Infants Of Low Socioeconomic Status Research Articles

Manual exploratory behaviors in six-month-old infants at environmental and biological risk

BackgroundExploratory behaviors are essential and may improve different skill development. Different risk factors may negatively impact neuromotor development, such as biological risk and environmental risk. ObjectiveAssess and discriminate exploratory behaviors of infants at environmental or biological risk and infants at non-risk. MethodsSixty-four six-month-old infants were divided into three independent groups: Group 1 (G1), 28 healthy full-term infants; Group 2 (G2), 21 full-term infants of low socioeconomic status (SES); Group 3 (G3), 15 very preterm infants. Nine exploratory behaviors were assessed: fingering, mouthing, waving, tapping, banging, transferring, rotating, alternating, and squeezing. ResultsFor the malleable object, fingering (p = 0.005) and transferring (p = 0.046) behaviors were different between G2 and G3 whereas waving behavior (p = 0.041) differed between G1 and G3 and transferring (p = 0.003) between G1 and G2. For the rigid object, waving was different between G1 and G3 (p = 0.018) whereas transferring behavior differed between G2 and G3 (p = 0.019). Total number of behaviors was significantly different between G1 and G2 for malleable (p = 0.019) and rigid objects (p = 0.009). Intragroup analysis revealed differences between malleable and rigid objects for transferring (p = 0.013), squeezing (p < 0.0001), fingering (p < 0.0001), and banging (p = 0.013) behaviors in infants from G1. Fingering and squeezing (p < 0.0001) were different between malleable and rigid objects in G2 (p = 0.009 and p < 0.0001) and G3 (p = 0.004 and p < 0.0001). ConclusionRisk factors and object properties influence exploratory behaviors, mainly in low SES infants. Fingering and banging behaviors are favored by rigid objects, while squeezing is favored by malleable objects.

Socioeconomic disparities and infancy growth trajectory: a population-based and longitudinal study

BackgroundThe association of low socioeconomic status (SES) with childhood and adolescent obesity has been reported. It is unknown whether low SES affects body mass index (BMI) growth trajectory in the first 12 mo of life. Moreover, accelerated growth as a compensatory mechanism for low birth weight (LBW) during infancy, is an important predictor of later obesity. The aim of the present study was to examine the association of low SES with infancy BMI growth rate and trajectory for LBW and normal birth weight (NBW) infants.MethodsFrom September 2012 to October 2014, a total of 387 infants in this longitudinal study was subjected to repeated measures of weight and length from birth to 12 mo in Hefei. Generalized growth mixture modeling was used to classify the infancy BMI growth trajectories. Differences in infancy BMI z score (zBMI) and BMI growth rate between low SES and high SES were estimated based on linear regression after adjusting for several confounders including maternal age, pregnancy BMI, physical activity during pregnancy, paternal BMI as well as alcohol use, paternal smoking status, breastfeeding duration and delivery mode.ResultsInfancy BMI trajectories in this study were classified into three categories: rapid growth (class 1), normal growth (class 2) and slow growth (class 3). Low SES infants had the higher zBMI than high SES infants for LBW group at age 6 mo [zBMI difference with 95% CI at 6 mo: 0.28(0.03, 0.53); at 12 mo: 0.21(0.01, 0.43)]. Low SES infants had more rapid zBMI growth rate than those with high SES for low birth weight between 0 and 6 months. Controlling for the confounders, these associations remained robust. We found the lower SES in the rapid growth group.ConclusionsThese findings highlighted the impact of low SES on increasing BMI and accelerated growth during early infancy. Health care and relatively optimal family environment in the first 12 mo of life, especially for LBW infants, are benefit to shape the better infancy growth trajectory.

Randomized Manipulation of Early Cognitive Experience Impacts Adult Brain Structure.

Does early exposure to cognitive and linguistic stimulation impact brain structure? Or do genetic predispositions account for the co-occurrence of certain neuroanatomical phenotypes and a tendency to engage children in cognitively stimulating activities? Low socioeconomic status infants were randomized to either 5 years of cognitively and linguistically stimulating center-based care or a comparison condition. The intervention resulted in large and statistically significant changes in brain structure measured in midlife, particularly for male individuals. These findings are the first to extend the large literature on cognitive enrichment effects on animal brains to humans, and to demonstrate the effects of uniquely human features such as linguistic stimulation.

