Young Babies Research Articles

Making assessment locally relevant: measuring functioning for maternal depression in Khayelitsha, Cape Town.

We developed a locally relevant functioning assessment instrument (FAI) for pregnant women and mothers of young babies to complement a widely validated instrument-the World Health Organization's Disability Assessment Schedule (WHODAS) 12-item version. The FAI is an outcome measure in a randomised controlled trial on the effectiveness of a lay counsellor administered intervention for distressed pregnant women in Khayelitsha, Cape Town. Nine items most commonly reported by 40 pregnant women or mothers with young babies in qualitative interviews were selected for the instrument, with a 10th item 'Other'. The FAI was validated with 142 pregnant women and mothers in Khayelitsha. Analysis was conducted to assess internal reliability, exploratory factor analysis and convergent validity. The FAI had good internal reliability (Cronbach's alpha = 0.77) and the explanatory factor analysis showed a clear 3-factor solution, relating to domestic, childcare and social activities. The FAI scores showed floor effects, but were positively correlated with the two measures of functioning (WHODAS 2.0 and Washington Group Short Set). The FAI scores also correlated with the measure of depression (Edinburgh Postnatal Depression Scale-EPDS), reflecting increased functional limitations associated with increased depressive symptoms. The results show that the FAI has good internal reliability, and good convergent and construct validity as a measure of functioning for this context. This paper reports on the process of developing an instrument and highlights the importance of using instruments that are locally relevant to ensure accurate measurement of functional status.

Incredible Babies programme: A pilot evaluation in Northern Ireland

A practice-based evaluation within a health Trust in Northern Ireland investigated the impact of the Incredible Years parents and babies programme on parenting self-efficacy. Thirteen mothers of babies aged 2–8 months participated in an 8-week group-based programme. Data were collected using a pre-test and post-test design. Results indicated that mothers reported increased self-efficacy following participation. These results support the use of the Incredible Babies programme in early intervention service provision with very young babies.

Sources of pertussis infection in young babies from São Paulo State, Brazil.

Household contacts are important sources of Bordetella pertussis in infants. A total of 353 household contacts of 97 index cases were evaluated for pertussis by culture and polymerase chain reaction. Twenty eight contacts were positive (8.0%). The presence of symptoms did not influence the rate of diagnosed bacteriologic pertussis in communicants. We conclude that contacts with an index case can be positive for B. pertussis independently of the presence of symptoms.

Marino Ortolani: "Does That Baby's Hip Go Click?".

Marino Ortolani (1904-1983), a pediatrician from Ferrara, in northeastern Italy, was an outstanding pioneer in the early diagnosis and treatment of hip dysplasia. In 1935, while examining hip abduction-adduction in a six-month-old baby, Ortolani noted that a clearly audible and palpable "click" was sufficient to reveal congenital pre-dislocation of the hip, a condition he confirmed by an X-ray of the pelvis. This discovery suggested that the sound alone could be used for early diagnosis and treatment of the condition. Ortolani's test is now a widespread diagnostic technique, described in all pediatric and orthopedic textbooks. To confirm his conjecture, Ortolani dissected many hip specimens in very young babies who had died of unrelated causes. He also collected excellent specimens of congenital hip pathology in fetuses at all stages of intrauterine development, proving that hip dysplasia may already occur in utero. After his death, his entire collection was donated to the Institute of Anatomy of the University of Padua, where it is now exhibited in a special showcase. This collection, very impressive for both the number and high anatomical quality of its specimens, is famous worldwide because it demonstrates the etiopathology of hip dysplasia so clearly.

Near-infrared spectroscopy: recent advances in infant speech perception and language acquisition research.

