Infants In Nursery Research Articles

Mothers of infants in neonatal nurseries had challenges in establishing feelings of being a good mother

Mothers of infants in neonatal nurseries had challenges in establishing feelings of being a good mother

Post-partum maternity ‘blues’ as a reflection of newborn nursing care in Japan

Objectives: To investigate the prevalence of post-partum ‘blues’ in mothers whose babies are cared for in a newborn nursery, compared with mothers providing rooming-in care. Methods: Japanese normal primiparous women were prospectively studied from 1998 to 1999. The newborns of these mothers were managed in the newborn nursery or by rooming-in care. To diagnose maternity ‘blues’ and ‘depression’, the Stein's Questionnaire and the Edinburgh Postnatal Depression Scale were used. Results: Ninety-seven and 93 women were managed by newborn nursery care and by rooming-in care, respectively. Of these women, a total of 181 women were considered for analysis. ‘Blues’ was noted in 31 of 92 mothers (33.7%) receiving newborn nursery care and in 18 of 89 (20.2%) receiving rooming-in care with a significant difference ( P<0.05), and in 49 of 181 (27.1%) as a whole. The daily Stein's scores changed significantly during the 10 days post-partum in each group ( P<0.0001). Post-partum ‘depression’ was observed in three mothers (3.4%) in the newborn nursery care group and in four (4.8%) of the rooming-in care group, not a significant difference, and in seven (4.1%) as a whole. Conclusion: Maternity ‘blues’ is experienced by 25% or more of Japanese primiparous women delivering healthy babies via uncomplicated delivery. The system of newborn nursery infant care may be a potential causal factor for maternity ‘blues’, although it should be confirmed by a prospective randomized trial.

Outcome of neonatal screening for hearing loss in neonatal intensive care unit and well-born nursery infants

A newborn hearing screening was conducted on 319 neonatal intensive care unit (NICU) and 1200 well-born nursery (WBN) infants. Mean NICU birth weight was 1997 g and mean gestational age 34 weeks. Auditory brainstem response was studied in screening in NICU infants. Otoacoustic emission (OAE) or automated auditory brainstem response (AABR) was used in primary WBN screening. All infants not bilaterally passing hearing screening before discharge were recalled for outpatient retesting. If the outcome was still failure, ABR screening was conducted. The prevalence of infants diagnosed with hearing loss was 1.1% (16 of 1519). Of these 16, 75% were from the NICU and 75% were at risk for hearing loss. Mean age at hearing loss identification was 12.9 weeks in the WBN and mean age at hearing aid fitting was 16.1 weeks. Mean age at hearing aid fitting was lower for WBN than for NICU infants. Hearing loss identification and hearing aid fitting are thus feasible in NICU and WBN infants in universal newborn hearing screening.

Changing Characteristics of Neonatal Follow-up Studies

After completing this article, readers should be able to: 1. Describe changes over time in the characteristics of study subjects in neonatal follow-up studies. 2. Describe changes over time in the outcome assessments of neonatal follow-up studies. 3. Delineate four broad research themes of neonatal follow-up studies. 4. Summarize the evolution of studies of the prevalence of disability and contributing causes of developmental impairments in preterm infants. 5. Summarize the evolution of studies of severely ill term and near-term infants. Within a few years of the opening of the first preterm infant nursery in the United States in 1922, reports appeared describing the long-term outcomes of treated infants. Early studies of health and developmental outcome described the frequency of impairments for specific groups of high-risk neonates. More recently, neonatal follow-up studies have been used to evaluate the effectiveness of therapeutic interventions and to test specific hypotheses about the etiology of an impairment. The outcome of interest in neonatal follow-up studies is the health or development, beyond the first months of life, of high-risk neonates. In observational follow-up studies, risk factors of interest have included biologic (eg, perinatally acquired brain damage), environmental (eg, maternal depression), and “established” risk factors (eg, cytomegalovirus infection, genetic syndromes). Table 1⇓ summarizes changes in research methods in follow-up studies during the 20th century Based on epidemiologic principles, Kiely and Paneth offered the following suggestions for improving neonatal follow-up studies: 1) use of population-based rather than hospital-based samples for prevalence studies; 2) inclusion of appropriate controls; 3) assessment of confounding due to social class; and 4) minimizing lost-to-follow-up rates. In addition, they commented on issues specific to neonatal follow-up, including: 1) continued follow-up of subjects to school age; 2) reporting of mortality rates as well as morbidity; 3) reporting of birthweight-specific data; and 4) more detailed reporting of the co-occurrence of …

