Early Days Of Life Research Articles

Risk assessment for extending the Biopharmaceutics Classification System-based biowaiver of immediate release dosage forms of fluconazole in adults to the paediatric population.

The paediatric population undergoes developmental changes in gastric pH, gastric emptying, intestinal transit time, membrane permeability, protein binding, body water, distribution and metabolism. It is widely recognised that changes in these parameters may result in an alteration of the plasma profile and thus in key bioequivalence parameters such as Cmax (maximum plasma concentration of drug) and area under the plasma concentration vs time profile curve. The aim of this work is to assess the risk of extending the biowaiver for immediate release dosage formulations of fluconazole from the adult to the paediatric population. Fluconazole exhibits good solubility and very rapid dissolution characteristics in various pH media. The absorption of fluconazole in children is known to be complete (over 90%) and not impaired by elevated pH, which is prevalent during the early days of life. Dose numbers calculated using body surface area are less than 1. Therefore, the risk to drug absorption due to differences in gastric pH, gastric emptying, intestinal transit, membrane permeability and metabolising enzymes between adults and children is considered low. Thus, it can be safely concluded that fluconazole meets highly soluble and highly permeable criteria in the paediatric population and can be allocated to class 1 of the Biopharmaceutics Classification System (BCS) for this population as well as in adults. Additionally, fluconazole has an excellent safety profile in children, similar to that in adults. The BCS-based biowaiver claimed in adults can be safely extended to the paediatric population provided that the requirements in excipient selection and dissolution profile comparison using BCS-based dissolution conditions as stated in the biowaiver monograph for fluconazole immediate release dosage forms in adults are fulfilled.

Awareness of Jaundice among Pharmacy Undergraduates at, Karachi, Pakistan

Jaundice is the most common condition that needs medical attention in newborns. About 80% of preterm and 50% of term infants develop jaundice in their early days of life. The purpose of this study is to check the awareness of this disease amongst the undergraduate students in our society. The main underlying reason for this study is to create awareness about the disease, its symptoms. Prior to fill these questinorrae the student got a brief lecture and understanding of the disease so they can link and understand the purpose well. A yellow coloration disease, jaundice is a medical condition due to hyperbilirubinaemia or increases the levels of bilirubin in the body. Depending on the position of jaundice, i.e. pre-hepatic, hepatic or post-hepatic, cause may vary. Common symptoms are dark coloured urine or pale coloured stool. Jaundice is caused due to abnormal destruction of red blood cells because bilirubin is made as a by-product in this process. CBC, LFT and different imaging techniques are used for the diagnosis of jaundice. Exchange transfusion, phototherapy, surgery and medications are usually considered as the treatment strategies. Our survey aimed to find out its awareness among the pharmacy undergraduates at Jinnah University for Women, Karachi, Pakistan. A random and cross-sectional method was to collect the data in the month of November- December, 2014. After our survey on awareness about jaundice at JUW, we find that 98.7% pharmacy undergraduates have awareness about the term jaundice, 70% pharmacy undergraduates have awareness about the Etiology of jaundice, 88.7% pharmacy undergraduates have knowledge about the symptoms of jaundice, 47.3% pharmacy undergraduates have knowledge about the pathophysiology of jaundice, 77.3% pharmacy undergraduates have knowledge about the diagnostic tools and techniques of jaundice and 63.3% pharmacy undergraduates have knowledge about the treatment strategies of jaundice.

Diminished HLA-DR expression on monocyte and dendritic cell subsets indicating impairment of cellular immunity in pre-term neonates: a prospective observational analysis.

