A Cognitive Approach to Child Mistreatment Prevention among Medically At-Risk Infants

ERIC Educational Resources Information Center

Bugental, Daphne Blunt; Schwartz, Alex

2009-01-01

The authors assessed the effectiveness of a home visitation program in enhancing the early parenting history of infants born at medical risk--a population that is at risk for mistreatment. A randomized clinical trial design was used to compare the effects of a cognitively based extension of the Healthy Start home visitation program (HV+) with a…

Effect of Early Intervention to Promote Mother - Infant Interaction and Maternal Sensitivity in Japan: A Parenting Support Program based on Infant Mental Health.

PubMed

Komoto, Keiko; Hirose, Taiko; Omori, Takahide; Takeo, Naoko; Okamitsu, Motoko; Okubo, Noriko; Okawa, Hiroji

2015-01-01

This study investigated the effects of the Japanese Early Promotion Program (JEPP), which is based on the Infant Mental Health (IMH) program. The JEPP aims to promote mother-infant interactions by enhancing the mother's ability to respond appropriately her child. Mothers in the JEPP group (n = 15) received support from IMH nurses in a pediatric clinic until their infants reached 12 months of age. The nurses provided positive feedback that emphasized strength of parenting, and assisted the mothers in understanding the construct of their infants. Mother-infant interactions and mother's mental health status were assessed at intake (1-3 months), and at 6, 9, and 12 months of infants' age. The JEPP group data were compared with cross-sectional data of the control group (n = 120). Although JEPP dyads were not found to be significantly different from the control group in general dyadic synchrony, both before and after intervention, JEPP mothers significantly improved their ability to understand their infant's cues and to respond promptly. In the JEPP group, unresponsiveness to infants was reduced in mothers, while infants showed reduced passiveness and enhanced responsiveness to the mother. Furthermore, the intervention reduced the mothers' parenting stress and negative emotions, thereby enhancing their self-esteem.

Implementation of the Hammersmith Infant Neurological Exam in a High-Risk Infant Follow-Up Program

PubMed Central

Maitre, Nathalie L; Chorna, Olena; Romeo, Domenico M; Guzzetta, Andrea

2017-01-01

Background High-Risk Infant Follow-Up (HRIF) programs provide early identification and referral for treatment of neurodevelopmental delays and impairments. In these programs, a standardized neurological exam is a critical component of evaluation for clinical and research purposes. Implementation To address primary challenges of provider educational diversity and standardized documentation, we designed an approach to training and implementation of the Hammersmith Infant Neurological Exam (HINE) with pre-course materials, a workshop model and adaptation of the electronic medical record. Conclusions Provider completion and documentation of a neurologic exam were evaluated before and after HINE training. Standardized training and implementation of the HINE in a large HRIF is feasible and effective and allows for quantitative evaluation of neurological findings and developmental trajectories. PMID:27765470

Measles Antibodies in Mother-Infant Dyads in Tianjin, China.

PubMed

Boulton, Matthew L; Wang, Xiexiu; Wagner, Abram L; Zhang, Ying; Carlson, Bradley F; Gillespie, Brenda W; Ding, Yaxing

2017-11-27

Many measles cases in Tianjin, China, occur in infants whose mothers were born after widespread vaccination programs. We assessed age-specific decreases in maternal measles antibodies in infants and examined maternal and infant characteristics in relation to infant antibody titers. Infant and mother dyads were enrolled from a sample of immunization clinics in all Tianjin districts. Participants' antibody titers were measured from dried blood spots. A multivariable log-linear model regressed infant antibody titers onto infant and mother characteristics. Among 551 infants aged ≤8 months, protective levels of measles antibodies were observed in infants whose mothers had measles titers ≥800 IU/mL (mean antibody titer, 542.5 IU/mL) or 400 to <800 IU/mL (mean, 202.2 IU/mL). Compared with infants whose mothers had no history of disease or vaccination, those with a history of disease had 1.60 times higher titers (95% confidence interval, 1.06-2.43). Limited vaccination programs in the 1980s have resulted in many Chinese women with inadequate protection against measles and an accordingly low efficiency of transplacental transmission to a fetus. Current vaccination programs, which target children aged 8 months through adolescence may be ineffective in controlling transmission of measles to infants. © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.

Evaluation of the localization auditory screening test in children 6-18 months of age.

PubMed

Tillis, C H; Grimm, W A

1978-01-01

The present paper is a report of a project to develop an automated auditory screening test for infants six to 18 months of age. The first year of the project was devoted to developing equipment and test procedures; the second year was concerned with testing the effectiveness of the equipment and procedures on an actual population of six to 18 month old infants. Two-hundred and fifty infants were screened auditorily as part of a county health department child development clinic. The pass/fail results of the screening test were evaluated in terms of physical and developmental examination following the screening and by means of a case review of the child's previous history. The results indicate that the procedure under investigation can be used to differentiate the normal hearing infant from the infant with possible hearing problems. It is shown by the test environment in which this study was conducted that the procedure reported can be successfully incorporated into a public health program, i.e., child development clinics or EPSDT programs.

Infant Formula and Fluorosis

MedlinePlus

... and School-Linked Dental Sealant Programs Coordinate Community Water Fluoridation Programs Targeted Clinical Preventive Services & Health Systems Changes State Oral Health Plans Research & Publications Oral Health In America: Summary of the ...

Promoting Change in State Policy Decisionmaking on Quality Infant/Toddler Child Care and Head Start Services: Study on a Technical Assistance Forum.

ERIC Educational Resources Information Center

Griffin, Abbey; Fiene, Richard

In June 1991, the National Center for Clinical Infant Programs invited 320 state policymakers, leaders of national and state advocacy organizations, and practitioners to a technical assistance forum on "Finding and Funding Quality Child Care and Head Start Services for Infants and Toddlers." The forum focused on essential practices in…

A Perinatal Intervention Program for Urban American Indians Part 1: Design, Implementation, and Outcomes

PubMed Central

Davis, Carol L.; Prater, Sandra L.

2001-01-01

High infant mortality rates among American Indians are disproportionate to state statistics for other races and higher than the national average. These findings prompted a community health center in a large Midwestern city to create and provide an American Indian infant mortality reduction project in the early 1990s. Strategies for program implementation included networking with local organizations, communicating with reservation health clinics throughout the state, educating American Indian mothers and their community about factors contributing to American Indian infant mortality, and providing individual case management to American Indian women and infants. We offer this article for three reasons: This grant project was successful, disparity in rates of infant mortality among peoples of color continues, and a paucity of information exists about the health behaviors of American Indian women. PMID:17273261

Infant-Toddler Child Care in the United States: Where Has It Been? Where Is It Now? Where Is It Going?

ERIC Educational Resources Information Center

Lally, J. Ronald

2003-01-01

The author summarizes trends in infant-toddler child care before 1960 and describes how interdisciplinary meetings on early development at the Mental Health Study Center of the National Institute of Mental Health in the 1970s led to the founding of The National Center for Clinical Infant Programs (now ZERO TO THREE) in 1977. Periodic legislative…

High mortality in HIV-infected children diagnosed in hospital underscores need for faster diagnostic turnaround time in prevention of mother-to-child transmission of HIV (PMTCT) programs.

PubMed

Wagner, Anjuli; Slyker, Jennifer; Langat, Agnes; Inwani, Irene; Adhiambo, Judith; Benki-Nugent, Sarah; Tapia, Ken; Njuguna, Irene; Wamalwa, Dalton; John-Stewart, Grace

2015-02-15

Despite expanded programs for prevention of mother-to-child HIV transmission (PMTCT), HIV-infected infants may not be diagnosed until they are ill. Comparing HIV prevalence and outcomes in infants diagnosed in PMTCT programs to those in hospital settings may improve pediatric HIV diagnosis strategies. HIV-exposed infants <12 months old were recruited from 9 PMTCT sites in public maternal child health (MCH) clinics or from an inpatient setting in Nairobi, Kenya and tested for HIV using HIV DNA assays. A subset of HIV-infected infants <4.5 months of age was enrolled in a research study and followed for 2 years. HIV prevalence, number needed to test, infant age at testing, and turnaround time for tests were compared between PMTCT programs and hospital sites. Among the enrolled cohort, baseline characteristics, survival, and timing of antiretroviral therapy (ART) initiation were compared between infants diagnosed in PMTCT programs versus hospital. Among 1,923 HIV-exposed infants, HIV prevalence was higher among infants tested in hospital than PMTCT early infant diagnosis (EID) sites (41% vs. 11%, p < 0.001); the number of HIV-exposed infants needed to test to diagnose one infection was 2.4 in the hospital vs. 9.1 in PMTCT. Receipt of HIV test results was faster among hospitalized infants (7 vs. 25 days, p < 0.001). Infants diagnosed in hospital were older at the time of testing than PMTCT diagnosed infants (5.0 vs. 1.6 months, respectively, p < 0.001). In the subset of 99 HIV-infected infants <4.5 months old followed longitudinally, hospital-diagnosed infants did not differ from PMTCT-diagnosed infants in time to ART initiation; however, hospital-diagnosed infants were >3 times as likely to die (HR = 3.1, 95% CI = 1.3-7.6). Among HIV-exposed infants, hospital-based testing was more likely to detect an HIV-infected infant than PMTCT testing. Because young symptomatic infants diagnosed with HIV during hospitalization have very high mortality, every effort should be made to diagnose HIV infections before symptom onset. Systems to expedite turnaround time at PMTCT EID sites and to routinize inpatient pediatric HIV testing are necessary to improve pediatric HIV outcomes.

The impact of a new universal postpartum program on breastfeeding outcomes.

PubMed

Sheehan, Debbie; Watt, Susan; Krueger, Paul; Sword, Wendy

2006-11-01

The Ontario Mother and Infant Study II examined changes in postpartum health outcomes, including breastfeeding initiation and discontinuation, for mothers and their infants and compared these results to data collected prior to the initiation of the Universal Hospital Stay and Postpartum Home Visiting Program policy change in 1998. Data were collected using cross-sectional surveys before discharge and at 4 weeks postdischarge. Ninety percent of the women surveyed at 4 weeks postpartum initiated breastfeeding. Of these, 84% were still breastfeeding at 4 weeks postpartum. None of the 3 major program components-extended length of stay, a postpartum phone call from a public health worker, or a postpartum in-home visit-were associated with breastfeeding continuation to 4 weeks. Discontinuation before 4 weeks postdischarge was associated with maternal attitudes toward breastfeeding, formula feeding or supplementation in hospital, infant readmission, and use of walk-in clinics for infant care.

Effect of home visit training program on growth and development of preterm infants: a double blind randomized controlled trial.

PubMed

Edraki, Mitra; Moravej, Hossian; Rambod, Masoume

2015-01-01

Home visit program can be effective in infants' growth and development. The present study aimed to investigate the effect of home visit program on preterm infants' growth and development within 6 months. It was a double-blind clinical trial study. The study was conducted in Hafez, Hazrat-e-Zeinab, and Namazee Hospitals affiliated to Shiraz University of Medical Sciences, Shiraz, Iran from 2010 to 2011. Preterm infants were divided into intervention (n=30) and control groups (n=30) through blocked randomization. The intervention group received home visit training program for 6 months, while the control group only received the hospital's routine care. Then, the infants' growth indexes, including weight, height, and head circumference, and development criteria were compared on the first day of admission in Neonatal Intensive Care Unit, and then first, second, third, and sixth months. The data were analyzed using Chi-square, independent t-test, and repeated measures ANCOVA. The mean weight of the intervention and control group infants was 7207.3±1129.74 and 6366.7±922.26 gr in the sixth month. Besides, the intervention group infants' mean weight was higher compared to the control group after six months (t=-3.05, P=0.03). Also, a significant difference was found between the two groups regarding development indexes, such as following moving objects with the head, keeping the head stable when changing the position from lying to sitting,  producing "Agha" sound, and taking objects by hand (P<0.05) during six months of age. The results showed that the home visit program was effective in preterm infants' weight gain and some development indexes at the sixth month. Considering the importance of infants' growth and development, healthcare staff is recommended to incorporate home visit training into their programs, so that steps can be taken towards improvement of preterm infants' health. IRCT2014082013690N3 

[Early diagnosis of human immunodeficiency virus-1 in infants: The prevention of mother-to-child transmission program in Equatorial Guinea].

PubMed

Prieto-Tato, Luis Manuel; Vargas, Antonio; Álvarez, Patrícia; Avedillo, Pedro; Nzi, Eugenia; Abad, Carlota; Guillén, Sara; Fernández-McPhee, Carolina; Ramos, José Tomás; Holguín, África; Rojo, Pablo; Obiang, Jacinta

2016-11-01

Great efforts have been made in the last few years in order to implement the prevention of mother-to-child transmission (PMTCT) program in Equatorial Guinea (GQ). The aim of this study was to evaluate the rates of mother-to-child HIV transmission based on an HIV early infant diagnosis (EID) program. A prospective observational study was performed in the Regional Hospital of Bata and Primary Health Care Centre Maria Rafols, Bata, GQ. Epidemiological, clinical, and microbiological characteristics of HIV-1-infected mothers and their exposed infants were recorded. Dried blood spots (DBS) for HIV-1 EID were collected from November 2012 to December 2013. HIV-1 genome was detected using Siemens VERSANT HIV-1 RNA 1.0 kPCR assay. Sixty nine pairs of women and infants were included. Sixty women (88.2%) had WHO clinical stage 1. Forty seven women (69.2%) were on antiretroviral treatment during pregnancy. Forty five infants (66.1%) received postnatal antiretroviral prophylaxis. Age at first DBS analysis was 2.4 months (IQR 1.2-4.9). One infant died before a HIV-1 diagnosis could be ruled out. Two infants were HIV-1 infected and started HAART before any symptoms were observed. The rate of HIV-1 transmission observed was 2.9% (95%CI 0.2-10.5). The PMTCT rate was evaluated for the first time in GQ based on EID. EID is the key for early initiation of antiretroviral therapy and to reduce the mortality associated with HIV infection. Copyright © 2015 Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

Do Diagnosis Delays Impact Receipt of Test Results? Evidence from the HIV Early Infant Diagnosis Program in Uganda

PubMed Central

Mugambi, Melissa Latigo; Deo, Sarang; Kekitiinwa, Adeodata; Kiyaga, Charles; Singer, Mendel E.

