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PubMed1998

A comparison of newborns' NBAS reflex responses using total and individual scores. Neonatal Behavioral Assessment Scale.

The purpose of this study was to compare results found using a total summative score of abnormal reflex responses with the results found using individual reflex scores. The 20 reflexes included as part of the Brazelton Neonatal Behavioral Assessment Scale (NBAS) were assessed on 196 neonates on the 1st and 2nd days postnatally. Differences due to of type of delivery, birth weight, whether their mothers were insulin-dependent diabetics or nondiabetics, and day of testing were assessed by using analysis of variance. The key results were that all effects found using the total reflex score were replicated with individual reflex scores and that individual reflex scores also revealed effects not shown using the total score. It was concluded that the individual reflex scores, rather than the total score, should be used when evaluating newborn reflex performance.

Adult↗
PubMed1991

Carrying as colic "therapy": a randomized controlled trial.

In healthy infants, crying behavior is reduced significantly by "supplemental" carrying; that is, increased carrying throughout the day in addition to that which occurs during feeding and in response to crying. To determine whether the recommendation to increase carrying would be effective as a therapy for colic, 66 mothers of infants 4 weeks of age or less who came to their pediatricians with complaints of crying problems ("colic") were randomized to receive standard pediatric advice (standard group) or standard advice plus the recommendation to increase supplemental carrying by 50% (supplemental group). Overall, the supplemental group carried their infants 6.1 hours/d throughout the intervention period, an increase of 2.2 hours/d (56%) more than that provided by the standard group. Despite this significant increase in carrying, there was no difference between groups in the duration or frequency of crying, fussing, or cry/fuss at any time throughout the intervention period. When the greatest treatment effect was expected at 6 weeks, the supplemental group infants cried only 3 minutes less per day (95% confidence interval: 37 minutes less to 32 minutes more per day). We conclude that, compared with standard pediatric advice to be "responsive," supplemental carrying does not reduce crying and fussing behavior further in infants who have colic. In marked contrast to healthy infants, this apparent resistance to increased carrying may indicate an important difference in state regulation and control in infants with colic.

Colic↗
PubMed2006

[Effects of non-nutritive sucking on the physiological and behavioral states of pre-term infants during tube feeding].

PURPOSE: This study was to investigate the effects of non-nutritive sucking on physiological and behavioral state of pre-term infants during tube feeding. METHOD: This nonequivalent, non-synchronized experimental study included 50 pre-term infants. An attempt was made to match gestational age and birth weight of infants in each group. Infants in the experimental group were given a pacifier 2 minutes before, during, and for 2 minutes after tube feeding. Infants in the control group did not get a pacifier. Both groups were tested at three stages for changes in the physiologic state and behavioral state--2 minutes before, during, and 2 minutes after feeding. Date was analyzed with SPSS WIN 10.0 using an Chi2-test, t-test, and repeated measures ANOVA. RESULT: Heart rates and oxygen saturation levels of the two groups were significantly different(P=.001, P=.000). The behavioral states of the two groups were significantly different during and post feeding(P=.000, P=.000). CONCLUSION: This result suggests non-nutritive sucking by using a pacifier is an effective intervention for pre-term infants during tube feeding.

Enteral Nutrition↗
PubMed2000

Are infant crying and maternal responsiveness during the first year related to infant-mother attachment at 15 months?

In this longitudinal investigation, Bell and Ainsworth's (1972) Baltimore study on maternal responsiveness, infant crying and infant attachment security was replicated and extended. Each of the 50 families was observed at home during more than 20 hours, and infant crying behavior as well as maternal responses were recorded. Mothers and their infants were observed in the Strange Situation procedure at 15 months of age. Descriptive results showed that infants produced about the same number of crying bouts across the first 40 weeks after birth, but the duration of the bouts decreased by half during this period. The duration of crying peaked in the first nine weeks. The descriptive data are remarkably similar to the findings of Bell and Ainsworth (1972). Maternal responsiveness influenced crying behavior. Contrary to our expectations, the more frequently mothers ignored their infants' crying bout in the first nine-week period, the less frequently their infants cried in the following nine-week period, even if intervening variables like earlier crying and synchronous responsiveness were controlled for. 'Benign neglect' of fussing may stimulate the emergent abilities in infants to cope with mild distress. Extending an earlier report on this investigation (Hubbard & van IJzendoorn, 1991), we found that crying at home did not differentiate between secure and insecure attachment classifications, and it was not related to Strange Situation crying. Mothers of avoidant infants responded most promptly to their infants' crying. The failure to replicate the Baltimore findings was interpreted in terms of 'differential responsiveness'.

