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Reliable individual differences in preterm infants' excitation management.

2 large independent cohorts of preterm infants ranging between 32 weeks and term were given a neurobehavioral assessment (the NAPI) that measures, among other things, individual differences in excitation management. This assessment, which has high test-retest reliability and developmental and clinical validity, presents each infant with an identical sequence of events. Infant reactions to the standard stimulation provided by this assessment were used as measures of differential excitability. The results showed that over a period of weeks, preterms were highly self-consistent in their reactions. Highly reliable individual differences between infants were also seen. The self-consistencies and individual differences were independent of the infants' prior medical complications. With very few exceptions, these results replicated over the 2 independent cohorts. The individual consistencies and differences in excitation management found in this study might predispose children to later differences in temperament.

Apgar Score↗

Prenatal maternal reactivity to infant cries predicts postnatal perceptions of infant temperament and marriage appraisal.

In a sample of 60 primiparous women, cardiac response and ratings of subjective aversiveness to recordings of unfamiliar infant cries were studied at 32 weeks' gestation. Regression analyses were used to examine relations between cardiac acceleration and subjective aversiveness and 3 groups of postnatal dependent variables: perception of infant temperament, the mother's emotional state, and her appraisal of her marriage. Mothers who prenatally rated the cry recordings as more aversive postnatally described their 3-month-old infants as more fussy/difficult and unpredictable. With statistical control for prenatal variation on the emotional state and marital outcome measures, cardiac acceleration predicted later marital quality. Women who showed greater cardiac acceleration to the cries described their postnatal marital relationships more negatively.

Adult↗

Development of preterm and full-term infant ability on AB, recall memory, transparent barrier detour, and means-end tasks.

10 preterm and 10 full-term infants were tested longitudinally from 28 to 60 weeks of age on a modified version of the AB task, a nonreaching AB task, a Barrier Detour task, a Means-End task, and Perseveration in the Means-End task. Results show that age-corrected (age since conception) premature infants tolerated longer delays than full-term infants on the modified and nonreaching AB tasks. However, when compared by chronological age (age since birth), there were no group differences on either the reaching or nonreaching AB task. No group differences were found on Barrier Detour, Means-End, or Perseveration in either the age-corrected or chronological age comparisons. The results suggest that the function that mediates modified AB performance is one of memory and not of perseveration or means-end ability. Further, these findings suggest that current proposals about brain development based on single samples of infants may be tenuous. Finally, the results of this study suggest that development of the brain structure(s) that mediate modified AB performance is strongly influenced by experience in the postnatal environment.

Age Factors↗

[Assessment of spontaneous motor activity in young infants: an effective method for the detection of brain function disorders].

A method for the assessment of the brain function of young infants was recently introduced. It consists of evaluation of the quality of spontaneously generated generalized movements (general movements, GMs). GMs appear at an early stage of pregnancy and persist until approximately the 4th month after term. Normal GMs are characterized by the triad of complexity, variation and fluency. Mildly abnormal GMs. indicating mild dysfunction of the nervous system, are not fluent but jerky or stiff. Markedly abnormal GMs, indicating major nervous system dysfunction, are characterized mostly by absence of complexity and variation of the movements: the movements are monotonous and stereotyped. The quality of the GMs can be evaluated by means of so-called global Gestalt perception. The technique can be learned in a few days. The quality of the GMs has a clear predictive significance for the child's development. Children with normal GMs will be free of handicaps in later life, whereas three-quarters of the children showing clearly abnormal GMs throughout the postnatal GM period do develop handicaps. Assessment of the quality of the GMs is a relatively cheap, non-invasive method of evaluating the current and future brain function of young infants.

Brain Damage, Chronic↗

[A look at babies].

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Child Development↗

Symbolic expression of feelings and depressive symptoms in high-risk pregnant women.

Pregnant women using rural health departments for prenatal care often experience chronic stressors (minority status, poor education, low income, young age, and single parenting of young children) that contribute to depression. Yet these same women may be reluctant to express their feelings. Because depression has been related to negative patterns of motherchild interaction and even newborn irritability, it is important to identify symptoms in high-risk mothers. For years, symbolic methods of expression have been used to reveal psychological traits or to identify clinical diagnoses, but few have been used to evaluate pregnant women. Women attending a rural health department were administered a comprehensive health and psychosocial questionnaire, including the Center for Epidemiologic Studies-Depression Scale (CES-D). They were then asked to complete a drawing expressing their feelings regarding their pregnancy. The relationship between CES-D scores and drawing ratings determined by two different methods of interpretation (expert, non-expert) was then examined. Non-expert art analysis was able to distinguish those women with the highest scores on the depression index, while expert analysis was able to discern racial differences consistent with risk status. Suggestions for the use of this drawing measure in the clinical setting are discussed. Alternative (non-verbal) methods of assessment that may improve communication with pregnant women are important for optimizing maternal and infant health and well-being and child development.