2013-01-01

Background There is scant evidence on the association between diagnosis delays and the receipt of test results in HIV Early Infant Diagnosis (EID) programs. We determine the association between diagnosis delays and other health care system and patient factors on result receipt. Methods We reviewed 703 infant HIV test records for tests performed between January 2008 and February 2009 at a regional referral hospital and level four health center in Uganda. The main outcome was caregiver receipt of the test result. The primary study variable was turnaround time (time between sample collection and result availability at the health facility). Additional variables included clinic entry point, infant age at sample collection, reported HIV status and receipt of antiretroviral prophylaxis for prevention of mother-to-child transmission. We conducted a pooled analysis in addition to separate analyses for each facility. We estimated the relative risk of result receipt using modified Poisson regression with robust standard errors. Results Overall, the median result turnaround time, was 38 days. 59% of caregivers received infant test results. Caregivers were less likely to receive results at turnaround times greater than 49 days compared to 28 days or fewer (ARR = 0.83; 95% CI = 0.70–0.98). Caregivers were more likely to receive results at the PMTCT clinic (ARR = 1.81; 95% CI = 1.40–2.33) and less likely at the pediatric ward (ARR = 0.54; 95% CI = 0.37–0.81) compared to the immunization clinic. At the level four health center, result receipt was half as likely among infants older than 9 months compared to 3 months and younger (ARR= 0.47; 95% CI = 0.25–0.93). Conclusion In this study setting, we find evidence that longer turnaround times, clinic entry point and age at sample collection may be associated with receipt of infant HIV test results. PMID:24282502

Maternal Combination Antiretroviral Therapy is Associated with Improved Retention of HIV-Exposed Infants in Kinshasa, Democratic Republic of Congo

PubMed Central

FEINSTEIN, Lydia; EDMONDS, Andrew; OKITOLONDA, Vitus; COLE, Stephen R; VAN RIE, Annelies; CHI, Benjamin H; NDJIBU, Papy; LUSIAMA, Jean; CHALACHALA, Jean Lambert; BEHETS, Frieda

2015-01-01

Background Programs to prevent mother-to-child HIV transmission (PMTCT) are plagued by loss to follow-up (LTFU) of HIV-exposed infants. We assessed if providing combination antiretroviral therapy (cART) to HIV-infected mothers was associated with reduced LTFU of their HIV-exposed infants in Kinshasa, DR Congo. Methods We constructed a cohort of mother-infant pairs using routinely collected clinical data. Maternal cART eligibility was based on national guidelines in effect at the time. Infants were considered LTFU following three failed tracking attempts after a missed visit or if more than six months passed since they were last seen in clinic. Statistical methods accounted for competing risks (e.g. death). Results 1318 infants enrolled at a median age of 2.6 weeks (interquartile range [IQR]: 2.1-6.9), at which point 24% of mothers were receiving cART. Overall, 5% of infants never returned to care following enrollment and 18% were LTFU by 18 months. The 18-month cumulative incidence of LTFU was 8% among infants whose mothers initiated cART by infant enrollment and 20% among infants whose mothers were not yet on cART. Adjusted for baseline factors, infants whose mothers were not on cART were over twice as likely to be LTFU, with a subdistribution hazard ratio of 2.75 (95% confidence limit: 1.81, 4.16). The association remained strong regardless of maternal CD4 count at infant enrollment. Conclusion Increasing access to cART for pregnant women could improve retention of HIV-exposed infants, thereby increasing the clinical and population-level impacts of PMTCT interventions and access to early cART for HIV-infected infants. PMID:25886922

Study protocol: an early intervention program to improve motor outcome in preterm infants: a randomized controlled trial and a qualitative study of physiotherapy performance and parental experiences

PubMed Central

2012-01-01

Abstract Background Knowledge about early physiotherapy to preterm infants is sparse, given the risk of delayed motor development and cerebral palsy. Methods/Design A pragmatic randomized controlled study has been designed to assess the effect of a preventative physiotherapy program carried out in the neonatal intensive care unit. Moreover, a qualitative study is carried out to assess the physiotherapy performance and parents' experiences with the intervention. The aim of the physiotherapy program is to improve motor development i.e. postural control and selective movements in these infants. 150 infants will be included and randomized to either intervention or standard follow-up. The infants in the intervention group will be given specific stimulation to facilitate movements based on the individual infant's development, behavior and needs. The physiotherapist teaches the parents how to do the intervention and the parents receive a booklet with photos and descriptions of the intervention. Intervention is carried out twice a day for three weeks (week 34, 35, 36 postmenstrual age). Standardized tests are carried out at baseline, term age and at three, six, 12 and 24 months corrected age. In addition eight triads (infant, parent and physiotherapist) are observed and videotaped in four clinical encounters each to assess the process of physiotherapy performance. The parents are also interviewed on their experiences with the intervention and how it influences on the parent-child relationship. Eight parents from the follow up group are interviewed about their experience. The interviews are performed according to the same schedule as the standardized measurements. Primary outcome is at two years corrected age. Discussion The paper presents the protocol for a randomized controlled trial designed to study the effect of physiotherapy to preterm infants at neonatal intensive care units. It also studies physiotherapy performance and the parent's experiences with the intervention. Trial registration ClinicalTrials.gov NCT01089296 PMID:22336194

The potential effectiveness of the nutrition improvement program on infant and young child feeding and nutritional status in the Northwest and Southwest regions of Cameroon, Central Africa.

PubMed

Reinsma, Kate; Nkuoh, Godlove; Nshom, Emmanuel

2016-11-15

Despite the recent international focus on maternal and child nutrition, little attention is paid to nutrition capacity development. Although infant feeding counselling by health workers increases caregivers' knowledge, and improves breastfeeding, complementary feeding, and children's linear growth, most of the counselling in sub-Saharan Africa is primarily conducted by nurses or volunteers, and little is done to develop capacity for nutrition at the professional, organizational, or systemic levels. The Cameroon Baptist Convention Health Services Nutrition Improvement Program (NIP) has integrated a cadre of nutrition counselors into prevention of mother-to-child transmission of HIV programs, infant welfare clinics, and antenatal clinics to improve infant and young child feeding practices (IYCF). The study objective was to evaluate the effects of NIP's infant feeding counselors on exclusive breastfeeding (EBF), complementary feeding (CF), and children's linear growth. A cross-sectional evaluation design was used. Using systematic random sampling, caregivers were recruited from NIP sites (n = 359) and non-NIP sites (n = 415) from Infant Welfare Clinics (IWCs) in the Northwest (NWR) and Southwest Regions (SWR) of Cameroon between October 2014 and April 2015. Differences in EBF and CF practices and children's linear growth between NIP and non-NIP sites were determined using chi-square and multiple logistic regression. After adjusting for differences in religion, occupation, and number of months planning to breastfeed, children were almost seven times (Odds Ratio [OR]: 6.9; 95% Confidence Interval [CI]: 2.30, 21.09; β = 1.94) more likely to be exclusively breastfed at NIP sites compared to non-NIP sites. After adjusting for differences in occupation, religion, number of months planning to breastfeed, rural environment, economic status, attending other Infant Welfare Clinics, and non-biological caregiver, children were five times more likely to be stunted at non-NIP sites compared to NIP sites. Training a cadre of nutrition counselors is one approach towards increasing nutrition human resources to implement nutrition interventions to improve maternal and child nutrition. In this research project, the study design did not allow for conclusive results, but rather suggest IYCF counseling provided by nutrition counselors was effective in increasing EBF and reduced the risk of stunting in children 6-8 months.

Effect of Early Physical Activity Programs on Motor Performance and Neuromuscular Development in Infants Born Preterm: A Randomized Clinical Trial

PubMed Central

Valizadeh, Leila; Sanaeefar, Mahnaz; Hosseini, Mohammad Bager; Asgari Jafarabadi, Mohammad; Shamili, Aryan

2017-01-01

Introduction: Although the survival rate of infants born preterm has increased, the prevalence of developmental problems and motor disorders among this population of infants remains the same. This study investigated the effect of physical activity programs in and out of water on motor performance and neuromuscular development of infants born preterm and had induced immobility by mechanical ventilation. Methods: This study was carried out in Al-Zahra hospital, Tabriz. 76 premature infants were randomly assigned into four groups. One group received daily passive range of motion to all extremities based on the Moyer-Mileur protocol. Hydrotherapy group received exercises for shoulders and pelvic area in water every other day. A combination group received physical activity programs in and out of water on alternating days. Infants in a containment group were held in a fetal position. Duration of study was two weeks ‘from 32 through 33 weeks post menstrual age (PMA). Motor outcomes were measured by the Test of Infant Motor Performance. Neuromuscular developmental was assessed by New Ballard scale and leg recoil and Ankle dorsiflexion items from Dubowitz scale. Data were analyzed using SPSS version 13. Results: TIMP and neuromuscular scores improved in all groups. Motor performance did not differ between groups at 34 weeks PMA. Postural tone of leg recoil was significantly higher in physical activity groups post intervention. Conclusion: Physical activities and containment didn’t have different effects on motor performance in infants born preterm. Leg recoil of neuromuscular development items was affected by physical activity programs. PMID:28299299

The primary prevention of asthma in children study: design of a multifaceted prevention program.

PubMed

Kuiper, Sandra; Maas, Tanja; van Schayck, Constant P; Muris, Jean W M; Schönberger, Huub J A M; Dompeling, Edward; Gijsbers, Barbara; van Weel, Chris; Knottnerus, J André

2005-06-01

The PREVASC study addresses the primary prevention of asthma in infants and small children. The objective of this study is to investigate whether a multifaceted prenatally started intervention strategy in high-risk infants leads to a decrease in the occurrence of (severe) asthma and whether a refinement of the prevention strategy leads to an increase in the adherence to the prevention program. The primary prevention program includes house dust mite impermeable bed coverings, education on breast feeding, hypoallergenic feeding, timing of introduction of solid food and smoking cessation. A total of 888 infants were prenatally included. By the time of inclusion the mothers were 3-7 months pregnant. About 27 infants were excluded from the study and 18 dropped out. Of the remaining 843 infants 535 had a first-degree familial predisposition of asthma (high-risk group), whereas a reference group of 308 (162 boys) infants was not predisposed for asthma in the first-degree (low-risk group). To evaluate the (cost-)effectiveness of the preventive intervention, 222 (118 boys) infants of the high-risk group allocated to the intervention group and 221 (112 boys) allocated to a control group are followed up. The low-risk infants served as controls to evaluate the predictive value of high risk (first-degree familial predisposition of asthma). The infants are followed from the prenatal stage until they reach the age of 6 yr. The remaining 92 high-risk infants were included in an optimized randomized-clinical adherence trial (RCAT). Of these 92 infants, 45 (20 boys) were allocated to an intervention group and 47 (24 boys) to a control group. Until now all infants have been followed for at least 1 yr.

Case series of infants presenting with end stage retinopathy of prematurity to two tertiary eye care facilities in Mexico: underlying reasons for late presentation.

PubMed

Zepeda-Romero, Luz C; Meza-Anguiano, Alonso; Barrera-de León, Juan C; Angulo-Castellanos, Eusebio; Ramirez-Ortiz, Marco A; Gutiérrez-Padilla, José A; Gilbert, Clare E

2015-06-01

To describe the characteristics of infants with bilateral Stage 4b or 5 ROP (i.e. with subtotal or total retinal detachment) who presented to eye departments in two major cities in Mexico, to identify reasons why they may have become blind in order to recommend how programs could be improved. A large case-series of infants with Stage 4b or 5 ROP in both eyes confirmed by ultrasound who attended the ROP Clinic, Hospital Civil de Guadalajara from September 2010 to November 2012, and the Department of Ophthalmology, Hospital Infantil de Mexico Federico Gomez from December 2011 to December 2012 were identified from the diagnostic databases of each hospital. Mothers of infants in Guadalajara had a telephone interview. 89/94 eligible infants were included in the study, 48 in Guadalajara and 41 in Mexico City. Cases came from 22 of the 32 states in Mexico. Half of the infants attending Guadalajara 24/48 (50 %) had been cared for in NICUs without ROP screening programs and were not examined. Among the 24 infants cared for in NICUs with ROP programs, 7/24 (29.1 %) mothers reported that their infant had not been examined while in the NICU, and a further 9/24 (37.5 %) were either not referred for screening after discharge or they did not attend. Two infants had failed laser treatment. Strategies and resources to prevent end stage ROP have not been firmly established in Mexico. There is an urgent need to expand the coverage and quality of ROP programs, to ensure that existing screening guidelines are better adhered to, and to improve communication with parents.

75 FR 22608 - Part D Comprehensive Services and Access to Research for Women, Infants, Children and Youth Grant...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-29

... HIV/AIDS Program AGENCY: Health Resources and Services Administration (HRSA), HHS. ACTION: Notice of... order to ensure continuity of critical HIV medical care and treatment services, and to avoid a disruption of HIV clinical care and support services to women, infants, children, and youth in the Charlotte...

A randomized clinical trial in preterm infants on the effects of a home-based early intervention with the 'CareToy System'

PubMed Central

Sgandurra, Giuseppina; Lorentzen, Jakob; Inguaggiato, Emanuela; Bartalena, Laura; Beani, Elena; Cecchi, Francesca; Dario, Paolo; Giampietri, Matteo; Greisen, Gorm; Herskind, Anna; Nielsen, Jens Bo; Rossi, Giuseppe; Cioni, Giovanni

2017-01-01

CareToy system is an innovative tele-rehabilitative tool, useful in providing intensive, individualized, home-based, family-centred Early Intervention (EI) in infants. Our aim was to evaluate, through a Randomized Clinical Trial (RCT) study, the effects of CareToy intervention on early motor and visual development in preterm infants. 41 preterm infants (range age: 3.0–5.9 months of corrected age) were enrolled and randomized into two groups, CareToy and Standard Care. 19 infants randomized in CareToy group performed a 4-week CareToy program, while 22 allocated to control group completed 4 weeks of Standard Care. Infant Motor Profile (IMP) was primary outcome measure, Alberta Infant Motor Scale (AIMS) and Teller Acuity Cards were secondary ones. Assessments were carried out at baseline (T0) and at the end of CareToy training or Standard Care period (T1). T1 was the primary endpoint. After RCT phase, 17 infants from control group carried out a 4-week CareToy program, while 18 infants from the CareToy group continued with Standard Care. At the end of this phase, infants were re-assessed at T2. In RCT phase, delta IMP total score and variation and performance sub-domains were significantly higher (P<0.050) in CareToy group if compared to Standard Care group. Similar results were found for Teller Acuity Cards, while no differences between groups were found for AIMS. No differences were found in any outcome measure results (T2-T0), between infants who started CareToy training before or after one month of standard care. This RCT study confirms the results of a previous pilot study, indicating that CareToy system can provide effective home-based EI. Trial Registration: This trial has been registered at www.clinicaltrials.gov (Identifier NCT01990183). PMID:28328946

Clinical Experience of Using Cortical Auditory Evoked Potentials in the Treatment of Infant Hearing Loss in Australia

PubMed Central

Punch, Simone; Van Dun, Bram; King, Alison; Carter, Lyndal; Pearce, Wendy

2016-01-01

This article presents the clinical protocol that is currently being used within Australian Hearing for infant hearing aid evaluation using cortical auditory evoked potentials (CAEPs). CAEP testing is performed in the free field at two stimulus levels (65 dB sound pressure level [SPL], followed by 55 or 75 dB SPL) using three brief frequency-distinct speech sounds /m/, /ɡ/, and /t/, within a standard audiological appointment of up to 90 minutes. CAEP results are used to check or guide modifications of hearing aid fittings or to confirm unaided hearing capability. A retrospective review of 83 client files evaluated whether clinical practice aligned with the clinical protocol. It showed that most children could be assessed as part of their initial fitting program when they were identified as a priority for CAEP testing. Aided CAEPs were most commonly assessed within 8 weeks of the fitting. A survey of 32 pediatric audiologists provided information about their perception of cortical testing at Australian Hearing. The results indicated that clinical CAEP testing influenced audiologists' approach to rehabilitation and was well received by parents and that they were satisfied with the technique. Three case studies were selected to illustrate how CAEP testing can be used in a clinical environment. Overall, CAEP testing has been effectively integrated into the infant fitting program. PMID:27587921

Teaching Chilean mothers to massage their full-term infants: effects on maternal breast-feeding and infant weight gain at age 2 and 4 months.

PubMed

Serrano, Maria Sylvia Campos; Doren, Francisca Márquez; Wilson, Lynda

2010-01-01

The purpose of this study was to evaluate the effects of massage on infant weight gain and exclusive maternal breast-feeding of an intervention that involved teaching mothers to massage their full-term infants. The sample included 100 healthy newborn infants who were receiving primary healthcare at 3 health centers in a low-income neighborhood of Santiago, Chile. The control group included 65 infants and the massage group included 35 infants. During their second well-child clinic visit, clinic nurses provided instruction to massage-group mothers about how to massage their infants, based on the methods of the Baby's First Massage program (http://www.babysfirstmassage.com/Scripts/default.asp). Mothers were encouraged to massage their infants for 10 to 15 minutes at least once a day, starting when their infants were 15 days old. There was no difference in the mean weights of the infants between the massage and control groups at baseline, but at age 2 months, massage group infants weighed significantly more than control-group infants. There were no weight differences between the 2 groups at age 4 months. There were no differences between the 2 groups on the incidence of exclusive maternal breast-feeding at age 2 or 4 months. The findings suggest that teaching mothers to massage their newborn infants may have a beneficial effect on the infant's early weight gain. There is a need for additional studies to evaluate the effect of maternal massage on other health and welfare outcomes for both mothers and infants.