The risk of neonates for severe infection/sepsis is reciprocally proportional to gestational age and birth weight. As monocytes and dendritic cells (DC) are recognised key antigen-presenting immune cells, we aimed to elucidate whether neonatal age is associated with reduced expression of human-leukocyte antigen-DR (HLA-DR) antigens on subsets of monocytes and DCs. Forty-three consecutive neonates (20 male, mean gestational age 236.0±26.8 days; mean 1-min Apgar score 7.5±2.0) were included in a monocentric prospective observational analysis. Patients were grouped according to gestational age (n=15 full-term, n=28 pre-term defined as <33 weeks). Ten healthy adult volunteers were assessed also. Flow-cytometric assessment of HLA-DR expression was performed in subsets of peripheral blood myeloid and plasmacytoid DCs (MDC and PDC) and monocytes (CD14brightCD16negative/CD14positiveCD16positive/CD14dimCD16positive). Clinical and routine laboratory data were followed up. At birth, leukocyte counts were increased in full-term neonates. Monocyte counts were significantly increased in neonates when compared with adults (all P<0.05). A significant numerical increase of CD14brightCD16negative and CD14positiveCD16positive monocytes was noted in pre-term and full-term neonates (all P<0.05), while HLA-DR expression in these subsets was significantly diminished (most pronounced in pre-term infants, P<0.0001). MDC and PDC HLA-DR expression was reduced also (all P<0.05). Clinical indices (e.g., pH, days on antibiotics/mechanical ventilation, fever/sepsis) were not found to correlate with immunological indices. We observed a markedly diminished HLA-DR expression on monocyte and DC subsets in pre-term and full-term neonates, which may contribute to impaired antimicrobial defence mechanisms in the early days of life.

A Giant Congenital Lobular Capillary Haemangioma

Lobular capillary haemangioma is a relatively common benign mucocutaneous lesion in paediatric age. The etiopathogenesis is not very clear, but it seems that lesions originate de novo from a process of lobular vascular proliferation that appears to be neoplastic. Congenital onset is usually very rare; it happens only in 1.1% in literature. We report a case of a newborn with a giant congenital lobular capillary haemangioma of the head (left occipital region) which increased rapidly with superficial ulcers in the early days of life. The baby was operated on by full-thickness excision using the linear closure technique; this treatment allows histological examination, ensures the most efficacy aesthetic results and gives the lowest recurrence rate.

Urea cycle disorders in Spain: an observational, cross-sectional and multicentric study of 104 cases.

BackgroundAdvances in the diagnosis and treatment of urea cycle disorders (UCDs) have led to a higher survival rate. The purpose of this study is to describe the characteristics of patients with urea cycle disorders in Spain.MethodsObservational, cross-sectional and multicenter study. Clinical, biochemical and genetic data were collected from patients with UCDs, treated in the metabolic diseases centers in Spain between February 2012 and February 2013, covering the entire Spanish population. Heterozygous mothers of patients with OTC deficiency were only included if they were on treatment due to being symptomatic or having biochemistry abnormalities.Results104 patients from 98 families were included. Ornithine transcarbamylase deficiency was the most frequent condition (64.4%) (61.2% female) followed by type 1 citrullinemia (21.1%) and argininosuccinic aciduria (9.6%). Only 13 patients (12.5%) were diagnosed in a pre-symptomatic state. 63% of the cases presented with type intoxication encephalopathy. The median ammonia level at onset was 298 μmol/L (169-615). The genotype of 75 patients is known, with 18 new mutations having been described. During the data collection period four patients died, three of them in the early days of life. The median current age is 9.96 years (5.29-18), with 25 patients over 18 years of age. Anthropometric data, expressed as median and z-score for the Spanish population is shown. 52.5% of the cases present neurological sequelae, which have been linked to the type of disease, neonatal onset, hepatic failure at diagnosis and ammonia values at diagnosis. 93 patients are following a protein restrictive diet, 0.84 g/kg/day (0.67-1.10), 50 are receiving essential amino acid supplements, 0.25 g/kg/day (0.20-0.45), 58 arginine, 156 mg/kg/day (109-305) and 45 citrulline, 150 mg/kg/day (105-199). 65 patients are being treated with drugs: 4 with sodium benzoate, 50 with sodium phenylbutyrate, 10 with both drugs and 1 with carglumic acid.ConclusionsStudies like this make it possible to analyze the frequency, natural history and clinical practices in the area of rare diseases, with the purpose of knowing the needs of the patients and thus planning their care.