Crying↗
PubMed1996

Effects of Brazelton demonstrations on later parenting: a meta-analysis.

Meta-analysis of parenting interventions based on the Neonatal Behavioral Assessment Scale (NBAS) was conducted. Only published studies (n = 13) were included in this analysis, with one effect size entered for each study. The studies contained a total of 668 families, an average of about 51 per study. Effect sizes are reported in terms of the correlation coefficient (r) as well as the difference between experimental and control group means divided by the pooled standard deviation (Cohen's d). Analyses were conducted by weighting each study equally (unit weighting) and also by sample size. Similar average effect size were obtained for both weighting procedures (r's of about.2, d's of about.4), indicating that Brazelton-based interventions during the neonatal period have a small-moderate beneficial effect on the quality of later parenting. The probability of obtaining these findings by chance approached zero. The potential factors influencing these results are discussed, as well as directions for future research.

Effect Modifier, Epidemiologic↗
PubMed1995

Use of sevoflurane during elective cesarean birth: a comparison with isoflurane and spinal anesthesia.

This randomized study compared sevoflurane 1% and isoflurane 0.5% in terms of maternal and neonatal outcomes. In addition, neonatal outcome in both groups was compared with a cohort of patients delivered by cesarean birth using spinal anesthesia. Fifty-five patients presenting for elective cesarean birth under general anesthesia were randomly assigned to receive either sevoflurane 1% or isoflurane 0.5% in a 50% nitrous oxide and oxygen mixture for maintenance. Twenty patients requesting regional anesthesia received a subarachnoid block using 1.5 mL bupivacaine 0.75% in 8.25% dextrose with fentanyl 10 micrograms. Intraoperative hemodynamic variables and perioperative adverse events were recorded. Neonatal data included Apgar scores at 1 and 5 min, umbilical artery gas analysis, neurologic adaptive capacity scores (NACS) at 2 and 24 h, and a modified neonatal behavioral assessment scale (NBAS) at 24 h. Sevoflurane and isoflurane at equianesthetic concentrations (0.46 MAC-h [minimum alveolar anesthetic concentration hours]) were associated with similar blood pressure and heart rate changes during the operation. Blood loss, uterine tone, and perioperative complications were not problematic and were similar with the two drugs. No differences were seen in emergence times or in the time to being judged fit for discharge from the recovery room. Similarly, the level of postoperative comfort was the same in both groups. Comparing the general and the spinal anesthetic groups, no differences could be detected in neonatal outcome. Fluoride concentrations were modestly increased above preoperative levels in maternal and umbilical blood samples after sevoflurane administration.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

[Postoperative analgesia with tramal in newborn children using the method of continuous intravenous infusion].

The purpose of the study was to evaluate the efficiency of postoperative analgesia with tramal in the newborns. Analgesia with tramal (5% solution for injections, "Gruonental GmbH", Germany) was administered postoperatively in 20 newborn children. Thirteen children were operated for congenital malformations in the gastrointestinal and urinary tracts, three children were operated for purulent-septic diseases and four children were operated for neoplasms. Hemodynamics indices, i.e. heart rate (HR) and arterial pressure, as well as SaO2, respiratory rate (RR), acid-base condition and behavioral reactions were assessed. Analgesia was implemented by the method of continuous intravenous infusion of tramal, 0.1-0.2 mg/kg.h combined with boluses, 1-2 mg/kg. The newborns were asleep for a major part of time during analgesia with tamal; the stable indices of hemodynamics, acid-base balance, glycemia and of the cortisol level were registered. Arterial hypertension, caused by several factors including the effect produced by tamal, was noted in 70% of children. Dose-dependent hypercapnia was registered in 80% of tests in children at unassisted respiration during the infusion of tamal, which is indicative of that tamal affects the respiratory center during the neonatal period and that it is necessary to monitor thoroughly the respiratory functions, i.e. RR, SatO2, pO2, pCO2, and to choose accurately a preparation dose. The continuous infusion of tamal ensures a sufficient analgesia after different operations and especially after medium-traumatic operations.