Outcome of Preterm Infants With Postnatal Cytomegalovirus Infection via Breast Milk

PubMed Central

Jim, Wai-Tim; Chiu, Nan-Chang; Ho, Che-Sheng; Shu, Chyong-Hsin; Chang, Jui-Hsing; Hung, Han-Yang; Kao, Hsin-An; Chang, Hung-Yang; Peng, Chun-Chih; Yui, Bey-Hwa; Chuu, Chih-Pin

2015-01-01

Abstract Approximately 15% of preterm infants may develop postnatal cytomegalovirus (CMV) infection from seropositive mothers via breast milk and are at risk for neurological sequelae in childhood. The aims of this study were to assess the effects and outcomes on growth, neurodevelopmental status, and hearing in very low birth weight (VLBW) premature infants with postnatal CMV infection via breast milk at the corrected age of 12 and 24 months. The prospective follow-up study population comprised all living preterm children (n = 55) with a birth weight ≤1500 g and gestational age of ≤35 weeks, who had been participated in our “postnatal CMV infection via breast milk” studies in 2000 and 2009, respectively. The cohort of children was assessed at 12 and 24 months. Clinical outcomes were documented during hospitalization and after discharge. Long-term outcomes included anthropometry, audiologic tests, gross motor quotient, Infant International Battery, and neurodevelopmental outcomes; all were assessed at postcorrected age in 12 and 24 months during follow-up visits. Of the 55 infants enrolled in the study (4 noninfected infants were excluded because their parents did not join this follow-up program later), 14 infants postnatally acquired CMV infection through breast-feeding (infected group) and were compared with 41 infants without CMV infection (control group). No significant differences were observed between the groups with regard to baseline characteristics, clinical outcomes, anthropometry, or psychomotor and mental development on the Bayley scale of infant development. None of the infants had CMV-related death or permanent sensorineural hearing loss. Transmission of CMV from seropositive mother via breast milk to preterm infants does not appear at this time to have major adverse effects on clinical outcomes, growth, neurodevelopmental status, and hearing function at 12 and 24 months corrected age. PMID:26512588

Outcome of Preterm Infants With Postnatal Cytomegalovirus Infection via Breast Milk: A Two-Year Prospective Follow-Up Study.

PubMed

Jim, Wai-Tim; Chiu, Nan-Chang; Ho, Che-Sheng; Shu, Chyong-Hsin; Chang, Jui-Hsing; Hung, Han-Yang; Kao, Hsin-An; Chang, Hung-Yang; Peng, Chun-Chih; Yui, Bey-Hwa; Chuu, Chih-Pin

2015-10-01

Approximately 15% of preterm infants may develop postnatal cytomegalovirus (CMV) infection from seropositive mothers via breast milk and are at risk for neurological sequelae in childhood. The aims of this study were to assess the effects and outcomes on growth, neurodevelopmental status, and hearing in very low birth weight (VLBW) premature infants with postnatal CMV infection via breast milk at the corrected age of 12 and 24 months.The prospective follow-up study population comprised all living preterm children (n = 55) with a birth weight ≤1500 g and gestational age of ≤35 weeks, who had been participated in our "postnatal CMV infection via breast milk" studies in 2000 and 2009, respectively. The cohort of children was assessed at 12 and 24 months. Clinical outcomes were documented during hospitalization and after discharge. Long-term outcomes included anthropometry, audiologic tests, gross motor quotient, Infant International Battery, and neurodevelopmental outcomes; all were assessed at postcorrected age in 12 and 24 months during follow-up visits.Of the 55 infants enrolled in the study (4 noninfected infants were excluded because their parents did not join this follow-up program later), 14 infants postnatally acquired CMV infection through breast-feeding (infected group) and were compared with 41 infants without CMV infection (control group). No significant differences were observed between the groups with regard to baseline characteristics, clinical outcomes, anthropometry, or psychomotor and mental development on the Bayley scale of infant development. None of the infants had CMV-related death or permanent sensorineural hearing loss.Transmission of CMV from seropositive mother via breast milk to preterm infants does not appear at this time to have major adverse effects on clinical outcomes, growth, neurodevelopmental status, and hearing function at 12 and 24 months corrected age.

A model for community-based pediatric oral heath: implementation of an infant oral care program.

PubMed

Ramos-Gomez, Francisco J

2014-01-01

The Affordable Care Act (ACA) mandates risk assessments, preventive care, and evaluations based on outcomes. ACA compliance will require easily accessible, cost-effective care models that are flexible and simple to establish. UCLA has developed an Infant Oral Care Program (IOCP) in partnership with community-based organizations that is an intervention model providing culturally competent perinatal and infant oral care for underserved, low-income, and/or minority children aged 0-5 and their caregivers. In collaboration with the Venice Family Clinic's Simms/Mann Health and Wellness Center, UCLA Pediatrics, Women, Infants, and Children (WIC), and Early Head Start and Head Start programs, the IOCP increases family-centered care access and promotes early utilization of dental services in nontraditional, primary care settings. Emphasizing disease prevention, management, and care that is sensitive to cultural, language, and oral health literacy challenges, IOCP patients achieve better oral health maintenance "in health" not in "disease modality". IOCP uses interprofessional education to promote pediatric oral health across multiple disciplines and highlights the necessity for the "age-one visit". This innovative clinical model facilitates early intervention and disease management. It sets a new standard of minimally invasive dental care that is widely available and prevention focused, with high retention rates due to strong collaborations with the community-based organizations serving these vulnerable, high-risk children.

The Austrian Toxoplasmosis Register, 1992-2008.

PubMed

Prusa, Andrea-Romana; Kasper, David C; Pollak, Arnold; Gleiss, Andreas; Waldhoer, Thomas; Hayde, Michael

2015-01-15

We aimed to determine the incidence of primary gestational infections with Toxoplasma gondii and congenital toxoplasmosis in Austria, a country with a nationwide prenatal serological screening program since 1974. We analyzed retrospective data from the Austrian Toxoplasmosis Register of pregnant women with Toxoplasma infection and their offspring with births between 1992 and 2008, identified by the prenatal mandatory screening program. Treatment was administered to women from diagnosis of a Toxoplasma infection until delivery. Infected infants were treated up to 1 year of life routinely. Clinical manifestations in infected infants were monitored at least for 1 year and documented in the register. The Austrian Toxoplasmosis Register included 2147 pregnant women with suspected Toxoplasma infection. Annually, 8.5 per 10 000 women acquired Toxoplasma infection during pregnancy, and 1.0 per 10 000 infants had congenital toxoplasmosis (13% mean transmission rate). Our data showed that women treated according to the Austrian scheme had a 6-fold decrease in the maternofetal transmission rate compared to women without treatment. Results from the Austrian Toxoplasmosis Register show the efficiency of the prenatal screening program. Our results are of clinical relevance for infants, healthcare systems, and policy makers to consider preventive Toxoplasma screening as a potential tool to reduce the incidence of congenital toxoplasmosis. © The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

Partner testing, linkage to care, and HIV-free survival in a program to prevent parent-to-child transmission of HIV in the Highlands of Papua New Guinea

PubMed Central

Carmone, Andy; Bomai, Korai; Bongi, Wayaki; Frank, Tarua Dale; Dalepa, Huleve; Loifa, Betty; Kiromat, Mobumo; Das, Sarthak; Franke, Molly F.

2014-01-01

Background To eliminate new pediatric HIV infections, interventions that facilitate adherence, including those that minimize stigma, enhance social support, and mitigate the influence of poverty, will likely be required in addition to combination antiretroviral therapy (ART). We examined the relationship between partner testing and infant outcome in a prevention of parent-to-child transmission of HIV program, which included a family-centered case management approach and a supportive environment for partner disclosure and testing. Design We analyzed routinely collected data for women and infants who enrolled in the parent-to-child transmission of HIV program at Goroka Family Clinic, Eastern Highlands Provincial Hospital, Papua New Guinea, from 2007 through 2011. Results Two hundred and sixty five women were included for analysis. Of these, 226 (85%) had a partner, 127 (56%) of whom had a documented HIV test. Of the 102 HIV-infected partners, 81 (79%) had been linked to care. In adjusted analyses, we found a significantly higher risk of infant death, infant HIV infection, or loss to follow-up among mother–infant pairs in which the mother reported having no partner or a partner who was not tested or had an unknown testing status. In a second multivariable analysis, infants born to women with more time on ART or who enrolled in the program in later years experienced greater HIV-free survival. Conclusions In a program with a patient-oriented and family-centered approach to prevent vertical HIV transmission, the majority of women's partners had a documented HIV test and, if positive, linkage to care. Having a tested partner was associated with program retention and HIV-free survival for infants. Programs aiming to facilitate diagnosis disclosure, partner testing, and linkage to care may contribute importantly to the elimination of pediatric HIV. PMID:25172429

Breast-feeding attitudes and behavior among WIC mothers in Texas.

PubMed

Vaaler, Margaret L; Stagg, Julie; Parks, Sharyn E; Erickson, Tracy; Castrucci, Brian C

2010-01-01

This study explored the influence of demographic characteristics on attitudes toward the benefits of breast-feeding, approval of public breast-feeding, and the use of infant formula. Additionally, the study examined whether attitudes were related to infant feeding practices among mothers enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in Texas. This study used a cross-sectional design. Participants completed questionnaires at WIC clinic sites across Texas. Mothers of young children who were receiving WIC benefits. Attitudes toward the benefits of breast-feeding, attitudes toward public breast-feeding, attitudes toward infant formula, and the choice of infant feeding practice. Descriptive statistics, multivariate ordinary least squares regression, and multinomial logistic regression. A key finding was that many Hispanic mothers held favorable attitudes toward both breast milk and infant formula. Younger and less educated mothers were least likely to agree with the benefits of breast-feeding. Mothers with positive attitudes toward the benefits of breast-feeding were likely to exclusively breastfeed and use both formula and breast milk. Attitudes toward breast-feeding, public breast-feeding, and infant formula and their influence on breast-feeding behavior should inform the curriculum of breast-feeding promotion programs. Published by Elsevier Inc.

Inter-Agency Collaboration between a Clinical Early Intervention Program and a Residential Care Setting To Meet the Needs of a Toddler.

ERIC Educational Resources Information Center

Herz, Susan; And Others

This paper discusses the interagency collaboration between a clinical assessment and intervention program for toddlers offered through the psychiatry department of a large metropolitan west coast medical center and a group home for infants and young children who are positive for the human immunodeficiency virus (HIV). The paper presents the case…

Design of an Incubator for Premature Infant Based on LabVIEW.

PubMed

Zhang, Lina; Zhou, Runjing

2005-01-01

This paper introduces the system structure, hardware circuits, control algorithms, and software program of the incubator for premature infant based on LabVIEW. The main advantages of this device are that preheating is less time than others, the capability of meeting of emergency is provided, control track of temperature and humidity are visible, operation is easy to clinical practice, and maintainability is possessed.

Pediatric Perimeter-A Novel Device to Measure Visual Fields in Infants and Patients with Special Needs.

PubMed

Satgunam, PremNandhini; Datta, Sourav; Chillakala, Koteswararao; Bobbili, Karthik R; Joshi, Dhruv

2017-07-01

There are no commercially available devices to measure visual fields in infants. We developed a device, "Pediatric Perimeter," that quantifies visual field extent (VFE) for infants. We describe the construction, validation, and use of this device. A hemispherical dome with light emitting diodes (LEDs) was constructed. The LEDs were controlled using a computer program to measure reaction time (RT) to gross visual fields (GVF) and the VFE. Participants were tested in supine position in a dark room. Eye or head movement towards the stimuli was monitored with an infrared (IR) camera. Validation was done on 10 adults (mean age: 24.4 ± 5 years) with tunnel vision simulator. Perimetry was performed on 19 infants (age: 2.3-12 months), five infants with normal milestones. GVF and VFE were estimated in 17 and 7 infants, respectively. Median RT of infants with developmental delay was 663 ms and 380 ms for healthy infants. Also, 14 children (age: 14 months-6 years) with developmental delay and five patients with cognitive impairment were tested. Visual field isopter and RT can be examined with the Pediatric Perimeter device on infants and patients with special needs. Further testing on infants will need to assess the repeatability. A large-scale study will be needed to compare typically developing infants and infants with delayed milestones with this device. Quantifiable parameters obtained with this device can be used as outcome measures in clinical examination of infants and patients with special needs. This device can be used in pediatric, neurology, and ophthalmology clinics.

Clinical Indicators of Child Development in the Capitals of Nine Brazilian States: The Influence of Regional Cultural Factors

PubMed Central

de Carvalho, André Laranjeira; da Silva, Luiz Fernando Ferraz; Grisi, Sandra Josefina Ferraz Ellero; de Ulhôa Escobar, Ana Maria

2008-01-01

OBJECTIVE Evaluating the interaction between mother or caregiver and infant through the Clinical Indicators of Risks in Infant Development and investigating whether local and cultural influences during infant development affect these clinical indicators. INTRODUCTION The Clinical Indicators of Risks in Infant Development was created in order to fully assess infants’ development and the subjective relationship between the babies and their caregivers. The absence of two or more Clinical Indicators of Risks in Infant Developments suggests a possibly inadequate mental development. Given the continental size of Brazil and its accentuated cultural differences, one might question how trustworthy these indicators can be when applied to each of the geographical regions of the country. METHODS This was a cross-sectional study with 737 infants from the capitals of 9 Brazilian states. The size of the initial sample population was based on a pilot study carried out in the cities of São Paulo and Brasília. The ages of children were grouped: 0–3 months, 4–7 months, 8–11 months and 12–18 months. The chi-square test was used together with analyses by the statistical software SPSS 13.0. RESULTS Statistical analysis of results from the different municipalities against the total sample did not reveal any statistically significant differences. Municipalities represented were Belém (p=0.486), Brasília (p=0.371), Porto Alegre (p=0.987), Fortaleza (p=0.259), Recife (p=0.630), Salvador (0.370), São Paulo (p=0.238), Curitiba (p=0.870), and Rio de Janeiro (p= 0.06). DISCUSSION Care for mental development should be considered a public health issue. Its evaluation and follow-up should be part of the already available mother-child assistance programs, which would then be considered to provide “full” care to children. CONCLUSIONS Local habits and culture did not affect the results of the Clinical Indicators of Risks in Infant Development indicators. Clinical Indicators of Risks in Infant Development proved to be robust despite the specificities of each region. PMID:18297207

Special Supplemental Nutrition Program for Women, Infants, and Children participation and infants' growth and health: a multisite surveillance study.