Turning 1 Year of Age in a Low Socioeconomic Environment: A Portrait of Disadvantage.

To evaluate maternal, home, and neighborhood environment of low and higher socioeconomic status (SES) infants from birth to 1 year and to evaluate the impact of SES and environment on infant developmental outcome at 1 year. Low (n = 30) and higher SES (n = 30) African-American mothers and their healthy term gestation female infants were prospectively compared for environmental characteristics and infant developmental outcome. Wechsler Adult Intelligence Scale-IV (WAIS-IV); Beck Depression Inventory; Perceived Stress Scale; Parenting Stress Index-Fourth Edition (PSI-4); Social Support Scale; Home Observation Measurement of the Environment (HOME); Household Food Insecurity (HFI); Concentrated Neighborhood Disadvantage (CND). Bayley Scales of Infant Development Third Edition (BSID-III); Preschool Language Scale (PLS-5). Environmental risk was greater for low compared with higher SES: lower WAIS-IV (p < .001); higher PSI-4 total (p = .003); lower HOME total and 3 subscales (p < .002); higher HFI (p = .012); and higher CND (p = .027). Low SES infant outcomes differed from higher SES: lower BSID-III Cognitive Composite (p = .005), PLS-5 Total Language (p ≤ .017), and Auditory Comprehension (p ≤ .008). In regressions, after controlling for SES, effects of environmental factors were not found. By age 1, low SES infants had been exposed to greater environmental disadvantage and already exhibited poorer developmental functioning than higher SES infants. These findings suggest that support for families and children from impoverished circumstances cannot begin too early.

Socioeconomic status (SES) affects means–end behavior across the first year

This study assessed the impact of SES on early means–end behavior. Sixty-one 6- to 8- and 10- to 12-month-old infants from high and low SES families were presented with two tasks requiring a two-step process to retrieve a toy. On the cloth task, overall performance improved with age, but low SES infants showed delays. Performance by the 10- to 12-month-old low SES infants was identical to that of the 6- to 8-month-old high SES infants. On the hook task, again overall performance improved with age, but significant SES differences emerged at 10 to 12months, with only 20% of low SES infants succeeding at the task, compared to 73% of high SES infants. The results suggest a divergence in means–end behavior between high and low SES infants by 6months of age, adding to the well-known documentation of gaps in cognitive skills evident between high and low SES infants.

A stepped intervention increases well-child care and immunization rates in a disadvantaged population.

To test a stepped intervention of reminder/recall/case management to increase infant well-child visits and immunization rates. We conducted a randomized, controlled, practical, clinical trial with 811 infants born in an urban safety-net hospital and followed through 15 months of life. Step 1 (all infants) involved language-appropriate reminder postcards for every well-child visit. Step 2 (infants who missed an appointment or immunization) involved telephone reminders plus postcard and telephone recall. Step 3 (infants still behind on preventive care after steps 1 and 2) involved intensive case management and home visitation. Infants in the intervention arm, compared with control infants, had significantly fewer days without immunization coverage in the first 15 months of life (109 vs 192 days P < .01) and were more likely to have >or=5 well-child visits (65% vs 47% P < .01). In multivariate analyses, infants in the intervention arm were more likely than control infants to be up to date with 12-month immunizations and to have had >or=5 well-child visits. The cost per child was $23.30 per month. This stepped intervention of tracking and case management improved infant immunization status and receipt of preventive care in a population of high-risk urban infants of low socioeconomic status.

Socio-economic and environmental factors influence energy utilization in Brazilian breast-fed infants.

