Status Of Infants Research Articles

Neonatal nosocomial infections.

Prevention of infection in the high-risk infant presents a challenge for all members of the health care team. The infant's condition must be constantly assessed for risk factors, and a plan of care must be developed to reduce that risk. That plan requires a thorough understanding of the multiple factors (the infant host, potential pathogens, and therapeutic procedures) involved in neonatal infections and strict adherence to infection control procedures.

Early detection of handicapping conditions in infancy and early childhood: Toward a multivariate model

The major purpose of this study was to relate to infancy the occurence of significant learning or behavioral problems in adolescence. Original participants in the National Collaborative Perinatal Project in Rhode Island, who were also judged as handicapped after school entry, comprised the sample for this study. Environmental factors and child performance data collected at birth and at 4, 8, and 12 months of age were examined in terms of their power to predict handicapping conditions in the adolescent. Our results indicated that maternal education was a more accurate predictor of later learning and behavioral competency than the child's own developmental status up to 12 months of age. Furthermore, combining child-centered data and maternal education did not enhance predictive accuracy beyond that of maternal education considered in isolation. These findings underscore the critical role of molar environmental variables as antecedents of school failure, and suggest that models for screening in the first year of life and of multidisciplinary team diagnosis for handicapped children should include both environmental and child-focused dimensions to minimize overall classification error.

The clinical diagnosis of iron deficiency anemia and related conditions in infancy, childhood and adolescence.

The clinical diagnosis of iron deficiency anemia and related conditions in infancy, childhood and adolescence.

Obstetrical and neonatal risk factors in very low birth weight infants related to their neurological development.

An analysis of pre- and perinatal risks in very low birth weight (VLBW) infants showed that children later suffering from severe neurodevelopmental sequelae were exposed to a significantly higher number of risk factors compared to normally developed VLBW controls. This was not only due to a higher incidence of specific risks, but to the accumulation of risk factors, which consequently made an ischaemic or haemorrhagic brain lesion more likely to occur. This result suggests that brain lesions in VLBW infants are essentially multifactorial. The improved outcome of VLBW infants cared for in the NICU of the Children's Hospital of Tübingen during 1977-1983 was accompanied by a decreasing incidence of obstetrical and neonatal risks. This was mainly due to more frequent transport in utero, earlier obstetrical intervention, and immediate postnatal stabilization of the infant's condition. These changes in perinatal care strategy evidently favoured the postnatal course and thus also improved the neurodevelopmental outcome.

Medical pluralism and infant mortality in a rural area of Bangladesh

This paper examines some aspects of the health search behavior of parents in a rural area of Bangladesh who were unsuccessful in their attempt to save their infant's life. This issue is analyzed within the pluralist medical milieu and very high infant mortality rates prevalent in Bangladesh. There are several different medical cultures in Bangladesh each with their distinctive ideologies about disease causation and the nature of medical intervention. Practitioners of the modern cosmopolitan or western system of medicine are only one of the major types among several types of healers. The choice of a healer by the parents of infants is a complex process depending on a great variety of conditions such as the health status of the infant, relative proximity of the healer, cost of health care, transportation facilities, gender of the infant, attitude of the parents toward different systems of medicine, the past experience of the parents and the like. We posit that the choice of healer of a particular type may be related less to the traditional or modern orientation of the parents than to the severity of the infant's condition and the expectancy of cure. Thus, infants exhibiting acute symptoms of a disease may be more likely to be placed under the care of a ‘western’ type physician than taken for treatment to an indigenous medical practitioner. Such attitude on the part of the parents may, however, result in the loss of precious time at the most critical moments, and thus may reduce their chances of success to save their infant's life. The introduction of ‘Palli Chikitshok’ (village doctor) may have had some impact on the reduction of infant mortality by bringing preventive measures within the reach of village communities.

Differential diagnosis of seborrheic dermatitis.

