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Lis-Kuberka, Jolanta, and Magdalena Orczyk-Pawiłowicz. "Sialylated Oligosaccharides and Glycoconjugates of Human Milk. The Impact on Infant and Newborn Protection, Development and Well-Being." Nutrients 11, no. 2 (February 1, 2019): 306. http://dx.doi.org/10.3390/nu11020306.
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Human milk not only has nutritional value, but also provides a wide range of biologically active molecules, which are adapted to meet the needs of newborns and infants. Mother’s milk is a source of sialylated oligosaccharides and glycans that are attached to proteins and lipids, whose concentrations and composition are unique. Sialylated human milk glycoconjugates and oligosaccharides enrich the newborn immature immune system and are crucial for their proper development and well-being. Some of the milk sialylated oligosaccharide structures can locally exert biologically active effects in the newborn’s and infant’s gut. Sialylated molecules of human milk can be recognized and bound by sialic acid-dependent pathogens and inhibit their adhesion to the epithelial cells of newborns and infants. A small amount of intact sialylated oligosaccharides can be absorbed from the intestine and remain in the newborn’s circulation in concentrations high enough to modulate the immunological system at the cellular level and facilitate proper brain development during infancy. Conclusion: The review summarizes the current state of knowledge on sialylated human milk oligosaccharides and glycoconjugates, discusses the significance of sialylated structures of human milk in newborn protection and development, and presents the advantages of human milk over infant formula.
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Windarti, Siti Wahyu, and Ahmad Suryawan. "Effectiveness of The Newborn Behavioral Observation (NBO) System in Improving Mother and Infant Interaction." Folia Medica Indonesiana 57, no. 2 (June 1, 2021): 90. http://dx.doi.org/10.20473/fmi.v57i2.21558.
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The interaction of mother and infant is a fundamental basis for the development of the infant. It can also determine the success of the baby in the future. About 4 out of 10 infants experience problems interacting with their parents. The NBO system was created to sensitize parents on their infant’s competencies to help them understand their infant’s behavior, and promote positive interactions between parents and their new infant. This study aimed to evaluate the effectiveness of the NBO system to improve mother-infant interactions and find out the mothers’ knowledge about their infant’s behavior when participating in this observation. This study was a cross-sectional study consisting of all the newborns and their mothers admitted to the Dr. Soetomo General Academic Hospital Surabaya from May 2019 to January 2020 who met the inclusion criteria. Mothers and infants participated in the NBO within 1-3 days after delivering their infants and one month postpartum for the second NBO. The NBO was carried out with 35 mothers and infants. The mothers’ age was on average 28.5±5.98 years old, multiparous mothers accounted for 71.4%, most infants were male (65.7%), the median gestational age was 38 weeks with the median birth weight 2900 grams. The median score of mothers’ knowledge about their infants before the NBO session was 2 (1-6). After the session, these median scores increased to 7 (5–10) significantly (p<0.001). The NBO system was significant to strengthen mother-infant interaction and increased the mothers’ knowledge about their infants’ behavior.
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Purdy, Isabell. "Newborn Auditory Follow-Up." Neonatal Network 19, no. 2 (March 2000): 25–33. http://dx.doi.org/10.1891/0730-0832.19.2.25.
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Because hearing is a key component in the infant’s development of speech, language, and cognition, early detection of infant hearing loss is critically important. The routine evaluation of hearing should include the identification of parental concerns regarding infant hearing as well as the assessment and diagnosis of infants with potential hearing impairment. Identification of hearing loss should be followed by early interventions to prevent developmental delays. This article promotes universal screening of newborn hearing. The article also provides a review of the embryogenesis of hearing and includes a breakdown of risks for hearing loss, recommendations for auditory testing, and suggestions for follow-up, early intervention, and support for families of infants with hearing impairment.
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MERCHANT, NAZAKAT, and DENIS AZZOPARDI. "HYPOXIC ISCHAEMIC ENCEPHALOPATHY IN NEWBORN INFANTS." Fetal and Maternal Medicine Review 21, no. 3 (May 19, 2010): 242–62. http://dx.doi.org/10.1017/s0965539510000069.
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Neonatal encephalopathy has been defined as “a clinically defined syndrome of disturbed neurological function in the earliest days of life in the term infant, manifested by difficulty with initiating and maintaining respiration, depression of tone and reflexes, sub normal level of consciousness and often seizures”. It occurs in about 2–3 per 1000 births in developed countries. In developing countries, neonatal encephalopathy accounts for the largest number of deaths in infancy and childhood – approximately 1 million per year worldwide. Neonatal encephalopathy is associated with significant morbidity and mortality and is an important predictor of long term neurodevelopmental disability in near- and full-term newborn infants. Fifteen to 20 percent of infants with neonatal encephalopathy die in the neonatal period, and a further 25 percent have permanent neurologic deficits.
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VandenBerg, Kathleen A., and Erin Sundseth Ross. "Individualized Developmental Care in the Neonatal Intensive Care Nursery." Perspectives on Swallowing and Swallowing Disorders (Dysphagia) 17, no. 3 (October 2008): 84–93. http://dx.doi.org/10.1044/sasd17.3.84.
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Abstract Advances in medical care have improved the success of medical interventions in treating high-risk and premature infants, but long-term developmental outcomes are less positive. The neonatal intensive care unit (NICU) setting influences infant brain development and organization, as well as the parent-infant relationship. One advanced-practice role for a speech-language pathologist (SLP) is that of a newborn developmental specialist (NDS). The NDS working in the NICU understands the influence of medical, environmental, and caregiving interactions on the neurologic and neurobehavioral organization of the infant. The NICU setting advanced practice skills are grounded in an individualized, developmentally supportive care model, such as the Newborn Individualized Developmental Care and Assessment Program (NIDCAP). Neurodevelopmental assessment focuses on the competence of the infant. The developmental assessment and intervention strategies are individualized to support the infant's own goal strivings. In this framework, interactions with infants become modified to increase competence and organization. The SLP working in the NICU is in a unique position to facilitate communication between the infant and the parent, as well as between the infant and professional caregivers. The SLP can help the parent interpret and respond appropriately to the infant's communication by focusing on non-verbal stress and stability cues, and by planning all interactions with a goal of co-regulation. Interactions with infants and families in this Model in the NICU have beneficial lifelong implications.
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Beiranvand, Shourangiz, Fatemeh Valizadeh, Reza Hosseinabadi, and Yadollah Pournia. "The Effects of Skin-to-Skin Contact on Temperature and Breastfeeding Successfulness in Full-Term Newborns after Cesarean Delivery." International Journal of Pediatrics 2014 (2014): 1–7. http://dx.doi.org/10.1155/2014/846486.
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Background. The skin-to-skin contact (SSC) of mother and newborn is uncommon full-term newborns after delivering via cesarean section due to the possibility of hypothermia in the infants. The aim of this study was to compare mothers’ and infant’s temperatures after delivering via cesarean section.Material and Methods. In this randomized clinical trial, 90 infant/mothers dyads delivered via cesarean section were randomized to SSC (n=46) and routine care (n=44). In experimental group, skin-to-skin contact was performed for one hour and in the routine group the infant was dressed and put in the cot according to hospital routine care. The newborns’ mothers’ temperatures in both groups were taken at half-hour intervals. The data was analyzed using descriptive statistics,t-tests, and chi-square tests.Results. The means of the newborns’ temperatures immediately after SSC (P=0.86), half an hour (P=0.31), and one hour (P=0.52) after the intervention did not show statistically significant differences between the two groups. The mean scores of the infants’ breastfeeding assessment in SSC (8.76±3.63) and routine care (7.25±3.5) groups did not show significant differences (P=0.048).Conclusion. Mother and infant’s skin-to-skin contact is possible after delivering via cesarean section and does not increase the risk of hypothermia.
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Barbara, Janet Mann. "BEHAVIORAL DEVELOPMENT IN WILD BOTTLENOSE DOLPHIN NEWBORNS (TURSIOPS SP.)." Behaviour 136, no. 5 (1999): 529–66. http://dx.doi.org/10.1163/156853999501469.
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AbstractNewborn characteristics, patterns of motoric and social behavioural development, and mother-infant relationships in free-ranging and semi-provisioned bottlenose dolphins (Tursiops sp.) are examined. Nine newborns were observed for 189 hours over the first 10 weeks of life. Newborn infants breathe more often than their mothers, and synchronize their breathing and swimming with her soon after birth, but show a gradual decline in synchrony as they age. Virtually all patterns of infant behaviour, mother-infant proximity, and spatial relationships with the mother changed as a function of infant age. Maternal activity, however, does not change over time, except that mothers decrease their role in maintaining proximity to their infants from the first month to the second month of infant life. Infants spend less time close to their mothers, less time echelon swimming (close, alongside the mother), and more time infant-position swimming (in contact under the mother) as they age. Infants spend more time traveling and socializing independently over time. They also separate from their mothers more often and for longer periods of time. Infants do not forage during the newborn period, but are observed 'practice foraging' by the end of the first month. Rubbing, petting, chasing, and displaying with other animals (including the mother) were common forms of socializing. Infants frequently initiate rubbing with their mothers, with particular focus on her head region. Infants typically associate with young females, adult females and other infants, but not with adult or subadult males. Developmental shifts and overall patterns are discussed in the context of the bottlenose dolphin's fission-fusion social organization and ecology. The effects of provisioning on dolphin behaviour are addressed.
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Pateva, Irina, Elisabeth Kerling, Susan Carlson, Manju Reddy, Dan Chen, and Jakica Tancabelic. "Effect Of Maternal Cigarette Smoking On Newborn Iron Stores." Blood 122, no. 21 (November 15, 2013): 4671. http://dx.doi.org/10.1182/blood.v122.21.4671.4671.