PubMed

Black, Maureen M; Cutts, Diana B; Frank, Deborah A; Geppert, Joni; Skalicky, Anne; Levenson, Suzette; Casey, Patrick H; Berkowitz, Carol; Zaldivar, Nieves; Cook, John T; Meyers, Alan F; Herren, Tim

2004-07-01

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is the largest food supplement program in the United States, serving almost 7 500 000 participants in 2002. Because the program is a grant program, rather than an entitlement program, Congress is not mandated to allocate funds to serve all eligible participants. Little is known about the effects of WIC on infant growth, health, and food security. To examine associations between WIC participation and indicators of underweight, overweight, length, caregiver-perceived health, and household food security among infants < or =12 months of age, at 6 urban hospitals and clinics. A multisite study with cross-sectional surveys administered at urban medical centers in 5 states and Washington, DC, from August 1998 though December 2001. A total of 5923 WIC-eligible caregivers of infants < or =12 months of age were interviewed at hospital clinics and emergency departments. Weight-for-age, length-for-age, weight-for-length, caregiver's perception of infant's health, and household food security. Ninety-one percent of WIC-eligible families were receiving WIC assistance. Of the eligible families not receiving WIC assistance, 64% reported access problems and 36% denied a need for WIC. The weight and length of WIC assistance recipients, adjusted for age and gender, were consistent with national normative values. With control for potential confounding family variables (site, housing subsidy, employment status, education, and receipt of food stamps or Temporary Assistance for Needy Families) and infant variables (race/ethnicity, birth weight, months breastfed, and age), infants who did not receive WIC assistance because of access problems were more likely to be underweight (weight-for-age z score = -0.23 vs 0.009), short (length-for-age z score = -0.23 vs -0.02), and perceived as having fair or poor health (adjusted odds ratio: 1.92; 95% confidence interval: 1.29-2.87), compared with WIC assistance recipients. Rates of overweight, based on weight-for-length of >95th percentile, varied from 7% to 9% and did not differ among the 3 groups but were higher than the 5% expected from national growth charts. Rates of food insecurity were consistent with national data for minority households with children. Families that did not receive WIC assistance because of access problems had higher rates of food insecurity (28%) than did WIC participants (23%), although differences were not significant after covariate control. Caregivers who did not perceive a need for WIC services had more economic and personal resources than did WIC participants and were less likely to be food-insecure, but there were no differences in infants' weight-for-age, perceived health, or overweight between families that did not perceive a need for WIC services and those that received WIC assistance. Infants < or =12 months of age benefit from WIC participation. Health care providers should promote WIC utilization for eligible families and advocate that WIC receive support to reduce waiting lists and eliminate barriers that interfere with access.

Blended Infant Massage-Parenting Enhancement Program on Recovering Substance-Abusing Mothers' Parenting Stress, Self-Esteem, Depression, Maternal Attachment, and Mother-Infant Interaction.

PubMed

Porter, Luz S; Porter, Brian O; McCoy, Virginia; Bango-Sanchez, Vivian; Kissel, Bonnie; Williams, Marjorie; Nunnewar, Sachin

2015-12-01

This study aimed to determine whether a blended Infant Massage-Parenting Enhancement Program (IMPEP) improved maternal psychosocial health outcomes (parenting stress, depressive symptoms, self-esteem, maternal attachment) and maternal-infant interaction among substance-addicted mothers (SAMs) actively engaged in outpatient rehabilitation. Designed as a randomized, three-group controlled trial testing two levels of psychoeducational intervention (IMPEP vs. PEP) and a control group (standard care parenting resources), the study was conducted in two substance abuse centers in southeast Florida on a convenience sample of 138 recovering SAM-infant pairs. IMPEP or PEP classes were held weekly on Weeks 2-5, with data collected at baseline (Week 1), Week 6, and Week 12 via structured interviews, observation (Observation Checklist on Maternal-Infant Interaction), and self-administered questionnaires (Abidin Parenting Stress Index, Beck Depression Inventory, Rosenberg Self-Esteem Scale, Muller's Maternal Attachment Inventory), analyzed descriptively and inferentially using Kruskall-Wallis analysis of variance and post hoc Wilcoxon rank sum and Mann-Whitney U tests. Both IMPEP and PEP groups had significantly increased Parenting Stress Index scores (decreased parenting stress) and decreased Beck Depression Inventory scores (decreased depressive symptoms) compared to controls at Week 12, whereas there were no clinically meaningful differences among study groups in Rosenberg Self-Esteem Scale, Muller's Maternal Attachment Inventory, or Observation Checklist on Maternal-Infant Interaction scores. Only the IMPEP group showed significant improvements in both psychological and physical (waist-hip ratio) measures of parenting stress over time. The findings suggest that infant massage blended into a structured parenting program has value-added effects in decreasing parenting stress and maternal depressive symptoms, but not on SAM's self-esteem, attachment, or maternal-infant interaction. Copyright © 2015. Published by Elsevier B.V.

Comparison of methods for recruiting and engaging parents in online interventions: study protocol for the Cry Baby infant sleep and settling program.

PubMed

Cook, Fallon; Seymour, Monique; Giallo, Rebecca; Cann, Warren; Nicholson, Jan M; Green, Julie; Hiscock, Harriet

2015-11-10

Anticipatory guidance around the management of sleep and crying problems in early infancy has been shown to improve both infant behaviour and parent symptoms of postnatal depression. Digital technology offers platforms for making such programs widely available in a cost-efficient manner. However, it remains unclear who accesses online parenting advice and in particular, whether the parents who would most benefit are represented amongst users. It is also unknown whether the uptake of online programs can be improved by health professional recommendations, or whether parents require additional prompts and reminders to use the program. In this study we aim to: (1) determine whether weekly email prompts increase engagement with and use of a brief online program about infant sleeping and crying, (2) determine whether encouragement from a maternal and child health nurse promotes greater engagement with and use of the program, (3) examine who uses a brief online program about infant sleeping and crying; and, (4) examine the psychosocial characteristics of participants. This study is a randomised, parallel group, superiority trial, with all participating primary carers of infants aged 2 to 12 weeks, receiving access to the online program. Two modes of recruitment will be compared: recruitment via an online notice published on a non-commercial, highly credible and evidence-based website for parents and carers and via the parent's Maternal and Child Health nurse. After baseline assessment, parents will be randomised to one of two support conditions: online program alone or online program plus weekly email prompts. Follow up data will be collected at 4 months of infant age. Results from this trial will indicate whether involvement from a health professional, and/or ongoing email contact is necessary to engage parents in a brief online intervention, and promote parental use of strategies suggested within the program. Results of this trial will inform the development of recruitment and engagement strategies for other online interventions. Australian New Zealand Clinical Trials Registry: ACTRN12613001098729. Registered 01 October 2013.

INTERFACING INFANT MENTAL HEALTH KNOWLEDGE SYSTEMS: REFLECTIONS ON THE NARRATIVES OF LAY HOME VISITORS' EXPERIENCES OF LEARNING AND APPLYING RELATIONAL CONCEPTS OF DEVELOPMENT IN A SOUTH AFRICAN INTERVENTION PROGRAM.

PubMed

Baradon, Tessa; Bain, Katherine

2016-07-01

The question of interfacing research and clinically generated knowledge in the field of infant mental health (IMH) with local cultural knowledge and belief systems has provoked extended discussion in recent years. This article explores convergences and divergences between current research-based, relational IMH mental health models and "community" knowledge held by a group of South African lay home visitors from a socioeconomically deprived township. These women were trained in a psychoanalytic and attachment-informed infant mental health program that promotes a relational model of infant development. They provide an intervention that supports high risk mother-infant relationships in the same locality. A two-tiered approach was taken to the analysis of the home visitor interviews and focused on the home visitors' constructed narratives of infant development posttraining as well as the personal impact of the training and work on the home visitors themselves. The study found that psychoanalytic and attachment-informed thinking about development makes sense to those operating within the local South African cultural context, but that the accommodation of this knowledge is a complex and challenging process. © 2016 Michigan Association for Infant Mental Health.

Complementary feeding: clinically relevant factors affecting timing and composition.

PubMed

Krebs, Nancy F; Hambidge, K Michael

2007-02-01

Exclusive breastfeeding for the first 6 mo of life followed by optimal complementary feeding are critical public health measures for reducing and preventing morbidity and mortality in young children. Clinical factors, such as birth weight, prematurity, and illness, that affect the iron and zinc requirements of younger infants are discussed. Maternal diet and nutritional status do not have a strong effect on the mineral content of human milk, but physiologic changes in milk and the infants' status determine the dependence of the infant on complementary foods in addition to human milk to meet iron and zinc requirements after 6 mo. The nature of zinc absorption, which is suitably characterized by saturation response modeling, dictates that plant-based diets, which are low in zinc, are associated with low absolute daily absorbed zinc, which is inadequate to meet requirements. Foods with a higher zinc content, such as meats, are much more likely to be sufficient to meet dietary requirements. Current plant-based complementary feeding patterns for older fully breastfed infants in both developed and developing countries pose a risk of zinc deficiency. The strong rationale for the potential benefits of providing meat as an early complementary food, and the examples of successful intervention programs, provide potent incentives to pursue broader implementation programs, with concurrent rigorous evaluation of both efficacy and effectiveness.

Early neurodevelopmental outcomes of infants with intestinal failure.

PubMed

So, Stephanie; Patterson, Catherine; Gold, Anna; Rogers, Alaine; Kosar, Christina; de Silva, Nicole; Burghardt, Karolina Maria; Avitzur, Yaron; Wales, Paul W

2016-10-01

The survival rate of infants and children with intestinal failure is increasing, necessitating a greater focus on their developmental trajectory. To evaluate neurodevelopmental outcomes in children with intestinal failure at 0-15months corrected age. Analysis of clinical, demographic and developmental assessment results of 33 children followed in an intestinal rehabilitation program between 2011 and 2014. Outcome measures included: Prechtl's Assessment of General Movements, Movement Assessment of Infants, Alberta Infant Motor Scale and Mullen Scales of Early Learning. Clinical factors were correlated with poorer developmental outcomes at 12-15months corrected age. Thirty-three infants (17 males), median gestational age 34weeks (interquartile range 29.5-36.0) with birth weight 1.98kg (interquartile range 1.17-2.50). Twenty-nine (88%) infants had abnormal General Movements. More than half had suspect or abnormal scores on the Alberta Infant Motor Scale and medium to high-risk scores for future neuromotor delay on the Movement Assessment of Infants. Delays were seen across all Mullen subscales, most notably in gross motor skills. Factors significantly associated with poorer outcomes at 12-15months included: prematurity, low birth weight, central nervous system co-morbidity, longer neonatal intensive care admission, necrotizing enterocolitis diagnosis, number of operations and conjugated hyperbilirubinemia. Multiple risk factors contribute to early developmental delay in children with intestinal failure, highlighting the importance of close developmental follow-up. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Pediatric Perimeter—A Novel Device to Measure Visual Fields in Infants and Patients with Special Needs

PubMed Central

Satgunam, PremNandhini; Datta, Sourav; Chillakala, Koteswararao; Bobbili, Karthik R.; Joshi, Dhruv

2017-01-01

Purpose There are no commercially available devices to measure visual fields in infants. We developed a device, “Pediatric Perimeter,” that quantifies visual field extent (VFE) for infants. We describe the construction, validation, and use of this device. Methods A hemispherical dome with light emitting diodes (LEDs) was constructed. The LEDs were controlled using a computer program to measure reaction time (RT) to gross visual fields (GVF) and the VFE. Participants were tested in supine position in a dark room. Eye or head movement towards the stimuli was monitored with an infrared (IR) camera. Validation was done on 10 adults (mean age: 24.4 ± 5 years) with tunnel vision simulator. Results Perimetry was performed on 19 infants (age: 2.3–12 months), five infants with normal milestones. GVF and VFE were estimated in 17 and 7 infants, respectively. Median RT of infants with developmental delay was 663 ms and 380 ms for healthy infants. Also, 14 children (age: 14 months–6 years) with developmental delay and five patients with cognitive impairment were tested. Conclusion Visual field isopter and RT can be examined with the Pediatric Perimeter device on infants and patients with special needs. Further testing on infants will need to assess the repeatability. A large-scale study will be needed to compare typically developing infants and infants with delayed milestones with this device. Translational Relevance Quantifiable parameters obtained with this device can be used as outcome measures in clinical examination of infants and patients with special needs. This device can be used in pediatric, neurology, and ophthalmology clinics. PMID:28685105

Food Safety Education Using an Interactive Multimedia Kiosk in a WIC Setting: Correlates of Client Satisfaction and Practical Issues

ERIC Educational Resources Information Center

Trepka, Mary Jo; Newman, Frederick L.; Huffman, Fatma G.; Dixon, Zisca

2010-01-01

Objective: To assess acceptability of food safety education delivered by interactive multimedia (IMM) in a Supplemental Nutrition Program for Women, Infants and Children Program (WIC) clinic. Methods: Female clients or caregivers (n = 176) completed the food-handling survey; then an IMM food safety education program on a computer kiosk.…

The Impact of an Educational Program Regarding Total Parenteral Nutrition on Infection Indicators in Neonates Admitted to the Neonatal Intensive Care Unit.

PubMed

Marofi, Maryam; Bijani, Nahid; Abdeyazdan, Zahra; Barekatain, Behzad

2017-01-01

One of the basic care measures for preterm infants is providing nutrition through total parenteral nutrition (TPN) and one of the most important complications of it is infection. Because prevention of nosocomial infections is an important issue for neonate's safety, this study aimed to determine the effects of a continuing medical education (CME) course on TPN for neonatal intensive care unit (NICU) nurses on indicators of infection in newborns. This quasi-experimental study was conducted on 127 neonates who fulfilled the inclusion criteria. They were selected through simple convenience sampling method at two stages of before and after the CME program. The inclusion criteria were prescription of TPN by the physician and lack of clinical evidences for infection in newborns before the beginning of TPN. Death of the infant during each stage of the study was considered as the exclusion criteria. The data gathering tool was a data record sheet including clinical signs of infection in the infants and their demographic characteristics. Data were analyzed using Chi-square test, Fisher's exact test, and student's t -test in SPSS software. The results showed the frequency of clinical markers for infection in newborns at the pre-intervention stage ( n = 41; 65.10%) was significantly less than at the post-intervention stage ( n = 30; 46.90%) ( p = 0.04). Nursing educational programs on TPN reduce infection rates among neonates in NICUs.

The Mother and Infant Home Visiting Program Evaluation: Early Findings on the Maternal, Infant, and Early Childhood Home Visiting Program. A Report to Congress. OPRE Report 2015-11

ERIC Educational Resources Information Center

Michalopoulos, Charles; Lee, Helen; Duggan, Anne; Lundquist, Erika; Tso, Ada; Crowne, Sarah Shea; Burrell, Lori; Somers, Jennifer; Filene, Jill H.; Knox, Virginia

2015-01-01

"The Mother and Infant Home Visiting Program Evaluation: Early Findings on the Maternal, Infant, and Early Childhood Home Visiting Program--A Report to Congress" presents the first findings from the Mother and Infant Home Visiting Program Evaluation (MIHOPE), the legislatively mandated national evaluation of the Maternal, Infant, and…

A systematic review of compliance with palivizumab administration for RSV immunoprophylaxis.

