Months In Infants Research Articles

Faecal microflora and urease activity during the first six months of infancy.

Gastrointestinal degradation of urea might, according to a new hypothesis, have consequences for the regulation of acid-base balance as well as control of breathing during infancy. Thirteen infants were investigated from their first few days of life to the age of 6 months by collecting faecal samples at the age of 3 days, 2, 3, and 6 months, respectively. The faecal microflora was determined after aerobic and anaerobic cultivation and the faecal urease activity was assessed after 36 h aerobic and anaerobic preincubation. The infants were mostly breast fed and had a faecal microflora containing anaerobic bacteria such as Bifidobacteria, Bacterioides and Lactobacilli but also aerobics such as Escherichia coli, Enterococci and sometimes Klebsiella. The faecal pH increased from approximately 5.30 to 5.90, the pH after anaerobic preincubation being on an average 0.2 pH units lower than after aerobic preincubation. Simultaneously the nitric oxide production of the faecal specimens increased approximately 10-fold and the urease activity decreased by a factor of 3 to 5. We also found an inhibitory action of nitrate, nitrite (in mumolar concentration) and nitric oxide (in parts per million concentration) on the faecal urease activity. Hence, the present results warrant further research in order to determine more precisely the action of different concentrations of various nitrous oxides on individual bacterial species, and furthermore, to assay the faecal urease activity in victims of sudden infant death syndrome as well as in infants dead due to other causes.

Pneumonia in neonates: can it be managed in the community?

Neonatal pneumonia kills about two million children a year worldwide. The World Health Organisation recommends hospitalisation of all cases of pneumonia in the first two months of infancy. In a field trial of community based management of childhood pneumonia in Gadchiroli, India, neonatal pneumonia contributed more than half of the pneumonia deaths. Parents refused referral even when advised therefore community based health workers and traditional birth attendants managed cases of neonatal pneumonia with co-trimoxazole. Case fatality was 15% (10/65) in all cases and 6% (3/52) in cases without high risk or referral indications. Case fatality in 56 babies aged 30-59 days treated for pneumonia was zero. During the two years of the trial, pneumonia specific mortality rate in the intervention area was 40% less in the neonates and about 80% less in the second month and rest of infancy compared with the control area. Pneumonia in the second month of infancy and uncomplicated cases of neonatal pneumonia can be safely and effectively managed in the community using co-trimoxazole.

Faecal excretion in infants

Data on normal defaecation patterns in relation to diet during the first months of infancy are very limited. We therefore investigated in a prospective study faecal weight and gastro-intestinal passage time of breast fed (n = 12) and formula fed (n = 14) male infants. These were studied in 72 h collecting periods at the age of 17, 35, 57, 87 and 113 (+/- 4) days. Breast fed infants had a significantly lower daily dry faecal weight than formula fed infants in all periods investigated (median at the age of 113 days: 0.28 (0.17-0.75) g/kg and 0.81 (0.22-1.2) g/kg, respectively). Breast fed infants showed a large variation of gastro-intestinal passage time (6.79 h [range: 1.79-13.38 h] at the age of 17 days, 21.84 h [range: 5.41-75 h] at the age of 113 days). Comparable values of formula red infants were 13.75 h (range: 7.13-35.25 h) and 17.42 h (range: 5.38-36.5 h). Despite the efforts of approximation of infant formula to breast milk, differences of defaecation patterns in relation to diet are still relevant at this age and have to be considered in clinical practice.

Ontogenesis of nocturnal organization of sleep spindles: a longitudinal study during the first 6 months of life