Near-Infrared Spectroscopy (NIRS) is a relatively novel and increasingly popular optical imaging technique that has revolutionized brain research in the developmental populations (Villringer and Chance, 1997; Lloyd-Fox et al., 2009; Gervain et al., 2011). After more than a decade of technological development, NIRS has become a reliable, easy-to-use and efficient tool to explore the linguistic and cognitive abilities of neonates and young infants, opening new vistas for the investigation of language acquisition and cognitive development. This Research Topic covers the latest advances in these areas brought about by NIRS imaging. The main focus is to highlight innovative and foundational studies that go beyond methodological issues and advance our theoretical understanding of infant and child development. Contributions from the pioneers of this method are selected, illustrating how NIRS has allowed developmental researchers to ask theoretically relevant questions that more traditional methods couldn't address. The first two contributions, by Fava et al. (2011) and Benavides-Varela et al. (2011), cover general theoretical issues and methodological principles. They provide a critical, but constructive overview of theoretical questions about linguistic and cognitive development that have been asked, outline challenges that the NIRS community still needs to face and offer recommendations for optimal experimental designs and data interpretations practices. These general contributions are followed by a series of empirical papers exploring a key issue in the study of the neural correlates of language learning and development, the nature and origins of the brain specialization for speech and language. While it is well established that in the majority of right-handed adults, language is preferentially processed in the left hemisphere (e.g., Friederici, 2005), the reasons for and the ontogenetic origins of this left lateralization have so far been less well understood, partly because the field lacked a safe, fully non-invasive, participant-friendly brain imaging method with which to probe the infant brain. NIRS has filled this gap, opening up the way for exciting new discoveries about the brain specialization for speech and language in young babies (e.g., Pena et al., 2003; Sato et al., 2012). Five experimental articles in the current volume contribute to this exciting inquiry. May et al. (2011) compare newborn infants' brain responses to the native language, spoken by the mother during pregnancy, and to an unknown language, in an attempt to investigate how prenatal experience with speech might shape the brain specialization for language. Telkemeyer et al. (2011), Arimitsu et al. (2011) as well as Minagawa-Kawai et al. (2011) take a different approach, seeking to identify the acoustic, spectro-temporal properties of the speech signal might underlie brain specialization. In adults, it has been shown that fast-changing sounds or sounds modulated in time preferentially recruit areas in the left hemisphere that are part of the language network, while slowly changing sounds or sounds modulated spectrally tend to engage the right hemisphere (Zatorre et al., 2002; Hickok and Poeppel, 2007). This offers a potential explanation for why most language stimuli, with their fast phoneme and syllable transitions, activate the left hemisphere, with prosody being the only aspect of language that is processed in the right hemisphere. However, adults have extensive experience with language, leaving open the issue of causation. Telkemeyer et al. (2011), Arimitsu et al. (2011), and Minagawa-Kawai et al. (2011) now test these hypotheses on newborns and young infants using different temporally and spectrally modulated tone stimuli, asking whether the observed hemispheric specializations are the causes or the results of lateralized language processing. As an innovative extension of the research on early brain specialization for speech, Sato et al. (2011) investigate whether, and if yes, how this specialization might be different in an atypical population, stuttering children and adults. The last three contributions inquire into more advanced or higher level mechanisms of language processing and comprehension. Homae et al. (2011) used a new method of NIRS data analysis to explore functional connectivity and networks in 3-month-old infants at rest and while they listen to speech stimuli, identifying a large-scale brain network engaged in language processing. Wagner et al. (2011) explore the neural correlates of learning abstract linguistic rules at 7 and at 9 months of life and show important developmental changes signaling infants increased specialization for and attunement to language structure. Tabea Brink et al. (2011) study the brain mechanisms underlying the understanding of empathy in verbal and picture-based stories in pre-school children, an age which is believed to be crucial for the development of emotional and cognitive empathy. It is my hope that these NIRS studies further our understanding of language and cognitive development and bring us closer to bridging the gap between brain, mind and behavior at the very beginning of life.