Seborrheic dermatitis is a common skin condition of infancy of unknown etiology. The disorder is usually mild and responsive to therapy. In severe or atypical cases, a variety of other entities should be considered in the differential diagnosis. Atopic dermatitis, psoriasis, psoriasiform-id reaction, fungal infections, and irritant contact dermatitis can be differentiated on clinical grounds. Less common but more serious disorders, such as histiocytosis X, immunodeficiency disorders, and nutritional and metabolic diseases, may be considered in the child whose disease does not spontaneously resolve or respond satisfactorily to local therapy. Laboratory studies including skin biopsy may be helfpul in these cases. Seborrheic dermatitis is uncommon in children after infancy and before puberty. In this age group, scalp scaling is likely to be due to other causes, such as tinea capitis, atopic dermatitis, or psoriasis.

Mothers' Beliefs About Behavioral Causes for Their Developmentally Disabled Infant's Condition: What Do They Signify?

Mothers' Beliefs About Behavioral Causes for Their Developmentally Disabled Infant's Condition: What Do They Signify?

Endocrine complications of ACTH therapy of infantile spasms

At the end of conventional ACTH therapy of infantile spasms sudden deteriorations of the infant's condition and even deaths are not rare. We followed 10 infants during and after carboxymethylcellulose ACTH therapy. 80 IU was given at 8 a.m. for 3 weeks and 40 IU for 2 weeks, with tapering during and termination at the end of the 6th week. During therapy 24h urinary cortisol increased 100-fold, morning plasma cortisol did not increase, and plasma aldosterone decreased slightly. After therapy, cortisol and AVP levels fell precipitously, cortisol remained subnormal for >2 weeks. Plasma renin and aldosterone peaked abruptly. Urine flow decreased and body weight increased sharply. Plasma cortisol response to AVP remained decreased for >2 weeks. Plasma cortisol response to ACTH was shortened at 3d and diminished at 1 to 2 weeks, indicating suppression of ACTH secretion. The risk at the end of ACTH therapy appears to be associated with 1) sudden subsidence of cortisol hypersecretion resulting in hypocortisolism and hypomineralocorticoidism 2) abrupt activation of the renin-angiotensin-aldosterone axis subsequent to the hypomineralocorticoidism, and 3) impairment of water excretion subsequent to the hypocortisolism.

Continuous naloxone infusion in two neonates with septic shock

SEVERAL REPORTS HAVE DESCRIBED the use of naloxone in patients with refractory hypotension secondary to sepsis. '3 In one 8-year-old child with meningococcemia, the blood pressure, which had been unresponsive to conventional treatment, normalized after the administration of naloxone.: We report two neonates with overwhelming sepsis whose blood pressure was unresponsive to conventional treatment but dramatically improved within minutes of naloxone administration. CASE REPORTS Patient 1. This 8-day-old, 2900 gm white infant girl was admitted to Children's Hospital because of lethargy and poor feeding. She was pale and slightly dusky, and markedly lethargic. Examination of the cerebrospinal fluid revealed WBC 468/tzL, protein 660 mg/dL, and glucose 4 mg/dl. The cultures of spinal fluid and blood subsequently grew group B streptococcus. Despite antibiotic therapy with ampicillin 300 mg/kg/day and gentamicin 7.5 mg/kg/day, the infant's condition deteriorated and she required mechanical ventilation 3 hours after admission. Generalized seizures were treated with phenobarbital, phenytoin, and diazepam. Further deterioration occurred rapidly, and the blood pressure did not respond to administration of 30 ml/kg fresh-frozen plasma and continuous infusion of increasing doses of dopamine to a maximum of 30 ug/kg/min; methylprednisolone 30 mg/kg also had no effect. After informed consent was obtained, naloxone thereby was initiated. An irfitial dose of 0.01 mg/kg intravenously had no effect on blood wessure, but a dose of 0.02 mg/kg resulted in a rise of 10 to 15 m~,Hg systolic and 5 to 10 mm Hg diastolic. The blood pressure remained high for approxi

Aortoplasty and aortic valve replacement for annuloaortic ectasia in an infant with Marfan's syndrome, forme fruste

This report describes our experience with a 4-month-old infant with annuloaortic ectasia in whom intractable heart failure developed because of acute exacerbation of aortic regurgitation. He underwent an aortoplasty with aortic valve replacement and made an uneventful recovery. Since there has been no report of a successful repair of this condition in infancy, the case is presented and relevant problems are discussed.