Commentary on: The Lancet Series on Midwifery – Midwifery and midwives: Lives saved and better lives built

Of an estimated 139 million births globally each year, an estimated 289,000 women will die during pregnancy, labour or soon after, 2.6 million will suffer stillbirths and 2.9 million infants will die in the first month of life (Renfrew et al., 2014). Behind these figures lie individual stories of lives lost, bereavement, grief, family and social disruption, economic consequences. For many women and babies, ill health and morbidity will follow birth. Poor quality maternity and new born care is a factor. While many women have no or inadequate access to any care, others are exposed to unnecessary interventions, with underuse and overuse of treatment contributing to acute and chronic clinical and psychological morbidity for an estimated 20 m childbearing women (Renfrew et al., 2014). A significant contribution of the Lancet Series on Midwifery was to highlight the problems of inadequate or lack of care and high mortality and morbidity rates in some parts of the world but also to describe over intervention, to give prominence to a problem that often seems to be in a blind spot. It sets the foundation for a global approach to the provision of high quality care. Midwifery and midwives have the potential to resolve these problems. The Lancet Series on Midwifery offers a comprehensive evidence based framework for quality based on the needs of women and infants, supported by an explicit philosophy and framed by values and consideration of the organisation of care and the characteristics of care providers. This is a framework for quality care that has the potential not only to save lives, but to build better long term health and well-being, stronger family relationships and capability to care for the baby to adulthood. The aim of the Series was to ‘examine, comprehensively and systematically the contribution that midwifery can and does make to the care of women and infants, and the health system and other conditions for it to work effectively’. This examination started with the needs and wishes of women and babies, ‘to be healthy, safe, supported and respected to give birth to a healthy baby that can thrive’ (ten Hoope-Bender and Renfrew, 2014). The application of the evidence presented could avert more than 80% of maternal and new born deaths including stillbirths. Midwifery has a pivotal, yet widely neglected part to play in accelerating progress to end preventable mortality of women and children (Horton and Astudillo, 2014). The definition of midwifery proposed is of a package of care that can be provided by a number of caregivers, with an emphasis on ensuring that women receive the complete package of midwifery. This definition may be contentious, because it is proposed that it is not only midwives who can provide this package of care, however it is a pragmatic approach to ensure effective quality care for women and babies in services which are provided by a number of personnel, and situations in which there are no midwives, or where midwives are unable to implement their full scope of practice. Nevertheless ‘midwifery was associated with more efficient use of resources and improved outcomes when provided by midwives who were educated, trained, licensed and regulated’ (Renfrew et al., 2014) and integrated into a functioning health system as part of a multidisciplinary team (ten Hoope-Bender and Renfrew, 2014). The crucial part that midwives play is very clear. Importantly, this framework takes us beyond ‘a focus on essential and emergency interventions for the minority to skilled care for all’ to emphasising and arguing convincingly of the need for improvement in the quality of care alongside universal coverage. The approach described will provide lifesaving skills more effectively, but also ‘identifies the value of promoting and supporting the normal processes of pregnancy, birth, post partum and the early days of life, and of strengthening women's own capabilities to care for themselves and their families’. It highlights the important balance that midwifery brings to the care of mothers and infants, preventing expensive and potentially harmful interventions (ten Hoope-Bender and Renfrew, 2014). There is evidence of the effectiveness of midwifery and midwives, particularly when working in systems of care where there is continuity, where services are integrated across communities and facilities. Much of this evidence is based on high and middle income countries but modelling the scaling up of midwifery, particularly when family planning is included, could avert many maternal and infant deaths. The inclusion of specialist care in the scenarios resulted in a greater number of deaths being prevented (Homer et al., 2014). Where will the Lancet Series on Midwifery take us? How can we use the Series, which offers a quality framework (Renfrew et al., 2014), modelling of the effect of scaling up midwifery