PubMed

Frogel, Michael P; Stewart, Dan L; Hoopes, Michael; Fernandes, Ancilla W; Mahadevia, Parthiv J

2010-01-01

Respiratory syncytial virus (RSV) is a leading cause of lower respiratory tract infection (LRTI) in infants and young children, accounting for approximately 75,000-125,000 hospitalizations per year. It is estimated that in 2000, RSV infection accounted for 1.7 million office visits, 402,000 emergency room visits, and 236,000 hospital outpatient visits per year for children younger than 5 years of age. Palivizumab, a humanized monoclonal antibody directed against RSV, is the only immunoprophylaxis therapy approved by the FDA for prevention of serious lower respiratory tract disease caused by RSV in infants (up to 2 years of age) who meet 1 or more of the following criteria for high risk: (a) gestational age up to 35 weeks;(b) diagnosis of chronic lung disease (CLD, formerly bronchopulmonary dysplasia [BPD]); or (c) diagnosis of cyanotic or complex congenital heart disease. The RSV season typically occurs between November and March but may vary by region. During the period of our review, depending on local duration of the RSV season, infants usually required 5 monthly (every 28-30 days) intramuscular injections of palivizumab. Infants born in the middle of the season received their palivizumab doses from the time of birth to the end of the season and, therefore, may have required less than 5 doses.It is unclear if compliance with monthly doses is a problem and whether noncompliance increases the risk of RSV hospitalizations in routine clinical practice. To (a) identify and describe compliance rates and the factors that influence parental compliance with immunoprophylaxis regimens, (b)review intervention programs and describe those that have been associated with increased compliance, and (c) summarize the association of compliance with RSV hospitalization rates. An electronic literature search was conducted using journal databases, including Ovid, Current Contents, Embase, Medline In-Process & Other Non-Indexed Citations; Ovid Medline, PubMed, and Web of Science;and an abstract database, Medical Intelligence Solution, for citations through April 2008. Specific search terms used were palivizumab with patient compliance, patient adherence, or patient persistence. Twenty-five articles and abstracts met the inclusion criteria. Available studies were mostly retrospective or observational prospective.Compliance, defined in various ways across the studies, varied between 25% and 100%, and 12 studies identified some of the factors related to noncompliance. Compliance generally was lower among Medicaid patients,African American patients, and other minorities. Ten studies (3 manuscripts and 7 abstracts) investigated the association of administration of prophylaxis through monthly home visits by a health professional with parental compliance with therapy. Most of the home-based programs were associated with higher compliance rates compared with clinic or office programs.Rates as high as 94% and 64% were achieved when Medicaid infants and infants of minority descent, respectively, received their doses through a home health program. When these infants received their doses at a clinic or office, depending on the definition of compliance, rates were 61%-100% for Medicaid infants and 44% for infants of minority descent. Reminder telephone calls to parents or caregivers, comprehensive multidisciplinary programs that included extensive counseling of parents, calendars with sticker reminders, and education in the language native to parents also were associated with increased compliance, although statistical significance was reported in only 1 study. Several studies recommended educating parents on the benefits of RSV prophylaxis, alleviating transportation and language difficulties, recognizing cultural differences and biases, and clarifying misperception of RSV illness severity. Home health programs had lower rates of RSV hospitalizations than office-based programs in 3 analyses conducted in 2 studies. In 4 other abstracts, the rates of RSV hospitalization for home health programs and office-based administration did not significantly differ. In a large, 4-season, prospective outcome study, compliant infants had lower RSV hospitalization rates than those who were not compliant under one definition of compliance (doses within 35-day intervals). RSV hospitalization rates were not significantly different using another definition of compliance (receipt of anticipated doses, expected vs. observed rates).In a large survey of 10,390 infants identified from pharmacy dispensing records, RSV hospitalization rates were 1.4% in the compliant group versus 3.1% in the noncompliant group (OR = 2.2, 95% CI = 1.4-3.5, P < 0.001).Adjustment for confounding was not reported in these studies. Medicaid and minority infants were less likely to receive scheduled palivizumab doses. Home-based programs for the administration of palivizumab have been investigated more than other interventions and are associated with improved compliance compared with office-based administration. Compliance with dosing, in general, was associated with lower RSV hospitalization rates. However, these strategies should be further investigated using well-designed studies.

Sugar, stress, and the Supplemental Nutrition Assistance Program: early childhood obesity risks among a clinic-based sample of low-income Hispanics.

PubMed

Watt, Toni Terling; Appel, Louis; Roberts, Kelley; Flores, Bianca; Morris, Sarajane

2013-06-01

The nationwide epidemic of pediatric obesity is more prevalent among Hispanic children than white children. Recent literature suggests that obesity has early origins, leading scholars to call for interventions in pregnancy and infancy. However, there is little theoretical or empirical research to guide the development of early prevention programs for Hispanics. The present study seeks to identify risk factors for early childhood obesity among a low-income, predominately Hispanic sample. Data were gathered to inform the design of a primary care childhood obesity prevention program targeting pregnancy through age 12 months. Baseline data were gathered on 153 women attending the clinic for prenatal care or for their child's 2, 6 or 12 month well-check. All women completed surveys on diet, exercise, social support, food security, stress, infant feeding practices, health, and demographics. For women with children (n = 66), survey data were matched with medical records data on infant weight. Results reveal that 55 % of women in the sample had an infant profiling in the 85th percentile or higher, confirming the need for an early childhood obesity intervention. While mothers exhibited several potential risk factors for childhood obesity (e.g. fast food consumption), only maternal consumption of sweets and sugar-sweetened beverages, stress, and SNAP (food stamp receipt) were associated with infant overweight. Findings further reveal that stress and SNAP relate to child overweight, in part, through mothers' sugar-sweetened beverage consumption. Results suggest that obesity prevention efforts must address specific individual choices as well as the external environment that shapes these consumption patterns.

Instituting parent education practices in the neonatal intensive care unit: an administrative case report of practice evaluation and statewide action.

PubMed

Dusing, Stacey C; Van Drew, Catherine M; Brown, Shaaron E

2012-07-01

Infants born preterm are at high risk of developmental disabilities and benefit from early developmental intervention programs. Physical therapists with neonatal expertise are ideally suited to educate parents about ways to support their infant's development in the first months of life. However, administrative policies are needed to support the therapist in providing adequate parent education in the neonatal intensive care unit (NICU). This administrative case report describes the process used by a team of neonatal therapists to evaluate clinical practice, determine the need for change, and develop and implement a new parent education program in the NICU. Physical therapy parent education practices were evaluated in an academic medical center with a 36-bed, level-3 NICU. Physical therapists with neonatal expertise covered multiple units within the hospital each day. A series of focus groups, a small descriptive study, and staff discussion were used to evaluate parent education practices in this academic medical center. A new parent education program was developed based on data collected and literature to improve clinical care. The new parent education model was implemented over the course of several months using overlapping initiatives. Administrative support for the change was developed through collaboration, open communication, and presentation of clinical data. In addition, this hospital-based program contributed to the development of a statewide initiative to educate parents of preterm infants about the importance of supporting development in the first months of life. A collaborative and data-driven approach to evaluating parent education practices supported the development of a new parent education practice while acknowledging the need to meet staff productivity standards and provide excellent care throughout the hospital.

Instituting Parent Education Practices in the Neonatal Intensive Care Unit: An Administrative Case Report of Practice Evaluation and Statewide Action

PubMed Central

Van Drew, Catherine M.; Brown, Shaaron E.

2012-01-01

Background and Purpose Infants born preterm are at high risk of developmental disabilities and benefit from early developmental intervention programs. Physical therapists with neonatal expertise are ideally suited to educate parents about ways to support their infant's development in the first months of life. However, administrative policies are needed to support the therapist in providing adequate parent education in the neonatal intensive care unit (NICU). This administrative case report describes the process used by a team of neonatal therapists to evaluate clinical practice, determine the need for change, and develop and implement a new parent education program in the NICU. Case Description Physical therapy parent education practices were evaluated in an academic medical center with a 36-bed, level-3 NICU. Physical therapists with neonatal expertise covered multiple units within the hospital each day. A series of focus groups, a small descriptive study, and staff discussion were used to evaluate parent education practices in this academic medical center. A new parent education program was developed based on data collected and literature to improve clinical care. Outcomes The new parent education model was implemented over the course of several months using overlapping initiatives. Administrative support for the change was developed through collaboration, open communication, and presentation of clinical data. In addition, this hospital-based program contributed to the development of a statewide initiative to educate parents of preterm infants about the importance of supporting development in the first months of life. Discussion A collaborative and data-driven approach to evaluating parent education practices supported the development of a new parent education practice while acknowledging the need to meet staff productivity standards and provide excellent care throughout the hospital. PMID:22466024

Assessment and evaluation of the high risk neonate: the NICU Network Neurobehavioral Scale.

PubMed

Lester, Barry M; Andreozzi-Fontaine, Lynne; Tronick, Edward; Bigsby, Rosemarie

2014-08-25

There has been a long-standing interest in the assessment of the neurobehavioral integrity of the newborn infant. The NICU Network Neurobehavioral Scale (NNNS) was developed as an assessment for the at-risk infant. These are infants who are at increased risk for poor developmental outcome because of insults during prenatal development, such as substance exposure or prematurity or factors such as poverty, poor nutrition or lack of prenatal care that can have adverse effects on the intrauterine environment and affect the developing fetus. The NNNS assesses the full range of infant neurobehavioral performance including neurological integrity, behavioral functioning, and signs of stress/abstinence. The NNNS is a noninvasive neonatal assessment tool with demonstrated validity as a predictor, not only of medical outcomes such as cerebral palsy diagnosis, neurological abnormalities, and diseases with risks to the brain, but also of developmental outcomes such as mental and motor functioning, behavior problems, school readiness, and IQ. The NNNS can identify infants at high risk for abnormal developmental outcome and is an important clinical tool that enables medical researchers and health practitioners to identify these infants and develop intervention programs to optimize the development of these infants as early as possible. The video shows the NNNS procedures, shows examples of normal and abnormal performance and the various clinical populations in which the exam can be used.

Prematurity and respiratory outcomes program (PROP): study protocol of a prospective multicenter study of respiratory outcomes of preterm infants in the United States.

PubMed

Pryhuber, Gloria S; Maitre, Nathalie L; Ballard, Roberta A; Cifelli, Denise; Davis, Stephanie D; Ellenberg, Jonas H; Greenberg, James M; Kemp, James; Mariani, Thomas J; Panitch, Howard; Ren, Clement; Shaw, Pamela; Taussig, Lynn M; Hamvas, Aaron

2015-04-10

With improved survival rates, short- and long-term respiratory complications of premature birth are increasing, adding significantly to financial and health burdens in the United States. In response, in May 2010, the National Institutes of Health (NIH) and the National Heart, Lung, and Blood Institute (NHLBI) funded a 5-year $18.5 million research initiative to ultimately improve strategies for managing the respiratory complications of preterm and low birth weight infants. Using a collaborative, multi-disciplinary structure, the resulting Prematurity and Respiratory Outcomes Program (PROP) seeks to understand factors that correlate with future risk for respiratory morbidity. The PROP is an observational prospective cohort study performed by a consortium of six clinical centers (incorporating tertiary neonatal intensive care units [NICU] at 13 sites) and a data-coordinating center working in collaboration with the NHLBI. Each clinical center contributes subjects to the study, enrolling infants with gestational ages 23 0/7 to 28 6/7 weeks with an anticipated target of 750 survivors at 36 weeks post-menstrual age. In addition, each center brings specific areas of scientific focus to the Program. The primary study hypothesis is that in survivors of extreme prematurity specific biologic, physiologic and clinical data predicts respiratory morbidity between discharge and 1 year corrected age. Analytic statistical methodology includes model-based and non-model-based analyses, descriptive analyses and generalized linear mixed models. PROP incorporates aspects of NICU care to develop objective biomarkers and outcome measures of respiratory morbidity in the <29 week gestation population beyond just the NICU hospitalization, thereby leading to novel understanding of the nature and natural history of neonatal lung disease and of potential mechanistic and therapeutic targets in at-risk subjects. Clinical Trials.gov NCT01435187.

A Tale of Treatable Infantile Neuroregression and Diagnostic Dilemma with Glutaric Aciduria Type I

PubMed Central

Yoganathan, Sangeetha; Varman, Mugil; Oommen, Samuel Philip; Thomas, Maya

2017-01-01

Nutritional deficiencies related neurological manifestations are not uncommon in infants and children. Here, we describe an infant with Vitamin B12 deficiency due to depleted maternal Vitamin B12 status presenting with progressive encephalopathy and extrapyramidal signs. Diagnosis of infantile tremor syndrome was established in our patient based on the clinical and biochemical parameters. Magnetic resonance imaging had shown frontotemporal atrophy with widened Sylvian fissures and prominent cerebrospinal fluid spaces. Clinical and imaging findings might create a diagnostic dilemma with glutaric aciduria type I. Knowledge and identification of infantile tremor syndrome are essential, as it is a potentially treatable disorder. Our patient had significant developmental gains with Vitamin B12 treatment and infant stimulation program. Vitamin B12 deficiency must be looked for as a cause of neuroregression in children hailing from low socioeconomic status, infants of vegetarian mother, and infants with delayed or improper weaning. Screening for Vitamin B12 deficiency is essential in all infants and children with unexplained neuroregression, as this disorder is potentially treatable. More population-based studies in India are needed to explore the prevalence of Vitamin B12 deficiency in pregnant and lactating women and also to assess the need for Vitamin B12 supplementation during pregnancy and lactation. PMID:29675077

A Tale of Treatable Infantile Neuroregression and Diagnostic Dilemma with Glutaric Aciduria Type I.

PubMed

Yoganathan, Sangeetha; Varman, Mugil; Oommen, Samuel Philip; Thomas, Maya

2017-01-01

Nutritional deficiencies related neurological manifestations are not uncommon in infants and children. Here, we describe an infant with Vitamin B12 deficiency due to depleted maternal Vitamin B12 status presenting with progressive encephalopathy and extrapyramidal signs. Diagnosis of infantile tremor syndrome was established in our patient based on the clinical and biochemical parameters. Magnetic resonance imaging had shown frontotemporal atrophy with widened Sylvian fissures and prominent cerebrospinal fluid spaces. Clinical and imaging findings might create a diagnostic dilemma with glutaric aciduria type I. Knowledge and identification of infantile tremor syndrome are essential, as it is a potentially treatable disorder. Our patient had significant developmental gains with Vitamin B12 treatment and infant stimulation program. Vitamin B12 deficiency must be looked for as a cause of neuroregression in children hailing from low socioeconomic status, infants of vegetarian mother, and infants with delayed or improper weaning. Screening for Vitamin B12 deficiency is essential in all infants and children with unexplained neuroregression, as this disorder is potentially treatable. More population-based studies in India are needed to explore the prevalence of Vitamin B12 deficiency in pregnant and lactating women and also to assess the need for Vitamin B12 supplementation during pregnancy and lactation.

Intervention for infants with brain injury: Results of a randomized controlled study

PubMed Central

Badr, Lina Kurdahi; Garg, Meena; Kamath, Meghna

2009-01-01

A randomized clinical trail (RCT) employed a 12-month individualized cognitive/sensorimotor stimulation program to look at the efficacy of the intervention on 62 infants with suspected brain injury. The control group infants received the State-funded follow-up program provided by the Los Angeles (LA) Regional Centers while the intervention group received intensive stimulation using the Curriculum and Monitoring System (CAMS) taught by public health nurses (PHNs). The developmental assessments and outcome measures were performed at 6, 12 and 18 months corrected age and included the Bayley motor and mental development, the Home, mother–infant interaction (Nursing Child Assessment Feeding Scale (NCAFS) and Nursing Child Assessment Teaching Scale (NCATS)), parental stress and social support. At 18 months, 43 infants remained in the study. The results indicate that the intervention had minimal positive effects on the Bayley mental and motor development scores of infants in the intervention group. Likewise, the intervention did not contribute to less stress or better mother–infant interaction at 12 or 18 months although there were significant differences in the NCAFS scores favoring the intervention group at 6 months. There was a significant trend, however, for the control group to have a significant decrease over time on the Bayley mental scores. Although the sample was not large and attrition was at 31%, this study provides further support to the minimal effects of stimulation and home intervention for infants with brain injury and who may have more significant factors contributing to their developmental outcome. PMID:17138264

Developmental Outcomes of Preterm Infants With Neonatal Hypoglycemia.