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Objective Previous small-scale studies suggest that maternal smoking lowers neonatal body iron. Our objective was to study and compare the relationship between maternal and infants’ body iron in smokers and non-smokers in a large matched-pair cohort. Method This was a prospective cohort study involving 144 mothers – 72 smokers and 72 non-smokers and their respective infants. Samples were obtained from maternal blood and infants’ cord blood at delivery for serum transferrin receptor (sTfR) and ferritin levels. Serum TfR and ferritin levels were measured by RAMCO ELISA and RIA assays. The total body iron (TBI) was calculated using the sTfR/ferritin ratio. Results Maternal total body iron and smoking status Women who smoked had lower sTfR, higher ferritin and higher body iron compared to nonsmoking women. Infant’s total body iron, measurements at birth and smoking status In contrast to their respective mothers, we found a small but statistically significant negative correlation between smoking and infants’ total body iron. The number of PPD smoked was negatively correlated with infants’ ferritin and total body iron. The number of days smoked during pregnancy was also negatively correlated with infants’ ferritin and total body iron and positively correlated with infants' sTfR. Birth weight was lower in babies of smokers compared to nonsmokers (mean /- SD =3270 +/-475 vs. 3393 g +/- 475 g, p=0.03). Correlation studies revealed that birth weight in infants of smokers was negatively correlated with PPD smoked and number of days smoked. Birth length in the same infants was also negatively correlated with PPD smoked and number of days smoked. Conclusion Mothers who smoked during pregnancy had higher iron stores but their newborn infants had lower iron stores than those of non-smoking mothers. There may be a negative dose-dependent response between fetal smoke exposure and infant iron stores. Disclosures: No relevant conflicts of interest to declare.
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Kaitz, M., A. M. Rokem, and A. I. Eidelman. "Infants' Face-Recognition by Primiparous and Multiparous Women." Perceptual and Motor Skills 67, no. 2 (October 1988): 495–502. http://dx.doi.org/10.2466/pms.1988.67.2.495.
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We have compared the ability of 49 primiparous and 75 multiparous women to recognize photographs of their newborn infants. In line with previous research on infant cries, we found that multiparous women who had been with their infant 0.5 to 5.0 hr. were significantly more successful in recognizing their infants' photographs than primiparous women with comparable exposure to their newborns. For women who had not been with their infants more than 5 hr., parity was not related to recognition. We propose that the transient performance deficit of the primiparous women indicates a short-lived impairment of perceptual/cognitive skills associated with their more stressful childbearing experience.
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Nolan, Lila S., Olivia B. Parks, and Misty Good. "A Review of the Immunomodulating Components of Maternal Breast Milk and Protection Against Necrotizing Enterocolitis." Nutrients 12, no. 1 (December 19, 2019): 14. http://dx.doi.org/10.3390/nu12010014.
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Breast milk contains immunomodulating components that are beneficial to newborns during maturation of their immune system. Human breast milk composition is influenced by an infant’s gestational and chronological age, lactation stage, and the mother and infant’s health status. Major immunologic components in human milk, such as secretory immunoglobulin A (IgA) and growth factors, have a known role in regulating gut barrier integrity and microbial colonization, which therefore protect against the development of a life-threatening gastrointestinal illness affecting newborn infants called necrotizing enterocolitis (NEC). Breast milk is a known protective factor in the prevention of NEC when compared with feeding with commercial formula. Breast milk supplements infants with human milk oligosaccharides, leukocytes, cytokines, nitric oxide, and growth factors that attenuate inflammatory responses and provide immunological defenses to reduce the incidence of NEC. This article aims to review the variety of immunomodulating components in breast milk that protect the infant from the development of NEC.
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Kalhan, Satish C., Prabhu Parimi, Ron Van Beek, Carol Gilfillan, Firas Saker, Lourdes Gruca, and Pieter J. J. Sauer. "Estimation of gluconeogenesis in newborn infants." American Journal of Physiology-Endocrinology and Metabolism 281, no. 5 (November 1, 2001): E991—E997. http://dx.doi.org/10.1152/ajpendo.2001.281.5.e991.
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The rate of glucose turnover (Ra) and gluconeogenesis (GNG) via pyruvate were quantified in seven full-term healthy babies between 24 and 48 h after birth and in twelve low-birth-weight infants on days 3 and 4 by use of [13C6]glucose and2H2O. The preterm babies were receiving parenteral alimentation of either glucose or glucose plus amino acid with or without lipids. The contribution of GNG to glucose production was measured by the appearance of 2H on C-6 of glucose. Glucose Ra in full-term babies was 30 ± 1.7 (SD) μmol · kg−1 · min−1. GNG via pyruvate contributed ∼31% to glucose Ra. In preterm babies, the contribution of GNG to endogenous glucose Rawas variable (range 6–60%). The highest contribution was in infants receiving low rates of exogenous glucose infusion. In an additional group of infants of normal and diabetic mothers, lactate turnover and its incorporation into glucose were measured within 4–24 h of birth by use of [13C3]lactate tracer. The rate of lactate turnover was 38 μmol · kg−1 · min−1, and lactate C, not corrected for loss of tracer in the tricarboxylic acid cycle, contributed ∼18% to glucose C. Lactate and glucose kinetics were similar in infants that were small for their gestational age and in normal infants or infants of diabetic mothers. These data show that gluconeogenesis is evident soon after birth in the newborn infant and that, even after a brief fast (5 h), GNG via pyruvate makes a significant contribution to glucose production in healthy full-term infants. These data may have important implications for the nutritional support of the healthy and sick newborn infant.
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Gaertner, Vincent D., Sophie A. Flemmer, Laila Lorenz, Peter G. Davis, and C. Omar Farouk Kamlin. "Physical stimulation of newborn infants in the delivery room." Archives of Disease in Childhood - Fetal and Neonatal Edition 103, no. 2 (June 9, 2017): F132—F136. http://dx.doi.org/10.1136/archdischild-2016-312311.
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ObjectiveNeonatal resuscitation guidelines recommend that newborn infants are stimulated to assist with the establishment of regular respirations. The mode, site of application and frequency of stimulations are not stipulated in these guidelines. The effectiveness of stimulation in improving neonatal transition outcomes is poorly described.MethodsWe conducted a retrospective review of video recordings of neonatal resuscitation at a tertiary perinatal centre. Four different types of stimulation (drying, chest rub, back rub and foot flick) were defined a priori and the frequency and infant response were documented.ResultsA total of 120 video recordings were reviewed. Seventy-five (63%) infants received at least one episode of stimulation and 70 (58%) infants were stimulated within the first minute after birth. Stimulation was less commonly provided to infants <30 weeks’ gestation (median (IQR) number of stimulations: 0 (0–1)) than infants born ≥30 weeks’ gestation (1 (1–3); p<0.001). The most common response to stimulation was limb movement followed by infant cry and facial grimace. Truncal stimulation (drying, chest rub, back rub) was associated with more crying and movement than foot flicks.ConclusionLess mature infants are stimulated less frequently compared with more mature infants and many very preterm infants do not receive any stimulation. Most infants were stimulated within the first minute as recommended in resuscitation guidelines. Rubbing the trunk may be most effective but this needs to be confirmed in prospective studies.
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Luong, Deandra, Po-Yin Cheung, Keith J. Barrington, Peter G. Davis, Jennifer Unrau, Shyamala Dakshinamurti, and Georg M. Schmölzer. "Cardiac arrest with pulseless electrical activity rhythm in newborn infants: a case series." Archives of Disease in Childhood - Fetal and Neonatal Edition 104, no. 6 (February 22, 2019): F572—F574. http://dx.doi.org/10.1136/archdischild-2018-316087.
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The 2015 neonatal resuscitation guidelines added ECG to assess an infant’s heart rate when determining the need for resuscitation at birth. However, a recent case report raised concerns about this technique in the delivery room. We report four cases of pulseless electrical activity during neonatal cardiopulmonary resuscitation in levels II–III neonatal intensive care units in Canada (Edmonton [n=3] and Winnipeg [n=1]).Healthcare providers should be aware that pulseless electrical activity can occur in newborn infants during cardiopulmonary resuscitation. We propose an adapted neonatal resuscitation algorithm to include pulseless electrical activity. Furthermore, in compromised newborns, heart rate should be assessed using a combination of methods/techniques to ensure accurate heart rate assessment. When ECG displays a heart rate but the infant is unresponsive, pulseless electrical activity should be suspected and chest compression should be started.
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Urquia, ML, TA Stukel, K. Fung, RH Glazier, and JG Ray. "Estimating gestational age at birth: a population-based derivation-validation study." Chronic Diseases and Injuries in Canada 31, no. 3 (June 2011): 103–8. http://dx.doi.org/10.24095/hpcdp.31.3.04.
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Introduction Information on newborn gestational age (GA) is essential in research on perinatal and infant health, but it is not always available from administrative databases. We developed and validated a GA prediction model for singleton births for use in epidemiological studies. Methods Derivation of estimated GA was calculated based on 130 328 newborn infants born in Ontario hospitals between 2007 and 2009, using linear regression analysis, with several infant and maternal characteristics as the predictor (independent) variables. The model was validated in a separate sample of 130 329 newborns. Results The discriminative ability of the linear model based on infant birth weight and sex was reasonably approximate for infants born before the 37th week of gestation (r2 = 0.67; 95% CI: 0.65–0.68), but not for term births (37–42 weeks; r2 = 0.12; 95% CI: 0.12–0.13). Adding other infant and maternal characteristics did not improve the model discrimination. Conclusion Newborn gestational age before 37 weeks can be reasonably approximated using locally available data on birth weight and sex.
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Namgung, Ran, and Reginald C. Tsang. "Factors affecting newborn bone mineral content: in utero effects on newborn bone mineralization." Proceedings of the Nutrition Society 59, no. 1 (February 2000): 55–63. http://dx.doi.org/10.1017/s0029665100000070.