Ontogenesis of sleep spindles was studied on overnight longitudinal recordings in 12 full-term infants at 1.5–3–4.5 and 6 months of life. Six parameters (density, duration, frequency, amplitude, asymmetry and asynchrony) were analyzed during both slow wave sleep (SII and delta) and during 5 periods of the night. Results show a significant increase of most parameters between 1.5 and 3 months of age. All spindle patterns developed quite rapidly during the first 3 months of infancy, possibly reflecting developmental changes in thalamo-cortical structures and maturation of the physiological system that produces spindles. The density of 12–14 Hz spindle frequency was higher in stage II when compared to stage delta, as in adults. Our data confirm previous reports on spindle ontogenesis and give a more complete aspect of this ontogenesis in relation to sleep development. Three months of age appeared to be a turning point in maturational processes and might reflect changes in central nervous system activity and behavior which take place during that period. Sleep spindle evolution seems to be an accurate reflection of the slow wave sleep (SWS) development, and our results are discussed in terms of the developmental aspect of SWS production and characterization of sleep stages in young infants. Concordance between quantitative aspects and nocturnal organization leads us to consider that the individualization of slow wave sleep (SWS) in infants occurs from 4.5 months of life.

Copper Status of Very Low Birth Weight Infants during the First 12 Months of Infancy

The Cu intake and status of 106 very low birth weight (VLBW) infants (birth weight 1152 +/- 251 g, gestational age 29 +/- 3 wk, mean +/- SD) were determined approximately 1 mo before hospital discharge, at discharge (time 0), and at 3, 6, 9, and 12 mo +/- 3 wk corrected for gestational age. Infants were fed either formula plus supplemental Zn/Cu (SUPPL, n = 29); formula plus placebo (PLAC, n = 26); or a low birth weight formula (LBWF, n = 26) or were breast-fed (BRMLK, n = 25). Plasma Cu levels in the formula-fed infants increased significantly at each time period with no significant differences between feeding groups. Hair Cu was significantly higher in the SUPPL group compared to the PLAC, LBWF, and BRMLK groups at 3 and 6 mo. Erythrocyte Cu,Zn-superoxide dismutase (CuZnSOD) activity was lowest in the PLAC group. Cu intake was positively correlated with both hair Cu (r = 0.291, p less than 0.0001) and erythrocyte CuZnSOD activity (r = 0.281, p less than 0.001) but not with plasma Cu. An increasing number of formula-fed infants had very low CuZnSOD activity (less than 2 SD below mean) with increasing age (n = 1, 2, 8, 11, and 13 infants at times 0, 3, 6, 9, and 12 mo, respectively). At 12 mo, approximately one third of the formula-fed VLBW infants in this study had low Cu status as assessed by CuZnSOD activity. Infants with the lowest CuZnSOD activity were those with the largest weight gains from 0 to 6 mo and were observed in all formula-fed groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Melatonin and maturation of REM sleep.

The discovery in 1953 of rapid eye movement (REM) sleep and the appreciation that sleep is a heterogeneous physiological state stimulated major research into sleep disorders. Electroencephalographic studies have shown that the amount of REM sleep changes with age. While newborns spend almost 50% of their sleep time in REM, the percentage of REM sleep decreases to 30% by the age of 3 months and to 20% by the age of 6 months. In addition, newborns enter REM sleep soon after the initiation of sleep, but by the age of 4 months entry into sleep assumes the adult pattern in which a significant period of non-REM sleep precedes the onset of REM sleep. Since reduction in the amount of REM sleep is associated with cerebral maturation and since the pineal gland has been implicated both in cerebral development and in the organization of REM sleep, the pineal gland may be involved in the maturation of the adult REM sleep pattern. Prior to the age of 3 months melatonin plasma levels are low and the characteristic circadian rhythms of melatonin are absent. Thereafter, melatonin secretion increases and circadian rhythmicity of melatonin becomes apparent. Thus, the abundance of REM sleep during the first 3 months of infancy is associated with deficient pineal melatonin functions, while the decline in the percentage of REM sleep coincides with the emergence of melatonin secretion coincident with the maturation of the pineal gland. I propose, therefore, that a state of low melatonin secretion is permissive for REM sleep and that maturation of the pineal gland retards REM sleep. This hypothesis is supported by the findings that melatonin suppresses REM sleep in cats and that in rats and humans pinealectomy induces a narcoleptic-like pattern of REM sleep which strikingly resembles that of the newborn and which is reversed by the administration of melatonin. A further hypothesis is advanced to explain the pathophysiology of narcolepsy in terms of a maturational defect of the pineal gland in infancy.