USE OF THE VIDEOTAPE IN THE INTENSIVE CARE NURSERY

Maternal adjustment to the birth and transport of a high risk infant can be facilitated by the use of videotape. Concerns about the infant's health, accompanied by anticipatory grieving, depression, and self deprecation reduce the mother's capacity to cope and to maintain emotional investment in her infant.Seventeen mothers were randomized into a trial designed to assess the impact of videotaped visits. Nine study mothers viewed a videotaped miniprogram of their babies and the support team within 36 hrs. of transport, in addition to standard daily communication. Eight control mothers received only standard support. Prior to discharge, all mothers were evaluated by a questionnaire (Benfield, 1976) to assess anticipatory grief and affective and behavioral reactions following the baby's transport.Results indicate significantly lower anticipatory grief scores (P<0.05) among the study group. All mothers reported that the tape helped them feel their baby was getting good care, and that the team understood their importance to the baby "to a great degree". Eight of 9 reported that the tape improved their outlook about the baby's future and their understanding of the infant's condition and special needs. Responses to open ended questions confirmed the positive quality of this experience. In our study population, the videotape improved communication between mother and staff and helped prepare her for her visit to the ICN.

Breath hydrogen excretion in normal newborn infants in response to usual feeding patterns: Evidence for “functional lactase insufficiency” beyond the first month of life

Sequential studies of morning breath hydrogen excretion were carried out in the homes of 16 normal breast-fed or formula-fed infants during the first 5 months of life. Except for two infants whose stools did not produce H2, all infants had elevated breath H2 excretion (greater than 10 parts per million) during and after the first month of life. There was a significant relationship to age (P less than 0.005) for all three measures of H2 excretion (4-hour average, peak, and preprandial), with mean values being highest in month 2, elevated but lower in month 1, and dropping significantly in months 3 and after. Additional 24-hour studies with six 7-week-old infants demonstrated that H2 excretion was inversely related to state of arousal, more likely to be detected in the afternoon, and not clearly related to time of feeding. These findings suggest that incomplete lactose absorption in response to usual feeding patterns persists beyond the first months of life in all infants. The pattern of breath H2 excretion indicates a probable developmental change in quantity and consistency of carbohydrate substrate delivered to colonic flora. Although elevated breath H2 excretion in response to normal feeding demonstrates incomplete absorption, it should not be used to determine an infant's status as a "lactose malabsorber."

Spina Bifida: The State of the Art of Medical Management

They told me I had a baby girl. I started to cry. I wanted to hold her. That was what was supposed to happen. But they said no. And then they put me to sleep. So began the ordeal of Mr. and Mrs. A, and of their daughter, known only as Baby Jane Doe (New York Times, November 6, 1983). For Baby Jane Doe was born with spina bifida and associated defects, and her parents decided to forego corrective surgery, which, they felt, would only prolong a life of pain and suffering. While thousands of parents every year hear the sorrowful news that their newborn baby has a serious illness or some physical or mental disability, and have to make painful decisions concerning treatment for the infant, the case of Baby Jane Doe has become the occasion for a public debate about the care of all such babies. The ethical dimensions of this problem have been discussedfor at least a decade. While there is no resolution, a moderate consensus is emerging, expressed in the President's Commission 1983 report Deciding to Forego Life-Sustaining Treatment: Parents should be the surrogates for a seriously ill newborn unless they are disqualified by decisionmaking incapacity, an unresolvable disagreement between them, or their choice of a course of action that is clearly against the infant's best interests. Not everyone accepts this principle; some believe either that parents' or other family members' interests should sometimes (or always) outweigh those of the infant, or that treatment should always be mandated, no matter what the infant's condition. Yet even those who do accept the principle that the infant's best interests should prevail have difficulty in applying it to specific cases. The two articles that follow illustrate why. Much of the controversy about whether Baby Jane Doe should have had surgery turns on a judgment about her medical prognosis. Anthony Gallo explains in general terms and Bonnie Steinbock describes in the case of Baby Jane Doe how widely that prognosis can vary in spina bifida. Medical management depends partly on the severity of defects in a particular infant, but also on the physician's philosophy of treatment, knowledge of the latest technology, and presentation of the probable disabilities to parents. Physicians communicate to parents not only their medical judgments but also their interpretation of what the disabilities will mean to the life of the child and to the family. Moreover, when parents' decisions are challenged, as they were in the Baby Jane Doe case, the legal system becomes the locus for the discussion. Yet, as the President' s Commission pointed out, Judicial

