress response was greater in the older group. During recovery, the older group had a more rapid return of heart rate, behavioural state, and facial expressions of pain to baseline levels in the presence of compared to the absence of music. It was concluded that music is an effective NICU intervention following a stress-provoking stimulus in infants older than 31 weeks PCA.

Heel↗
PubMed2002

The reality of neonatal pain.

Pain has been unrecognized and undertreated throughout the history of neonatal care. Misconceptions about the infant's ability to feel, remember, and express pain contribute to this long-standing problem. These misconceptions include beliefs that infants are unable to feel pain like adults or to remember it. This article describes the embryology of pain and includes a discussion of emerging evidence that infants do remember pain and consequently react differently to subsequent painful experiences. In addition, the adverse long-term effects of pain on the developing infant are identified and discussed. Permanent structural and function changes in the brain and spinal cord occur with repeated painful experiences, and adverse outcomes are described. An enhanced understanding of the infant's ability to experience pain and the long-term effects of unrelieved pain are essential to avoid harm and to maximize short- and long-term neurodevelopmental outcomes in this vulnerable population.

Adaptation, Psychological↗
PubMed2004

History and description of the Neonatal Intensive Care Unit Network Neurobehavioral Scale.

This article provides an introduction and background to the Neonatal Intensive Care Unit Network Neurobehavioral Scale (NNNS). First is a summary of the history of the field of infant assessment. This is followed by a description of the NNNS, including its basic features and how the NNNS differs from other examinations. We then describe the biobehavioral basis for the examination and review studies in which the NNNS has been used. Finally we discuss the developmental model on which the NNNS is based and consider the implications of using the examination.

Female↗