Energy intake recommendations for infants are based on data from industrialized countries. FAO/WHO/UNU expressed the need for studies on total energy expenditure (TEE) and basal metabolic rate from developing countries covering current and changing lifestyles. For this observational study, 65 infants of differing socioeconomic status (SES) (n = 32 middle SES, n = 33 low SES) were selected in Pelotas, southern Brazil, aiming to: 1) compare TEE, minimum observable energy expenditure (MOEE), activity energy expenditure (AEE) between breast-fed infants 8.7 mo of age from middle and low SES; and 2) investigate the effect of potential mediating factors on TEE and AEE. TEE and total body water were measured with doubly labeled water, MOEE with respiration calorimetry, breast milk intake using the dose-to-the-mother deuterium-oxide turnover method, food intake using 1-d food weighing, and prevalence of overweight using BMI Z-scores. TEE adjusted for ethnicity was 257 (95% CI 232-281) kJ/(kg . d) in middle SES infants vs. 318 (95%CI 294-342) kJ/(kg . d) in low SES infants (P = 0.001). MOEE did not differ between groups and the difference in TEE was therefore attributed to AEE (P = 0.008). The effect of SES on AEE was mediated by the number of persons per bedroom (crowding). Prevalence of overweight tended to be higher in middle SES infants (P = 0.054) than in low SES infants. The difference in TEE and AEE between SES groups emphasizes the importance of an accurate description of the SES of any population in which TEE is studied and questions the extent to which TEE data from middle-class infants in transitional countries should be considered normative.

Full Breast-Feeding for at Least Four Months Has Differential Effects on Growth before and after Six Months of Age among Children in a Mexican Community

This study examines the relationship between breast-feeding and growth from 0 to 6 and 6 to 20 mo among 185 children in a Mexican community. Infants from a previous 6-mo longitudinal study were followed up for additional anthropometric measurements at a mean age of 19.9 mo. Size at 6 mo and at follow-up were modeled as outcomes of whether infants were fully breast-fed (exclusively or predominantly breast-fed) for at least 4 mo, controlling for size at birth and 6 mo, respectively, and potential confounders. From birth to 6 mo, fully breast-fed infants had ponderal index increments of 0.07 units larger (P = 0.04) than comparison infants. There were no differences in weight. For length, an interaction between full breast-feeding and socioeconomic status (SES) was found, with fully breast-fed infants of low SES growing more than comparison infants, whereas the opposite was seen at upper SES levels. From 6 to 20 mo, fully breast-fed infants had weight and length increments of 0.53 cm (P < 0.001) and 0.72 kg (P = 0.01) smaller than those of comparison infants. For ponderal index, an interaction between mother's education and breast-feeding revealed an inverted U-shaped response across levels of education. Additionally, logistic regressions of monthly breast-feeding on lagged measurements revealed that relatively heavier infants had higher odds of being fully breast-fed at 2 and 3 mo. Our findings indicate that the benefits of full breast-feeding on growth may be most pronounced early in life. Further research of unmeasured confounders may explain the association of full breast-feeding with slower growth beyond 6 mo.

Speech-like vocalizations in infancy: an evaluation of potential risk factors.

This work reports longitudinal evaluation of the speech-like vocal development of infants born at risk due to prematurity or low socio-economic status (SES) and infants not subject to such risk. Twenty infants were preterm (10 of low SES) and 33 were full term (16 of low SES), and all were studied from 0;4 through 1;6. The study provides the indication that at-risk infants are not generally delayed in the ability to produce well-formed speech-like sounds as indicated in tape-recorded vocal samples. At the same time, premature infants show a tendency to produce well-formed syllables less consistently than full terms after the point at which parents and laboratory personnel note the onset of the canonical babbling stage (the point after which well-formed syllables are well established in the infant vocal repertoires). Further, even though low SES infants produce well-formed speech-like structures on schedule, they show a reliably lower tendency to vocalize in general, as reflected by fewer utterances per minute in recorded samples.