Esophageal Spasm Associated with Apnea and Bradycardia in an Infant

A newborn infant was found to have diffuse esophageal spasm in association with apnea and bradycardia. This association has not been physiologically documented before. The infant's condition improved after the administration of glycopyrrolate, an anticholinergic agent. It is speculated that the association of esophageal spasm and bradycardia may be mediated by the vagus.

A syndrome of congenital hypoplasia of the alae nasi, situs inversus, and severe hypoproteinemia in two siblings.

Patient 1. This boy was the second of four children of healthy parents. We are not aware of any consanguinity, and no familial anomalies are known. The first and third siblings are healthy; the fourth is presented as Patient 2. The 22-year-old mother had an uneventful pregnancy and a normal delivery at term. The birth weight was 3,440 gin, length 49 cm, and head circumference 34 cm. The infant had hypoplastic alae nasi and slightly hypoplastic auricular conchae, together with a midline ectodermal scalp abnormality including an atrophic skin area over and in front of the anterior fontanelle. At 6 days of age he was discharged in clinically good condition. Two weeks later he was hospitalized because of failure to thrive, accompanied by vomiting and poor weight gain. The clinical findings included slight icterus, with a bilirubin concentration of 180 #mol/L (10.5 mg/dl), liver enlargement, and a pansystolic murmur localized mainly to the right of the sternum. Radiologic examination of the chest and lungs revealed situs inversus and cardiac decompensation. Because of his poor general condition, no further investigations could be performed regarding the nature of the suspected cardiac malformation. An ECG showed suspected signs of dextrocardia but no other conclusive signs of heart disease. Gradually increasing hypoproteinemic edema was noted, especially of the hands and feet. The hypoproteinemia could not be attributed to severe impairment of liver function or to renal protein loss. Though laboratory investigations revealed slightly increased levels of aspartate-aminotransferase and alanine-aminotransferase, the prothrombin index was normal. The liver enzyme values returned to normal after treatment for the heart failure. The serum protein concentration of 46 gm/L with an albumin level of only 22 gm/L was not affected by repeated infusions of albumin. The infant's condition was too precarious to allow further studies concerning proiein-losing gastroenteropathy or trypsinogen deficiency disease. Fibrocystic disease

Umbilical venous blood pH: a useful aid in the diagnosis of asphyxia at birth.

Umbilical venous blood, and umbilical arterial blood pH, PO2, PCO2, and base excess were determined in 453 term infants at birth. The results indicate that umbilical venous blood pH, and umbilical arterial blood pH are significantly related to each another. Acidosis, as defined by an umbilical venous blood pH less than 7 X 27, is associated with a lower PO2, a raised PCO2, and a reduced buffer base when compared with PO2, PCO2, and buffer base associated with a normal pH (7 X 27-7 X 42), or alkalosis (pH greater than 7 X 42). The infant's condition at birth was recorded using modified Apgar scores, in which the gradings were vigorous (5-6), intermediate (3-4), or depressed (0-2). In the neonatal period, neurological abnormalities occurred in infants who had been in a depressed condition at birth in the presence of acidosis. Other infants, who had been in a depressed condition with a normal pH or alkalosis and the remaining infants who had an intermediate or a vigorous condition at birth, did not manifest neurological abnormalities in the neonatal period. Our findings suggest that measurement of umbilical venous blood pH, whose values correlate well with those of umbilical arterial blood pH, in infants who are in a depressed condition at birth improves the clinical assessment of the severity of asphyxia.

