Irritability In Infants Research Articles

Effectiveness of the traditional Japanese Kampo medicine Yokukansan for chronic migraine

Rationale:The traditional Japanese Kampo medicine Yokukansan (TSUMURA Yokukansan extract granules) was originally used to treat neurosis, insomnia, night crying, and irritability and/or agitation in infants and recently it has also been used for neuropsychiatric symptoms in Alzheimer's disease or other dementia in Japan. Furthermore, several recent studies have reported the efficacy of Kampo medicines for various types of headache. Here, we report a case of severe chronic migraine refractory to prophylactic therapy using various western medicines and Japanese Kampo medicines that had resulted in a leave of absence from work, but for which the frequency and severity were markedly decreased by Yokukansan (2.5 g 3 times/d), enabling the patient to return to work fully.Patient concerns:The patient was a 39-year-old woman with a diagnosis of migraine without aura, which started around the age of 17 years and had been well managed with oral triptan preparations. However, due to lifestyle changes after childbirth, the frequency and severity of migraine increased at 38 years of age, prompting her to visit our hospital.Diagnoses:Our initial examination found no neurological abnormality, and our diagnosis was also migraine without aura based on the International Classification of Headache Disorders version 3.Interventions:Her migraine had become refractory to several western medicines (lomerizine hydrochloride, propranolol, sodium valproate, amitriptyline, and duloxetine) and 2 Japanese Kampo medicines (Goshuyuto and Chotosan). The migraine episodes worsened, and consequently she took a leave of absence from work.Outcomes:Yokukansan was then tried, and this markedly improved the chronic migraine, enabling her full return to work.Lessons:Yokukansan might have exerted a prophylactic effect on chronic migraine via its action on the glutamatergic and serotonergic systems, inhibitory action on orexin A secretion, and anti-inflammatory action. Yokukansan might be useful as a prophylactic for migraine worldwide, and a future large-scale clinical study is warranted.

Fever prophylaxis can reduce vaccine responses: A caution.

Prophylactic administration of antipyretic/analgesic drugs, started at the time of immunization and repeated 6 and 12 hours later, is sometimes undertaken to reduce postimmunization fever and irritability in infants. Two recent studies showed that such prophylaxis can reduce immune responses to some infant vaccines, warranting judicious use. In contrast, implementing treatment 6 hours or more after immunization had no effect on vaccine responses and would reduce drug exposure of asymptomatic infants.

Vitamin A supplementation for the prevention of morbidity and mortality in infants one to six months of age.

Vitamin A deficiency is a significant public health problem in low- and middle-income countries. Vitamin A supplementation provided to infants less than six months of age is one of the strategies to improve the nutrition of infants at high risk of vitamin A deficiency and thus potentially reduce their mortality and morbidity. To evaluate the effect of synthetic vitamin A supplementation in infants one to six months of age in low- and middle-income countries, irrespective of maternal antenatal or postnatal vitamin A supplementation status, on mortality, morbidity and adverse effects. We used the standard search strategy of Cochrane Neonatal to search the Cochrane Central Register of Controlled Trials (CENTRAL 2016, Issue 2), MEDLINE via PubMed (1966 to 5 March 2016), Embase (1980 to 5 March 2016) and CINAHL (1982 to 5 March 2016). We also searched clinical trials databases, conference proceedings and the reference lists of retrieved articles for randomised controlled trials and quasi-randomised trials. Randomised or quasi-randomised, individually or cluster randomised trials involving synthetic vitamin A supplementation compared to placebo or no intervention provided to infants one to six months of age were eligible. Two review authors assessed the studies for eligibility and assessed their risk of bias and collected data on outcomes. The review included 12 studies (reported in 22 publications). The included studies assigned 24,846 participants aged one to six months to vitamin A supplementation or control group. There was no effect of vitamin A supplementation for the primary outcome of all-cause mortality based on seven studies that included 21,339 (85%) participants (risk ratio (RR) 1.05, 95% confidence interval (CI) 0.89 to 1.25; I2 = 0%; test for heterogeneity: P = 0.79; quality of evidence: moderate). Also, there was no effect of vitamin A supplementation on mortality or morbidity due to diarrhoea and respiratory tract infection. There was an increased risk of bulging fontanelle within 24 to 72 hours of supplementation in the vitamin A group compared to control (RR 3.10, 95% CI 1.89 to 5.09; I2 = 9%, test for heterogeneity: P = 0.36; quality of evidence: high). There was no reported subsequent increased risk of death, convulsions or irritability in infants who developed bulging fontanelle after vitamin A supplementation, and it resolved in most cases within 72 hours. There was no increased risk of other adverse effects such as vomiting, irritability, diarrhoea, fever and convulsions in the vitamin A supplementation group compared to control. Vitamin A supplementation did not have any statistically significant effect on vitamin A deficiency (RR 0.86, 95% CI 0.70 to 1.06; I2 = 27%; test for heterogeneity: P = 0.25; quality of evidence: moderate). There is no convincing evidence that vitamin A supplementation for infants one to six months of age results in a reduction in infant mortality or morbidity in low- and middle-income countries. There is an increased risk of bulging fontanelle with vitamin A supplementation in this age group; however, there were no reported subsequent complications because of this adverse effect.