AT1 receptor blockade abolishes metabolic and cardiovascular programming effects of neonatal obesity and undernutrition (1085.5)

The variation of litter size from rodents in the early days of life, which results in neonatal overfeeding or undernutrition, is a very useful model for the obesity study since programs the animals to become obese adults. Moreover, several studies have demonstrated the importance of the angiotensin II (ANG II) in the pathophysiology of obesity and its correlation with cardiovascular diseases. Thus, we aimed to study the role of type 1 ANG II receptors (AT1) on metabolic and cardiovascular effects induced by neonatal obesity or undernutrion programming. For this, the litters were divided into 3 groups: Normal Litter (NL, 10 pups), Small Litter (SL, 3 pups) and Large Litter (LL, 16 pups). The reduction and increment of the litter size increased and decreased , respectively, the body weight (BW) gain in SL (~25%) and LL (~19%) groups, at the weaning (21st day). Despite adult (60 days) SL rats remained with elevated BW, no differences were observed between LL and NL groups. Plasma ANG II levels are higher in both SL (~40%) and LL (~120%) groups in relation to NL at the weaning, with no differences in the adulthood. Both SL and LL groups showed an increase in visceral adipose tissue (~34 and 19%), obesity Lee index (~4 and 3%), and mean arterial pressure (~12 and 10%) in relation to the NL group, respectively. The treatment with losartan (AT1 receptor antagonist) in the drinking water (~ 8 mg / kg / day) from 30 to 60 days of age reduced the visceral adipose tissue weight, Lee index and mean arterial pressure from SL and NL groups. Our data suggest that AT1 receptors are essential for the programming of obesity and hypertension due to neonatal overnutrition or undernutrition.Grant Funding Source: Supported by FAPESP

Neonatal neurobehavioral assessment in healthy and at-risk infants

Beyond the prematurity several factors can interfere with the neurobehavioral responses of newborn infants in their early days of life [1]. Indeed, although the modern medicine have reduced the impact of many preand peri-natal risks factors, there are many others – such as adverse effects of prenatal toxic substances, fetal growth problems, hyperbilirubinemia, perinatal asphyxia, acute fetal distress and gestational and pre-gestational diabetes – that remained unchanged [2]. The possible influence of these factors on infants’ behavioral response profiles suggests that, even if born at term, these infants are at-risks of adverse outcomes [3]. For istance, several studies about infants of drugs-addicted mothers indicate neurobehavioral problems in the neonatal period; the most common findings in the infant’s neurobehavior are problems of states regulation, irritability, difficult consolability, instable motor control [1]. This neurobehavioral dysregulation predicts behavior problems in childhood and long term cognitive, emotional and behavioral disturbances [4]. It has been suggested that these behavior outcomes are originated by multiple pathways, direct and indirect [5]: the direct path is tought to be a “true” teratogenic drugs effect, including epigenetic mechanisms [6], whereas the indirect path is represented by a cascade of social, environmental, maternal (e.g., mother’s psychic state) conditions that can interfere with a normal attacchment process [7]. Indeed, newborn behavioral dysegulation may interfere with the first steps of bonding because the parents may have difficulties to know the infant’s competencies or to be unable to see them for their emotional state: the inadequate capacity of understanding infants’ signals, the difficulty of effective soothing and regulating the infant behavior may lead to increasing maternal stress and to lowered maternal self-esteem and, consequently, hamper a harmonious mother–infant relation. Similar features emerge in the SGA/IUGR population. These infants exhibit a reduced or instable motor activity, lower capacity to respond to external stimuli, self-quieting difficulties, poor state regulation, more stress/abstinence signs [3]. These neurobehavioral features reduce, as in drug-addicted mothers, the mothers’s ability “to understand” their baby and to establish a good relation with him/her. Mother–baby bonding appears at risk even in the populations of adolescent mothers who are generally emotionally immature [8] and frequently affected by psychiatric disorders, such as depression, anxiety, post-traumativ stress disorder. The bonding is further threatened since these infants are disorganized, excitable, harder to comfort than other