Retinopathy of Prematurity: History, Classification, and Pathophysiology

After completing this article, readers should be able to: 1. Describe the onset of retinopathy of prematurity (ROP). 2. Explain the role of oxygen in ROP. 3. Compare and contrast zones I, II, and III disease. 4. Describe the stages of ROP. 5. Characterize “plus” disease. 6. Describe the infants in whom severe ROP leading to the need for surgery is common. 7. Describe the timeframe at which ROP is visible in the eye. ### The First ROP In 1942, Terry described the first infant who had grey, blood vessel-covered membranes behind the pupil. As more cases were described, the name retrolental fibroplasia (RLF) was coined (Fig. 1⇓ ). Distressingly, it became common around the world in special units for preterm infants. Pathologic specimens were rare (Fig. 2⇓ ) , but serial examinations of preterm infants following birth revealed that infants were not born with RLF; they developed it after birth. By the end of the 1940s, many innovations in the new preterm infant nurseries had been implicated, some were exonerated, and it was time to examine the role of oxygen. Figure 1. End-stage ROP. The white pupils (leukocoria) of stage 5 ROP result from total retinal detachment, with the mass of fibrous neovascularization and the retina pushing up against the lens from behind. This is the source of the historical name retrolental fibroplasia. Photograph courtesy of A. Patz, MD, used with permission. Reprinted with permission from Pediatrics . 1957;19:502–504. Figure 2. A. Artist’s rendering of stage 5 retinal detachment. B. Pathologic specimen of an eye with stage 5 ROP. In this cross section, the lens is displaced into the anterior chamber by the mass of tissue in the vitreous composed of the detached retina and the large number of extraretinal vessels and accompanying scar tissue (fibroplasia). The retina remains attached at the posterior pole at the optic disc and around the rim …

Significance of grunting respirations in infants admitted to a well-baby nursery.

(1) To determine the frequency and duration of grunting in term and near-term newborns; (2) to determine the peripartum characteristics associated with grunting; and (3) to compare the short-term outcomes of newborns with and without grunting. Medical record review of all newborns admitted to a well-baby nursery during a 2-month period. University well-baby nursery for term infants, with more than 2700 deliveries annually. Frequency and duration of grunting, maternal and newborn clinical characteristics, clinical course, and length of stay. Grunting respirations beginning during the first 4 hours of life were recorded for 81 (17.4%) of 466 newborns. Fifty-five (68%) stopped grunting within 30 minutes of birth, 69 (85%) by 1 hour, and 75 (93%) by 2 hours. More mothers of grunting infants received intrapartum antibiotics than mothers of nongrunters (33% vs 20%; P =.03). More grunting infants than nongrunters received bag and mask resuscitation (15% vs 5%; P =.01). More chest radiographs, blood cell counts, and blood cultures were ordered for grunting infants, and antibiotics were more often given to grunting than nongrunting infants (11.1% vs 4.6%; P =.04). Grunters' length of stay exceeded that of nongrunters (72 vs 55 hours; P =.01), but only 3 were transferred to a neonatal intensive care unit. All grunting infants should be carefully observed, but because nearly all otherwise healthy term or near-term infants will stop grunting and have a benign course, other interventions can be postponed for 1 or 2 hours to give the newborn a chance to stop grunting or show other signs of respiratory illness.

Relationships of the rate of waiting for admission to nurseries for infants up to 2 years of age with the employment rate of women aged 25-39years and with socioeconomic factors in 694 municipalities in Japan

Relationships of the rate of waiting for admission to nurseries for infants up to 2 years of age with the employment rate of women aged 25-39years and with socioeconomic factors in 694 municipalities in Japan

Nursery paradigm enhances motor engagement of a novel environment by infants of mothers who had a demanding task.