Black or African American↗

[Relationships between wakefulness of mothers and their infants' movements during night sleep of postpartum 6 weeks].

Relationships between wakefulness of mothers and their infants' movements during night sleep in postpartum period were studied under conditions in daily life. Subjects were ten primiparae, aged 23-31 yrs (mean age, 26.8 yrs), who had a normal course of pregnancy and delivery. Eight of their infants were breast-fed, and two were formula-fed. Mother's polysomnograms, (EEG, EOG, EMG, and ECG) and actigrams of infants' legs were simultaneously recorded using Medilog 9000 at home in the 1st, 3rd and 6th postpartum weeks. Mothers' sleep stages and their infants' movements were visually scored by an epoch of one minute. The infants' movements were classified into four states, MOV0, MOV1, MOV2, and MOV3. We defined MOV0 as no activities during one epoch, MOV1 as less than 20 seconds activities, MOV2 as from 20 to 40 seconds activities and MOV3 as from 40 to 60 seconds activities. The average times of wakefulness on the mothers were 102.6 min (SD = 23.5), 84.8 min (SD = 52.8) and 79.4 min (SD = 40.5) for 1st, 3rd and 6th postpartum weeks, respectively. There were no significant differences among them. The mothers' wakefulness coincided with the infants' movements MOV3 was 86.9% for total epochs of MOV3, while deep sleep of the mothers was observed during epochs of MOV0 and MOV1. This trend did not change across the postpartum weeks. The time-lag between the mothers' wakefulness and their infants' movements was calculated. In 85.4% of 48 times of mother's awakenings for feeding their infants, their infants began to move before their mothers woke up. In 63.4% of the cases, the mothers woke up within two minutes after their infants began to move. In the present study, eight of the ten mothers satisfactorily adapted themselves to the life style in the postpartum period, while two had difficulties in adaptation. In conclusion, ten mothers' wakefulness during night sleep in postpartum period was related to their infants' movements, and its relationship did not change through the 1st, 3rd and 6th weeks of delivery.

Adaptation, Psychological↗

A dangerous case of colic: anomalous left coronary artery presenting with paroxysms of irritability.

Anomalous left coronary artery originating from the pulmonary artery (ALCAPA) is a rare, but potentially lethal, cause for irritability in infancy. We present the case of a 12-week-old male infant who was managed as a colic patient for several weeks before the diagnosis of ALCAPA was established. A brief review of previous case reports demonstrated that paroxysms of irritability can be a presentation of this disorder. In the majority of cases the manifestations of ALCAPA can be differentiated from other diseases known to cause a infant to be colicky.

Colic↗

[Axillary versus rectal temperature measurement in premature and newborn infants].

We performed a prospective study to see whether axillary temperature accurately reflects rectal temperature in premature and sick mature newborns nursed in incubators and whether axillary temperature measurement is better tolerated than rectal measurement. 561 pairs of rectal and axillary temperatures were obtained in 20 infants. Mean axillary temperatures were 0.16 degree C (SD 0.33 degree C) lower than rectal temperatures. In infants < 1000 g axillary temperatures were only 0.06 degree C (SD 0.30 degree C) lower than rectal temperatures whereas in infants > 2500 g axillary temperatures were 0.37 degree C (SD 0.38 degree C) lower than rectal temperatures. Our results show that axillary and rectal temperatures are interchangeable in extremely premature infants. In newborn infants however 0.4 degree C should be added to axillary temperatures to make them comparable to rectal temperatures. Assessment of infant behaviour during temperature measurement by the nursing staff showed that infants tolerated rectal better than axillary temperature measurements. The decision which kind of measurement will be performed can be taken individually for every infant.

Axilla↗

Organizational behavior of the premature infant.