Hepatic CYP3A expression and activity in low birth weight developing female rats

We aimed to investigate the effects of low birth weight (LBW) on the hepatic expression of cytochrome P-450 3A (CYP3A) in developing female rats. Pregnant rats were divided into two groups, a nourished group and an under-nourished group. The offspring of the nourished rats were defined as a normal weight, normal diet group (NN group). The offspring of the under-nourished rats were designated as a LBW, normal diet group (LN group). CYP3A mRNA expression, protein expression, protein localization and activity were determined. The CYP3A1 mRNA expression levels of the LN group on days 3, 21, and 56 were significantly higher than those of the same age in the NN group (P≤0.01). The mRNA expression of CYP3A2 in the LN group on day 21 was higher than in rats of the same age in the NN group (P<0.01). The staining intensity and frequency of CYP3A1-positive hepatocytes were significantly lower on days 7 and 21 in the LN group than those of rats of the same age in the NN group (P<0.05). The staining intensity and frequency of CYP3A2-positive hepatocytes on days 14 and 21 were higher in the LN group than those on the same days in the NN group (P<0.05). The mean CYP3A activity of the LN group on day 3 was significantly higher than that of the NN group (P<0.001). We found the effect of LBW on CYP3A activity was most prominent during the early days of life in rats. Investigators and clinicians should consider the effect of LBW on CYP3A in both pharmacokinetic study design and data interpretation, when prescribing drugs to LBW infants.

Pain in Premature Infants: What Is Conclusive Evidence and What Is Not

Premature infants spend much of their early days of life in an environment that is stressful and in many situations painful. Short and long term consequences of pain are not well documented, yet postulated to have a negative impact on stress-response systems and on deployment. To date there is insufficient evidence for the best methods to assess or to effectively treat their pain. Though a variety of uni- and multidimensional assessment tools are available, many lack sufficient psychometric testing, do not incorporate essential developmental cues to premature infants, and do not distinguish between acute and chronic pain. This review paper will discuss the etiology, sources, and manifestations of pain as well as the short and long term consequences of pain. The available assessment tools for pain in premature infants along with reliability and validity will also be presented.

PH, Temperature, Hydration of the Stratum Corneum of the Dorsal Hand and the Cord Area, and Acid Mantle Formation during Early Days of life in High-risk Newborns

The study was done to explore variations in physiologic parameters of the stratum corneum (SC) of the dorsal hand and cord area during early days of life in high-risk newborns. In this longitudinal study, a total of 77 high-risk newborns were assessed for pH, temperature and hydration of the SC of the dorsal hand and the cord area on the 1st, 2nd, 3rd, 5th and 7th days of life. Results showed that an acid mantle (AM) was formed in 57.1% for dorsal hand and 35.1% for cord area, implying significant delay regardless of decrease in pH (F=103.60, p<.001), and hydration (F=4.00, p=.003) across days in both areas. Peripheral hypothermia with low hydration level was also observed in both areas. There was a positive relation between hydration and temperature (.14<r<.27, p<.010), and negative relation between hydration and pH in both areas (-.23<r<-.15, p<.010). Antibiotics may play a positive role in AM formation. High-risk newborns may experience delay in acid mantle formation on SC, hypothermia and decreases in hydration on peripheral sites during the first 7 days of life.

Administration of clomipramine to neonatal mice alters stress response behavior and serotonergic gene expressions in adult mice

Early life exposure to antidepressants frequently occurs when pregnant mothers take the medication during late pregnancy. Previous studies in animal models have shown that early exposure to certain antidepressants can alter some behaviors in adulthood. We examined whether the administration of clomipramine, a serotonin reuptake inhibitor, to neonatal mice could result in depression-related behavioral alterations in adult mice. In addition, in an attempt to uncover the mechanism underlying these behavioral changes, we examined the expression of candidate genes in different areas of the brain. Here we show that mice chronically injected with clomipramine specifically during early postnatal development demonstrated depression-like behavior as well as altered stress responses in adulthood. An analysis of the expression of serotonergic genes after exposure to social defeat stress revealed small but significant changes in the expression of 5-HT1A receptor gene (Htr1a) and 5-HTT gene (Slc6a4) in the mice treated with clomipramine compared with the mice injected with saline. We concluded that antidepressant exposure in early days of life could alter stress-related behavior in adulthood and that the behavioral alterations are accompanied by altered serotonergic gene expressions.