The role of prematurity and socioeconomic status in the onset of canonical babbling in infants

The onset of canonical babbling (implying production of well-formed syllables) is a landmark event in the development of the capacity for speech, capping a series of vocal stages of the infant's first year of life. Infants who are handicapped with regard to linguistic development are, in some cases, delayed in the onset of speech-like sounds such as canonical syllables. The age of onset of canonical babbling in infants born at risk, either due to prematurity or due to low socioeconomic status (SES) has not been extensively studied. This research, based on a longitudinal investigation of babbling and other motor milestones in term and preterm infants of middle and low SES, indicates that the onset of canonical babbling is robust with regard to such risk factors. Neither preterm infants whose ages were corrected for gestational age, nor infants of low SES were delayed in the onset of canonical babbling. In fact, at corrected ages, the preterm infants appeared to begin canonical babbling earlier than their full-term counterparts. It is suggested that the greater auditory experience of the preterms in this study may account for the early appearance of canonical babbling and hand banging, both of which can be viewed as rhythmic stereotypies that may require auditory feedback for normal development. Other motor milestones studied showed neither delay nor acceleration of onset in the same infants.

Lower respiratory illness in infants and low socioeconomic status.

Infants from families of low socioeconomic status are said to suffer higher rates of lower respiratory illness, but this assertion has not been carefully examined. We studied the frequency and determinants of lower respiratory illness in infants of different socioeconomic status (n = 393) by analyzing data from a community-based cohort study of respiratory illness during the first year of life in central North Carolina. The incidence of lower respiratory illness was 1.41 in the low socioeconomic group, 1.26 in the middle group, and 0.67 in the high group. The prevalence of persistent respiratory symptoms was 39% in infants in the low socioeconomic group, 24% in infants in the middle group, and 14% in infants in the high group. The odds of persistent respiratory symptoms in infants of low and middle socioeconomic status were reduced after controlling for environmental risk factors for lower respiratory illness. Enrollment in day care was associated with an increased risk of persistent symptoms among infants of high but not low socioeconomic status. Infants of low socioeconomic status are at increased risk of persistent respiratory symptoms. This risk can be partly attributed to environmental exposures, most of which could be changed.

Follow-up of premature infants of low socioeconomic status.

Follow-up of premature infants of low socioeconomic status.

18. CONSUMPTION OF IRON FORTIFIED MILK DOES NOT MODIFY BOWEL BACTERIAL ECOLOGY

Bacterial enteropathogens (BP) were prospectively evaluated in a cohort of infants of low socio-economic status. One group consumed an iron fortified milk formula (IF) and a control group was fed a similar non fortified milk (NF). A total of 578 diarrheal (D) episodes (290 IF and 288 NF) and 615 asymptomatic (A) infants (300 IF; 315 NF) had stool cultures. The incidence of BP was similar in IF and NF infants in symptomatics (42 - 40%) and assymptomatics(15 - 13%). The number of cases with mixed bacterial infections and/or protracted excretion (>7 days), as well as the species distribution (see table) did not show significant differences between IF and NF groups, either for the diarrheal episodes or the asymptomatics.

Enteropathogens Associated with Acute Diarrhea in Hospitalized Infants

Thirty-five infants of low socioeconomic status who were living in urban Santiago were hospitalized for acute diarrhea were prospectively evaluated for the presence of enteropathogens associated with the episode. Some degree of malnutrition was evident in 20 infants (57.1%); 15 of these (75%) were under 6 months of age. Mean duration of the hospital stay was 11.8 days for well-nourished patients and 15.7 days for the malnourished patients. One or more enteropathogens were found in 60% of the cases studied: in 17 cases (48.6%) these were bacteria and in four cases (11.4%) it was rotavirus. Parasites were not detected. In three patients, two different pathogens were demonstrated. Among the bacteria, 12 isolates (34.3%) were enteropathogenic E. coli (EPEC) and two (5.7%) were Shigella. Campylobacter jejuni was also isolated from two different cases (5.7%) and Salmonella from one case (2.9%). The recovery of pathogens was independent of the nutritional status. Mean age of detection of EPEC was 3.2 months among well-nourished infants and 6.2 months among the malnourished (p less than 0.001). Half of the EPEC strains isolated were multiresistant to antibiotics. One of these strains transferred some of its resistance in vitro to E. coli K12. Ampicillin and kanamycin were the antibiotics to which EPEC showed the greatest resistance. The other bacterial pathogens were mostly sensitive to antibiotics. Campylobacter jejuni, together with Shigella, was the second most frequent pathogen isolated during episodes of diarrhea. Campylobacter should be included in the routine study of diarrheal episodes in our setting.