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Several factors have been found recently to have a significant impact on newborn bone mineral content (BMC) and developing fetal bone. Recently we showed that maternal vitamin D deficiency may affect fetal bone mineralization. Korean winter-born newborn infants had extremely low serum 25-hydroxyvitamin D (25-OHD), high serum cross-linked carboxy-terminal telopeptide of type I collagen (ICTP; a bone resorption marker), and markedly lower (8 %) total body BMC than summer-born newborn infants. Infant total body BMC was positively correlated with cord serum 25-OHD and inversely correlated with ICTP, which was also negatively correlated with vitamin D status. In three separate studies on North American neonates we found markedly lower (8–12 %) BMC in summer newborn infants compared with winter newborn infants, the opposite of the findings for Korean neonates. The major reason for the conflicting BMC results might be the markedly different maternal vitamin D status of the North American and Korean subjects. Recently, we found evidence of decreased bone formation rates in infants who were small-for-gestational age (SGA) compared with infants who were appropriate-for-gestational age; we reported reduced BMC, cord serum osteocalcin (a marker of bone formation) and 1,25-dihydroxyvitamin D (the active metabolite of vitamin D), but no alterations in indices of fetal bone collagen metabolism. In theory, reduced utero-placental blood flow in SGA infants may result in reduced transplacental mineral supply and reduced fetal bone formation. Infants of diabetic mothers (IDM) have low BMC at birth, and infant BMC correlated inversely with poor control of diabetes in the mother, specifically first trimester maternal mean capillary blood glucose concentration, implying that factors early in pregnancy might have an effect on fetal BMC. The low BMC in IDM may be related to the decreased transplacental mineral transfer. Cord serum ICTP concentrations were higher in IDM than in control subjects, implying increased intrauterine bone resorption. BMC is consistently increased with increasing body weight and length in infants. Race and gender differences in BMC appear in early life, but not at birth. Ethanol consumption and smoking by the mother during pregnancy affect fetal skeletal development.
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Funes, Samanta C., Miguel A. Mansilla, Gisela Canedo-Marroquín, Margarita K. Lay, Claudia A. Riedel, and Alexis M. Kalergis. "Role of Regulatory T Cells in Infection and Vaccination During Early Infancy." Current Pharmaceutical Design 24, no. 30 (December 8, 2018): 3495–505. http://dx.doi.org/10.2174/1381612824666180829094315.
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Reducing infant mortality due to infectious diseases is one of the most important public health goals worldwide. Several approaches have been implemented to reach this goal and vaccination has been an effective strategy for reducing infant and newborn mortality. However, the immunological features of neonates and infants represent a significant barrier to the effectiveness of vaccination. Since regulatory T cells (Treg cells) are known to play an active role in contributing to various mechanisms of suppression of the immune cell function. It has been proposed that these immune cells could decrease the immunogenicity of vaccines administered in newborns and infants. In this article, we discuss the various types of Treg cells, along with their suppressing and inhibitory mechanisms, which are used by these cells in the context of infectious and immunization processes in newborns and infants.
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Hamby, Tyler, Nayana Kunnel, John S. Dallas, and Don P. Wilson. "Maternal iodine excess: an uncommon cause of acquired neonatal hypothyroidism." Journal of Pediatric Endocrinology and Metabolism 31, no. 9 (September 25, 2018): 1061–64. http://dx.doi.org/10.1515/jpem-2018-0138.
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AbstractBackgroundExcessive iodine exposure is an often overlooked cause of neonatal hypothyroidism.Case presentationWe present an infant with iodine-induced hypothyroidism, which was detected at age 15 days by newborn screening. The infant’s iodine excess resulted from maternal intake of seaweed soup both during and after pregnancy. Treatment included discontinuation of seaweed soup, temporary interruption of breastfeeding and short-term levothyroxine therapy. By age 4 months, the infant’s hypothyroidism had resolved, and her growth and development were normal.ConclusionsThis case illustrates the importance of considering excess dietary iodine as a possible cause of hypothyroidism in infants.
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Yakobson, Dana, Shmuel Arnon, Christian Gold, Cochavit Elefant, Ita Litmanovitz, and Bolette Daniels Beck. "Music Therapy for Preterm Infants and Their Parents: A Cluster-Randomized Controlled Trial Protocol." Journal of Music Therapy 57, no. 2 (2020): 219–42. http://dx.doi.org/10.1093/jmt/thaa002.
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Abstract Music therapy (MT) interventions and skin-to-skin care (SSC) both aim to address the varied needs of preterm infants, including sensory regulation and stress reduction, inclusion of parents in their infant’s care, support of parents’ emotional state, and enhancing the parent–infant attachment process. Few studies have investigated the combination of both modalities through randomized controlled trials. Evidence of longer-term effects is missing. This article presents a study protocol that will investigate the effects of combined family-centered MT intervention and SSC on preterm-infants’ autonomic nervous system (ANS) stability, parental anxiety levels, and parent–infant attachment quality. 12 clusters with a total of 72 preterm infants, with their parents, will be randomized to one of two conditions: MT combined with SSC or SSC alone. Each parent–infant dyad will participate in 3 sessions (2 in the hospital and a 3-month follow-up). The primary outcome of preterm infants’ ANS stability will be measured by the high frequency power of their heart rate variability. Secondary outcomes will be physiological measures and behavioral states in infants and anxiety and attachment levels of parents. This trial will provide important, evidence-based knowledge on the use of the “First Sounds: Rhythm, Breath, and Lullaby” model of MT in neonatal care, through an intervention that is in line with the Newborn Individualized Developmental Care and Assessment Program model for supportive developmental care of preterm infants and their parents. Ethical approval (no. 0283-15) was granted from the local Institutional Review Board in April 2017. This trial is registered in ClinicalTrials.gov, NCT03023267.
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Genna, Catherine Watson, and Micaela Notarangelo. "Differentiating Normal Newborn Weight Loss From Breastfeeding Failure." Clinical Lactation 9, no. 4 (November 2018): 183–92. http://dx.doi.org/10.1891/2158-0782.9.4.183.
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There is increasing concern for the risk of hypernatremic dehydration in infants breastfeeding poorly. It is important to differentiate normal weight changes as infants adapt to extrauterine life from excessive weight loss from breastfeeding failure or mismanagement. We review recent data on normal weight changes in exclusively breastfeeding infants and those at risk for hypernatremic dehydration to help health professionals determine when infants require further scrutiny and supplementation. The data suggest that perinatal practices influence infant weight changes. Protecting normal birth and early initiation of breastfeeding should reduce the incidence of excessive weight loss and risk of hypernatremic dehydration
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Pejic, Katarina, Borisav Jankovic, Zeljko Mikovic, Zorica Rakonjac, Jelena Martic, and Natasa Stajic. "Non-immune hydrops fetalis: Clinical experience in newborn infants." Medical review 64, no. 9-10 (2011): 507–10. http://dx.doi.org/10.2298/mpns1110507p.
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Introduction. Non-immune hydrops fetalis is a condition of excessive accumulation of extravascular fluid without identifiable circulating antibody to erythrocytes membrane antigens. In newborn infants it is characterized by skin oedema and pleural, pericardial or peritoneal effusion. In the era of routine Rh immunization for the prevention of foetal erythroblastosis, non-immune pathophysiologic mechanisms are presented in 76-87% of all hydropic newborns. Non-immune hydrops fetalis can be associated with numerous and various disorders. The mortality rate may exceed 50%. This study was aimed at presenting our clinical experience in treating newborn infants with non-immune hydrops fetalis. Material and methods. A retrospective-prospective study included newborn infants with non-immune hydrops fetalis, who were treated in the Neonatal Intensive Care Unit of Mother and Child Health Institute of Serbia between January 1, 2001 and October 31, 2010. All valid data about aetiology, diagnosis, clinical course and outcome were recorded. Results. The diagnosis of non-immune hydrops fetalis was made in 11 newborns. The etiologic diagnosis was established in 8 patients: anaemia due to fetomaternal transfusion in 4 patients and conatal cytomegalovirus infection, intracranial haemorrhage, isolated pulmonary lymphangiectasia and diffuse skin and mediastinal lymphangiomatosis in the remaining 4 patients. Conclusion. Non-immune hydrops of newborn infant is associated with a high mortality rate and requires complex diagnostic and therapeutic procedures. An optimal management of neonates with non-immune hydrops fetalis demands a multidisciplinary approach to the treatment in a neonatal intensive care unit.
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Karinski, Debra, Dhruv Balkundi, Lewis Rubin, and James Padbury. "The Use of Inhaled Glucocorticosteroids and Recovery from Adrenal Suppression after Systemic Steroid Use in a VLBW Premature Infant with BPD: Case Report and Literature Discussion." Neonatal Network 19, no. 8 (December 2000): 27–32. http://dx.doi.org/10.1891/0730-0832.19.8.27.
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Despite development of many prevention and treatment modalities for bronchopulmonary dysplasia (BPD), a form of chronic respiratory insufficiency in premature infants recovering from respiratory distress syndrome, BPD remains a treatment challenge and a significant cause of long-term morbidity. A ventilator-dependent very low birth weight infant in our newborn special care unit was receiving multiple courses of systemic dexamethasone for severe respiratory failure. The infant demonstrated adrenal suppression manifested by a baseline cortisol concentration below reported levels in infants of similar birth weight and postnatal age. We hypothesized that he had developed adrenal insufficiency as a result of the prolonged systemic steroid administration used to treat his respiratory problems. We further hypothesized that inhaled beclomethasone therapy would aid in the infant’s recovery phase during relative adrenal insufficiency—and so substituted inhaled for systemic steroids. Inhaled corticosteroid treatment improved the clinical respiratory course and postnatal growth of this premature infant with BPD without inhibiting his recovery from adrenal insufficiency.