Patterns of Disruptive Feeding Behaviors in Infants With Neonatal Abstinence Syndrome.

Severe irritability in infants with neonatal abstinence syndrome often impacts their ability to feed successfully, which challenges a mother's ability to demonstrate this most basic parenting skill. There is little empiric evidence to guide recommendations for practice in this population. Describe the infant behaviors that disrupt feeding in infants with neonatal abstinence syndrome. A mixed-method approach was used to describe digitally recorded infant feeding behaviors. Qualitative methodology was first used to identify categories of behaviors during the feeding. The categories were used as a coding scheme to identify the temporal sequence, duration, and frequency of behaviors observed during a feeding. The behavior categories that disrupted feeding were identified as fussing, resting, crying, and sleeping/sedated. Infants spent almost twice as much time in fussing as in feeding. The majority of the infants were fussing between 1 and 11 minutes during the feeding, and fussing disrupted feeding in every subject at least once. Feeding behavior occurred only 24% of the time, while fussing and crying occurred 51%. Fussing was the primary transitional behavior from one category to another. Infants who did not complete their feeding had nearly twice the mean number of fussing episodes as those who completed their feeding. Fussing is a transitional state and appears to provide an opportunity to test interventions that help the mothers re-engage their infants in feeding. The frequency of the behavioral transitions provides a measure of irritability that has not been previously described in this population. Additional study is needed to evaluate the impact and contributions of maternal behaviors and external variables on infant behavioral transition.

Gut Motility Alterations in Neonates and Young Infants

C olic usually affects babies in the first few weeks of their lives and persists for about 4 months. Crying can be intense and furious and it may last for several hours per day for several weeks. Although crying can occur at any time, it is usually worse in the late afternoon and evening, and occasionally affects the baby’s sleep. Infantile colic is not considered a disease, fulfilling instead criteria for a functional disorder. Research shows that babies with colic continue to eat and gain weight appropriately, despite the crying (1). The main risk for these babies relates to the stress and anxiety that the condition creates at home, especially when it affects the first child. The cause of colic is not known. Painful flatus may contribute to colic, but there is little evidence to prove that it is linked to digestive problems (2). Another theory is that while the digestive system is maturing, some babies are more sensitive to substances such as lactose ingested through breast-feeding and formula milk; however, evidence to support this hypothesis also is limited. Other possible causes relate to the baby’s behavior and temperament. Among the gastrointestinal (GI) factors, we focus on non-nutritive pathophysiology such as the relation of colic to gastroesophageal reflux (GER), GI motility disorders, the role of gut hormones, and intestinal microflora.

Connecting ncRNA Cigarette Smoking Studies with Tobacco Use Behaviors and Health Outcomes.

Connecting ncRNA Cigarette Smoking Studies with Tobacco Use Behaviors and Health Outcomes.

A review of nonsurgical treatment for the symptom of irritability in infants with GERD.

The purpose of this review was to assess effectiveness of nonsurgical treatment on irritable behavior of infants with gastroesophageal reflux disease. A systematic literature review was conducted. Research targeted treatment for irritability in infants with gastroesophageal reflux disease. All interventions including placebo were similar in reducing irritability. Which specific intervention is best for which infant is not yet known. Minor adverse effects that could increase discomfort in infants were found with pharmacologic treatments. Knowledge of the effects of treatment on irritability and regurgitation can assist the nurse to work with other care providers in deciding how best to treat an individual infant.

EVALUATION OF FEBRILE URINARY TRACT INFECTION CLINICAL PRACTICE GUIDELINES IN THE PEDIATRIC EMERGENCY ROOM.