Two groups of bonnet macaque (Macaca radiata) mother-infant dyads were exposed to 12 wk. of a variable foraging demand paradigm for the mothers beginning when the infants were approximately 18 weeks of age. For the nursery group, infants were required to remain in a nursery within the mothers' living area during the entire treatment period. Testing of the dyads of both groups in a novel room subsequent to the differential rearing experience showed that only the infants required to remain within the nursery exhibited an increase in motor engagement of the novel environment over the first hour of exposure, possibly reflecting greater security of attachment in these nursery infants.

The initial care of newborn infants and subsequent hay fever

Patterns of neonatal exposure to microorganisms have changed substantially over the last 100 years, and it has been suggested that this has influenced the risk of immune-mediated disease. Using a proxy measure, we tested the hypothesis that the initial handling of newborn infants, which is known to affect the pattern of exposure to microorganisms, may alter the risk of developing subsequent atopy, as indicated by hay fever. Analysis was performed on 5,519 members of the 1970 British Cohort Study, a nationally representative birth cohort. Cohort members with hay fever were identified at intervals up to the age of 26 years. Details of neonatal care and childhood circumstances were recorded prospectively. Those who had spent their first night away from their mother in the communal infant nursery were selected as likely to have experienced atypical exposure compared with infants who remained with their mother. Adjustment was made for potential confounding factors in infancy and childhood by multiple logistic regression analysis. Unadjusted relative odds (with 95% CI) for developing hay fever among those spending the first night in the communal nursery, when compared with other infants who remained with the mother, were 1.48 (1.23-1.77), P<0.001. Comprehensive adjustment for the potential confounding factors, including feeding practices on the first day of life, markers of social and material circumstances, and region, did not substantially alter this relationship, with adjusted relative odds of 1.31 (1.08-1.59), P=0.005. While our proxy measure is associated with an increased risk of hay fever, further research is required to confirm that this is due to the pattern of infectious exposure in very early life. The results are consistent with the hypothesis that the first challenges are particularly important in the development of the newborn infant's immune system.

Identification of neonatal hearing impairment: auditory brain stem responses in the perinatal period.

1) To describe the auditory brain stem response (ABR) measurement system and optimized methods used for study of newborn hearing screening. 2) To determine how recording and infant factors related to the screening, using well-defined, specific ABR outcome measures. Seven thousand one hundred seventy-nine infants, 4478 from the neonatal intensive care unit (NICU) and the remaining from the well-baby nursery, were evaluated with an automated ABR protocol in each ear. Two channel recordings were obtained (vertex to mastoid or channel A and vertex to nape of neck or channel B) in response to click stimuli of 30 and 69 dB nHL in all infants as well as 50 dB nHL in infants who did not meet criteria for response at 30 dB. Criteria for response included F(SP) > or =3.1 and a tester-judgment of response. Criteria could be met in the first or repeat test with a maximum of 6144 accepted sweeps per test. More than 99% of infants could complete the ABR protocol. More than 90% of NICU and well-baby nursery infants "passed" given the strict criteria for response, whereas 86% of those with high risk factors met criterion for ABR response detection. The number of infants who did not meet ABR response criteria in one or both ears was systematically related to stimulus level with the largest group not meeting criteria at 30 dB followed by 50 and 69 dB nHL. Meeting criteria on the ABR was positively correlated with the amplitude of wave V, with low noise and low electrode impedance. Factors that predicted how many sweeps would be needed to reach criterion F(SP) included noise level of the test site, state of the baby (for example, quiet sleep versus crying), recording noise, electrode impedance and response latency. Channel A (vertex to mastoid) reached criterion more often than channel B (vertex to nape of neck) due to higher noise in channel B. Average total test time for 30 dB nHL screening in both ears was under 8 minutes. Well babies with risk factors took slightly longer to evaluate than other groups with this automated ABR procedure and have higher noise levels. ABR implemented with an automated detection algorithm using a 30 dB nHL click stimulus is reliable technique for rapid assessment of auditory status in newborns. Factors other than hearing loss that influenced the test result include infant state, electrode location and impedance, testing site, and infant risk status. Even so, ABRs were reliably recorded in the vast majority of babies under circumstances in which most babies are found in the perinatal period.