Normal oscillometric heart rate of term African infants in the early days of life

Background: Heart rate (HR) measurement is an important means of evaluating clinical status of newborns. Differences in HR between caucasian and negroid infants have been reported. Clinical estimation of HR is less accurate than estimates using devices.Aim: To establish the normal HR of term negroid newborns in the early days of life using an oscillometric device.Methods: The mean of three HR readings of consecutively recruited term newborns was obtained with Dinamp 8100 monitor (Critikon, Tampa, FL). On recruitment, the infants were aged between 1 and 4 days. Gestational age was determined by menstrual dates and the Dubowitz method.Results: A total of 473 term newborns were recruited, 229 (48·4%) of whom were males. Median HR was 132 (range 90–189) beats per minute (bpm). The lowest median HR (130 bpm) was obtained on the 3rd day of life and this was significantly different from the highest value of 138 bpm recorded on the 4th day of life (P = 0·025). The 5th and 95th percentiles were 111 and 158 bpm, respectively.Conclusion: The lower limit of the range of oscillometrically generated normal HR in term African newborns in the early days of life is lower than that which is commonly used in clinical practice.

Physiological basis of food intolerance in VLBW

To provide an overview on the role of gut immunity, nervous system and motility patterns in the development of feeding intolerance in newborns. Maturation of the GI is important not only for digestion and absorption, but for endocrine and exocrine function as well. There is little data available about the development of the motility function and of the mucosal barrier of the human gut, and in particular about the motility patterns and mucosal changes in newborns during early days of life. It is known that functional maturation of the gastrointestinal tract is quite different over time with respect to its anatomical development. Besides, the gastrointestinal tract through innate and specific immunologic factors, acts as a defense against ingested antigens. In addition to the mucous membrane integrity and digestion, numerous specific immunologic cells and mediators orchestrate such defensive mechanisms. In case of food antigens, the outcome is usually in favor of tolerance. Defects in that barrier, however, can lead to the development of aberrant immunologic responses, including hypersensitivity reactions. It is obvious that an appropriate feeding regimen during early infancy is in favor of food tolerance. However, in addition to genetic predisposition, development of tolerance is facilitated by an adequate gut barrier (immune or nonimmune), well-coordinated GI motility and nervous network, and appropriate food regimen.

An unusual lateral nasal wall mass: Heterotopic glial tissue

To describe clinical, radiologic, and histological features of a heterotopic glial tissue presented as a rare cause of lateral nasal wall mass in a child. The medical record of 13-month-old male who was referred to a tertiary care pediatric hospital for assessment of a nasal mass was reviewed. Data included relevant history and physical examination, diagnostic work up, and management. The child presented with a slowly growing nasal mass located on the right lateral nasal wall since the early days of life. The mass started to cause external deformity of the nose. The child had no difficulty breathing through nose, no epistaxis, no recurrent sinus infection, and no snoring. Physical examination revealed a mass located on the right lateral nasal wall causing displacement of the nose to the left. MRI of the face documented a lobulated mass located in the region of nasal process of the right maxillary bone. There was no definite intracranial extension. CT demonstrated a mild enlargement of the foramen cecum. Upon resection of the mass, histologic evaluation showed glial tissue intermixed with fibrous bands. Immunohistochemical staining documented positive glial fibrillary acid protein confirming heterotopic glial tissue. At 7 month follow-up, the surgical site was healed with no evidence of recurrent lesion. Heterotopic glial tissue, although uncommon, should be considered in the differential diagnosis of a lateral nasal wall mass in children.