Analgesics, Opioid↗
PubMed2000

Effects of an energy and micronutrient supplement on play behavior in undernourished children in Indonesia.

OBJECTIVES: This paper reports the effects of an energy and micronutrient supplementation on quantitative and qualitative aspects of play among poorly nourished children. At issue is whether the supplement led to a progression in complexity of play. DESIGN: Two cohorts of children were randomly assigned to three treatments: E = 1171 kJ + 12 mg iron; M = 12 mg iron + 209 kJ; S = 104 kJ. Supplementation was given for 6 months. Evaluations of play behavior were repeated four times. SETTING: The sites were six tea plantations in Pangalengan, West Java. SUBJECTS: The present study utilized a subsample of 55 children recruited for the larger Pangalengan project 6 months into the study. Thirty-eight children were recruited late enough to allow for longitudinal observations. The remaining cases were used for cross sectional observations only. Inclusion criteria were: no chronic disease; length-for-age < or = -1 standard deviation (s.d.) and weight-for-length between -1 and -2 s.d. of the median of the reference of the World Health Organization. METHODS: The children were videotaped during play. These tapes were coded for eight mutually exclusive categories of activities. Four activities coded represented manipulative, relational, functional and symbolic play. RESULTS: Treatment did not affect qualitative play. Girls that received E increased functional play but boys showed the opposite effect. Children in the S group were breastfed more during play as compared to the E group. Children in the E group waited less to begin play.

Brain↗
PubMed2003

Characterizing the functional significance of the neonatal rat vibrissae prior to the onset of whisking.

The present series of experiments assessed how information from the whiskers controls and modulates infant rat behavior during early learning and attachment. Passive vibrissal stimulation can elicit behavioral activity in pups throughout the first two postnatal weeks, although orienting to the source of stimulation is evident only after ontogenetic emergence of whisking. In addition, while pups were capable of demonstrating learning in a classical conditioning paradigm pairing vibrissa stimulation with electric shock, no corresponding changes were detected in the anatomy of the barrel cortex as determined by cytochrome oxidase (CO) staining. Finally, the role of whiskers in a more naturalistic setting was determined in postnatal day (PN)3-5 and PN11-12 pups. Our results showed that both nipple attachment and huddling were disrupted in whisker-clipped PN3-5 pups but only marginally altered in PN1I 1-12 pups. Together, these results suggest that the neonatal whisker system is behaviorally functional and relevant for normal mother-infant interactions, though it lacks the sophistication of a mature whisker system that evokes very specific and directed responses.

Animals↗
PubMed2000

Effects of an energy and micronutrient supplement on iron deficiency anemia, physical activity and motor and mental development in undernourished children in Indonesia.

OBJECTIVES: This paper reports the effects of an energy and micronutrient supplementation on mental and motor development, activity and behavior under natural conditions of children classified as iron deficient anemic and iron replete. DESIGN: Children were randomly assigned to two different nutritional supplements: (1) 12 mg iron + either 1171 or 209 kJ; (2) 104 kJ + 0 iron. Treatment lasted for 6 months. SETTING: The sites were six tea plantations in Pangalengan, West Java. SUBJECTS: Eighteen anemic subjects (hemoglobin < 110 g/L; transferrin saturation (TS) < 16%) and 18 matched (sex and age) controls (hemoglobin > 110 g/L; TS > 16%) were selected from a pool of children with the following characteristics: no chronic disease; length-for-age < or = -1 standard deviation (s.d.) and weight-for-length between -1 and -2 s.d. of the median of the reference of the World Health Organization. METHODS: Hemoglobin, ferritin, transferrin saturation and erythrocyte protoporphyrin were evaluated before and 6 months after treatment. The following psychological measurements were obtained at baseline and 2, 4 and 6 months later. Mental and motor development was evaluated with the Bayley Scale. Motor activity was measured by 4 h continuous observations at home and at day care centers. The interactions between the child and its social and physical environment were also evaluated during 4 h of observations. RESULTS: Anemic children showed faster motor development and greater physical activity than the control children did. None of the other tests showed inter-group differences.