PubMed

Goode, Rachel H; Rettiganti, Mallikarjuna; Li, Jingyun; Lyle, Robert E; Whiteside-Mansell, Leanne; Barrett, Kathleen W; Casey, Patrick H

2016-12-01

Neonatal hypoglycemia has been associated with abnormalities on brain imaging and a spectrum of developmental delays, although historical and recent studies show conflicting results. We compared the cognitive, academic, and behavioral outcomes of preterm infants with neonatal hypoglycemia with those of normoglycemic controls at 3 to 18 years of age. A secondary analysis of data from the Infant Health and Development Program, a national, multisite, randomized controlled longitudinal intervention study of long-term health and developmental outcomes in preterm infants. Of the 985 infants enrolled in the Infant Health and Development Program, 745 infants had glucose levels recorded. Infants were stratified into 4 groups by glucose level. By using standardized cognitive, academic, and behavioral assessments performed at 3, 8, and 18 years of age, we compared groups after adjusting for intervention status, birth weight, gestational age, sex, severity of neonatal course, race, maternal education, and maternal preconception weight. No significant differences were observed in cognitive or academic skills between the control and effected groups at any age. Participants with more severe neonatal hypoglycemia reported fewer problem behaviors at age 18 than those without hypoglycemia. No significant differences in intellectual or academic achievement were found between preterm infants with and without hypoglycemia. A statistical difference was found in behavior at age 18, with hypoglycemic children showing fewer problematic behaviors than normoglycemic children. This difference was not clinically meaningful. Using extended outcomes, our results are consistent with previous studies that found no significant neurodevelopmental outcomes associated with neonatal hypoglycemia in preterm-born children. Copyright © 2016 by the American Academy of Pediatrics.

Developmental Outcomes of Preterm Infants With Neonatal Hypoglycemia

PubMed Central

Rettiganti, Mallikarjuna; Li, Jingyun; Lyle, Robert E.; Whiteside-Mansell, Leanne; Barrett, Kathleen W.; Casey, Patrick H.

2016-01-01

BACKGROUND AND OBJECTIVES: Neonatal hypoglycemia has been associated with abnormalities on brain imaging and a spectrum of developmental delays, although historical and recent studies show conflicting results. We compared the cognitive, academic, and behavioral outcomes of preterm infants with neonatal hypoglycemia with those of normoglycemic controls at 3 to 18 years of age. METHODS: A secondary analysis of data from the Infant Health and Development Program, a national, multisite, randomized controlled longitudinal intervention study of long-term health and developmental outcomes in preterm infants. Of the 985 infants enrolled in the Infant Health and Development Program, 745 infants had glucose levels recorded. Infants were stratified into 4 groups by glucose level. By using standardized cognitive, academic, and behavioral assessments performed at 3, 8, and 18 years of age, we compared groups after adjusting for intervention status, birth weight, gestational age, sex, severity of neonatal course, race, maternal education, and maternal preconception weight. RESULTS: No significant differences were observed in cognitive or academic skills between the control and effected groups at any age. Participants with more severe neonatal hypoglycemia reported fewer problem behaviors at age 18 than those without hypoglycemia. CONCLUSIONS: No significant differences in intellectual or academic achievement were found between preterm infants with and without hypoglycemia. A statistical difference was found in behavior at age 18, with hypoglycemic children showing fewer problematic behaviors than normoglycemic children. This difference was not clinically meaningful. Using extended outcomes, our results are consistent with previous studies that found no significant neurodevelopmental outcomes associated with neonatal hypoglycemia in preterm-born children. PMID:27940690

The Use of the Ambulatory Setting for Patient Self-Education.

ERIC Educational Resources Information Center

Newkirk, Gary; And Others

1979-01-01

A self-instructional health education program that utilizes a slide-tape device was studied to determine whether it could be educationally effective in an ambulatory clinical setting without being an inconvenience to patients. Infant and child nutrition was chosen as the topic to be used in the waiting room of a pediatric clinic. (JMD)

Risk of fever and sepsis evaluations after routine immunizations in the neonatal intensive care unit.

PubMed

Navar-Boggan, A M; Halsey, N A; Golden, W C; Escobar, G J; Massolo, M; Klein, N P

2010-09-01

Premature infants can experience cardiorespiratory events such as apnea after immunization in the neonatal intensive care unit (NICU). These changes in clinical status may precipitate sepsis evaluations. This study evaluated whether sepsis evaluations are increased after immunizations in the NICU. We conducted a retrospective cohort study of infants older than 53 days who were vaccinated in the NICU at the KPMCP (Kaiser Permanente Medical Care Program). Chart reviews were carried out before and after all immunizations were administered and for all sepsis evaluations after age 53 days. The clinical characteristics of infants on the day before receiving a sepsis evaluation were compared between children undergoing post-immunization sepsis evaluations and children undergoing sepsis evaluation at other times. The incidence rate of sepsis evaluations in the post-immunization period was compared with the rate in a control time period not following immunization using Poisson regression. A total of 490 infants met the inclusion criteria. The rate of fever was increased in the 24 h period after vaccination (2.3%, P<0.05). The incidence rate of sepsis evaluations was 40% lower after immunization than during the control period, although this was not statistically significant (P=0.09). Infants undergoing a sepsis evaluation after immunization were more likely to have an apneic, bradycardic or moderate-to-severe cardiorespiratory event in the day before the evaluation than were infants undergoing sepsis evaluations at other times (P<0.05). Despite an increase in fever and cardiorespiratory events after immunization in the NICU, routine vaccination was not associated with increased risk of receiving sepsis evaluations. Providers may be deferring immunizations until infants are clinically stable, or may have a higher threshold for initiating sepsis evaluations after immunization than at other times.

Sustainable clinical research, health economic aspects and medical marketing: drivers of product innovation.

PubMed

Haschke, Ferdinand; Klassen-Wigger, Petra

2010-01-01

Marketing-driven innovation in the field of pediatric nutrition, in particular in the infant formula segment is not sustainable. New benefits of products must be scientifically proven and safety and efficacy of new formulae established in clinical trials. The scientific innovation process of three infant formulae is described. Improvement in protein quality allowed to reduce the protein concentration in whey-based infant formula. Weight gain and BMI of infants fed those formulae corresponds to breastfed infants and is lower than in infants fed traditional formulae with higher protein concentration. A meta-analysis indicates associations between rapid weight gain in infancy and obesity later in life. If infants cannot be exclusively breastfed until 4-6 months of age, feeding low-protein formulae may contribute to positive long-term health outcome with potentially important health economic effects. A partially hydrolyzed whey based formula for prevention of allergic symptoms in children with hereditary risk for allergic diseases was developed more than 25 years ago. The most recent meta-analysis which included 15 randomized clinical trials indicates that the risk of all allergic diseases and atopic dermatitis/eczema is significantly reduced in infants at risk when the partially hydrolyzed formula is fed. The partially hydrolyzed formula had the same protective effect as casein-based high-degree extensively hydrolyzed formula. Because of substantial price differences between the two formulae, feeding the partially hydrolyzed whey formula is cost saving. Hypoallergenic claims can be made in many countries, and international nutrition committees have positively commented the preventive effect of those formulae. Acidified formulae have been widely used during the last decade in replacement feeding programs for infants whose mothers are HIV positive. The formula was innovated by improving whey protein quality and lowering protein concentration. The bacteriostatic properties of the new formula were proven in in vitro tests. Meta-analysis indicated that feeding the formula to immunocompromised infants resulted in growth similar to breastfeeding. The bacteriostatic effects of the acidified formula need to be communicated to health care professionals, but also the risks if replacement feeding is not acceptable, feasible, affordable, sustainable, and safe for mother and infant. Copyright © 2010 S. Karger AG, Basel.

Genetics objective structured clinical exams at the Maimonides Infants & Children's Hospital of Brooklyn, New York.

PubMed

Altshuler, Lisa; Kachur, Elizabeth; Krinshpun, Shifra; Sullivan, Deborah

2008-11-01

In 2003, the Maimonides Infants & Children's Hospital received a Title VII Residency Training in Primary Care grant to integrate genetic-specific competencies into postgraduate pediatrics education. As part of that endeavor, mandatory yearly genetics objective structured clinical exams (OSCEs) were instituted for third-year residents. This article reports on the first three years of experience with this innovative educational tool.After an overview of genetic concepts, dysmorphology, and communication styles, residents complete a five-station OSCE and receive feedback from standardized patients and from the faculty who observe them. After this clinical exercise, the residents participate in a small-group debriefing session to share strategies for effective communication and clinical case management and to discuss the ethical issues that arise with these genetic cases.In three years, 60 residents have completed the genetics OSCE program. Evaluation data demonstrate that the program has been effective in both introducing genetic-specific challenges and assessing residents' clinical skills. It has helped trainees self-identify both strengths and further training needs. Pre- and postsurveys among the trainees show increased comfort levels in performing 5 of 12 genetic-related clinical tasks.We conclude that genetics OSCEs are an enriching educational tool. Merely providing trainees and practicing physicians with the latest scientific information is unlikely to prepare them for counseling patients about complex genetic issues. Developing proficiency requires focused practice and effective feedback.This article is part of a theme issue of Academic Medicine on the Title VII health professions training programs.

Maternal health behaviors and infant health outcomes among homeless mothers: U.S. Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) 2000-2007.

PubMed

Richards, Rickelle; Merrill, Ray M; Baksh, Laurie; McGarry, Joanne

2011-01-01

To determine whether participation in the Women, Infants, and Children Program is associated with improved maternal and infant health outcomes among homeless women in the Pregnancy Risk Assessment Monitoring System. Analyses were based on Pregnancy Risk Assessment Monitoring System participants from 31 states/cities in the United States, 2000-2007 (n=272,859). Overall, 4% of women completing the Pregnancy Risk Assessment Monitoring System survey were homeless, with 76% participating in the Women, Infants, and Children Program, a federally-funded supplemental nutrition program for low-income women and children less than 5 years old. Among women in the Pregnancy Risk Assessment Monitoring System survey who reported using the Women, Infants, and Children Program, those experiencing homelessness were older, less educated, less likely to have private health insurance, and more likely to receive government assistance. Homeless women in the Women, Infants, and Children Program compared with those not in the program were significantly more likely to have a higher body mass index, to initiate breastfeeding after delivery, have prenatal care visits, have a longer gestational age, and have a greater infant birth weight. Characteristics of homeless pregnant women choosing to participate in the Women, Infants, and Children Program are consistent with the requirements for program participation for women in general. Homeless women accessing the Women, Infants, and Children Program had better maternal and infant health outcomes. Copyright © 2010 Elsevier Inc. All rights reserved.

A cognitive approach to child mistreatment prevention among medically at-risk infants.

PubMed

Bugental, Daphne Blunt; Schwartz, Alex

2009-01-01

The authors assessed the effectiveness of a home visitation program in enhancing the early parenting history of infants born at medical risk--a population that is at risk for mistreatment. A randomized clinical trial design was used to compare the effects of a cognitively based extension of the Healthy Start home visitation program (HV+) with a visitation condition that did not include this component (HV). In the HV+ condition, they observed (a) a lower use of corporal punishment, (b) greater safety maintenance in the home, and (c) fewer reported child injuries. The sample (N = 102) was primarily Latino; however, the effects of the intervention were not qualified by ethnicity, maternal education, or immigration status.

75 FR 15603 - Special Supplemental Nutrition Program for Women, Infants and Children (WIC): Vendor Cost...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-30

... Supplemental Nutrition Program for Women, Infants and Children (WIC): Vendor Cost Containment AGENCY: Food and... Nutrition Program for Women, Infants and Children (WIC): Vendor Cost Containment.'' DATES: Effective Date... Supplemental Nutrition Program for Women, Infants and Children (WIC): Vendor Cost Containment,'' 74 FR 51745...

Infant feeding counselling in Uganda in a changing environment with focus on the general population and HIV-positive mothers - a mixed method approach.

PubMed

Fadnes, Lars T; Engebretsen, Ingunn Marie S; Moland, Karen Marie; Nankunda, Jolly; Tumwine, James K; Tylleskär, Thorkild

2010-09-06

Health workers' counselling practices are essential to improve infant feeding practices. This paper will assess how infant feeding counselling was done and experienced by counsellors and mothers in Eastern Uganda in the context of previous guidelines. This has implications for implementation of the new infant feeding guidelines from 2009. This paper combines qualitative and quantitative data from Mbale District in Eastern Uganda. Data was collected from 2003 to 2005 in a mixed methods approach. This includes: key-informant interviews among eighteen health workers in the public hospital, health clinics and non-governmental organisations working with people living with HIV, fifteen focus group discussions in the general population and among clients from an HIV clinic, two cross-sectional surveys including 727 mothers from the general population and 235 HIV-positive mothers. The counselling sessions were often improvised. Health workers frequently had pragmatic approaches to infant feeding as many clients struggled with poverty, stigma and non-disclosure of HIV. The feasibility of the infant feeding recommendations was perceived as challenging among health workers, both for HIV-positive mothers and in the general population. Group counselling with large groups was common in the public health service. Some extra infant feeding teaching capacities were mobilised for care-takers of undernourished children. A tendency to simplify messages giving one-sided information was seen. Different health workers presented contradicting simplified perspectives in some cases. Outdated training was a common concern with many health workers not being given courses or seminars on infant feeding since professional graduation. Other problems were minimal staffing, lack of resources, and programs being started and subsequently stopped abruptly. Many of the HIV-counsellors in the non-governmental organisations got extended training in counselling which seemed to be beneficial. Health workers were faced with challenges related to workload, resources, scientific updating, and also a need to adjust to frequent changes in programs, recommendations and guidelines. The clients were faced with difficult choices, poverty, lack of education and stigma. Feasibility of the recommendations was a major concern. Systematic approaches to update health workers should be a priority.

Management of hypoxemic respiratory failure and pulmonary hypertension in preterm infants.

PubMed

Ambalavanan, N; Aschner, J L

2016-06-01

While diagnoses of hypoxemic respiratory failure (HRF) and pulmonary hypertension (PH) in preterm infants may be based on criteria similar to those in term infants, management approaches often differ. In preterm infants, HRF can be classified as 'early' or 'late' based on an arbitrary threshold of 28 postnatal days. Among preterm infants with late HRF, the pulmonary vascular abnormalities associated with bronchopulmonary dysplasia (BPD) represent a therapeutic challenge for clinicians. Surfactant, inhaled nitric oxide (iNO), sildenafil, prostacyclin and endothelin receptor blockers have been used to manage infants with both early and late HRF. However, evidence is lacking for most therapies currently in use. Chronic oral sildenafil therapy for BPD-associated PH has demonstrated some preliminary efficacy. A favorable response to iNO has been documented in some preterm infants with early PH following premature prolonged rupture of membranes and oligohydramnios. Management is complicated by a lack of clear demarcation between interventions designed to manage respiratory distress syndrome, prevent BPD and treat HRF. Heterogeneity in clinical phenotype, pathobiology and genomic underpinnings of BPD pose challenges for evidence-based management recommendations. Greater insight into the spectrum of disease phenotypes represented by BPD can optimize existing therapies and promote development of new treatments. In addition, better understanding of an individual's phenotype, genotype and biomarkers may suggest targeted personalized interventions. Initiatives such as the Prematurity and Respiratory Outcomes Program provide a framework to address these challenges using genetic, environmental, physiological and clinical data as well as large repositories of patient samples.

Improving the outcome of infants born at <30 weeks' gestation - a randomized controlled trial of preventative care at home

PubMed Central

2009-01-01

Background Early developmental interventions to prevent the high rate of neurodevelopmental problems in very preterm children, including cognitive, motor and behavioral impairments, are urgently needed. These interventions should be multi-faceted and include modules for caregivers given their high rates of mental health problems. Methods/Design We have designed a randomized controlled trial to assess the effectiveness of a preventative care program delivered at home over the first 12 months of life for infants born very preterm (<30 weeks of gestational age) and their families, compared with standard medical follow-up. The aim of the program, delivered over nine sessions by a team comprising a physiotherapist and psychologist, is to improve infant development (cognitive, motor and language), behavioral regulation, caregiver-child interactions and caregiver mental health at 24 months' corrected age. The infants will be stratified by severity of brain white matter injury (assessed by magnetic resonance imaging) at term equivalent age, and then randomized. At 12 months' corrected age interim outcome measures will include motor development assessed using the Alberta Infant Motor Scale and the Neurological Sensory Motor Developmental Assessment. Caregivers will also complete a questionnaire at this time to obtain information on behavior, parenting, caregiver mental health, and social support. The primary outcomes are at 24 months' corrected age and include cognitive, motor and language development assessed with the Bayley Scales of Infant and Toddler Development (Bayley-III). Secondary outcomes at 24 months include caregiver-child interaction measured using an observational task, and infant behavior, parenting, caregiver mental health and social support measured via standardized parental questionnaires. Discussion This paper presents the background, study design and protocol for a randomized controlled trial in very preterm infants utilizing a preventative care program in the first year after discharge home designed to improve cognitive, motor and behavioral outcomes of very preterm children and caregiver mental health at two-years' corrected age. Clinical Trial Registration Number ACTRN12605000492651 PMID:19954550

Tools for teen moms to reduce infant obesity: a randomized clinical trial.