The association between age and the development of respiratory syncytial virus neutralising antibody responses following natural infection in infants

To determine the age at which infants mount significant neutralising antibody responses to both natural RSV infection and live vaccines that mimic natural infection, RSV-specific neutralising antibodies in the acute and convalescent phase sera of infants with RSV infection were assayed. Age-specific incidence estimates for hospitalisation with severe RSV disease were determined and compared to age-specific neutralising antibody response patterns. Disease incidence peaked at between 2 and 3.9 months of life. Following natural infection, relative to the mean acute phase antibody titre, the mean convalescent titre was lower in the 0–1.9 month age class, no different in the 2–3.9 month age class and greater in all age classes greater than 4 months. These data suggest effective vaccination with live vaccines that mimic natural infection may not be achieved before the age of 4 months. Maternal vaccination may be an alternative to direct infant vaccination in order to protect very young babies.

Limited professional guidance and literature are available to guide the safe use of neuromuscular block in infants.

AimNeuromuscular blocking agents (NMBAs) are used in a range of critical illnesses in neonates and infants, despite a lack of guidelines and professional standards. This study reviewed the current evidence base and ascertained UK practice regarding the continuous use of these agents in this age range.MethodsWe reviewed the literature and carried out a telephone questionnaire of all tertiary units in England and specialist children's hospital neonatal units in the UK.ResultsNo best practice guidelines or general consensus statements were found, and the only randomised trial to feature an NMBA protocol expressed concerns about its use in such young babies. Of the 56 units contacted, 54 (96.4%) shared information. Only three of the 56 (5.4%) used intermittent boluses of NMBAs, 91.1% used NMBA infusions, 11 (19.6%) routinely used regular neuromuscular blocker pause to assess depth, and only one (1.8%) used peripheral nerve stimulation monitoring. All the units carried out clinical assessments, but only one (1.8%) had a written protocol.ConclusionThere is a paucity of literature and professional standards to guide the safe use of NMBAs in infants. Of the 54 units who participated in the survey, only one had a protocol for using NMBAs in babies.

Checkers and Dot at the Beach by J. Torres

Torres, J. Checkers and Dot at the Beach. Illus. J. Lum. Toronto: Tundra Books, 2013. Print.The team of Ontario-based author and illustrator (and comics veterans) J. Torres and J. Lum brings young babies the duo of Checkers and Dot. Torres is best known for his Alison Dare graphic novels and other comics while this is graphic designer Lum’s first opportunity at illustrating for a children’s audience.Checkers, a young boy in a checkered shirt and his friend Dot, a little girl in a polka-dotted jumper are introduced as part of a larger series of Checkers and Dot titles, all with a high-contrasted and heavily-designed black and white motif. This high contrast design is said to appeal to young babies and toddlers as well as provide visual stimulation that may lead to increased brain development. The small size and sturdy binding is a plus.In Checkers and Dot on the Farm, the youngest of children are introduced to animal sounds in rhyming prose that will be fun for any parent or caregiver to read aloud. The images are highly stylized and will be mesmerizing to young children and the characters, a little reminiscent of anime, are quite cute. In Checkers and Dot at the Beach the concept of basic counting to 5 is introduced via ocean animals. Both volumes have a slight plot which makes it more palatable to adults.Though toddlers will enjoy re-reading these books to practice their farm animal sounds and basic counting, they may bore of the black and white in favour of more colourful & engaging board books aimed at preschoolers. The series is aimed at ages 0-4, however I feel it better suits the 0-2 age range. Suitable for public and home libraries.Recommended: 3 stars out of 4Reviewer: Debbie FeisstDebbie is a Public Services Librarian at the H.T. Coutts Education Library at the University of Alberta. When not renovating, she enjoys travel, fitness and young adult fiction.