Anemia, Iron-Deficiency↗
PubMed2003

Reliability of two behavioral tools to assess pain in preterm neonates.

CONTEXT: One of the main difficulties in adequately treating the pain of neonatal patients is the scarcity of validated pain evaluation methods for this population. OBJECTIVE: To analyze the reliability of two behavioral pain scales in neonates. TYPE OF STUDY: Cross-sectional. SETTING: University hospital neonatal intensive care unit. PARTICIPANTS: 22 preterm neonates were studied, with gestational age of 34 +/- 2 weeks, birth weight of 1804 +/- 584 g, 68% female, 30 +/- 12 hours of life, and 30% intubated. PROCEDURES: Two neonatologists (A and B) observed the patients at the bedside and on video films for 10 minutes. The Neonatal Facial Coding System and the Clinical Scoring System were scored at 1, 5, and 10 minutes. The final score was the median of the three values for each observer and scale. A and B were blinded to each other. Video assessments were made three months after bedside evaluations. MAIN MEASUREMENTS: End scores were compared between the observers using the intraclass correlation coefficient and bias analysis (paired t test and signal test). RESULTS: For the Neonatal Facial Coding System, at the bedside and on video, A and B showed a significant correlation of scores (intraclass correlation score: 0.62), without bias between them (t test and signal test: p > 0.05). For the Clinical Scoring System bedside assessment, A and B showed correlation of scores (intraclass correlation score: 0.55), but bias was also detected between them: A scored on average two points higher than B (paired t test and signal test: p < 0.05). For the Clinical Scoring System video assessment, A and B did not show correlation of scores (intraclass correlation score: 0.25), and bias was also detected between them (paired t-test and signal test: p < 0.05). CONCLUSION: The results strengthen the reliability of the Neonatal Facial Coding System for bedside pain assessment in preterm neonates.

Beds↗
PubMedDate not supplied

Prenatal PCB exposure and neonatal behavioral assessment scale (NBAS) performance.

We examined the relationship between prenatal (cord blood) polychlorinated biphenyls (PCBs) and Neonatal Behavioral Assessment Scale (NBAS) performance in babies born to women who consumed contaminated Lake Ontario fish. Cord blood PCBs, DDE, HCB, Mirex, lead, and hair mercury levels were determined for 152 women who reported never consuming Lake Ontario fish and 141 women who reported consuming at least 40 PCB-equivalent lbs. of Lake Ontario fish over their lifetime. Earlier work demonstrated that the newborns of fish eaters are exposed to a more heavily chlorinated distribution of PCB congeners, and that highly chlorinated PCBs (hepta-, octa-, and nonachlorinated biphenyls) are most strongly correlated with breast milk levels, perhaps providing the best index of PCB exposure in the Oswego cohort. Given the above, one would predict that these PCBs would be related to impaired performance on those NBAS clusters associated with fish consumption: namely Habituation, Autonomic, and Reflex clusters of the NBAS. Excepting the Relex cluster, these predictions were confirmed. Results revealed significant linear relationships between the most heavily chlorinated PCBs and performance impairments on the Habituation and Autonomic clusters of the NBAS at 25-48 h after birth. Additionally, higher prenatal PCB exposure was associated with a nonspecific performance impairment on the NBAS as evidenced by a significantly greater proportion of NBAS scales in which poor performance was exhibited (more than 1 standard deviation below the mean) in the most highly exposed neonates. Moreover, PCBs of lighter chlorination were unrelated to NBAS performance, as were DDE, Mirex, HCB, lead, and mercury. These results corroborate our earlier findings linking Lake Ontario fish consumption to the most heavily chlorinated PCB congeners, and suggest that the chlorination and persistence of PCBs may be an important factor both for exposure assessment and for determining relationships with neurobehavioral functions.

Animals↗
PubMed1989

Maternal self-efficacy and infant attachment: integrating physiology, perceptions, and behavior.