PubMed

Horodynski, Mildred A; Silk, Kami; Hsieh, Gary; Hoffman, Alice; Robson, Mackenzie

2015-01-21

Unhealthy infant feeding practices, such as a combination of formula feeding and early introduction of solids may lead to rapid or excessive weight gain in early infancy. Adolescent mothers' feeding behaviors are most directly related to infant weight gain in the first year of life. Compared to adult mothers, adolescent mothers are less knowledgeable, less responsive, more controlling, and less skilled in infant feeding, which interferes with infants' healthy growth. The Tools for Teen Moms trial aims to compare the effect of a social media intervention for low-income adolescent, first-time mothers of infants 2 months of age or younger, versus standard care on infant weight, maternal responsiveness, and feeding style and practices. The intervention is conducted during the infant's first four months of life to promote healthy transition to solids during their first year. Tools for Teen Moms is an intervention delivered via a social media platform that actively engages and coaches low-income adolescent mothers in infant-centered feeding to reduce rapid/excessive infant weight gain in the first six months of life. We describe our study protocol for a randomized control trial with an anticipated sample of 100 low-income African- American and Caucasian adolescent, first-time mothers of infants. Participants are recruited through Maternal-Infant Health Programs in four counties in Michigan, USA. Participants are randomly assigned to the intervention or the control group. The intervention provides infant feeding information to mothers via a web-based application, and includes daily behavioral challenges, text message reminders, discussion forums, and website information as a comprehensive social media strategy over 6 weeks. Participants continue to receive usual care during the intervention. Main maternal outcomes include: (a) maternal responsiveness, (b) feeding style, and (c) feeding practices. The primary infant outcome is infant weight. Data collection occurs at baseline, and when the baby is 3 and 6 months old. Expected outcomes will address the effectiveness of the social media intervention in helping teen mothers develop healthy infant feeding practices that contribute to reducing the risk of early onset childhood obesity. Clinical Trials.Gov NCT02244424, June 24, 2014.

34 CFR 303.1 - Purpose of the early intervention program for infants and toddlers with disabilities.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 34 Education 2 2012-07-01 2012-07-01 false Purpose of the early intervention program for infants... EDUCATION EARLY INTERVENTION PROGRAM FOR INFANTS AND TODDLERS WITH DISABILITIES General Purpose and Applicable Regulations § 303.1 Purpose of the early intervention program for infants and toddlers with...

34 CFR 303.1 - Purpose of the early intervention program for infants and toddlers with disabilities.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 34 Education 2 2010-07-01 2010-07-01 false Purpose of the early intervention program for infants... EDUCATION EARLY INTERVENTION PROGRAM FOR INFANTS AND TODDLERS WITH DISABILITIES General Purpose, Eligibility, and Other General Provisions § 303.1 Purpose of the early intervention program for infants and...

34 CFR 303.1 - Purpose of the early intervention program for infants and toddlers with disabilities.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 34 Education 2 2013-07-01 2013-07-01 false Purpose of the early intervention program for infants... EDUCATION EARLY INTERVENTION PROGRAM FOR INFANTS AND TODDLERS WITH DISABILITIES General Purpose and Applicable Regulations § 303.1 Purpose of the early intervention program for infants and toddlers with...

34 CFR 303.1 - Purpose of the early intervention program for infants and toddlers with disabilities.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 34 Education 2 2011-07-01 2010-07-01 true Purpose of the early intervention program for infants... EDUCATION EARLY INTERVENTION PROGRAM FOR INFANTS AND TODDLERS WITH DISABILITIES General Purpose, Eligibility, and Other General Provisions § 303.1 Purpose of the early intervention program for infants and...

34 CFR 303.1 - Purpose of the early intervention program for infants and toddlers with disabilities.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 34 Education 2 2014-07-01 2013-07-01 true Purpose of the early intervention program for infants... EDUCATION EARLY INTERVENTION PROGRAM FOR INFANTS AND TODDLERS WITH DISABILITIES General Purpose and Applicable Regulations § 303.1 Purpose of the early intervention program for infants and toddlers with...

Higher protein intake increases cardiac function parameters in healthy children: metabolic programming by infant nutrition-secondary analysis from a clinical trial.

PubMed

Collell, Rosa; Closa-Monasterolo, Ricardo; Ferré, Natalia; Luque, Veronica; Koletzko, Berthold; Grote, Veit; Janas, Roman; Verduci, Elvira; Escribano, Joaquín

2016-06-01

Protein intake may modulate cardiac structure and function in pathological conditions, but there is a lack of knowledge on potential effects in healthy infants. Secondary analysis of an ongoing randomized clinical trial comparing two groups of infants receiving a higher (HP) or lower (LP) protein content formula in the first year of life, and compared with an observational group of breastfed (BF) infants. Growth and dietary intake were assessed periodically from birth to 2 y. Insulin-like growth factor 1 (IGF-1) axis parameters were analyzed at 6 mo in a blood sample. At 2 y, cardiac mass and function were assessed by echocardiography. HP infants (n = 50) showed a higher BMI z-score at 2 y compared with LP (n = 47) or BF (n = 44). Cardiac function parameters were increased in the HP group compared with the LP and were directly related to the protein intake during the first 6 mo of life. Moreover, there was an increase in free IGF-1 in the HP group at 6 mo. A moderate increase in protein supply during the first year of life is associated with higher cardiac function parameters at 2 y. IGF-1 axis modifications may, at least in part, underlie these effects.

76 FR 71579 - Center for Scientific Review; Notice of Closed Meetings

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-18

...: Interventions for SIDS and Other Sleep Related Infant Deaths. Date: December 7-8, 2011. Time: 10 a.m. to 6 p.m... Assistance Program Nos. 93.306, Comparative Medicine; 93.333, Clinical Research, 93.306, 93.333, 93.337, 93...

Clinical considerations for an infant oral health care program.

PubMed

Ramos-Gomez, Francisco J

2005-05-01

The American Academy of Pediatric Dentistry and the American Association of Pediatrics recommend dental assessments and evaluations for children during their first year of life. Early dental intervention evaluates a child's risk status based on parental interviews and oral examinations. These early screenings present an opportunity to educate parents about the medical, dental, and cost benefits of preventive--rather than restorative-care and may be more effective in reducing early childhood caries than traditional infectious disease models. A comprehensive infant oral care program includes: (1) risk assessments at regularly scheduled dental visits; (2) preventive treatments such as fluoride varnishes or sealants; (3) parental education on the correct methods to clean the baby's mouth; and (4) incentives to encourage participation in ongoing educational programming. Recruiting mothers during pregnancy improves the likelihood that they will participate in the assessment program. To maximize interest, trust, and success among participating parents, educational and treatment programs must be tailored to the social and cultural norms within the community being served.

Early intervention and recovery among children with failure to thrive: follow-up at age 8.

PubMed

Black, Maureen M; Dubowitz, Howard; Krishnakumar, Ambika; Starr, Raymond H

2007-07-01

We sought to examine the impact of a randomized, controlled trial of home visiting among infants with failure to thrive on growth, academic/cognitive performance, and home/classroom behavior at age 8. Infants with failure to thrive (N = 130) or adequate growth (N = 119) were recruited from pediatric primary care clinics serving low-income, urban communities. Eligibility criteria included age <25 months, gestational age >36 weeks, birth weight >2500 g, and no significant medical conditions. Evaluation included anthropometries, Bayley scales, maternal anthropometries, demographics, negative affect, IQ, and the Home Observation for Measurement of the Environment scale. Infants with failure to thrive were treated in an interdisciplinary growth and nutrition clinic and randomized into clinical-intervention-plus-home-intervention or clinical-care-only groups. The home-visiting curriculum promoted maternal sensitivity, parent-infant relationships, and child development. Follow-up visits were conducted by evaluators who were unaware of the children's growth or intervention history. At age 8, the evaluation included anthropometries, the Wechsler Intelligence Scale for Children III, and the Wide Range Achievement Test, Revised. Mothers completed the Child Behavior Checklist and teachers completed the Teacher Report Form. Multivariate analyses of variance were used to examine differences in growth, cognitive/academic performance, and home/school behavior, adjusted by maternal education, public assistance, and, when appropriate, infant Bayley score, maternal BMI, height, negative affect, IQ, and Home Observation for Measurement of the Environment scores. Retention was 74% to 78%. Children in the adequate-growth group were significantly taller, heavier, and had better arithmetic scores than the clinical-intervention-only group, with the clinical-intervention-plus-home-intervention group intermediate. There were no group differences in IQ, reading, or mother-reported behavior problems. Children in the clinical-intervention-plus-home-intervention group had fewer teacher-reported internalizing problems and better work habits than the clinical-intervention-only group. Early failure to thrive increased children's vulnerability to short stature, poor arithmetic performance, and poor work habits. Home visiting attenuated some of the negative effects of early failure to thrive, possibly by promoting maternal sensitivity and helping children build strong work habits that enabled them to benefit from school. Findings provide evidence for early intervention programs for vulnerable infants.

Behavioral analysis of preterm neonates included in a tactile and kinesthetic stimulation program during hospitalization.

PubMed

Ferreira, Andréia M; Bergamasco, Niélsy H P

2010-01-01

To evaluate the effect of tactile and kinesthetic stimulation on behavioral and clinical development in preterm neonates while still in the hospital. Thirty-two clinically stable preterm infants weighing <2.500 grams, with no significant perinatal asphyxia, were allocated to two groups: a control group (CG) in which no intervention was made (n=16) and a study group (SG) in which the newborn infants received tactile and kinesthetic stimulation (n=16). Data on the infants' clinical progress were collected from medical charts and behavioral evaluations by means of a series of weekly, eight-minute films recorded from the time of inclusion into the study until hospital discharge. There was a trend towards a shorter duration of hospital stay, increased daily weight gain and a predominance of self-regulated behavior (regular breathing, state of alertness, balanced tonus, a range of postures, coordinated movements, hand-to-face movement control, suction, grip, support) in infants in the SG. With respect to motor control, comparative analysis of postconceptional ages according to age-bracket (I - 31-33 weeks 6/7; II - 34-36 weeks 6/7; and III - 37-39 weeks 6/7) revealed balanced tonus and coordinated voluntary movements in all three periods, a longer time spent in a range of postures (age bracket I) or in flexion (age bracket II) and more regular breathing in age bracket I in the SG. In the hospital, tactile and kinesthetic stimulation was shown to have a positive effect, contributing towards adjustment and self-regulation of behavior in the preterm newborn infant. Article registered in the Australian New Zealand Clinical Trials Registry (ANZCTR) under the number ACTRN12610000133033.

Sustainability of the prevention of passive infant smoking within well-baby clinics.

PubMed

Crone, M R; Verlaan, M; Willemsen, M C; van Soelen, P; Reijneveld, S A; Sing, R A Hira; Paulussen, T G W M

2006-04-01

This study assessed the antecedents of continued use of an education program to prevent passive smoking in infants. It consists of a booklet for parents and a manual for health professionals describing a five-step procedure for discussing passive smoking. A questionnaire was sent to 67 managers, 670 nurses, and 335 physicians working in well-baby clinics (response rate: 70%, 53%, 47% respectively). Questions concerned the completeness of use, level of institutionalization, and characteristics of the organization, the user, and the dissemination strategy. Seventy-one percent of nurses and 42% of physicians worked with the program. They foremost provided the first three steps of the five-step procedure. Physicians' completeness of use was related to their perceived responsibility in providing this education, and nurses' use was related to their perceived self-efficacy, responsibility, training attendance, participation in the adoption decision, and level of institutionalization. Diffusion efforts should focus on improving the completeness of use and level of institutionalization.

78 FR 53150 - Advisory Committee on the Maternal, Infant and Early Childhood Home Visiting Program Evaluation...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-28

... and Services Administration Advisory Committee on the Maternal, Infant and Early Childhood Home... Maternal, Infant and Early Childhood Home Visiting Program Evaluation (MIECHVE). Authority: Section 10(a)(2... meeting: Name: Advisory Committee on the Maternal, Infant, and Early Childhood Home Visiting Program...

Understanding Infants: Characteristics of Early Childhood Practitioners' Interpretations of Infants and Their Behaviours

ERIC Educational Resources Information Center

Degotardi, Sheila; Davis, Belinda

2008-01-01

This research explored the nature of early childhood practitioners' interpretations of infants in their programs on the basis that such interpretations guide practitioner-infant interactions and curriculum decision-making processes. Twenty-four infant practitioners were asked to describe a nominated infant in their program and to interpret video…

Challenges faced by health-care providers offering infant-feeding counseling to HIV-positive women in sub-Saharan Africa: a review of current research.

PubMed

Tuthill, Emily L; Chan, Jessica; Butler, Lisa M

2015-01-01

Exclusive breastfeeding (EBF) has been identified as the optimal nutrition and critical behavior in attaining human immunodeficiency virus (HIV)-free infant survival in resource-limited settings. Health-care providers (HCPs) in clinic- and community-settings throughout sub-Saharan Africa (sSA) provide infant-feeding counseling. However, rates of EBF at 6 months of age are suboptimal. HCPs are uniquely positioned to educate HIV-positive mothers and provide support by addressing known barriers to EBF. However, limited evidence exists on the experiences faced by HCPs in providing counseling on infant feeding to HIV-positive women. Our objective is to describe experiences faced by HCPs when delivering infant-feeding counseling in the context of HIV in program settings in sSA. We searched a range of electronic databases, including PubMed, CINAHL, and PsycINFO from January 1990 to February 2013, in addition to hand-searching, cross-reference searching, and personal communications. The search was limited to publications in English. Empirical studies of HCP experiences providing infant-feeding counseling in the prevention of mother-to-child transmission (PMTCT) of HIV programs in sSA were selected. We identified 10 peer-reviewed articles reporting HCP challenges in infant-feeding counseling that met inclusion criteria. Articles included qualitative, cross-sectional and mixed-method studies, and cumulatively reported 31 challenges faced by HCPs. Among the challenges identified, the most commonly reported were personal beliefs held by the HCPs toward infant feeding in the context of HIV, contradictory messages, staff workload, directive counseling styles, and a lack of practical strategies to offer mothers, often leading to improvised counseling approaches. Counseling strategies need to be developed that are relevant, meaningful, and responsive to the needs of both HCPs and mothers.

WIC's promotion of infant formula in the United States

PubMed Central

Kent, George

2006-01-01

Background The United States' Special Supplemental Nutrition Program for Women, Infants and Children (WIC) distributes about half the infant formula used in the United States at no cost to the families. This is a matter of concern because it is known that feeding with infant formula results in worse health outcomes for infants than breastfeeding. Discussion The evidence that is available indicates that the WIC program has the effect of promoting the use of infant formula, thus placing infants at higher risk. Moreover, the program violates the widely accepted principles that have been set out in the International Code of Marketing of Breast-milk Substitutes and in the human right to adequate food. Summary There is no good reason for an agency of government to distribute large quantities of free infant formula. It is recommended that the large-scale distribution of free infant formula by the WIC program should be phased out. PMID:16722534

[Integrative parent-infant psychotherapy for early regulatory and relationship disorders].