“Shaken baby syndrome” and forensic pathology

The concept of shaking baby syndrome (SBS) and the ‘‘triad’’ of encephalopathy, subdural hemorrhage (SDH), and retinal hemorrhage (RH) have become, as Dr. Byard [1] states, a hotly debated topic. SBS has come under increased scrutiny as our understanding of the mechanisms underlying the physiologic responses of neonates and infants continues to evolve. The triad can be secondary to trauma, but many forensic pathologists consider that impact is necessary to account for the signs and symptoms; as a consequence, the term SBS has been replaced by ‘‘shaken impact’’ syndrome or the more nondescript ‘‘abusive head trauma.’’ The issue is not whether or not shaking is injurious; Finnie’s experiment [2] clearly shows that smaller animals can die from repeated shaking. Instead, the issue is whether shaking alone can generate the forces associated with bridging vein rupture and SDH described in experimental models of SDH [3]. It is now well established that bridging vein rupture is not the only source of SDH in infants [4–6]. RHs also have multifactorial etiology [7, 8]. The small intradural vessels of the parasagittal dura, the falx, and tentorium are more extensive in young babies, and these vessels can leak to produce intradural and subdural hemorrhage. The extensive valveless plexus within the intracranial dura connects with the venous plexus of the spine and together form the craniospinal venous system [9]; the function of this system is not fully understood, though it is known to be involved in the maintenance of intracranial pressure, and affected by posture and respiration. This brings us to the possible role of hypoxia in SDH. While hypoxia on its own is not enough to produce SDH, there is a strong association between hypoxia and SDH [5, 6]. Additional factors such as increased venous pressure or coagulation disorders may serve to extend an intradural hemorrhage (IDH) into a thin-film SDH over the hemispheres and along the dural folds. Pathologists who do large numbers of perinatal autopsies see the close association between hypoxia and IDH/SDH [10]. Critics who sustain that the trauma of delivery has not been accounted for ignore the fact that with current obstetric care, traumatic tears of the falx or tentorium are extraordinarily rare [5]. In fact the ‘‘trauma’’ of delivery is one of hypoxia and increased intracranial pressures and not one of traumatic acceleration/deceleration. Geddes et al. [11] were the first to report that the microscopic changes seen in the brain of infants who died of inflicted head injury were hypoxic-ischemic rather than traumatic. The lack of traumatic changes in the brain made them suggest an alternative pathway for the findings of SDH and RH [12]. Since then other authors have postulated neck injury as the event that precipitates apnea and results in hypoxic changes of the brain [13]. Most of the current literature lumps together children under 2–3 years of age; however, the anatomy of the dura of infants below the age of 6 months is very different from an infant of age 2. Age-dependent changes in the cardiovascular, respiratory, immune, and coagulation systems, as well as individual variation in maturation, need to be considered when evaluating the triad in infants. We agree that ascribing intention to a combination of symptoms is absurd. While lethal craniocerebral trauma seems appropriate [1], this does not include the children This comment refers to the article available at DOI 10.1007/s12024013-9514-7.

Chromatic visual evoked potentials in paediatric population

The purpose of this study was to investigate chromatic visual evoked potential (cVEP) response characteristics during the first year of life and to collect as large database of healthy baby responses as possible. This study also complements our previous studies on cVEP in schoolchildren and preschool children. Forty-four healthy babies aged 3-12months were binocularly tested. cVEP were recorded to isoluminant red-green (R-G) and blue-yellow (B-Y) stimuli. The stimulus represented a circle composed of horizontal sinusoidal gratings with 90% chromatic contrast and spatial frequency of 2 cycles/deg. Two stimulus sizes (7° and 21°) and onset-offset mode of stimulation (On-300ms, Off-700ms) were used. cVEP were recorded from Oz (mid-occipital) position with the reference at Fz. Waveform characteristics and its changes throughout the first year of life were studied. Chromatic visual evoked potential responses were reliably recorded in all but two youngest babies. Characteristic cVEP response consisted of negative-positive-negative complex, positive (P) wave being far more prominent than both negative waves (N1 and N2). cVEP response to larger stimulus size (21°) showed shorter latency and higher amplitude to both (R-G) and (B-Y) stimuli compared to smaller stimulus size (7°). The same was true when comparing R-G versus B-Y stimulus: R-G responses showed higher amplitude and shorter latency than B-Y response, for both stimulus sizes. P wave latency shortened with increasing age throughout the first year of life, both for R-G (R (2)=0.59) and B-Y (R (2)=0.41) 21° stimulation. P wave amplitude did not show significant changes throughout the first year of life. Chromatic visual evoked potential can be reliably recorded after the age of 3months and show significant maturational changes throughout the first year of life.