Pediatric Clostridium difficile: a phantom menace or clinical reality?

Clostridium difficile is the leading cause of nosocomial gastrointestinal illness in adult patients in hospitals. Even though C. difficile disease in adults has been well studied, research on pediatric C. difficile disease is still in its infancy. For many years it has been believed that C. difficile was a disease that affected only adults and was not a problem for children. This erroneous belief arose from the observation that neonates acquire C. difficile quickly (within 48 hours of birth) but show no intestinal symptoms (1–4). More recent evidence has been documented in case reports of pediatric C. difficile and outbreaks of C. difficile disease in pediatric populations (5– 7). Pediatric C. difficile disease has also been associated with the occurrence of severe complications and high mortality rates (8–10). The cascade of events in the pathogenesis of C. difficile disease is similar in children and adults. Normal intestinal microflora are disrupted by antibiotic exposure, medications, or surgery. If the child is then exposed to C. difficile (or its spores), colonization may occur, with production of toxins A and B. These toxins act on enterocytes, causing an inflammatory response and morphologic changes that lead to diarrhea or colitis. Host factors (age, diet, immune response) play an important role in determining whether C. difficile develops into asymptomatic carriage or active disease. Treatment for pediatric C. difficile disease usually relies on metronidazole or vancomycin, but clinical guidelines have not been defined for the pediatric population (11). As in adults, recurrent C. difficile disease that does not respond to conventional therapy develops in a proportion of children treated with antibiotic therapy.

NURSERY PARADIGM ENHANCES MOTOR ENGAGEMENT OF A NOVEL ENVIRONMENT BY INFANTS OF MOTHERS WHO HAD A DEMANDING TASK

Two groups of bonnet macaque (Macaca radiata) mother-infant dyads were exposed to 12 wk. of a variable foraging demand paradigm for the mothers beginning when the infants were approximately 18 weeks of age. For the nursery group, infants were required to remain in a nursery within the mothers' living area during the entire treatment period. Testing of the dyads of both groups in a novel room subsequent to the differential rearing experience showed that only the infants required to remain within the nursery exhibited an increase in motor engagement of the novel environment over the first hour of exposure, possibly reflecting greater security of attachment in these nursery infants.

Decreased Response to Phototherapy for Neonatal Jaundice in Breast-Fed Infants

Objective To evaluate the efficacy of phototherapy for nonhemolytic hyperbilirubinemia in breast-fed and formula-fed infants and infants receiving formula and breast milk. Design Prospective study. Setting Nursery for healthy infants. Method Full-term healthy infants with nonhemolytic hyperbilirubinemia (bilirubin concentration, >255 µmol/L [14.9 mg/dL] or 222 µmol/L [13.0 mg/dL] at ages younger than 48 hours) were treated with conventional phototherapy by using daylight fluorescent lamps. Three groups of infants were studied: group 1, formula-fed infants; group 2, breast-fed infants; and group 3, infants receiving formula and breast milk. All patterns of feeding started at birth. Phototherapy was terminated only when bilirubin concentrations had decreased to less than 185 µmol/L (10.8 mg/dL); the minimum exposure period was 24 hours. Results A total of 163 infants were studied: group 1, 79; group 2, 34; and group 3, 50. The age at the start of exposure was comparable in all groups. The mean±SD weight loss as a percentage of birth weight was as follows: group 1, 2.8%±5.0%; group 2, 6.1%±3.4%; and group 3, 3.2%±2.6%. The duration of exposure to phototherapy was as follows: group 1, 54.1±20.8 hours; group 2, 64.6±25.1 hours; and group 3, 54.9±21.5 hours; the 24-hour rate of decrease in the bilirubin concentration was as follows: group 1, 18.6%±11.7%; group 2, 17.1%±9.6%; and group 3, 22.9%±9.4%. The overall rate of decrease in the bilirubin concentration for the duration of exposure to phototherapy was as follows: group 1, 0.8%±0.3% per hour; group 2, 0.6%±0.3% per hour; and group 3, 0.8%±0.3% per hour. Weight loss at the start of phototherapy was significantly greater in group 2 compared with group 1( P P P =.06); however, the duration ofexposure of group 2 infants was 10 hours more than that of the other 2 groups. The 24-hour rate of decrease in the bilirubin concentration in group 3 was significantly better than that of group 2 ( P =.007) and group 3 ( P =.02); the rates of decrease for groups 2 and 3 were similar ( P =.52). The overall rate of decrease in the bilirubin concentration during the duration of exposure to phototherapy in group 2 was significantly less than that of group 1 ( P =.002) and group 3 ( P P =.35). The postexposure rebound bilirubin concentrations were comparable in all groups during the first 2 days; however, the duration of moderate jaundice in group 2 was more prolonged. Conclusions The response to phototherapy of group 2 infants was significantly slower than that of group 3 and group 1 infants; this response was still of adequate efficacy. The addition of formula to the feedings for totally breast-fed infants, without suspension of breast-feeding, would enhance the efficacy of phototherapy and reduce exposure time.