Introduction Urinary tract infections (UTIs) are a common cause of fever and irritability in infants and young children. Multiple UTIs may cause significant renal scarring, possibly resulting in long-term morbidity, including poor somatic growth, chronic renal insufficiency, hypertension, and pregnancy-induced hypertension. Therefore, it is important to make an accurate diagnosis of a UTI and structural renal tract anomalies. Appropriate treatment must include management of the acute infection and possible intervention to prevent further infections. Despite the value of treatment guidelines in patient care, the judgment of a physician can often take precedence. The purpose of this study was to compare current guidelines with emergency physicians9 practices. Methods In January 2005, a UTI Working Group at BC Children9s Hospital (BCCH) implemented the most recent clinical practice guideline for febrile UTIs for children under 2 years of age presenting to the emergency department. A chart review was performed on all children diagnosed with a febrile UTI between January 1, 2005, and December 31, 2005, at BCCH. Data were recorded for all diagnostic tests ordered, the results of each test, what treatment was given, and what follow-up each patient received. Results During 2005, 149 children were diagnosed with a UTI. All patients had a urinalysis and a urine culture performed. A renal sonogram was ordered for 141 of 149 patients (95%), and 129 of 149 patients (87%) received an acute-phase renal cortical scan. In addition, all children received parenteral or oral antibiotics as part of their management. Outpatient therapy was provided for 119 of 149 patients (80%). Conclusions The current UTI clinical practice guideline is being followed by emergency physicians at BCCH. Physician adherence to the current treatment guideline indicates a concordance between emergency physicians9 practices and established standards of care.

Antibiotics for acute pyelonephritis in children

AbstractBackgroundUrinary tract infection (UTI) is one of the most common bacterial infection in infants. The most severe form of UTI is acute pyelonephritis, which results in significant acute morbidity and may cause permanent renal damage. Published guidelines recommend treatment of acute pyelonephritis initially with intravenous (IV) therapy followed by oral therapy for seven to 14 days though there is no consensus on the duration of either IV or oral therapy.ObjectivesTo determine the benefits and harms of different antibiotic regimens for the treatment of acute pyelonephritis in children.Search strategyWe searched the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, reference lists of articles and abstracts from conference proceedings without language restriction.Date of most recent search: June 2004.Selection criteriaRandomised and quasi‐randomised controlled trials comparing different antibiotic agents, routes, frequencies or durations of therapy in children aged 0 to 18 years with proven UTI and acute pyelonephritis were selected.Data collection and analysisTwo reviewers independently assessed trial quality and extracted data. Statistical analyses were performed using the random effects model and the results expressed as relative risk (RR) for dichotomous outcomes or weight mean difference (WMD) for continuous data with 95% confidence intervals (CI).Main resultsEighteen trials (2612 children) were eligible for inclusion. No significant differences were found in persistent renal damage at six months (one trial, 306 infants: RR 1.45, 95% CI 0.69 to 3.03) or in duration of fever (WMD 0.80, 95% CI ‐4.41 to ‐ 6.01) between oral cefixime therapy (14 days) and IV therapy (three days) followed by oral therapy (10 days). Similarly no significant differences in persistent renal damage (three trials, 315 children: RR 0.99, 95% CI 0.72 to 1.37) were found between IV therapy (3‐4 days) followed by oral therapy and IV therapy for 7‐14 days. In addition no significant differences in efficacy were found between daily and thrice daily administration of aminoglycosides (one trial, 179 children, persistent symptoms at three days: RR 1.98, 95% CI 0.37 to 10.53).Authors' conclusionsThese results suggest that children with acute pyelonephritis can be treated effectively with oral cefixime or with short courses (2‐4 days) of IV therapy followed by oral therapy. If IV therapy is chosen, single daily dosing with aminoglycosides is safe and effective. Trials are required to determine the optimal total duration of therapy and if other oral antibiotics can be used in the initial treatment of acute pyelonephritis.Plain language summaryOral antibiotics may be as effective as the combination of injection and oral antibiotics for kidney infections in childrenAcute pyelonephritis refers to infection of the kidneys and is the most severe form of urinary tract infection (UTI). It causes high fever, vomiting, stomach pain, irritability and poor feeding in infants. Usual treatment is antibiotics given first by injection (IV) and then orally for 7‐14 days to clear the infection and prevent kidney damage. These results suggest that children with acute pyelonephritis can be treated effectively with oral cefixime or with short courses (2‐4 days) of IV therapy followed by oral therapy. If IV therapy is chosen, single daily dosing with aminoglycosides is safe and effective. Copyright © 2006 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

Relations Between Measures of Irritability and Contingency Detection at 6 Months

AbstractThe hypothesis that irritability and contingency detection are negatively correlated was examined in thirty‐one 6‐month‐old infants. Observation and maternal report‐based assessments of irritability were correlated with both a criterion score and a continuous score of contingency detection. Results indicated that greater irritability in infants was associated with lower contingency detection scores. Discussion focuses on identifying processes by which the 2 constructs may be associated.