The impact of maternal malaria on newborns

Each year, malaria threatens 125 million pregnancies, and gestational malaria is responsible for up to 200,000 infant deaths in sub-Saharan Africa. With advancing knowledge of malaria in pregnancy and its impact on newborns, improved preventive and therapeutic interventions are possible. We reviewed and, by consensus, evaluated published literature relevant to malaria and newborns. Important findings are summarised. Pregnant women are more likely than others to be inoculated with and infected by malaria parasites. Poor outcomes are particularly common in primigravid women and their offspring. The placenta is affected through cellular adhesion, cytokine production and mononuclear cell infiltrates. As a result, newborns may have low birthweight owing to intrauterine growth retardation or prematurity. Recent evidence suggests that a subset of these infants is also at higher risk of malaria infections later in life. Preventive strategies to improve maternal and fetal outcomes include intermittent preventive treatment and insecticide-treated bed nets. Asymptomatic malaria infection is not uncommon in newborns, and symptomatic disease occurs. Fever and death are possible during the early days of life, and presentation with a sepsis-like illness can occur during the 1st 2 months of life. Malaria-affected infants face higher than usual risks of infantile anaemia, subsequent malaria infection and death during the 1st year of life. Malaria is common during pregnancy and can have serious consequences for neonatal health. Neonatal morbidity and mortality can be significantly reduced by proper implementation of insecticide-treated nets and intermittent preventive treatment.

Mapping the Landscape of Personality in Childhood and Adolescence

From infancy, children vary in their typical emotions and behaviors, and by the middle of childhood, children have richly differentiated personalities. In this paper, I review the personality differences that youths exhibit from early childhood through adolescence, using a three-part taxonomy developed by (McAdams, D. P., & Pals, J. L. American Psychologist, 2006; 61, 204–217). First, children exhibit a dispositional signature, including first temperament traits and later the Big Five personality traits, which show some consistency across situations and over time. Second, youths display characteristic adaptations that are more specific to particular life contexts; these include mental representations, strategies, and goals. Third, adolescents form personal narratives, stories about their lives that reflect and shape their identities. I describe the differences youths exhibit in these three domains and situate these differences in the context of overall development in childhood and adolescence. New work on youths’ personalities can serve as the foundation for future lifespan perspectives on personality development. From the earliest days of life, children vary from one another in their typical emotions and behaviors. Parents often marvel at these early-emerging differences in their children. Some young children cry loudly, and often, some children squeal with delight at the sight of friendly faces or exciting toys, and some children focus intently on interesting new items and activities. As infants move into later childhood, their repertoire of behaviors grows increasingly complex, as they develop physically, cognitively, socially, and emotionally. As children’s behavioral repertoire expands, so, too, do their individual differences. By the elementary school years and continuing into adolescence, youths vary markedly from one another in many different ways: their typical emotions; their capacities for empathy, self-control, and imagination; their goals and expectations; their views of relationships and themselves; their ways of coping with stress and adversity; their emerging stories about who they are; and more. In short, by the middle of childhood, children have richly differentiated personalities. Parents, teachers, mental health clinicians, and policy makers all have a vested interest in understanding children’s personalities. Adults who care about children want to know whether children’s personalities portend and shape their life outcomes. Are children with certain personalities at risk for educational failure or for criminal behavior? What character traits and capacities are especially important for enabling children to become happy, productive, resilient people? Can children with challenging personalities be helped to develop in a positive manner? The answers to these questions are important for adults who are invested in helping children to flourish. To make good progress in answering these questions, however, it is important to begin with a clear understanding of what form children’s personalities take at various points in development. Given the dizzying

HYPOXIC ISCHAEMIC ENCEPHALOPATHY IN NEWBORN INFANTS

Neonatal encephalopathy has been defined as “a clinically defined syndrome of disturbed neurological function in the earliest days of life in the term infant, manifested by difficulty with initiating and maintaining respiration, depression of tone and reflexes, sub normal level of consciousness and often seizures”. It occurs in about 2–3 per 1000 births in developed countries. In developing countries, neonatal encephalopathy accounts for the largest number of deaths in infancy and childhood – approximately 1 million per year worldwide. Neonatal encephalopathy is associated with significant morbidity and mortality and is an important predictor of long term neurodevelopmental disability in near- and full-term newborn infants. Fifteen to 20 percent of infants with neonatal encephalopathy die in the neonatal period, and a further 25 percent have permanent neurologic deficits.