Factors associated with early neonatal attendance to a paediatric emergency department

AimTo examine the demographic and perinatal factors involved in the presentation of newborn babies to a paediatric emergency department (PED) and outcome following attendance.MethodsTerm babies who attended the PED of...

Immunisation: Changes in the UK for Children and Young People

Vaccination programmes are implemented either in response to a specific situation, or as new vaccines become available or evidence about them accumulates. Significant changes to the UK child and adolescent immunisation schedule have been implemented from 2013. Rotavirus vaccine was introduced for infants in July 2013. The influenza vaccination programme is being extended to include all two to 16 year olds eventually and, since September 2013, is being offered to all two and three year olds. To ensure protection against meningococcal C infection into adulthood, the immunisation schedule has been further modified. Since October 2012, in response to an increase in the number of cases of pertussis, particularly among young babies, all pregnant women have been offered a pertussis-containing vaccine during the last trimester of pregnancy. Large outbreaks of measles, particularly in Swansea and the north east of England, prompted a national campaign that was launched in April 2013 to ensure that all children and young people have received two doses of measles, mumps and rubella vaccine.

Calcium signaling-related proteins are associated with broncho-pulmonary dysplasia progression

Broncho-pulmonary dysplasia (BPD) is a chronic pulmonary disorder that follows premature birth. It is preceded by respiratory distress syndrome (RDS), characterized by acute respiratory failure due to deficiency of surfactant at birth. Clinical characteristics of infants affected by BPD have widely changed in the last decades: they are extraordinarly immature, with impaired alveolar and vascular lung development. To build up new therapeutic strategies for BPD babies, it is necessary to understand the pathogenic mechanisms, which are complicated by environmental risk factors and genetic predisposition. Therefore, the aim of this study was to highlight protein changes in the broncho-alveolar lavage fluid (BALF), thus providing an appropriate picture on what is happening in the locus of injury. We analyzed BALF samples from preterm babies, born at different stages of lung development. We confirmed that gestational age is relevant for BPD progression, but we also detected few de-regulated proteins in the younger babies; we discovered less abundant calcium signaling-related proteins, consistent with BPD severity, comparing severe to mild BPD babies with matched gestational age. In conclusion, this study suggests a subset of proteins to be investigated to better treat BPD babies and facilitate the definition of potential drug targets for novel therapies. Pulmonary biomarkers are needed to predict the clinical course of lung disease, status, progression and response to treatment. A key aspect in biomarker discovery is uncovering molecules that appear early during disease initiation, when the natural history of the disease can be modified. Using a proteomic-based approach we compared broncho-alveolar lavage fluid (BALF) protein profile from preterm neonates at different postmenstrual ages, to have a molecular description of broncho-pulmonary dysplasia (BPD) progression. BALF provided a snapshot of local molecular changes, which are relevant for early diagnosis, assessment and characterization of lung disorders. We showed that even if the studied patients had similar clinical phenotype (they all developed severe BPD and they were all cured in the same way in terms of mechanical ventilation, surfactant administration, antenatal steroid treatment and ibuprofen treatment for patent ductus arteriosus), however their BALF protein profiling displayed significant differences in a subset of proteins, which could be exploited to facilitate the development of novel effective therapies, distinct for age and severity of the disease.

The changing perspectives of librarians in the Better Beginnings family literacy program

Libraries across Australia are becoming increasingly involved in the development and implementation of family literacy programs, placing librarians at the centre of this initiative. Better Beginnings is a family literacy program developed by the State Library of Western Australian and delivered throughout the state. The program involves a partnership between public libraries, health professionals and local governments that has developed to support the delivery of early literacy resources and strategies to parents of young babies. Librarians play a major role in the delivery, implementation and sustainability of the program. This paper reports the findings from the longitudinal evaluation of Better Beginnings in four communities, across four years, in relation to the perspectives of librarians responsible for the program in their library. Librarians were interviewed about their role in the program and its effectiveness, the training they had received and the collaboration between the professionals involved in the program. The data revealed that over a period of four years librarians had developed an understanding of the purpose and importance of the program, which had led to a sense of ownership and commitment. This was supported by central coordination of the program and collaboration with child-health nurses. Over the four years, they had developed and increased library activities and created ‘family spaces’ linked to Better Beginnings. They felt the program was effective in promoting literacy in families with young children, but sought more strategies for engaging families that did not traditionally visit libraries or have access to libraries.