Early intervention in the family system: A framework and review

A framework for understanding the effect of early intervention on family structure and functioning is presented. The framework uses five sets of variables to characterize families: Their ecology; and the values, roles, personalities, and interactions of family members. Twenty research studies that met criteria of having comparison/control groups, beginning intervention either prenatally or during the first 3 months of infancy, and directing intervention to family functioning are abstracted and examined in detail. Successful and unsuccessful studies are compared as to population and nature of intervention. Two criteria of success are used: (1) The commonly used criterion of any positive change; (2) a more rigorous criterion of change in at least three areas of family functioning, based on the assumption that more pervasive change will have more lasting influence on child development. Application of the first criterion found that 75% of early family focused intervention studies showed a successful outcome. Application of the latter criterion found that 50% showed a successful outcome. Further, there were no significant differences between successful and unsuccessful studies as to target group or type of intervention. The review suggests that early intervention targeted at family functioning is effective and that a more pervasive and sustained effect is likely if the intervention includes at least 11 or more contacts over at least a 3-month period.

The epidemiology of acute diarrhoea in a rural community in Imo State, Nigeria

As part of an evaluation of a water supply and sanitation project, a baseline cross-sectional study of diarrhoea, and its putative risk factors, was conducted in 5 villages in Imo State, Nigeria. Data were collected from 4641 and 5920 persons during surveys in the dry and wet seasons, respectively. 8 d period prevalence rates for diarrhoea ranged from 5 to 50%, with the highest rates occuring in the 6 to 23 month age group. Diarrhoea was associated with up to 75% of all illnesses in young children and with about 20% in adults. Risk factors included lower socio-economic status, an unclean domestic environment, use of non-purified water, absence of soap, and feeding methods other than exclusive breast-feeding in the early months of infancy. These results suggest that the education component of water supply and sanitation projects should emphasize personal and domestic hygiene and infant feeding.

REDUCING THE SYMPTOMS OF INFANT COLIC BY INTRODUCTION OF A VIBRATION/SOUND BASED INTERVENTION

Infantile colic, a poorly understood but characteristic symptom complex, causes considerable distress to many infants, anguish to their parents and frustration to pediatricians. No method of treatment has consistently provided satisfactory relief during the early months of infancy when this condition disrupts family life. We studied sixty infants with colic (age range 2 wks. to 3 mos.). In a classic ABA, 2 × 2 factorial design which used a highly reliable colic severity score, infants were assigned randomly to receive motion simulation (two frequencies of vibration) with or without added sound. Either of the frequencies of vibration, with or without sound, reduced colic severity significantly in 97% of the infants. Statistical analyses confirmed clinical impressions that the lower frequency vibration with sound was most effective in relief of symptoms. Treatment effect was noted within 4 to 9 minutes, in contrast to prolonged symptoms in infants with untreated colic. During 25 percent of the treatments, infants fell asleep and remained so during posttreatment observation. Thirty-two of the sixty infants either fell asleep or entered a quiet restful state during treatment, but had some degree of return in colic severity when the treatment phase (15 minutes) was completed. Maternal stress levels were reduced during the treatment period of the study but escalated when the equipment was removed from the home. The results of this controlled trial demonstrated an effective and practical treatment approach for relief of infantile colic.