THE ASSOCIATION OF AN INCREASED URINARY CALCIUM-TO- CREATININE RATIO, AND ASYMPTOMATIC GROSS AND MICROSCOPIC HEMATURIA IN CHILDREN

The role of hypercalciuria for the evaluation of unexplained asymptomatic gross and microscopic hematuria in children remains unclear, as evidenced by conflicting reports in the literature. We study the function of hypercalciuria in these patients, and determine whether routine evaluation of urine for hypercalciuria and treatment with thiazide diuretics, based on the results of a urinary calcium-to-creatinine ratio, is necessary. We also wanted to compare the yield of a urinary calcium-to-creatinine ratio in patients with gross and microscopic hematuria subgroups. Between 1991 and 1998 we treated 96 patients with microscopic hematuria (group 1) and 46 with gross hematuria (group 2). All patients had isolated unexplained hematuria. Patients with organic and anatomical causes, including urinary tract infection and other urinary symptoms, were excluded from the study. Nephrological urine and serum analyses in patients with hematuria were otherwise normal, as were all imaging studies. Group 1 included 50 males and 46 females, with a mean age of 7.6 years (range 1 to 14), and a spot urinary calcium-to-creatinine ratio was done in 79. Group 2 included 35 males and 11 females, with a mean age of 8.5 years (range 8 months to 14 years), and a spot urinary calcium-to-creatinine ratio was done in 43. A ratio of 0.2 or greater was considered hypercalciuria. The season of presentation was noted to determine any pattern. There were no seasonal variations regarding presentation. Followup of 34 patients in group 1 and 15 group 2, with a mean followup of 10.6 months (range 1 month to 8 years), was available. A total of 28 (82.3%) patients in group 1 and 15 (71.4%) group 2 had complete resolution of hematuria. However, there were 6 patients in both groups who had persistent hematuria but remained totally asymptomatic. Hydrochlorothiazide was used in only 2 patients in group 1 and 1 group 2 due to intractable hematuria on expectant management, a markedly increased urinary calcium-to-creatinine ratio and positive family history of urolithiasis. Although we cannot establish a direct cause and effect relationship, hypercalciuria is detected in a substantial number of cases of unexplained gross and microscopic hematuria. However, based on our study we do not recommend treatment with thiazide diuretics in all patients diagnosed with hypercalciuria, as hematuria resolved in a majority with observation or expectant treatment and minor dietary modification. We reserve treatment with thiazide diuretics only for those patients with intractable hematuria, a markedly increased urine calcium-to-creatinine ratio and family history of urolithiasis

Irritability and dysuria in infants with idiopathic hypercalciuria

Idiopathic hypercalciuria (IH) is being diagnosed with increasing frequency in the pediatric population and occurs in approximately 2.9-6.2% of normal children. The majority of children with IH are asymptomatic; however, the most common clinical presentation is that of isolated hematuria (gross or microscopic). The prevalence, presentation and clinical course of IH is less well established in infants. We have recently seen two young infants with IH who had dysuria on presentation. Their hypercalciuria was difficult to manage and required frequent manipulations of drug therapy and diet restrictions. These cases emphasize the importance of evaluating infants with dysuria and irritability for IH, even in the absence of hematuria. Further studies are needed to establish the prevalence and classical presentation of IH in this population, and to determine the necessary duration of therapy.

Diffuse esophageal spasm: A cause of paroxysmal posturing and irritability in infants and mentally retarded children

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An association between herbal medicine ingestion and renal failure in Zambian infants.

A syndrome of renal failure and cerebral irritability in infants following the ingestion of a herbal medicine used (apparently effectively) in the treatment of diarrhea is described. The coincidence of the use of medicine made from roots and renal failure is highly suggestive of a direct cause and effect. Optimal management would appear to be rehydration with fluids appropriate to the blood chemistry care being taken not to overload the circulation; cautious maintenance therapy; and dialysis in the event of serious biochemical disturbance. Phenobarbitone would appear to be indicated to prevent convulsions the dose being adjusted to take account of the degree of renal failure. It is not possible from the cases studied to give a true estimate of prognosis from this rather biased series of 10 children. With frank renal failure it would appear to be poor. About 50% of such children die. However a much higher proportion of children with gastroenteritis receive herbal medicines and do not show evidence of renal failure--so the children presented in this series may only represent those who have received an overdose. However no children with this clinical picture have been seen who have not received herbal medicines orally.

The present state of infant and child feeding in the Eastern Mediterranean Region.