Decreased response to phototherapy for neonatal jaundice in breast-fed infants.

To evaluate the efficacy of phototherapy for nonhemolytic hyperbilirubinemia in breast-fed and formula-fed infants and infants receiving formula and breast milk. Prospective study. Nursery for healthy infants. Full-term healthy infants with nonhemolytic hyperbilirubinemia (bilirubin concentration, >255 micromol/L [14.9 mg/dL] or 222 micromol/L [13.0 mg/dL] at ages younger than 48 hours) were treated with conventional phototherapy by using daylight fluorescent lamps. Three groups of infants were studied: group 1, formula-fed infants; group 2, breast-fed infants; and group 3, infants receiving formula and breast milk. All patterns of feeding started at birth. Phototherapy was terminated only when bilirubin concentrations had decreased to less than 185 micromol/L (10.8 mg/dL); the minimum exposure period was 24 hours. A total of 163 infants were studied: group 1, 79; group 2, 34; and group 3, 50. The age at the start of exposure was comparable in all groups. The mean+/-SD weight loss as a percentage of birth weight was as follows: group 1, 2.8%+/-5.0%; group 2, 6.1%+/-3.4%; and group 3, 3.2%+/-2.6%. The duration of exposure to phototherapy was as follows: group 1, 54.1+/-20.8 hours; group 2, 64.6+/-25.1 hours; and group 3, 54.9+/-21.5 hours; the 24-hour rate of decrease in the bilirubin concentration was as follows: group 1, 18.6%+/-11.7%; group 2, 17.1%+/-9.6%; and group 3, 22.9%+/-9.4%. The overall rate of decrease in the bilirubin concentration for the duration of exposure to phototherapy was as follows: group 1, 0.8%+/-0.3% per hour; group 2, 0.6%+/-0.3% per hour; and group 3, 0.8%+/-0.3% per hour. Weight loss at the start of phototherapy was significantly greater in group 2 compared with group 1 (P<.001) and group 3 (P<.001), although the hemoglobin and hematocrit values were comparable. The duration of exposure to phototherapy was not significantly different in the 3 groups (P=.06); however, the duration of exposure of group 2 infants was 10 hours more than that of the other 2 groups. The 24-hour rate of decrease in the bilirubin concentration in group 3 was significantly better than that of group 2 (P = .007) and group 3 (P = .02); the rates of decrease for groups 2 and 3 were similar (P = .52). The overall rate of decrease in the bilirubin concentration during the duration of exposure to phototherapy in group 2 was significantly less than that of group 1 (P = .002) and group 3 (P<.001); the rates for groups 1 and 3 were similar (P = .35). The postexposure rebound bilirubin concentrations were comparable in all groups during the first 2 days; however, the duration of moderate jaundice in group 2 was more prolonged. The response to phototherapy of group 2 infants was significantly slower than that of group 3 and group 1 infants; this response was still of adequate efficacy. The addition of formula to the feedings for totally breast-fed infants, without suspension of breast-feeding, would enhance the efficacy of phototherapy and reduce exposure time.