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Gaur, Ajay, and Prakash Petchimuthu. "Growth outcome, feeding practices and co morbidities in follow up of discharged newborns from special newborn care unit Gwalior, India." International Journal of Contemporary Pediatrics 6, no. 6 (October 21, 2019): 2296. http://dx.doi.org/10.18203/2349-3291.ijcp20194189.
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Background: In spite of advances in neonatal care, infant mortality is still high in India. Regular follow up of discharged newborns could bring down infant mortality and reduce long term disability by early identification and intervention. The primary objective of the study is evaluating the Special Newborn Care Unit(SNCU) graduates for Comorbidities, feeding and immunization practices, growth assessment and outcome during follow up.Methods: The discharged neonates from SNCU, GRMC were examined for their morbidity and growth monitoring done. Feeding and immunization practices were observed.Results: Among 100 neonates observed, 2 neonates were excluded and 41(41.8%) were females and 57(58.1%) were males. Major causes of indication of admission were prematurity (25.5%) and birth asphyxia (22.4%). During follow up, 23(23.4%) neonates had respiratory infections followed by 19 cases (19.3%) of diarrhea. Around 45(45.9%) infants’ weight fall between -1 to +1 SD which was around 55 infants during admission. Length monitoring showed that around 68(69.3%) infants length fall between -1 to +1 SD which was 72 during admission. Exclusive breast feeding was observed in 68(69.3%) infants, 7 infants (7.1%) were exclusively top fed, and 19 infants (19.3%) were mixed fed. Immunization was appropriately done in only 51 infants (52%). Retinopathy of prematurity was observed in 2 infants during follow up. Hearing difficulty was observed in 1 infant.Conclusions: Most common indication of admission in SNCU was prematurity. Most common comorbidity during follow up was respiratory infection. Weight monitoring of infants showed the reduction in weight during follow up than admission whereas length and head circumference was relatively static during admission and follow up.
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Datta, Shyamali, Bijan Kumar Datta, Avirupa Kansha Banik, and Nilanjan Datta. "A study on the failure of breast feeding during the first month of life with effect on immunological level." International Journal of Contemporary Pediatrics 5, no. 5 (August 24, 2018): 1933. http://dx.doi.org/10.18203/2349-3291.ijcp20183534.
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Background: In the critical phase of immunological immaturity of the newborn, particularly for the immune system of mucous membranes, infants receive large amounts of bioactive components through colostrum and breast milk. Breastfeeding provides unsurpassed natural nutrition to the newborn and infant. Study was done to know the effects of breast milk feeding versus formula feeding in early infancy on the development of serum IgA, IgM and IgG.Methods: The present study investigated 100 cases of failure of breast feeding. The cases included both complete and partial failure. Values of immunoglobulin levels (IgA, IgM and IgG) in the serum of eleven breast fed and eleven artificially fed infants (all aged one month) were determined using Tripartigen plates.Results: Mean level of IgA in artificially fed infants was 20.72±3.82µg/100 ml. The diameter of precipitin ring using sample number 7 was 3.9 mm. The mean level of IgA in breast fed infants was 25.94±3.89 µg/100 ml. The mean level of IgM in artificially fed infants was 31.690±3.504 µg/100 ml. The mean level of IgM in breast fed infants was 36.81±5.13 µg/100 ml. The mean level of IgG in artificially fed infants was 480.25±52.23 µg /100 ml. The mean level of IgG in breast fed infants was 517.59±56.72 µg /100 ml.Conclusions: It is evident from the results of immunoglobulin estimation (Ig A, Ig M and IgG) in infants with artificial milk and in infants with breast milk (vide table 5, 6, 7, 8, 9 and 10) that though the mean serum levels (Ig A, Ig M and IgG) in breast fed infants were slightly higher than that of artificially fed infants. There was no statistically significant difference in the serum immunoglobulin levels between these two groups.
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Demers-Mathieu, Veronique, Robert K. Huston, Andi M. Markell, Elizabeth A. McCulley, Rachel L. Martin, Melinda Spooner, and David C. Dallas. "Differences in Maternal Immunoglobulins within Mother’s Own Breast Milk and Donor Breast Milk and across Digestion in Preterm Infants." Nutrients 11, no. 4 (April 24, 2019): 920. http://dx.doi.org/10.3390/nu11040920.
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Maternal antibody transfer to the newborn provides essential support for the infant’s naïve immune system. Preterm infants normally receive maternal antibodies through mother’s own breast milk (MBM) or, when mothers are unable to provide all the milk required, donor breast milk (DBM). DBM is pasteurized and exposed to several freeze–thaw cycles, which could reduce intact antibody concentration and the antibody’s resistance to digestion within the infant. Whether concentrations of antibodies in MBM and DBM differ and whether their survival across digestion in preterm infants differs remains unknown. Feed (MBM or DBM), gastric contents (MBM or DBM at 1-h post-ingestion) and stool samples (collected after a mix of MBM and DBM feeding) were collected from 20 preterm (26–36 weeks gestational age) mother–infant pairs at 8–9 and 21–22 days of postnatal age. Samples were analyzed via ELISA for the concentration of secretory IgA (SIgA), total IgA (SIgA/IgA), total IgM (SIgM/IgM) and IgG. Total IgA, SIgA, total IgM and IgG concentrations were 55.0%, 71.6%, 98.4% and 41.1% higher in MBM than in DBM, and were 49.8%, 32.7%, 73.9% and 39.7% higher in gastric contents when infants were fed with MBM than when infants were fed DBM, respectively. All maternal antibody isotypes present in breast milk were detected in the infant stools, of which IgA (not sIgA) was the most abundant.
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Mistry, Anahita, Samantha Lindsey, Judi Brooks, Angela Lukomski, and Renee Lajiness-O'Neill. "Growth Changes in Pre-Term and Full-Term Infants over the First 6-months of Life from the PediaTrac™ Project." Current Developments in Nutrition 4, Supplement_2 (May 29, 2020): 1040. http://dx.doi.org/10.1093/cdn/nzaa054_112.
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Abstract Objectives Changes in body weight, length and head circumference have long been indicators of infant growth and development. PediaTrac™ is a web-based measure designed to engage caregivers in the gathering of longitudinal, real-time, multi-domain data on infant/toddler growth and development at time periods corresponding to well-child visits. The purpose of this study was to assess the changes in growth (weight, length, head circumference) between the newborn and 6 m time periods for both term and pre-term (<37 weeks gestational age) infants as influenced by type of feeding (breast milk versus formula). Methods PediaTrac™ was used to gather data from caregivers and their infants across multiple sites (Michigan and Ohio).To date, 370 caregivers of both pre-term and term infants have completed PediaTrac™ regarding their infants’ growth and development. They reported their infant's body weight, length and head circumference, as well as the type of liquid nutrition their infants received at birth and 6 m. Caregiver responses were managed using REDCap, a secure platform for building and managing online databases and surveys. Data were analyzed using both R and SPSS. Results PediaTrac™ was used to gather data from caregivers and their infants across multiple sites (Michigan and Ohio). To date, 370 caregivers of both pre-term and term infants have completed PediaTrac™ regarding their infants’ growth and development. They reported their infant's body weight, length and head circumference, as well as the type of liquid nutrition their infants received at birth and 6 m. Caregiver responses were managed using REDCap, a secure platform for building and managing online databases and surveys. Data were analyzed using both R and SPSS. Conclusions By 6 m of age, fewer caregivers were feeding their infants breast milk. However, there were no significant differences in weight between infants fed breast milk and those fed formula. Funding Sources Eunice Kennedy Shriver National Institute of Child Health & Human Development of the National Institutes of Health. Eastern Michigan University College of Health and Human Services Research Support Award.
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McKenna, Laura. "Pancreatic Disorders in the Newborn." Neonatal Network 19, no. 4 (June 2000): 13–20. http://dx.doi.org/10.1891/0730-0832.19.4.13.
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Except for the hyperinsulinism associated with the infant of a diabetic mother (accounting for about 5 percent of NICU admissions annually), pancreatic disorders of the newborn are rare. Congenital anomalies (such as annular pancreas) and endocrine disorders (such as hyperinsulinism of nesidioblastosis or hyperglycemia of neonatal diabetes mellitus) present many challenges to the personnel caring for these infants and their families. The potential mortality and morbidity of these disorders make it imperative for nurses and nurse practitioners working with infants to recognize and understand pancreatic dysfunction so that appropriate and timely intervention can prevent complications of brain injury and developmental delay. The home care needs of these infants and the extensive teaching needs of their parents require skilled nursing care to ensure a safe discharge.
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Finster, Mieczyslaw, Margaret Wood, and Srinivasa N. Raja. "The Apgar Score Has Survived the Test of Time." Anesthesiology 102, no. 4 (April 1, 2005): 855–57. http://dx.doi.org/10.1097/00000542-200504000-00022.
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In 1953, Virginia Apgar, M.D. published her proposal for a new method of evaluation of the newborn infant. The avowed purpose of this paper was to establish a simple and clear classification of newborn infants which can be used to compare the results of obstetric practices, types of maternal pain relief and the results of resuscitation. Having considered several objective signs pertaining to the condition of the infant at birth she selected five that could be evaluated and taught to the delivery room personnel without difficulty. These signs were heart rate, respiratory effort, reflex irritability, muscle tone and color. Sixty seconds after the complete birth of the baby a rating of zero, one or two was given to each sign, depending on whether it was absent or present. Virginia Apgar reviewed anesthesia records of 1025 infants born alive at Columbia Presbyterian Medical Center during the period of this report. All had been rated by her method. Infants in poor condition scored 0-2, infants in fair condition scored 3-7, while scores 8-10 were achieved by infants in good condition. The most favorable score 1 min after birth was obtained by infants delivered vaginally with the occiput the presenting part (average 8.4). Newborns delivered by version and breech extraction had the lowest score (average 6.3). Infants delivered by cesarean section were more vigorous (average score 8.0) when spinal was the method of anesthesia versus an average score of 5.0 when general anesthesia was used. Correlating the 60 s score with neonatal mortality, Virginia found that mature infants receiving 0, 1 or 2 scores had a neonatal death rate of 14%; those scoring 3, 4, 5, 6 or 7 had a death rate of 1.1%; and those in the 8-10 score group had a death rate of 0.13%. She concluded that the prognosis of an infant is excellent if he receives one of the upper three scores, and poor if one of the lowest three scores.