This paper describes the infant and child feeding practices in the Eastern Mediterranean Region where the crude birth rate is 19-50/1000 and the infant mortality rate ranges from 20-200/1000 live births. Wide variations in the incidence and duration of breast feeding exist in the Region depending on the rate and extent of development modernization urbanization exposure to artificial foods and bottle feeding commercial advertising western trained professionals and maternal behavior. Prolonged breast feeding (18-24 months) is prevalent in all rural communities and among most low-income groups. However the duration of breast feeding is becoming increasingly shorter among the younger generations. The duration of exclusive breast feeding varies from 2-18 months. The highest frequency of introducing soft foods is between 6-9 months. The onset of subsequent pregnancy and milk inadequacy are the major causes for terminating breast feeding. Hazards of bottle feeding are exclusive feeding following early abrupt weaning under 3 months and mixed feeding. These hazardous patterns are predominent in the Gulf countries and in Libya. A study of Kuwaitis in 1978 indicates that out of a sample of 509 infants 86.1% were artificially fed. These patterns are associated with repeated episodes of diarrhea dehydration and cholera epidemics. Bottle feeding under the age of 3 months is responsible for the increase of malnutrition in the region. Evidence of breast feeding resurgence among women of the urban elite is not in view. Several aspects of breast feeding recur in several areas of the Region: 1) eye cosmetics containing lead are applied to the infant causing toxis infection 2) Qat is consumed in increasing epidemic proportions possibly causing adverse effects 3) poppy seeds often cause marked irritability in infants and 4) menstrual taboos and the evil-eye each affect the ability to breast feed.

SCHMERTZLER E: INTERRELATIONSHIP OF CALCIUM AND MAGNESIUM IN THE MATURE NEONATE.

The ions of calcium, magnesium, potassium, and sodium may be involved singly or in combination in the alteration of neuromuscular irritability in infants and children. Of these the role of magnesium in the neonatal period has received the least attention. Although hypocalcemia is generally considered the most important factor responsible for initiating tetany, the level of other cations may under certain conditions influence the production of tetanic manifestations. It has been demonstrated by several investigators that for normal neuromuscular activity a certain ratio of the concentrations of serum potassium and calcium should exist. Harrison et al 1,2 reported that when their patients with sprue had hypokalemia they showed none of the manifestations of tetany even though hypocalcemia was present. Engle et al 3 demonstrated that administration of potassium salts to asymptomatic hypocalcemic and hypokalemic patients may induce active tetany. Harbaugh and Dennis 4,5 noted, in their studies in cattle with

PSYCHOSOMATIC FACTORS WITH PARTICULAR REFERENCE TO THE PARENTS OF THE COLICKY INFANT

Whatever the etiology of colic in infancy, and multiple causes seem most likely, there is little doubt that emotional factors enter the picture. Whether these constitute one of the causes of colic on only intensify it, is at present impossible to determine. Some investigators have found the colicky infant to be hypertonic, tense, fussy, unhappy even before the onset of specific symptoms. McGee in 1943 suggested that fetal hiccoughs were common in babies who later developed colic. Spock has emphasized that fatigue of the infant in late afternoon may be a factor, and Gesell has pointed out that there is heightened tension and increased irritability in infants, starting at about 4 weeks of age and continuing to 2 on 3 months, as evidence by increased appetite, more frequent crying, and greaten difficulty in getting to sleep. Wessel and others have found family tensions greater and more frequent where there are colicky babies than where the infants are contented. The mother of the infant with colic has been described as tense, anxious, uncertain, inconsistent in her handling of the baby and often rejecting him. The psychiatrist's explanation of the reasons for this personality includes early rejection of the baby, rivalry with infant on husband, conflicts about accepting the feminine or maternal role and her dependency needs. A simpler explanation would seem to be that as it is the mother who first responds to the infant's needs, she feels frustrated and concerned if she is unable to satisfy them. Feeding is the focus of the first emotional relationship between the mother and child, and if this does not go well, the mother may become very upset.

Infantile cortical hyperostosis (Caffey-Smyth syndrome).

IN THE year 1945 Caffey and Silverman¹first described a new syndrome which they called "infantile cortical hyperostosis." At about the same time Smyth, Potter, and Silverman²reported independently a group of cases with similar changes under the title of "Periosteal Reaction, Fever and Irritability in Young Infants." Ross and Burke³suggested the name Caffey-Smyth for this new syndrome. It is a distinct clinical entity occurring in early infancy, usually before 3 months of age. It is characterized by a typical facial appearance, swelling of soft tissue, and roentgenographic changes in various bones, especially mandible, clavicles, scapulas, and ribs. Most of the cases have associated fever, anemia, and irritability. The etiology of the disease is obscure. The active manifestations subside completely after a variable period, usually within weeks, with no serious complications and no sequelae. The condition is now known to be not uncommon in pediatrics. We