Should acellular pertussis vaccine be recommended to healthcare professionals?

The aim of this study was to describe recent changes in the epidemiology of pertussis and existing policies regarding recommended and mandatory occupational vaccinations for healthcare professionals (HCPs). The authors carried out an extensive review of references on the PubMed and SciELO databases and the official sites of the World Health Organization, Pan American Health Organization, Centers for Disease Control and Prevention, and Brazilian Ministry of Health, using the keywords pertussis, vaccines and healthcare professionals. Vaccination against pertussis is recommended for HCPs in the United States, Canada, nine European countries, Australia, Hong Kong, Singapore, Costa Rica, Argentina and Uruguay, and in some countries it is compulsory. In Brazil, only one publication discussing the risk of pertussis among HCPs was found. Considering the reemergence of pertussis and the great number of associated hospitalizations and deaths registered in 2011, it is necessary to review public policies regarding HCP pertussis vaccination, particularly among workers in frequent contact with young babies.

Should acellular pertussis vaccine be recommended to healthcare professionals?

The aim of this study was to describe recent changes in the epidemiology of pertussis and existing policies regarding recommended and mandatory occupational vaccinations for healthcare professionals (HCPs). The authors carried out an extensive review of references on the PubMed and SciELO databases and the official sites of the World Health Organization, Pan American Health Organization, Centers for Disease Control and Prevention, and Brazilian Ministry of Health, using the keywords pertussis, vaccines and healthcare professionals. Vaccination against pertussis is recommended for HCPs in the United States, Canada, nine European countries, Australia, Hong Kong, Singapore, Costa Rica, Argentina and Uruguay, and in some countries it is compulsory. In Brazil, only one publication discussing the risk of pertussis among HCPs was found. Considering the reemergence of pertussis and the great number of associated hospitalizations and deaths registered in 2011, it is necessary to review public policies regarding HCP pertussis vaccination, particularly among workers in frequent contact with young babies.

Teacher education and soothing strategies with infants and toddlers

Observations of soothing strategies that daycare teachers used with infants and toddlers in 10 centres, revealed that distress episodes lasted the longest for the youngest babies (0–12 months). The youngest babies received more positive caregiver responses when distressed compared with babies 13–24 months or toddlers 25–36 months old. The frequency of distress cues did not differ by child gender. Recorded levels of distress were significantly lower for babies cared for by teachers who had high school education or less, and those teachers responded more rapidly to infant/toddler distress signals than did teachers with college-level education.

Childcare choices and voices: using interpreted narratives and thematic meaning-making to analyse mothers’ life histories

This paper focuses on the methodology of a study that asked what factors English mothers of very young babies consider when making employment decisions and childcare choices, and sought their views on the idea of carers in day care settings ‘loving’ their children. After a characterisation of life historical study, a four-staged process of analysis demonstrates how meaning was made from data created with six mothers. The discussion ‘voices’ their stories through excerpts from their expressions of emotion. The conclusion acknowledges insights generated into the dilemmas of mothers’ choices, but importantly points up how the careful listening and critical attending required by life historical study themselves generate stories that ‘go awry’ to reveal something of personal and of social importance. The paper concludes that using life story methods is a difficult process which may create discomfort for researcher and ‘researched’ long after the study is finished.

The common premise for uncommon conclusions

Recent controversy over philosophical advocacy of infanticide (or the comically-styled euphemism ‘postnatal abortion’) reveals a surprisingly common premise uniting many of the opponents and supporters of the practice. This is...

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