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Vuralli, Dogus. "Clinical Approach to Hypocalcemia in Newborn Period and Infancy: Who Should Be Treated?" International Journal of Pediatrics 2019 (June 19, 2019): 1–7. http://dx.doi.org/10.1155/2019/4318075.
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Introduction. Hypocalcemia is a common metabolic problem in newborn period and infancy. There is consensus on the treatment of the symptomatic cases while the calcium level at which the treatment will be initiated and the treatment options are still controversial in asymptomatic hypocalcemia. Methods. This review article will cover hypocalcemia with specific reference to calcium homeostasis and definition, etiology, diagnosis, and treatment of hypocalcemia in newborn and infancy period. Results. Hypocalcemia is defined as total serum calcium <8 mg/dL (2 mmol/L) or ionized calcium <4.4 mg/dL (1.1 mmol/L) for term infants or preterm infants weighing >1500 g at birth and total serum calcium <7 mg/dL (1.75 mmol/L) or ionized calcium <4 mg/dL (1 mmol/L) for very low birth weight infants weighing <1500 g. Early-onset hypocalcemia is generally asymptomatic; therefore, screening for hypocalcemia at the 24th and 48th hour after birth is warranted for infants with high risk of developing hypocalcemia. Late-onset hypocalcemia, which is generally symptomatic, develops after the first 72 h and toward the end of the first week of life. Excessive phosphate intake, hypomagnesemia, hypoparathyroidism, and vitamin D deficiency are commonest causes of late-onset hypocalcemia. Hypocalcemia should be treated according to etiology. Calcium replacement is the cornerstone of the treatment. Elementary calcium replacement of 40 to 80 mg/kg/d is recommended for asymptomatic newborns. Elementary calcium of 10 to 20 mg/kg (1–2 mL/kg/dose 10% calcium gluconate) is given as a slow intravenous infusion in the acute treatment of hypocalcemia in patients with symptoms of tetany or hypocalcemic convulsion. Conclusion. Since most infants with hypocalcemia are usually asymptomatic, serum total or ionized calcium levels must be monitored in preterm infants with a gestational age <32 weeks, small for gestational age infants, infants of diabetic mothers, and infants with severe prenatal asphyxia with a 1 min Apgar score of <4. The treatment of hypocalcemia should be initiated immediately in infants with reduced calcium levels while investigating the etiology.
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Cleaveland, Karen. "Feeding Challenges in the Late Preterm Infant." Neonatal Network 29, no. 1 (January 2010): 37–41. http://dx.doi.org/10.1891/0730-0832.29.1.37.
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A late preterm infant is defined as one born between 34 and 36 6/7 weeks of completed gestation. The rate of late preterm births has risen 18 percent since the late 1990s. Data are beginning to emerge concerning morbidity rates and the risks these newborns face with regard to feeding difficulties, temperature instability, hypoglycemia, and hyperbilirubinemia. Feeding challenges place these vulnerable infants at risk for prolonged hospital stays and readmission after discharge. To better address the unique needs of late preterm infants, providers should establish individual feeding orders. This article offers research-based suggestions for caring for these infants in the newborn nursery and the postpartum unit as well as parent teaching guidelines.
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Windmill, Sue, and Ian M. Windmill. "The Status of Diagnostic Testing following Referral from Universal Newborn Hearing Screening." Journal of the American Academy of Audiology 17, no. 05 (May 2006): 367–78. http://dx.doi.org/10.3766/jaaa.17.5.6.
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The Joint Committee on Infant Hearing 2000 position statement includes guidelines for the development of Early Hearing Detection and Intervention programs. These guidelines provide specific recommendations for the audiologic test battery for infants who fail a newborn infant hearing screening. The recommended test battery includes electrophysiologic measures such as the ABR, frequency specific electrophysiologic tests, bone-conducted ABR, OAEs, tympanometry using high frequency probe stimuli, and acoustic reflexes. In the Commonwealth of Kentucky, 42 centers are listed as providing follow-up diagnostic testing services for infants failing the newborn hearing screening. The purpose of this investigation was to determine how many of these centers were abiding by the Joint Committee guidelines. Results show that only three of 42 centers listed are providing services that meet the guidelines. Less than 50% of infants identified with hearing loss are referred for genetic evaluations by the audiologist. Only 19 of the 42 sites listed provide amplification services for infants identified with hearing loss.
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Sanjaya, Ayling, Nurhayati Masloman, Rocky Wilar, and Josef Tuda. "Toxoplasma gondii immunoglobulin G in paired infant-and-mother sera." Paediatrica Indonesiana 49, no. 2 (April 30, 2009): 65. http://dx.doi.org/10.14238/pi49.2.2009.65-8.
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Background Toxoplasmosis is a worldwide zoonotic diseasecaused by Toxoplasma gondii. Congenital toxoplasmosis (CT)is the result of vertical transmission during pregnancy thatmay cause pathologic effects on the newborn such as classicaltriad of congenital toxoplasmosis. Newborn humans are notimmunologically competent and the infant must be protected by passive lgG antibodies that are selectively transported across the placenta during development. We studied the transfer of passive lgG from the mother to developing infant using blood specimen taken from the infant within one month of birth.Objective To determine the seropositivity of lgG to T. gondii in paired sera of infants and mothers.Methods A cross sectional study was carried out on 50 pairedsera of infants of less than one month of age and their mothers. The study was carried out between November 2007 and January 2008 at Prof. R. D. Kandou Hospital in Manado. T. gondii lgG was detected using the Latex Agglutination method. The seropositivity ofT. gondii lgG was analyzed descriptively.Results A total of 28 mothers from 50 infant-mother pairs wereseropositive for T. gondii IgG. Of the 28 seropositive mothers, 22 of their paired infants were seropositive. The remaining six seropositive mothers had infants that were not seropositive for T. gondii.Conclusions The identification of seropositive lgG for T. gondii in infants less than one months age indicates that the lgGs in infants are mostly derived from their mothers. CT must be considered and further examinations are needed.
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White-Traut, Rosemary, Jean Powlesland, Deborah Gelhar, Robert Chatterton, and Mariana Morris. "Methodologic Issues in the Measurement of Oxytocin in Human Neonates." Journal of Nursing Measurement 6, no. 2 (January 1998): 155–74. http://dx.doi.org/10.1891/1061-3749.6.2.155.
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Oxytocin’s (OT) role in the onset and maintenance of labor and in the letdown reflex is well known. OT also has been recognized as a neurotransmitter having functions in the central nervous system, including an influence on behavior (e.g., initiation of maternal behavior). This research was conducted to (1) evaluate whether human tactile contact in the human newborn would increase urine OT levels and alter infant behavioral state, and (2) determine the reliability of measuring OT in human infant urine. Although the data did not support the hypotheses, it was noted that OT levels, significantly decreased in infants who cried during the study period and that there was no correlation between infant’s chronologic age and OT levels. The findings illustrate several methodologic and measurement problems in the study of OT in human infants and that urine sampling in the neonate is not the most reliable method to evaluate change in OT levels. Some general issues concerning research with human infants also are discussed. Further research is recommended to document baseline levels of OT in neonates and to explore the use of salivary OT to measure short-term responses to interventions.
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Casaburi, Giorgio, Rebbeca Duar, Bethany Henrick, and Steven Frese. "A Microbiome-Based Solution to Address Alarming Levels of Drug-Resistant Bacteria in the Newborn Infant Gut." Infection Control & Hospital Epidemiology 41, S1 (October 2020): s439. http://dx.doi.org/10.1017/ice.2020.1106.
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Background: Recent studies have focused on the early infant gut microbiome, indicating that antibiotic resistance genes (ARGs) can be acquired in early life and may have long-term sequelae. Limiting the spread of antimicrobial resistance without triggering the development of additional resistance mechanisms would be of immense clinical value. Here, we present 2 analyses that highlight the abundance of ARGs in preterm and term infants and a proof of concept for modulating the microbiome to promote early stabilization and reduction in ARGs in term infants. Methods: Large-scale metagenomic analysis was performed on 2,141 microbiome samples (90% from pre-term infants) from 10 countries; most were from the United States (87%) and were obtained from the Comprehensive Antibiotic Resistance Database (CARD). We assessed the abundance and specific types of ARGs present. In the second study, healthy, breastfed infants were fed B. infantis EVC001 for 3 weeks starting at postnatal day 7. Stool samples were collected at day 21 and were processed utilizing shotgun metagenomics. Selected antimicrobial-resistant bacterial species were isolated, sequenced, and tested for minimal inhibitory concentrations to clinically relevant antibiotics. Results: In the first study, globally, 417 distinct ARGs were identified. The most abundant gene among all samples was annotated as msrE, a plasmid gene known to confer resistance to macrolide-lincosamide-streptogramin B (MLSB) antibiotics. The remaining most-abundant ARGs were efflux-pump genes associated with multidrug resistance. No significant association in antimicrobial resistance was found when considering delivery mode or antibiotic treatment in the first month of life. In the second study, the EVC001-fed group showed a significant decrease (90%) in ARGs compared to controls (P < .0001). ARGs that differed significantly between groups were predicted to confer resistance to β-lactams, fluoroquinolones, or multiple drug classes. Minimal inhibitory concentration assays confirmed resistance phenotypes among isolates Notably, we found resistance to extended-spectrum β-lactamases among healthy, vaginally delivered breastfed infants who had never been exposed to antibiotics. Conclusions: In this study, we show that the term and preterm infant microbiome contains alarming levels of ARGs associated with clinically relevant antibiotics harbored by bacteria commonly responsible for nosocomial infections. Colonization of the breastfed infant gut by a single strain of B. longum subsp infantis had profound impacts on the fecal metagenome, including reduction in ARGs and reduction of potential pathogens. These findings highlight the importance of developing novel approaches to limit the spread of ARGs among clinically relevant bacteria and the relevance of an additional approach in the effort to solve AR globally.Funding: Evolve BioSystems provided Funding: for this study.Disclosures: Giorgio Casaburi reports salary from Evolve BioSystems.