Differential rearing affects corpus callosum size and cognitive function of rhesus monkeys

This study investigated the effects of different rearing conditions on neural and cognitive development of male rhesus monkeys ( Macaca mulatta). Infants raised individually in a nursery from 2 to 12 months of age (NURSERY, n=9) were compared to age-matched infants raised in a semi-naturalistic, social environment (CONTROL, n=11). Various brain regions were measured by MRI. Although overall brain volumes did not differ between NURSERY and CONTROL animals, corpus callosum (CC) size, measured in mid-sagittal sections, was significantly decreased in the NURSERY group. Group differences were most evident in the posterior aspects of the corpus callosum and appeared to result from changes in the number of cross-hemispheric projections rather than from a decrease in cortical gray matter volume. The decrease in corpus callosum size in the NURSERY animals persisted after 6 months of social housing in a peer-group. Rearing group differences were not found in other structures analyzed, including the hippocampus, cerebellum and anterior commissure. In cognitive testing, NURSERY animals had more difficulty acquiring the delayed non-matching to sample (DNMS) task, but showed no deficits in subsequent memory performance when a 2 or 10 min delay was imposed. The NURSERY infant monkeys were also impaired in object, but not in spatial, reversal learning, although there were no differences in a simple object discrimination task. The cognitive deficits exhibited by the NURSERY animals were significantly correlated with the alterations found in the CC. In summary, rearing environment was associated with sustained differences in cross-hemispheric projections, white matter volume and cognitive performance.

Recognition of the presence and severity of newborn jaundice by parents, nurses, physicians, and icterometer.

To determine how well parents, nurses, physicians, and an Ingram icterometer can detect the presence and the severity of jaundice in newborns. Normal newborn nursery in a 340-bed teaching hospital. Nurses and physicians caring for nursery infants and parents of the infants. Physicians and nurses examining newborns documented whether they detected jaundice in the infants and, if so, the estimated bilirubin level and the extent of cephalocaudal progression of the jaundice. An assistant taught the parents how to examine the infants for jaundice and determine its cephalocaudal progression. The assistant also obtained icterometer readings. Bilirubin testing was performed according to usual clinical practice. Nurse and physician estimates of bilirubin levels; parent, nurse, and physician assessment of the presence of jaundice and its cephalocaudal progression; icterometer readings; bilirubin levels. There was moderate agreement about the presence of jaundice in the infants (pairwise kappa, 0.48) However, all infants with bilirubin levels >12 mg/dL were correctly identified as jaundiced by all examiners. The parents' assessment of cephalocaudal progression and the icterometer readings were most highly correlated with serum bilirubin levels (adjusted Pearson correlations, 0.71 and 0.57, respectively). Many parents can be taught to accurately assess cephalocaudal progression of jaundice in the hospital. The icterometer is a useful tool for assessing jaundice severity. Both parent assessment and the icterometer were more highly correlated with bilirubin levels than physician and nurse estimates in this study. Additional research is needed to determine how accurate these methods of clinical assessment are at the higher bilirubin levels that typically occur after hospital discharge.

Transcutaneous bilirubinometry decreases the need for serum bilirubin measurements and saves money.

Except for routine screening for inborn errors of metabolism, the most frequent laboratory test performed in the well infant nursery is a serum bilirubin measurement. The Minolta/Airshields jaundice meter provides an objective measurement of the degree of newborn jaundice and is useful for identifying which infants require a serum bilirubin measurement.1,2 This instrument has been studied extensively and performs well as a screening device.1,2 We hypothesized that the routine use of the jaundice meter in our nursery would reduce both the need for serum bilirubin measurements and costs. We deliver more than 5000 infants annually, 80% of whom are cared for by private pediatricians. We first established the relationship between serum bilirubin levels and the transcutaneous bilirubinometry (TcB) index in 356 white newborn infants born at 36 weeks' gestation or later. All serum bilirubin determinations were performed in the clinical laboratories by direct spectrophotometry (Bilirubinometer; Advanced Instruments, Needham Heights, MA; or Paramax, Irvine, CA). Physicians ordered serum bilirubin levels on clinical indication, and directly after blood was drawn, a TcB measurement was obtained by nursery nurses from the lower end of the sternum. During this phase of the study, the TcB measurement was not provided to physicians. Ten TcB determinations on each of three infants yielded coefficients of variation of 0%, 3.6%, and 5.2%. The instrument's calibration was checked daily against the glass standards provided by the manufacturer. Once introduced for clinical use, TcB measurements were compared every 3 months with 10 bilirubin determinations to ensure consistency with the data previously obtained. The jaundice meter was introduced for routine clinical use on November 1, 1990. For the guidance of pediatricians, tables were posted in the nursery showing the relationship between the TcB index …