The ability of the premature infant to organize behavior was described in relation to auditory, kinesthetic, and vestibular stimulation. Twenty infants from 31--36 weeks gestation were shown to have heart rate responses to auditory stimuli. The 31 week infant showed deceleration, while 32--36 week infants showed comparable patterns of acceleration followed by deceleration.

Acoustic Stimulation↗

Unmasked thresholds and minimum masking in infants and adults: separating sensory from nonsensory contributions to infant-adult differences in behavioral thresholds.

OBJECTIVE: The purposes were to determine the degree to which infant unmasked thresholds differed from those of adults, to determine the effect of signal frequency on those differences, and to determine whether there is a difference in minimum effective masking as a function of age and frequency. The data were applied to a model to address the question of the origin (sensory versus nonsensory) of infant-adult differences in behavioral unmasked thresholds. DESIGN: Infant behavioral thresholds in quiet and in noise for pure tones of 0.5 and 2 kHz were measured using computer-based visual reinforcement audiometry. Adult thresholds were measured using the same apparatus and a modified conventional audiometric procedure. Twenty-three infants and 24 adults were included in the analyses. The masked thresholds versus masker intensity data were used to estimate minimum masking levels (MMLs). RESULTS: Group mean unmasked thresholds of infants were greater than those of adults at both frequencies and the difference was greater at 0.5 kHz (14.2 dB) than at 2 kHz (5.5 dB). Infant MMLs were greater than those of adults by 10.1 dB at 0.5 kHz and by 1.2 dB at 2 kHz. The fact that a masker had to be 10.1 dB greater in intensity for infants than for adults at 0.5 kHz and 1.2 dB greater at 2 kHz suggests that there is a difference in sensitivity between the groups of about 10 and 1 dB for the two frequencies, respectively. According to a proposed model, the difference between infants and adults in MMLs is less than the difference in unmasked thresholds owing to the influence of nonsensory factors that bias infant unmasked thresholds. Such factors, therefore, contribute 4.1 dB (i.e., 14.2 dB-10.1 dB) at 0.5 kHz and 4.3 dB (i.e., 5.5 dB-1.2 dB) at 2 kHz based on the data. CONCLUSIONS: The infant-adult differences in unmasked thresholds, with greater difference at 0.5 kHz than at 2 kHz, are consistent with earlier research on infant hearing. The data reveal that the greater difference between infants and adults at 0.5 kHz relative to 2 kHz is not a result of nonsensory factors alone, but is largely due to a difference in sensory processing. Only about 4 dB of the difference between infants and adults in unmasked thresholds can be attributed to nonsensory factors and the effect is not frequency specific according to the proposed model. Consideration of establishing audiometric reference values for infants that are different than those based on adults, owing to the elevated behavioral unmasked thresholds of normal-hearing infants, is suggested.

Adult↗

Spontaneous motility in premature infants: features of behavioral activity and rhythmic organization.

The spontaneous motor activity of clinically stable premature infants, 26-36 weeks gestational age, was investigated. Movements were recorded using a pressure-sensitive transducer positioned below the infant's head and torso. Behavior samples were digitized every 0.5 s during 2 and 3-hr continuous recording sessions. Time-series analyses revealed prominent motility cycles of circa 80 min and circa 30 min. These results are consistent with periodicities in motility and REM activation observed in full-term neonates. The longer rhythms of 70-100 min of motility found in this study establish that these periods are present at this stage of development independent of maternal zeitgebers. Developmental changes in motility rhythms and movement burst durations were also observed. Bout durations became somewhat longer in older (> 30 weeks) infants, but the relative time devoted to movement per session was comparable in older and younger (< or = 30 weeks) infants.

Age Factors↗

Mothers' behavior with home infant apnea monitors.

This study presents findings from 35 interviews with mothers of infants who were monitored for apnea following discharge from the same neonatal intensive care unit. The interviews took place at a mean of 28 weeks following discontinuation of the infant home apnea monitor and focused upon the mothers' behavior with the monitor. One family had independently ceased to use the monitor within 1 week of their infant's hospital discharge. All other mothers reported always having used the monitor at night, and 92% always used it during their infants' daytime naps. Approximately one half of the mothers would not have been able to consistently hear an alarm, however, when their infant was asleep. Consistency of availability to a monitored infant was not related to the mothers' background, attitudes, or experiences with their infant. These data indicate the need to emphasize for all caregivers the importance of being available to their monitored infant at all times.

Adult↗