48 mothers of 5-month-old infants were asked to estimate their control over the termination of an infant cry in a laboratory-simulated child-care task. Mothers who greatly overestimated their control differed from low or moderate "illusion-of-control" mothers by exhibiting a depression-prone attributional style, a depressed mood state, perceiving the father as participating less in child care, and responding to impending infant cries with heart-rate acceleration characteristic of aversive conditioning. At age 16 months, 40 of the mother-infant pairs participated in the Ainsworth Strange Situation. Insecure infant attachment at 16 months was associated with maternal perception of overcontrol, depressed mood state, and aversive conditioning to the impending cry in the laboratory task at the 5-month period.

Arousal↗
PubMed1997

Physical growth of low birthweight infants in the first year of life: impact of maternal behaviors.

Physical growth of preterm infants relates to many medical factors, such as birthweight, severity of medical illnesses, and nutritional status. We previously reported that maternal behaviors influence developmental outcomes in low birthweight infants (birthweight < 1600 g); we now hypothesize that maternal behaviors also influence physical somatic growth in low birthweight (LBW) infants. We serially followed 218 mother-infant pairs from birth through 12 months of age. One-hundred thirteen LBW infants were categorized based on severity of early medical complications. Low Risk infants (LR, n = 71) had acute respiratory distress and/or grade 1-2 intraventricular hemorrhage (IVH), or grade 3 IVH without hydrocephalus. High Risk infants (HR, n = 42) had chronic lung disease, grade 3 IVH with hydrocephalus or grade 4 IVH, and/or periventricular leukomalacia. We also studied 105 socioeconomic (SES) matched Full Term (FT) controls. Maternal behaviors were assessed during home visits with global ratings of Warm Sensitivity and Punitiveness. Infant weight was measured at birth and at 38 weeks, 6 months and 12 months corrected gestational age. We examined alternative expressions of weight growth across the three groups by developing the Weight Quotient (WQ), which is the ratio of actual measured weight to the median weight for age. For each infant the regression of the WQ ratio against correct gestational age was analyzed. We used a General Linear Model to compare the relation of the maternal variables to the weight quotients for the three groups. We determined the catch up growth as the slope of each regression. Results indicated that higher levels of maternal Punitiveness were related to slower rates of growth for High Risk (R2 = 0.36), but not Low Risk or Full Term. For maternal Warm Sensitivity (R2 = 0.36), there were significant (P < 0.05) inverse relations with weight gain growth for the Full Term infants. These data suggest that some maternal behaviors are related to the growth of term and premature infants, although the mechanisms through which this occurs is unclear.

Behavior↗
PubMed1990

Bicuculline induced seizures in infant rats: ontogeny of behavioral and electrocortical phenomena.

The effects of bicuculline, a gamma-aminobutyric acid (GABA) antagonist, were investigated in 258 immature rats between the third and 22nd postnatal days. Behavioral and electrocorticographic events were correlated. Bicuculline induced both behavioral and electrographic seizures as early as the third postnatal day, an age when the CD50 for bicuculline was lowest, and therefore the sensitivity to it was the greatest. Bicuculline may thus be a suitable convulsant for epilepsy studies involving rats during the first postnatal week.

Aging↗
PubMed1994

Experimental studies of infant-parent co-sleeping: mutual physiological and behavioral influences and their relevance to SIDS (sudden infant death syndrome).

We hypothesize that maternal sensory exchanges, likely involving a combination of heat, sound, gas, smells, movement, and touch, induce important physiological changes, especially in the healthy infant's arousal patterns, body temperature, and sleep architecture as defined by standard physiological measures. We summarize the results of two preliminary physiological studies, and some early data from a third, in which mothers and infants are monitored using standard polysomnographic techniques as they sleep in the same bed, and then in adjacent rooms. Our data suggest that infant-parent co-sleeping alters the infant's sleep experience as, for example, the characteristics of arousals, the frequency and duration of nursing, infant sleep position and the number of maternal inspections. For example, while sleeping in the same bed, mothers nurse their infants three times more frequently than they do while their infants sleep in an adjacent room. These preliminary data demonstrate significant differences between routine co-sleeping and solitary sleeping environments. This work underscores the importance of studying infant sleep as it unfolds in the co-sleeping environment, the environment within which it evolved over at least 5 million years of human evolution. Should our preliminary findings be confirmed in future studies they will provide a beginning point for considering additional, possibly unconventional ways of helping to reduce SIDS risks.

Adult↗