INDOOR ALLERGEN LEVELS IN DAY NURSERIES

The level of indoor allergens were lower in day nurseries than in most houses. Most samples contain allergen levels below threshold levels for sensitization. The risk of sensitization to indoor allergens in day nurseries for infants appears to be less than in their own homes. It also appears that the efficacy of avoidance measures such as the use of synthetic protective mattress covers and frequent washing of sheets and toys is effective.

Prenatal cocaine exposure effects on arousal-modulated attention during the neonatal period.

The organization of arousal and attention as a function of intrauterine cocaine exposure was investigated in 180 normal nursery infants prior to hospital discharge and at 1 month of age. This was done by studying visual looking preferences when infants were in three arousal conditions: less aroused (after feeding); more aroused-endogenous (before feeding); and more aroused-exogenous (after feeding but including 8-Hz visual stimulation prior to each visual preference trial). The stimuli were light panels illuminated at three temporal frequencies between 1 and 8 Hz presented in pairs using a balanced presentation series of trials. Infants not exposed to cocaine demonstrated strong arousal-modulated attention, preferring faster frequencies when less aroused and slower frequencies when more aroused in both endogenous and exogenous conditions. In contrast, cocaine-exposed infants showed a lack of arousal-modulated attention and preferred faster frequencies of stimulation regardless of arousal condition. Similar differences in arousal-modulated attention as a function of cocaine exposure were obtained at 1 month after birth, indicating that these effects lasted longer than would be reasonable to attribute to the active presence of cocaine or its metabolites. This form of stimulus-seeking behavior was shown to be independent of confounding factors associated with prenatal cocaine exposure such as the absence of prenatal care, alcohol use, minority status, or gender, as well as mediating factors associated with growth such as birthweight. A direct and more chronic effect of intrauterine cocaine exposure on arousal-modulated attention and presumably on the developing CNS therefore was supported.

Prenatal cocaine exposure effects on arousal‐modulated attention during the neonatal period

The organization of arousal and attention as a function of intrauterine cocaine exposure was investigated in 180 normal nursery infants prior to hospital discharge and at 1 month of age. This was done by studying visual looking preferences when infants were in three arousal conditions: less aroused (after feeding); more aroused-endogenous (before feeding); and more aroused-exogenous (after feeding but including 8-Hz visual stimulation prior to each visual preference trial). The stimuli were light panels illuminated at three temporal frequencies between 1 and 8 Hz presented in pairs using a balanced presentation series of trials. Infants not exposed to cocaine demonstrated strong arousal-modulated attention, preferring faster frequencies when less aroused and slower frequencies when more aroused in both endogenous and exogenous conditions. In contrast, cocaine-exposed infants showed a lack of arousal-modulated attention and preferred faster frequencies of stimulation regardless of arousal condition. Similar differences in arousal-modulated attention as a function of cocaine exposure were obtained at 1 month after birth, indicating that these effects lasted longer than would be reasonable to attribute to the active presence of cocaine or its metabolites. This form of stimulus-seeking behavior was shown to be independent of confounding factors associated with prenatal cocaine exposure such as the absence of prenatal care, alcohol use, minority status, or gender, as well as mediating factors associated with growth such as birthweight. A direct and more chronic effect of intrauterine cocaine exposure on arousal-modulated attention and presumably on the developing CNS therefore was supported. © 1996 John Wiley & Sons, Inc.