Infant Cry: A Clue to Diagnosis

It has been postulated that the infant cry is a reflection of complex neurophysiologic functions and that analysis of the infant cry can be utilized to assess the infant's status. To test this hypothesis a model of cry production was developed utilizing a computer-based signal processing system that enabled the observer to relate closely the acoustic properties of the cry to the anatomic and physiologic characteristics of the infant producing the cry. The cries of 87 infants were analyzed following a standardized pain stimulus. Cry features were grouped into eight evaluative tests. Only seven of 55 apparently normal term infants had the abnormality "glottal instability" whereas 11 of 12 infants with bilirubin values in the 10 to 20 mg/100 ml range displayed the glottal instability pattern. An additional group of 17 infants with a variety of problems was studied; 14 of 17 displayed two or more abnormalities, and ten of 12 infants with respiratory disease had a unique pattern. Of particular interest was the finding of acoustical features suggestive of a constriction in the vocal tract in three infants; two of these infants were studied prospectively and subsequently were victims of sudden infant death syndrome and the third had a sibling with recurrent apnea. These results suggest that the analysis of the infant cry holds promise for detecting a number of abnormalities and may prove valuable as screening test to detect infants at risk for sudden infant death syndrome.

Neurobehavioral effects of neonatal hypermagnesemia

To investigate the effects on the newborn infant of maternal magnesium therapy for treatment of pre-eclampsia, we studied 36 hypermagnesemic infants born to pre-eclamptic mothers treated with MgSO4, 18 neonates born to untreated pre-eclamptic mothers, and 25 infants born to normal mothers. Impairment of neuromuscular transmission, as well as neurobehavioral differences when compared to controls, were found in hypermagnesemic infants. Awareness of the changes produced in the neonate by magnesium is important for accurate clinical assessment of the infant's condition, as well as for anticipating the postnatal interaction of magnesium with other drugs administered during labor and delivery.

1981: A milestone for heart-lung transplants

Four human heart-lung transplants have been performed this year at Stanford University Medical Center, Palo Alto, Calif—one more than in all the previous history of this procedure. Three of the four patients are still alive. The other three such operations were carried out in the late 1960s and early 1970s (although development of the surgical techniques and early animal studies associated with heart-lung transplants date back to the 1940s and 1950s) and did not enjoy the same success. The first recipient apparently was a 2 1/2-month-old girl who was admitted to Texas Children's Hospital, Houston, with an atrioventricular canal defect and pulmonary hypertension. Because the infant's condition was considered to be nearly terminal, on Sept 15, 1968, Denton A. Cooley, MD, and colleagues transplanted into the infant the heart and lungs of a day-old anencephalic infant who was being maintained on a ventilator. The recipient infant died from pulmonary insufficiency

Perinatal factors affecting survival of very low birthweight infants — a study from two hospitals

ABSTRACT. Three hundred and seventy-seven consecutive liveborn infants with a birthweight between 500g and 1500g born at two perinatal centres in the calendar years 1977 and 1978 and 40 outborn infants in the same weight group admitted to one of the hospitals during the same period were studied. Although the survival rates in individual 100g weight groups vary between 14.3% and 97.4%, overall survival rates for inborn and outborn infants in both hospitals were similar, ranging from 69.0% to 71.5%. Twenty-two perinatal factors were found to have a significant effect on survival, of which 15 were common to the inborn populations in both hospitals. Eight of these 22 factors were indicators of intrapartum asphyxia. Multiple regression analysis showed that whereas birthweight was the most important variable influencing outcome in one hospital, the infant's condition at birth is the most important in the other. This difference may be related to the aggressive approach to perinatal intensive care of extremely preterm infants in the latter hospital.