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Hatfield, Linda A., and Elizabeth A. Ely. "Measurement of Acute Pain in Infants." Biological Research For Nursing 17, no. 1 (May 1, 2014): 100–111. http://dx.doi.org/10.1177/1099800414531448.
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Background: The use of non-validated pain measurement tools to assess infant pain represents a serious iatrogenic threat to the developing neonatal nervous system. One partial explanation for this practice may be the contradictory empirical data from studies that use newborn pain management tools constructed for infants of different developmental stages or exposed to different environmental stressors. Purpose: The purpose of this review is to evaluate the evidence regarding the physiologic and behavioral variables that accurately assess and measure acute pain response in infants. Methodology: A literature search was conducted using PUBMED and CINAHL and the search terms infant, neonate/neonatal, newborn, pain, assessment, and measurement to identify peer-reviewed studies that examined the validity and reliability of behavioral and physiological variables used for investigation of infant pain. Ten articles were identified for critical review. Principal findings: Strong evidence supports the use of the behavioral variables of facial expressions and body movements and the physiologic variables of heart rate and oxygen saturation to assess acute pain in infants. Conclusion: It is incumbent upon researchers and clinical nurses to ensure the validity, reliability, and feasibility of pain measures, so that the outcomes of their investigations and interventions will be developmentally appropriate and effective pain management therapies.
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Krüger, Esedra E., Alta AM Kritzinger, and Lidia L. Pottas. "Breastfeeding skills of full-term newborns and associated factors in a low-and-middle-income setting." African Health Sciences 19, no. 3 (November 7, 2019): 2670–78. http://dx.doi.org/10.4314/ahs.v19i3.43.
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Background: Normative information on the breastfeeding of term newborns may guide clinicians in early identification of breastfeeding difficulties and oro-pharyngeal dysphagia (OPD), and may support optimal breastfeeding practices. Objective: To describe breastfeeding skills of term newborn infants in a South African hospital, a lower-middle-income setting, and investigate associations between infants’ feeding and other factors.Method: One breastfeeding session of each of the 71 healthy newborn full-term infants (mean chronological age=1.9 days; mean gestation=39.1 weeks) was evaluated using the Preterm Infant Breastfeeding Behavior Scale (PIBBS), suitable for use with term newborns.Results: All participants were exclusively breastfed. Thirteen participants (18%) were HIV-exposed. There was no significant difference in the findings of the PIBBS between HIV-exposed and unexposed participants. Most newborns had obvious rooting, latched deeply onto the nipple and some of the areola, had repeated long sucking bursts (mean length=16.82 sucks/burst), and swallowed repeatedly. Most participants were in either the drowsy or quiet-alert state, which are optimal behavioural states for breastfeeding. One to two-hourly on-demand feeds was significantly associated with mothers who had normal births and did not use galactogogues to promote lactation.Conclusion: Results may be used for early identification of OPD in newborns. The findings may be useful to primary care clinicians.Keywords: Full-term, newborn, breastfeeding, feeding skills, feeding characteristics, normative data.
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Oluwole, Esther O., Titilope A. Adeyemo, Gbemisola E. Osanyin, Oluwakemi O. Odukoya, Phyllis J. Kanki, and Bosede B. Afolabi. "Feasibility and acceptability of early infant screening for sickle cell disease in Lagos, Nigeria—A pilot study." PLOS ONE 15, no. 12 (December 3, 2020): e0242861. http://dx.doi.org/10.1371/journal.pone.0242861.
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In Nigeria, about 150000 babies are born annually with sickle cell disease (SCD), and this figure has been estimated to increase by 100% by the year 2050 without effective and sustainable control strategies. Despite the high prevalence, newborn screening for SCD which allows for early prophylactic treatment, education of parents/guardians and comprehensive management is not yet available. This study explored a strategy for screening in early infancy during the first and second immunization visits, determined the prevalence, feasibility and acceptability of early infant screening for SCD and the evaluation of the HemoTypeSC diagnostic test as compared to the high-performance liquid chromatography (HPLC) gold standard. A cross-sectional study was conducted in two selected primary health care centres in Somolu local government area (LGA) in Lagos, Nigeria. Two hundred and ninety-one mother-infant pairs who presented for the first or second immunization visit were consecutively enrolled in the study following written informed consent. The haemoglobin genotype of mother-infant pairs was determined using the HemoTypeSC rapid test kit. Confirmation of the infants’ Hb genotype was done with HPLC. Data were analysed with SPSS version 22. Validity and Predictive value of HemotypeSC rapid screening test were also calculated. Infant screening for SCD was acceptable to 86% of mothers presenting to the immunization clinics. The prevalence of SCD among the infant cohort was 0.8%. The infants diagnosed with SCD were immediately enrolled in the paediatric SCD clinic for disease-specific care. The HemoTypeSC test had 100% sensitivity and specificity for sickle cell disease in early infancy compared to HPLC. This study affirms that it is feasible and acceptable for mothers to implement a SCD screening intervention program in early infancy in Lagos State. The study also demonstrates the utility of the HemotypeSC rapid testing for ease and reduced cost of screening infants for SCD.
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Hernandez-Alvarado, Nelmary, Ryan Shanley, Mark R. Schleiss, Jensina Ericksen, Jenna Wassenaar, Lulua Webo, Katherine Bodin, Katelyn Parsons, and Erin A. Osterholm. "Clinical, Virologic and Immunologic Correlates of Breast Milk Acquired Infections in Very Low Birth Weight (VLBW) Infants in a Newborn Intensive Care Unit (NICU) Setting." Viruses 13, no. 10 (September 22, 2021): 1897. http://dx.doi.org/10.3390/v13101897.
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Cytomegalovirus (CMV) infections acquired by very-low-birthweight (VLBW) infants are incompletely characterized. To examine CMV transmission in VLBW infants, we evaluated maternal DNAlactia, infant DNAemia, and presence of clinical disease in a blinded study in VLBW infants in our newborn intensive care unit (NICU). To examine these issues, 200 VLBW infants were enrolled in a surveillance study, with weekly breast milk and infant whole blood samples collected, as available. Virologic (breast milk and infant whole blood real time PCR) and immunologic (IgG, IgM, and IgG avidity) correlates were evaluated. A chart review examined whether infants had symptoms compatible with CMV disease. DNAlactia was identified in 65/150 (43%) of lactating mothers. Nine CMV infections were identified in 9/75 CMV-exposed infants (12% of exposed infants). A higher median breast milk viral load (DNAlactia) correlated with an increased likelihood of DNAemia (p = 0.05). Despite potential symptoms compatible with CMV infection, clinicians had not considered the diagnosis of CMV in 6/9 cases (66%). All of these infants had chronic lung disease at discharge. There was no correlation between IgG antibody titer or IgG avidity index and the likelihood of transmission or CMV disease. In conclusion, in VLBW infants receiving milk from seroposi-tive mothers, CMV infections are commonly acquired, and are frequently unrecognized. Future studies are needed to determine whether routine surveillance for CMV of either breast milk or infant plasma is beneficial in preventing or recognizing infection.
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Rundjan, Lily, Hardiono D. Pusponegoro, and Alan R. Tumbelaka. "Neonatal adaptive behavioral assessment in asphyxiated full-term newborn infants as measured by the Brazelton scale." Paediatrica Indonesiana 44, no. 6 (October 10, 2016): 234. http://dx.doi.org/10.14238/pi44.6.2004.234-8.
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Background Brazelton scale was designed to assess neonataladaptive behavior, a newborn infant’s ability to interact with envi-ronmental stimuli. It can be used as a screening tool to detect aninfant’s deviant behavior.Objective To assess the adaptive behavior of asphyxiated full-termnewborn infants compared to that of non-asphyxiated newborns.Methods A cross sectional analytic study was conducted from March2003 until March 2004. Subjects were allocated into two groups(non asphyxiated and asphyxiated infants) and enrolled consecu-tively. The evaluation was done twice, at the age of 3-7 days and 1month. A p value of <0.05 was considered statistically significant.Results Forty eight newborn infants in each group were compared.There were no characteristic differences between the groups. Atthe first evaluation, non asphyxiated infants scored better on mo-tor (p=0.015), reflex (p=0.000), habituation (p=0.022), and social-interaction (p=0.020) than asphyxiated infants did. At the age of 1month, motor (p<0.0001), reflex (p<0.0001), habituation(p<0.0001), state organization (p<0.0001), and social-interaction(p=0.045) were also better in non-asphyxiated infants.Conclusion Assesment by the Brazelton scale showed that theadaptive behavior of full-term asphyxiated newborn infants wasdifferent from that of non-asphyxiated infants
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Atkins, Anne E., Michael F. Cogley, and Mei W. Baker. "Newborn Screening for Severe Combined Immunodeficiency: Do Preterm Infants Require Special Consideration?" International Journal of Neonatal Screening 7, no. 3 (July 8, 2021): 40. http://dx.doi.org/10.3390/ijns7030040.