Causes of infant and early childhood deaths in Sierra Leone

Information about the causes of infant and early childhood (1–4 years) mortality was compiled from the vital registration system for the Western Area, records from the children's Hospital in Freetown and two demographic sample surveys conducted in various chiefdom headquarters towns around the country. The leading causes of infant mortality are tetanus, fevers, measles and diarrhoea. A breakdown of certified deaths in infancy showed that tetanus is quite important in the neonatal period accounting for as much as 68% of neonatal deaths. Measles and diarrhoea were the leading causes of death in the last 6 months of infancy. The leading causes of early childhood deaths were measles, diarrhoea and fevers. Nutritionally related diseases such as measles and diarrhoea were seen to account for up to 40% of all early childhood deaths. The major factors affecting these causes of death were childbirth and childcare practices in the case of tetanus and the nutritional status of the children in the case of measles and diarrhoea. The majority of deliveries were still being performed by Traditional Birth Attendants in very unhygienic surroundings which it was felt contributed significantly to the high incidence of neonatal tetanus. At the other childhood ages the poor nutritional status of the majority of children in Sierra Leone as shown by the results of the 1978 National Nutrition Survey was seen as the significant factor. The effects of the identified major causes of infant and early childhood mortality (tetanus, fevers, measles, and diarrhoea) can be largely diminished by effective intervention programmes such as oral rehydration therapy and the training of Traditional Birth Attendants.

Vitamin K-dependent clotting factors in normal breast-fed infants

BREAST-FEEDING has been implicated as a necessary factor in the pathogenesis of hemorrhagic disease of the newborn infant, ~ but little is known of its role in coagulation abnormalities beyond the neonatal period. Vitamin K is approximately four times more concentrated in cow milk than in breast milkfl and clotting factors depending on this vitamin are decreased in normal term infants, and even more reduced in premature infants. 3.4 Deficiency of vitamin K-dependent clotting factors with clinical bleeding has occasionally been reported in breast-fed infants older than one month, but these infants usually had also had diarrhea or had received antibiotic therapy? ,6 Since the levels ot ~ vitamin K-dependent clotting factors in healthy older breast-fed infants have not been systematically assessed, vitamin deficiency cannot be attributed to breast-feeding per se. To determine if breast-feeding during the first month of infancy is associated with an increased risk of bleeding caused by vitamin K deficiency, the present investigation compared coagulation studies and the levels of vitamin K-dependent clotting factors in normal breast-fed and bottle-fed infants.

GROWTH OF HEALTHY BREAST-FED INFANTS IN THE FIRST SIX MONTHS

Healthy breast-fed Australian infants had weight increments in the second 3 months of infancy which were well below standard figures for normal weight reported from Britain and more closely resembled data from developing countries. There is a need for more information about growth of healthy breast-fed infants and agreement about reference values against which international information can validly be compared.

Games fathers and mothers play with their infants

Both fathers and mothers successfully engaged their infants one to six months of age in interactive games in a laboratory play situation. Both parents played almost one game per minute with their infants. Mother played more conventional limb movement games and more distal, visual, attention maintaining games while fathers played more proximal, arousing, idiosyncratic limb movement games with their infants. Interactive games with parents even during the first six months of infancy provide differential experiences for the infant. These games may have developmental significance in selectively facilitating the acquisition of social and cognitive skills.

Vehicle Occupant Safety: The Pediatrician's Responsibility

The preeminent position of the automobile as a childhood health hazard has been recently emphasized in both the medical and lay literature.1-2 Contrary to the common impression, of the approximately 5,000 Americans below the age of 15 who die in traffic accidents each year, a majority are vehicle occupants.3 Baker, in this issue of Pediatrics (p 860) reemphasizes the magnitude of this public health problem and provides us with important additional information regarding the epidemiology of this "disease." Her vital statistics analysis demonstrates that it is during the earliest months of infancy, those months when, presumably, children are most carefully supervised by their parents and most dependent on them for their survival, that they are most likely to die in the automobile.

The quantitative effects of maternal dietary energy intake on pregnancy and lactation in rural Gambian women

The quantitative relationships between dietary energy intake and weight gain in pregnancy, birth-weight and lactation performance during the first three months of infancy have been studied in such a way as to take account of major differences in the patterns of heavy manual labour at different times of the year in a subsistence farming community. Maternal weight gain and the accumulation of subcutaneous fat were significantly lower when the last trimester of pregnancy fell during the time of heaviest farm work and lowest energy intakes. The birth-weight of babies was also significantly correlated with differences in energy intake throughout the year. During early lactation breast milk yields were significantly related to concomitant alterations in the subcutaneous fat stores. Evidence has been produced which suggests that in undernourished nursing women there could be a competition for dietary energy between the repleting maternal subcutaneous fat organs and the mammary glands at the expense of milk production.