Enteropathogens Associated with Acute Diarrhea in Hospitalized Infants

Summary:Thirty‐five infants of low socioeconomic status who were living in urban Santiago were hospitalized for acute diarrhea were prospectively evaluated for the presence of enteropathogens associated with the episode. Some degree of malnutrition was evident in 20 infants (57.1%); 15 of these (75%) were under 6 months of age. Mean duration of the hospital stay was 11.8 days for well‐nourished patients and 15.7 days for the malnourished patients. One or more enteropathogens were found in 60% of the cases studied: in 17 cases (48.6%) these were bacteria and in four cases (11.4%) it was rotavirus. Parasites were not detected. In three patients, two different pathogens were demonstrated. Among the bacteria, 12 isolates (34.3%) were enteropathogenic E. coli (EPEC) and two (5.7%) were Shigella. Campylobacter jejuni was also isolated from two different cases (5.7%) and Salmonella from one case (2.9%). The recovery of pathogens was independent of the nutritional status. Mean age of detection of EPEC was 3.2 months among well‐nourished infants and 6.2 months among the malnourished (p &lt; 0.001). Half of the EPEC strains isolated were multiresistant to antibiotics. One of these strains transferred some of its resistance in vitro to E. coli K 12. Ampicillin and kanamycin were the antibiotics to which EPEC showed the greatest resistance. The other bacterial pathogens were mostly sensitive to antibiotics. Campylobacter jejuni, together with Shigella, was the second most frequent pathogen isolated during episodes of diarrhea. Campylobacter should be included in the routine study of diarrheal episodes in our setting.

Enteropathogens Associated with Acute Diarrhea in Hospitalized Infants

Summary: Thirty-five infants of low socioeconomic status who were living in urban Santiago were hospitalized for acute diarrhea were prospectively evaluated for the presence of enteropathogens associated with the episode. Some degree of malnutrition was evident in 20 infants (57.1%); 15 of these (75%) were under 6 months of age. Mean duration of the hospital stay was 11.8 days for well-nourished patients and 15.7 days for the malnourished patients. One or more enteropathogens were found in 60% of the cases studied: in 17 cases (48.6%) these were bacteria and in four cases (11.4%) it was rotavirus. Parasites were not detected. In three patients, two different pathogens were demonstrated. Among the bacteria, 12 isolates (34.3%) were enteropathogenic E. coli (EPEC) and two (5.7%) were Shigella. Campylobacter jejuni was also isolated from two different cases (5.7%) and Salmonella from one case (2.9%). The recovery of pathogens was independent of the nutritional status. Mean age of detection of EPEC was 3.2 months among well-nourished infants and 6.2 months among the malnourished (p < 0.001). Half of the EPEC strains isolated were multiresistant to antibiotics. One of these strains transferred some of its resistance in vitro to E. coli K 12. Ampicillin and kanamycin were the antibiotics to which EPEC showed the greatest resistance. The other bacterial pathogens were mostly sensitive to antibiotics. Campylobacter jejuni, together with Shigella, was the second most frequent pathogen isolated during episodes of diarrhea. Campylobacter should be included in the routine study of diarrheal episodes in our setting.

Lumbar puncture and the diagnosis of meningitis.

Because the symptomatology of meningitis in infancy frequently is nonspecific, interns and residents staffing a busy pediatric hospital emergency room are encouraged to perform lumbar punctures at the slightest suspicion of meningitis. The effects of this policy were investigated with regard to the number of lumbar punctures done, number of meningitis cases diagnosed, number of meningitis cases missed, and whether the degree of pyrexia and peripheral leukocytosis were helpful diagnostic clues. The results indicate that particularly when inexperienced interns and residents are evaluating young infants in whom the possibility of meningitis is raised, the only definitive diagnostic procedure is lumbar puncture. Hyperpyrexia and/or elevated peripheral white blood cell counts for not helpful in establishing the diagnosis of meningitis. Black infants of low socioeconomic status are a high-risk group for meningitis.