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The Wisconsin Newborn Screening (NBS) Program began screening for severe combined immunodeficiency (SCID) in 2008, using real-time PCR to quantitate T-cell receptor excision circles (TRECs) in DNA isolated from dried blood NBS specimens. Prompted by the observation that there were disproportionately more screening-positive cases in premature infants, we performed a study to assess whether there is a difference in TRECs between full-term and preterm newborns. Based on de-identified SCID data from 1 January to 30 June 2008, we evaluated the TRECs from 2510 preterm newborns (gestational age, 23–36 weeks) whose specimens were collected ≤72 h after birth. The TRECs from 5020 full-term newborns were included as controls. The relationship between TRECs and gestational age in weeks was estimated using linear regression analysis. The estimated increase in TRECs for every additional week of gestation is 9.60%. The 95% confidence interval is 8.95% to 10.25% (p ≤ 0.0001). Our data suggest that TRECs increase at a steady rate as gestational age increases. These results provide rationale for Wisconsin’s existing premature infant screening procedure of recommending repeat NBS following an SCID screening positive in a premature infant instead of the flow cytometry confirmatory testing for SCID screening positives in full-term infants.
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Milašinović, Ljubomir, Ivan Hrabovski, Zorica Grujić, Mirjana Bogavac, and Aleksandra Nikolić. "Biochemical and Physiological Characteristics of Neonates Born to Mothers with Diabetes During Gestation." Journal of Medical Biochemistry 31, no. 1 (January 1, 2012): 47–52. http://dx.doi.org/10.2478/v10011-011-0042-2.
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Biochemical and Physiological Characteristics of Neonates Born to Mothers with Diabetes During GestationThe aim of this study was to investigate how glucose homeostasis disorders influence biochemical homeostasis and fetal maturation. A prospective randomized study included 102 infants: 31 newborns of mothers with glucose homeostasis disorders (Group I) and 71 newborns of healthy mothers (Group II). In the pregnant women, the mean age, body weight and height, BMI, parity, duration of the disease and the mode of labor were estimated. The following procedures were performed in each newborn infant: physical examination, determination of Apgar score, measurements of birth weight and length, estimation of neurological status, clinical estimation of gestational age, ECG and ultrasonography of the brain, as well as the basic hematologic, biochemical and microbiological analyses. Newborn infants of diabetic pregnancies were small for gestational age and of high birth weight. The levels of Na+, K+and Cl-ions did not show significant differences between the investigated groups, whereas the levels of total Ca and Mg were significantly decreased (2.18±0.59 and 0.65±0.17 mmol/L) (p<0.001) in the investigated group relative to the control group (2.42±0.53 and 0.81±0.09 mmol/L). The newborn infants of diabetic pregnancies presented with significantly decreased values of phosphates, bicarbonates and pH, whereas the difference in total osmolality was not statistically significant. The level of glucose at birth in the infants of diabetic mothers was lower (2.91±0.51 mmol/L) (p<0.001) than in the infants of healthy pregnancies (3.94±0.29 mmol/L). Glycemia lower than 2 mmol/L was recorded in 6.5% of infants of the investigated group. The level of bilirubin was significantly increased (209.71±56.66 mmol/L) (p<0.001) in infants of diabetic mothers compared to those of the healthy ones (155.70±61.14 mmol/L), like the incidence of clinically manifested hyperbilirubinemia. Disorders of maternal glucose homeostasis cause biochemical disorders such as hypoglycemia, hypocalcemia, hyperbilirubinemia, hypomagne semia and are associated with impaired maturation and congenital malformations of the fetus.
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Helve, Otto, Katri Korpela, Kaija-Leena Kolho, Terhi Saisto, Kirsi Skogberg, Evgenia Dikareva, Vedran Stefanovic, Anne Salonen, Willem M. de Vos, and Sture Andersson. "2843. Maternal Fecal Transplantation to Infants Born by Cesarean Section: Safety and Feasibility." Open Forum Infectious Diseases 6, Supplement_2 (October 2019): S68. http://dx.doi.org/10.1093/ofid/ofz359.148.
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Abstract Background A complication of cesarean section delivery is its interference with the normal intestinal colonization of the infant, affecting the development of immune system in early life—a process that has been associated with long-term morbidity, such as allergy and diabetes. We evaluated, in CS-delivered infants, whether the normal intestinal microbiome and its early life development could be restored by immediate postnatal transfer of maternal fecal microbiota to the newborn. Methods Seventeen healthy mothers with planned elective CS were recruited and screened thoroughly for infections, after which 7 mothers were included in the study. A fecal sample was processed according to a transplantation protocol and an aliquot (3–7 mg) was orally administered in breast-milk to the newborn during the first feeding. The infants were followed and fecal samples were gathered during the first 12 weeks of age and subsequently at the age of 8–18 months. Results The bacterial communities in the fecal samples of the mothers and their offspring were analyzed by sequencing of 16S rRNA amplicons from isolated fecal DNA and compared with that of 11 nontreated CS-delivered infants and 34 vaginally delivered infants. The fecal microbiota at 3 and 12 weeks was similar between treated CS and vaginally delivered infants, in contrast to that of the untreated CS-delivered infants both in overall composition (P = 0.001, Figure) and development of early-life signature bacteria, i.e., bacteroides and bifidobacteria and clostridia (P < 0.0001). Conclusion The seeding of maternal fecal microbes to the newborn intestine can be safely and successfully mimicked in elective CS by transferring a small amount of maternal fecal microbiome orally to the newborn infant. In these infants, this process results in a microbial development that is highly similar to that of the vaginally born infants, and provides support for the hypothesis that microbial colonization in early life results from a maternal fecal transfer. Disclosures All Authors: No reported Disclosures.
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Farsaie Alaie, Hesam, and Chakib Tadj. "Cry-Based Classification of Healthy and Sick Infants Using Adapted Boosting Mixture Learning Method for Gaussian Mixture Models." Modelling and Simulation in Engineering 2012 (2012): 1–10. http://dx.doi.org/10.1155/2012/983147.
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We make use of information inside infant’s cry signal in order to identify the infant’s psychological condition. Gaussian mixture models (GMMs) are applied to distinguish between healthy full-term and premature infants, and those with specific medical problems available in our cry database. Cry pattern for each pathological condition is created by using adapted boosting mixture learning (BML) method to estimate mixture model parameters. In the first experiment, test results demonstrate that the introduced adapted BML method for learning of GMMs has a better performance than conventional EM-based reestimation algorithm as a reference system in multipathological classification task. This newborn cry-based diagnostic system (NCDS) extracted Mel-frequency cepstral coefficients (MFCCs) as a feature vector for cry patterns of newborn infants. In binary classification experiment, the system discriminated a test infant’s cry signal into one of two groups, namely, healthy and pathological based on MFCCs. The binary classifier achieved a true positive rate of 80.77% and a true negative rate of 86.96% which show the ability of the system to correctly identify healthy and diseased infants, respectively.
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Hatfield, Linda A., Rebecca K. Hoffman, Rosemary C. Polomano, and Yvette Conley. "Epigenetic Modifications Following Noxious Stimuli in Infants." Biological Research For Nursing 20, no. 2 (January 30, 2018): 137–44. http://dx.doi.org/10.1177/1099800417754141.
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Purpose: To recruit healthy full- and preterm infants into genetic research and determine the effectiveness of a noninvasive DNA sampling technique for comparing epigenetic modifications. Background: Noxious stimuli during a vulnerable period of infant neuronal plasticity may trigger long-term epigenetic changes affecting neurodevelopment, pain modulation, and reactivity. Recognizing epigenetic pain findings is problematic because parents are reluctant to enroll newborns into genetic research. Methods: Design: Within-subject change over time candidate-gene DNA methylation association study. Setting/ sample: Urban teaching hospital’s neonatal intensive care unit and newborn nursery. Convenience sample of healthy full- (>37 weeks, n = 6) and preterm (<37 weeks, n = 6) infants. Procedure: Parents participated in a genetic presentation prior to informed consent. Infant buccal saliva was collected after admission to the unit and prior to discharge. Analysis: The methylation pattern at the 5′ end of µ-opioid receptor gene ( OPRM1) was examined. DNA was treated with bisulfite to convert all cytosines to uracil residues, leaving methylated cytosines unchanged. Sequencing of untreated and bisulfite-converted DNA was carried out. The sequences of unconverted and bisulfite-converted DNA were aligned with ClustalW, fidelity of the polymerase chain reaction and the sequencing reaction evaluated, and the methylation pattern identified. Results: Recruitment and assessment of a noninvasive DNA sampling technique for comparing epigenetic modifications were successful; however, infant stress did not produce a change in OPRM1 methylation expression. Relevance: This study established the feasibility of recruiting healthy full-term infants into genetic research and the effectiveness of noninvasive DNA sampling for comparing epigenetic modification in infants.
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Makino, Hiroshi, Akira Kushiro, Eiji Ishikawa, Delphine Muylaert, Hiroyuki Kubota, Takafumi Sakai, Kenji Oishi, et al. "Transmission of Intestinal Bifidobacterium longum subsp.longumStrains from Mother to Infant, Determined by Multilocus Sequencing Typing and Amplified Fragment Length Polymorphism." Applied and Environmental Microbiology 77, no. 19 (August 5, 2011): 6788–93. http://dx.doi.org/10.1128/aem.05346-11.