Screening and Prevention of Nutritional Anemia During Infancy

No important differences in hemoglobin and hematocrit values occurred among subgroups of a cohort of 295 healthy, mature infants who were fed various dietry regimens of iron-fortified products, including cereal, whole milk, and corn syrup. Among all infants between the ages of 4 and 27 months, the incidence of hematocrit readings and hemoglobin levels below 30% and 10 g/dl, respectively, was 0.6%, and below 33% and 11 g/dl, respectively, was 3.2%. Because of the low incidence of nutritional anemia after age 4 months, initial screening should be done at 1 to 4 months of age, and selectively thereafter. A formula of evaporated milk and corn syrum plus iron-fortified cereal during early months, then whole milk and a more diversified diet including continued use of iron-fortified cereal during later months of infancy, provides a nutritionally sound and economical diet with sufficient iron.

Exstrophy and Cloacal Exstrophy

Classic bladder exstrophy and cloacal exstrophy are grotesque anomalies in the eyes of young parents. An immediate evaluation by an experienced team is required to assess the variations in the condition and to devise a plan of treatment that can reassure the parents as to eventual prognosis and rehabilitation. This plan of treatment must include provisions for renal preservation, urinary control, cosmetic appearance, and sexual function. The newborn is usually normal in respect to nutrition and its cardiopulmonary state, and will tolerate surgery well. Passive parental immunity provides better resistance to intercurrent illness at this time than will be present in the later months of infancy. When applicable, the initial stages of surgery should be undertaken at birth when the pelvic ring can be approximated without osteotomy and the bladder mucosa has not deteriorated from inflammatory changes. Parental attitudes toward the child as well as successful reconstruction may both be best served by immediate surgery to begin reconstruction and reduce the visible defect.

Mid-upper arm circumference in infants.

A longitudinal study of mid-upper arm circumference of infants at monthly intervals indicated statistically insignificant male and female differences, greater increase in the first six months of infancy than the second six-month-period and significant positive correlation coefficients between weight and arm girth for all age periods and in both sexes.

Rett Syndrome: A Case Report

Rett Syndrome (RS) is a neurodevelopmental disorder in which girls are predominantly affected, transmitted as an X linked dominant inheritance and caused by mutation in MECP2 gene. The basic presentation in RS is regression of previously acquired developmental milestones, lack of social interaction skills and acquired microcephaly after a certain age, which starts in early months of infancy. It is frequently misdiagnosed as autism, cerebral palsy or nonspecific developmental delay and is relatively frequent cause of delayed development in girls. Diagnosis is mainly clinical after excluding the neurodegenerative and other causes of delayed milestones. The chromosomal analysis, confirmatory tool for diagnosis is available in limited centers. The treatment is mainly speech therapy and counseling though few pharmacological agents have been tried with little response. A ten years age girl presented with the history of seizures, regression of speech and delayed motor milestones in our out patient clinic which was subsequently diagnosed as Rett Syndrome. Key Words: Rett syndrome, Developmental Regression, X Linked Dominant. DOI = 10.3126/jnps.v28i1.1402 J. Nepal Paediatr. Soc. Vol.28(1) p.20-22

Diagnosis of hypogammaglobulinemia.

Prompt, accurate diagnosis of gamma globulin deficiency as a cause of unusual susceptibility to infection is extremely important for several reasons: first, replacement therapy with pooled normal gamma globulin is effective in the prevention of serious infections if initiated before structural damage has occurred; second, supplies of gamma globulin should not be wasted on patients whose susceptibility to infections is due to other causes; and third, patients should not be subjected to the discomfort and possible hazards of repeated large intramuscular injections of gamma globulin except upon clear-cut indications. Significant hypogammaglobulinemia occurs in 3 main forms: (1) in a transient form, as a prolongation of the normally occurring depression of gamma globulin levels between the second and fourth months of infancy; (2) in a congenital form, usually in boys, with sex-linked recessive inheritance; and (3) in an acquired form in both sexes at any age, either as a primary disease