Effect of a &lt;i&gt;Lactobacillus&lt;/i&gt; Species on Incidence of Diarrhea in Calves and Change of the Microflora Associated with Growth

To evaluate the effect of Lactobacillus plantarum strain Hokkaido, which was isolated from a kind of Japanese pickle, on the incidence of diarrhea in calves and on the intestinal microflora, we performed feeding tests with a milk replacer containing Lactobacillus sp. In Experiment 1, thirty two male Holstein calves were divided into two groups, a control (C) group and LPH group. L. plantarum strain HOKKAIDO was orally administered to the LPH group for 35 days. The diarrhea score and the number of calves with watery or soft stool were significantly (p<0.05) smaller in the LPH group than in the C group. In Experiment 2, ten male Holstein calves were divided into three groups: a control group, LPH group and BOV group. Bovactin ™ was administered to the BOV group and the experimental protocol followed that of Experiment 1. No significant difference was observed in the incidence of diarrhea among the three test groups. However, when the data of Experiments 1 and 2 were pooled, the incidence of diarrhea in the LPH group was significantly (p<0.05) lower than that of the control group. These results indicate that L. plantarum strain Hokkaido reduces the incidence of diarrhea in calves. Analysis of the microflora and measurement of the stool type of the fecal samples that were collected 0, 15 and 28 days after the start of administration were performed using a T-RFLP method and visual analysis, respectively. The clustering of the T-RFLP profiles indicated that when the significance of the distributions of the samples among the clusters was tested, a significant difference (p<0.01) was observed only among the sampling-date groups. The average value of the pairwise Pearson r within each sampling-date group indicated that T-RFLP profiles varied considerably among the calves on day 0 and day 15, while the profiles of day 28 closely resembled each other. From these results, we infer that the intestinal microflora of calves are less settled in the early days of life, and this might partially explain the higher incidence of diarrhea in this period. Bacteria belonging to the class Clostridia were most predominant at all the sampling-date groups. The day 0 samples were characterized by a larger population of bifidobacteria and lactic acid bacteria (LAB). The day 15 samples were characterized by larger populations of LAB and the class Bacteroidia. The day 28 samples were characterized by a larger population of Bacteroides.

The effect of maternal breast variations on neonatal weight gain in the first seven days of life

BackgroundThis study aims to examine whether specific maternal breast variations (such as flat nipple, inverted nipple, large breast or/and large nipple) are barriers for weight gain in breastfed infants during the first seven days of life.MethodsIn this prospective cohort study, 100 healthy term neonates were followed from birth to day seven in two groups; Group A: fifty neonates born to mothers with specified breast variations and Group B: fifty neonates born to mothers without such breast variations ("normal breasts"). All neonates were the first child of their families and there was no sex ratio difference between the two groups. Neonates' weight at birth and day seven were measured and the mean weight differences in the two groups were compared using paired t-test.ResultsNeonates born to mothers without the specified breast variations had a mean weight gain of (+) 53 ± 154.4 g at day seven., Not only there was no increase in the mean weight of neonates in the other group, but they had a mean decrease of weight of (-) 162 ± 125.5 g by the seventh day of their life compared to birth weight. Thus, neonates born to mothers without breast variations had significantly greater weight gain than neonates born to the mothers with the specified variations (p < 0.01).ConclusionBreast variation among first-time mothers acts as an important barrier to weight gain among breastfed neonates in the early days of life. Health professionals need skills in the management of breastfeeding among mothers with the specified breast variations, so that mothers are given appropriate advice on how to breastfeed and overcome these problems.