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ABSTRACTThe gastrointestinal tracts of neonates are colonized by bacteria immediately after birth. It has been discussed that the intestinal microbiota of neonates includes strains transferred from the mothers. Although some studies have indicated possible bacterial transfer from the mother to the newborn, this is the first report confirming the transfer of bifidobacteria at the strain level. Here, we investigated the mother-to-infant transmission ofBifidobacterium longumsubsp.longumby genotyping bacterial isolates from the feces of mothers before delivery and of their infants after delivery. Two hundred seven isolates from 8 pairs of mothers and infants were discriminated by multilocus sequencing typing (MLST) and amplified fragment length polymorphism (AFLP) analysis. By both methods, 11 strains ofB. longumsubsp.longumwere found to be monophyletic for the feces of the mother and her infant. This finding confirms that these strains were transferred from the intestine of the mother to that of the infant. These strains were found in the first feces (meconium) of the infant and in the feces at days 3, 7, 30, and 90 after birth, indicating that they stably colonize the infant's intestine immediately after birth. The strains isolated from each family did not belong to clusters derived from any of the other families, suggesting that each mother-infant pair might have unique family-specific strains.
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Pedroso, Rosa, Carla Freitas, Cristiana Nunes, and Marlene Rodrigues. "Breastfeeding: Non-pharmacological technique for NB and infants in painful procedures." International Journal of Developmental and Educational Psychology. Revista INFAD de Psicología. 1, no. 1 (June 11, 2016): 41. http://dx.doi.org/10.17060/ijodaep.2015.n1.v1.23.
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Background: For a long time it was believed that newborns and infants were incapable of feeling pain. In recent years, a significant corpus of knowledge has become more consolidated and ramified, proving not only that pain in the neonatal period exists, but also that it is hyperalgesic.Objective: To determine the effectiveness of breastfeeding as a non-pharmacological technique in relieving acute pain in newborns and infants undergoing painful procedures.Method: A systematic literature review was performed using the following search engines and databases: CINAHL, MEDLINE and SCIELO. Six scientific articles were selected based on previously established inclusion and exclusion criteria and descriptors. Data were extracted independently and the quality of the studies was assessed.Results: The various authors found changes in both behavioral (crying, facial expressions, self-regulation behaviors, and suction) and physiological responses (heart rate, oxygen saturation, and blood pressure) and pain characteristics when newborns and infants were breastfed compared with those who were not breastfed.Conclusion: Breastfeeding positively affects pain responses. Breastfeeding is an effective non-pharmacological technique in relieving acute pain during painful procedures that cause stress and pain to newborns and infants. It is important that health care professionals are able to adequately identify and assess the response to acute pain in newborns and infants using breastfeeding as a way to minimize it.Keywords: Breastfeeding, Pain, Newborn, Infant.
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Merjaneh, Nawal, Carmen Smotherman, Nizar Maraqa, and Ayesha Mirza. "309. Should Primary Care Practitioners Follow Hepatitis C Exposed Infants?" Open Forum Infectious Diseases 6, Supplement_2 (October 2019): S165. http://dx.doi.org/10.1093/ofid/ofz360.382.
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Abstract Background Hepatits C virus (HCV) infection in pregnancy is estimated between 1–4% and risk of vertical transmission ~5%. While the benefits of HCV testing for perinatally exposed infants under a year is debatable, a strategy for follow-up (F/U) is important. We instituted interventions to improve the F/U rate for HCV exposed infants in December 2012. Pediatric infectious diseases (PID) service was consulted in the newborn period to establish care. Perinatal HCV exposure was added to the infant’s electronic record. Educational brochures were given to guardians at discharge. We aimed to assess the efficacy of the interventions in improving the F/U rate. Methods A retrospective chart review of 227 HCV exposed infants born between January 2013 and December 2016 was done after obtaining IRB. Infant charts were reviewed for maternal age, race, insurance, HCV risk factors, HIV and Hep B co-infection, third trimester HCV PCR, delivery type, gestational age, birth weight and infant custody. Based on 2002 NIH guidelines: first visit at 6–8 weeks, second at 6–8 months, final visit ≥18 months of age. Maternal HCV infection is positive HCV antibody (Ab) during pregnancy, medical care defined as at least one infant PID clinic visit, and appropriate F/U as an 18-month visit for HCV (Ab) check. Univariate analysis is used for demographics, descriptive summaries were recorded as frequencies and percentages. Results 214 infants included in analysis (1 deceased and 12 adopted and left area). Baseline characteristics of those who had medical care vs. not were similar except for infant custody and HIV co-infection 94/214 (44%) had medical care. Of those, 32/94(34%) had appropriate F/U while 62/94(66%) did not 31/214 infants were followed by primary care practitioners (PCPs) at our institution. Of those 24/31(77.5%) were either tested inappropriately or lost to F/U HIV co- infection and custody by a relative (not mom) increase the likelihood of F/U (P 0.003 and 0.002, respectively) 5 infants contracted HCV infection. One infant who lost to F/U was diagnosed incidentally in the ER. Conclusion Appropriate F/U for HCV exposed infants poses challenges despite established systems of care. Because current guidelines recommend antibody testing at 18 months, educating PCPs who are more likely to establish regular F/U is important for appropriate testing. Disclosures All authors: No reported disclosures.
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Sastroasmoro, Sudigdo, Bambang Madiyono, Ismet N. Oesman, Sukman Tulus Putra, and Eva Jeumpa Soelaiman. "Transumbilical Balloon Atrial Septostomy with Echocardiographic Monitoring." Paediatrica Indonesiana 28, no. 7-8 (July 26, 2019): 160–6. http://dx.doi.org/10.14238/pi28.7-8.1988.160-6.
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Balloon atrial sept ostomy is usually necessary for survival beyond infancy in patients with transposition of the great arteries and insufficient intracardiac mixing. Since the umbilical vein and ductus venosus are often patent in the newborn infants, this route can be considered as an alternative to a femoral venous route in a critically ill infant. A 7 day-old newborn with D-transposition with intact ventricular septum and small patent foramen ovate was successfully managed by creating atrial septal defect through transumbilical balloon arterial septostomy. The procedure was carried out in the neonatal intensive care unit, guided by 2D-echocardiography. The arterial oxygen saturation increased dramatically upon the completion of the procedure, and a large atrial septal defect could be demonstrated echocardiographically. Unfortunately the infant died before further definitive surgery was performed.
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Jun, Kyungkoo, and Soonpil Choi. "Unsupervised End-to-End Deep Model for Newborn and Infant Activity Recognition." Sensors 20, no. 22 (November 12, 2020): 6467. http://dx.doi.org/10.3390/s20226467.
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Human activity recognition (HAR) works have mostly focused on the activities of adults. However, HAR is typically beneficial to the safety and wellness of newborn or infants because they have difficulties in verbal communication. The activities of infants are different from those of adults in terms of its types and intensity. Hence, it is necessary to study the behavior of infants separately. We study newborn and infant activity recognition by analyzing accelerometer data from the sensors attached to body. We aim to classify four types of activities: sleeping, moving in agony, moving in normal condition, and movement by external force. For this work, we collected 11 h videos and corresponding sensor data from 10 infant subjects. For recognition, we propose an end-to-end deep model using autoencoder and k-means clustering, which is trained in an unsupervised way. From a set of performance tests, our model can achieve 0.96 in balanced accuracy and F-1 score of 0.95.
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Maines, Evelina, Giorgia Gugelmo, Elisa Tadiotto, Angelo Pietrobelli, Natascia Campostrini, Andrea Pasini, Florina Ion-Popa, et al. "High-protein goat’s milk diet identified through newborn screening: clinical warning of a potentially dangerous dietetic practice." Public Health Nutrition 20, no. 15 (July 24, 2017): 2806–9. http://dx.doi.org/10.1017/s1368980017001628.
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AbstractObjectiveBreast-feeding is an unequalled way of providing optimal food for infants’ healthy growth and development and the WHO recommends that infants should be exclusively breast-fed for the first 6 months of life. For mothers who are unable to breast-feed or who decide not to, infant formulas are the safest alternative. Despite recommendations, it is possible that parents make potentially harmful nutritional choices for their children because of cultural beliefs or misinformation on infant nutrition. We describe a possible health risk of not breast-feeding, highlighting a potentially dangerous dietetic practice.Design/Setting/SubjectsWe report the case of a newborn who was fed with undiluted goat’s milk because her mother could not breast-feed and was not aware of infant formulas.ResultsThe dietary mistake was detected because of a positive expanded newborn screening result, characterized by severe hypertyrosinaemia with high methionine and phenylalanine levels, a pattern suggestive of severe liver impairment. The pattern of plasma amino acids was related to a goat’s milk diet, because of its very different composition compared with human milk and infant formula.ConclusionsOur experience demonstrates that, when breast-feeding is not possible or is not exclusive, infants may be at risk of dangerous nutritional practices, including diets with very high protein content, such as a goat’s milk diet. Families of not breast-fed infants may need appropriate advice on safe alternatives for infant nutrition to avoid the risks of inappropriate diets.
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JACOBY, P., K. GLASS, and H. C. MOORE. "Characterizing the risk of respiratory syncytial virus in infants with older siblings: a population-based birth cohort study." Epidemiology and Infection 145, no. 2 (November 8, 2016): 266–71. http://dx.doi.org/10.1017/s0950268816002545.
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SUMMARYFrom a population-based birth cohort of 245 249 children born in Western Australia during 1996–2005, we used linkage of laboratory and birth record datasets to obtain data including all respiratory syncytial virus (RSV) detections during infancy from a subcohort of 87 981 singleton children born in the Perth metropolitan area from 2000 to 2004. Using log binomial regression, we found that the risk of infant RSV detection increases with the number of older siblings, with those having ⩾3 older siblings experiencing almost three times the risk (relative risk 2·83, 95% confidence interval 2·46–3·26) of firstborn children. We estimate that 45% of the RSV detections in our subcohort were attributable to infection from an older sibling. The sibling effect was significantly higher for those infants who were younger during the season of peak risk (winter) than those who were older. Although older siblings were present in our cohort, they had very few RSV detections which could be temporally linked to an infant's infection. We conclude that RSV infection in older children leads to less severe symptoms but is nevertheless an important source of infant infection. Our results lend support to a vaccination strategy which includes family members in order to provide maximum protection for newborn babies.