PubMed

Papousek, Mechthild; de Chuquisengo, Ruth Wollwerth

2006-01-01

The author introduces both the concept and practice of Integrative Parent-Infant Psychotherapy (IPI-P), a treatment specifically designed for the most frequent developmental problems and psychological needs of infants and their parents. Based on growing knowledge from interdisciplinary infancy research, both basic and clinical, IPI-P has been developed and practised in the "Munich Interdisciplinary Research and Intervention Program" for early regulatory and relationship disorders since the early nineties. Preverbal parent-infant communication represents both the port of entry into the system and the main focus of diagnostics, developmental counselling, interaction guidance, or psychodynamic psychotherapy of distorted communication and distressed/disordered relationships. The method of videomicroanalysis during video-feedback with the parent has proven particularly efficient--while observing, reliving and working through brief episodes of recorded parent-infant interaction. The author illustrates the diagnostic and therapeutic procedures with excerpts from psychotherapy of a toddler with an age-specific regulatory disorder in the context of severely distressed primary relationships.

Newborn Screening for Severe Combined Immunodeficiency in 11 Screening Programs in the United States

PubMed Central

Kwan, Antonia; Abraham, Roshini S.; Currier, Robert; Brower, Amy; Andruszewski, Karen; Abbott, Jordan K.; Baker, Mei; Ballow, Mark; Bartoshesky, Louis E.; Bonagura, Vincent R.; Bonilla, Francisco A.; Brokopp, Charles; Brooks, Edward; Caggana, Michele; Celestin, Jocelyn; Church, Joseph A.; Comeau, Anne Marie; Connelly, James A.; Cowan, Morton J.; Cunningham-Rundles, Charlotte; Dasu, Trivikram; Dave, Nina; De La Morena, Maria T.; Duffner, Ulrich; Fong, Chin-To; Forbes, Lisa; Freedenberg, Debra; Gelfand, Erwin W.; Hale, Jaime E.; Celine Hanson, I.; Hay, Beverly N.; Hu, Diana; Infante, Anthony; Johnson, Daisy; Kapoor, Neena; Kay, Denise M.; Kohn, Donald B.; Lee, Rachel; Lehman, Heather; Lin, Zhili; Lorey, Fred; Abdel-Mageed, Aly; Manning, Adrienne; McGhee, Sean; Moore, Theodore B.; Naides, Stanley J.; Notarangelo, Luigi D.; Orange, Jordan S.; Pai, Sung-Yun; Porteus, Matthew; Rodriguez, Ray; Romberg, Neil; Routes, John; Ruehle, Mary; Rubenstein, Arye; Saavedra-Matiz, Carlos A.; Scott, Ginger; Scott, Patricia M.; Secord, Elizabeth; Seroogy, Christine; Shearer, William T.; Siegel, Subhadra; Silvers, Stacy K.; Stiehm, E. Richard; Sugerman, Robert W.; Sullivan, John L.; Tanksley, Susan; Tierce, Millard L.; Verbsky, James; Vogel, Beth; Walker, Rosalyn; Walkovich, Kelly; Walter, Jolan E.; Wasserman, Richard L.; Watson, Michael S.; Weinberg, Geoffrey A.; Weiner, Leonard B.; Wood, Heather; Yates, Anne B.; Puck, Jennifer M.

2015-01-01

IMPORTANCE Newborn screening for severe combined immunodeficiency (SCID) using assays to detect T-cell receptor excision circles (TRECs) began in Wisconsin in 2008, and SCID was added to the national recommended uniform panel for newborn screened disorders in 2010. Currently 23 states, the District of Columbia, and the Navajo Nation conduct population-wide newborn screening for SCID. The incidence of SCID is estimated at 1 in 100 000 births. OBJECTIVES To present data from a spectrum of SCID newborn screening programs, establish population-based incidence for SCID and other conditions with T-cell lymphopenia, and document early institution of effective treatments. DESIGN Epidemiological and retrospective observational study. SETTING Representatives in states conducting SCID newborn screening were invited to submit their SCID screening algorithms, test performance data, and deidentified clinical and laboratory information regarding infants screened and cases with nonnormal results. Infants born from the start of each participating program from January 2008 through the most recent evaluable date prior to July 2013 were included. Representatives from 10 states plus the Navajo Area Indian Health Service contributed data from 3 030 083 newborns screened with a TREC test. MAIN OUTCOMES AND MEASURES Infants with SCID and other diagnoses of T-cell lymphopenia were classified. Incidence and, where possible, etiologies were determined. Interventions and survival were tracked. RESULTS Screening detected 52 cases of typical SCID, leaky SCID, and Omenn syndrome, affecting 1 in 58 000 infants (95%CI, 1/46 000-1/80 000). Survival of SCID-affected infants through their diagnosis and immune reconstitution was 87%(45/52), 92%(45/49) for infants who received transplantation, enzyme replacement, and/or gene therapy. Additional interventions for SCID and non-SCID T-cell lymphopenia included immunoglobulin infusions, preventive antibiotics, and avoidance of live vaccines. Variations in definitions and follow-up practices influenced the rates of detection of non-SCID T-cell lymphopenia. CONCLUSIONS AND RELEVANCE Newborn screening in 11 programs in the United States identified SCID in 1 in 58 000 infants, with high survival. The usefulness of detection of non-SCID T-cell lymphopenias by the same screening remains to be determined. PMID:25138334

Introduction of Infant Flow nasal continuous airway pressure as the standard of practice in Poland: the initial 2-year experience.

PubMed

Swietliński, Janusz; Bober, Klaudiusz; Gajewska, Elzbieta; Helwich, Ewa; Lauterbach, Ryszard; Manowska, Małgorzata; Maruszewski, Bohdan; Szczapa, Jerzy; Hubicki, Lech

2007-03-01

The aim of this prospective study was to evaluate whether a change in the standard of newborn care for respiratory insufficiency by widely introducing more aggressive use of nasal continuous airway pressure (nCPAP) and including Infant Flow technology would result in satisfactory outcomes. Prospectively defined analysis. Fifty-seven secondary and tertiary care neonatal centers in Poland. Patients were 1,299 newborns. None. We carried out a prospectively defined analysis of 1,299 newborns included in the program between August 1, 2003, and April 30, 2005. The inclusion criterion was the occurrence of symptoms of respiratory failure irrespective of its etiology. Respiratory support was provided with the use of the Infant Flow Advance Driver. The analysis was made on data from prospectively designed questionnaires completed following each infant's treatment. Infants were placed into categories based on clinical indication for use. The primary end point was avoiding tracheal intubation. A high rate of acceptance of the new practice was observed across the substantial demographic and clinical diversity of newborns. Tracheal intubation was avoided in 78% of infants treated electively with nCPAP. Of those being weaned from mechanical ventilation, 61.2% were successfully weaned. Related complications were low (1.4% pneumothorax, 12% nasal injuries). The new method of nCPAP with Infant Flow was adopted as standard practice in Poland. We monitored its safety and effectiveness over a 2-yr period and found it to be safe and effective as implemented. Additional research is still needed to determine the optimum patient population, strategy for use, and devices.

75 FR 5877 - Commodity Supplemental Food Program (CSFP): Amendment Removing Priority Given to Women, Infants...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-02-05

... Supplemental Food Program (CSFP): Amendment Removing Priority Given to Women, Infants, and Children Before the... removing the priority given to women, infants, and children before the elderly in program participation, in... CSFP if funds were available after all women, infants, and children were first served. Section 4221 of...

Early Programming by Protein Intake: The Effect of Protein on Adiposity Development and the Growth and Functionality of Vital Organs

PubMed Central

Luque, Veronica; Closa-Monasterolo, Ricardo; Escribano, Joaquín; Ferré, Natalia

2015-01-01

This article reviews the role of protein intake on metabolic programming early in life. The observations that breastfeeding in infancy reduces the risk of being overweight and obese later in life and the differences in the protein content between formula milk and human milk have generated the early protein hypothesis. The present review focuses on a mechanistic approach to programmed adiposity and the growth and development of other organs by protein intake in infancy, which may be mediated by branched-chain amino acids, insulin, and insulin-like growth factor 1 via the mammalian target of rapamycin. Observational studies and clinical trials have shown that lowering the protein content in infant and follow-on formulas may reduce the risk of becoming obese later in life. The recent body of evidence is currently being translated into new policies. Therefore, the evolution of European regulatory laws and recommendations by expert panels on the protein content of infant and follow-on formulas are also reviewed. Research gaps, such as the critical window for programming adiposity by protein intake, testing formulas with modified amino acids, and the long-term consequences of differences in protein intake on organ functionality among well-nourished infants, have been identified. PMID:27013888

Medication Exposure in Pregnancy Risk Evaluation Program

PubMed Central

Andrade, Susan E.; Davis, Robert L.; Cheetham, T. Craig; Cooper, William O.; Li, De-Kun; Amini, Thushi; Beaton, Sarah J.; Dublin, Sascha; Hammad, Tarek A.; Pawloski, Pamala A.; Raebel, Marsha A.; Smith, David H.; Staffa, Judy A.; Toh, Sengwee; Dashevsky, Inna; Haffenreffer, Katherine; Lane, Kimberly; Platt, Richard; Scott, Pamela E.

2011-01-01

To describe a program to study medication safety in pregnancy, the Medication Exposure in Pregnancy Risk Evaluation Program (MEPREP). MEPREP is a multi-site collaborative research program developed to enable the conduct of studies of medication use and outcomes in pregnancy. Collaborators include the U.S. Food and Drug Administration and researchers at the HMO Research Network, Kaiser Permanente Northern and Southern California, and Vanderbilt University. Datasets have been created at each site linking healthcare data for women delivering an infant between January 1, 2001 and December 31, 2008 and infants born to these women. Standardized data files include maternal and infant characteristics, medication use, and medical care at 11 health plans within 9 states; birth certificate data were obtained from the state departments of public health. MEPREP currently involves more than 20 medication safety researchers and includes data for 1,221,156 children delivered to 933,917 mothers. Current studies include evaluations of the prevalence and patterns of use of specific medications and a validation study of data elements in the administrative and birth certificate data files. MEPREP can support multiple studies by providing information on a large, ethnically and geographically diverse population. This partnership combines clinical and research expertise and data resources to enable the evaluation of outcomes associated with medication use during pregnancy. PMID:22002179

Medication Exposure in Pregnancy Risk Evaluation Program.

PubMed

Andrade, Susan E; Davis, Robert L; Cheetham, T Craig; Cooper, William O; Li, De-Kun; Amini, Thushi; Beaton, Sarah J; Dublin, Sascha; Hammad, Tarek A; Pawloski, Pamala A; Raebel, Marsha A; Smith, David H; Staffa, Judy A; Toh, Sengwee; Dashevsky, Inna; Haffenreffer, Katherine; Lane, Kimberly; Platt, Richard; Scott, Pamela E

2012-10-01

To describe a program to study medication safety in pregnancy, the Medication Exposure in Pregnancy Risk Evaluation Program (MEPREP). MEPREP is a multi-site collaborative research program developed to enable the conduct of studies of medication use and outcomes in pregnancy. Collaborators include the U.S. Food and Drug Administration and researchers at the HMO Research Network, Kaiser Permanente Northern and Southern California, and Vanderbilt University. Datasets have been created at each site linking healthcare data for women delivering an infant between January 1, 2001 and December 31, 2008 and infants born to these women. Standardized data files include maternal and infant characteristics, medication use, and medical care at 11 health plans within 9 states; birth certificate data were obtained from the state departments of public health. MEPREP currently involves more than 20 medication safety researchers and includes data for 1,221,156 children delivered to 933,917 mothers. Current studies include evaluations of the prevalence and patterns of use of specific medications and a validation study of data elements in the administrative and birth certificate data files. MEPREP can support multiple studies by providing information on a large, ethnically and geographically diverse population. This partnership combines clinical and research expertise and data resources to enable the evaluation of outcomes associated with medication use during pregnancy.

Motivational Interviewing Skills are Positively Associated with Nutritionist Self-Efficacy

ERIC Educational Resources Information Center

Marley, Scott C.; Carbonneau, Kira; Lockner, Donna; Kibbe, Debra; Trowbridge, Frederick

2011-01-01

Objective: To examine the relationships between physical and social self-concepts, motivational interviewing (MI), and nutrition assessment skills with dimensions of counseling self-efficacy. Design: Cross-sectional survey. Setting: Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) clinics. Participants: Sixty-five WIC…

Involvements of Parents in the Care of Preterm Infants: A Pilot Study Evaluating a Family-Centered Care Intervention in a Chinese Neonatal ICU.

PubMed

Zhang, Rong; Huang, Rui-Wena; Gao, Xi-Ronga; Peng, Xiao-Minga; Zhu, Li-Hui; Rangasamy, Ramanathan; Latour, Jos M

2018-05-17

To evaluate the effectiveness and safety of a family-centered care intervention in a Chinese neonatal ICU. Pilot study using a randomized controlled trial design to inform a main randomized controlled trial study. Stand-alone tertiary children's hospital in China with a 60-bed neonatal ICU serving as a regional neonatal ICU center. Premature infants (n = 61) and their parents (n = 110). Parent education program followed by parents' participation in care as primary caregiver until discharge for a minimum of 4 hours per day. Primary outcomes were infants' weight gain at discharge, length of stay, and readmission. Parental outcomes were stress, anxiety, satisfaction, and clinical knowledge. Infants in family-centered care group (n = 31) had higher weight gain (886g vs 542g; p = 0.013), less neonatal ICU length of stay in days (43 vs 46; p = 0.937), and decreased readmission rate at 1 week (41.9 vs 70.0; p = 0.045) and at 1 month (6.5% vs 50%; p < 0.001) compared with the control group (n = 30). Total Mean Parental Stress and Anxiety scores were lower in the family-centered care group (42 vs 59; p ≤ 0.007), mean satisfaction rates in family-centered care group were higher compared with control group (96 vs 90; p < 0.001), and parents in the family-centered care group had better educational outcomes related to neonatal specialized care skills (p < 0.05). Involving parents in the care of their infant improved clinical outcomes of infants. Family-centered care also contributed to a better understanding of parent's clinical education, decrease stress levels, and increased parental satisfaction. Our study suggests that involving parents in the daily care of their infants is feasible and should be promoted by neonatal ICU clinicians.

Hospital-based surveillance of congenital rubella syndrome in Indonesia.

PubMed

Herini, Elisabeth Siti; Gunadi; Triono, Agung; Mulyadi, Asal Wahyuni Erlin; Mardin, Niprida; Rusipah; Soenarto, Yati; Reef, Susan E

2017-03-01

Congenital rubella syndrome (CRS) has serious consequences, such as miscarriage, stillbirth, and severe birth defects in infants, resulting from rubella virus infection during pregnancy. However, rubella vaccine has not yet been implemented in Indonesia. This study aimed (1) to estimate the incidence of CRS in Indonesia, (2) describe the clinical features of CRS at our referral hospital, and (3) pilot a CRS surveillance system to be extended to other hospitals. We conducted a 4-month prospective surveillance study of infants aged <1 year with suspected CRS in 2013 at an Indonesian hospital. Infants with suspected CRS were examined for rubella-specific IgM antibody or rubella IgG antibody levels. Of 47 suspected cases of CRS, 11/47 (23.4%), 9/47 (19.1%), and 27/47 (57.5%) were diagnosed as laboratory-confirmed, clinically compatible, and discarded CRS, respectively. The most common defects among laboratory-confirmed CRS cases were hearing impairment (100%), congenital cataracts (72.7%), microcephaly (72.7%), and congenital heart defects (45.5%). The number of laboratory-confirmed CRS cases among Indonesian infants is high. Furthermore, hearing impairment is the most common clinical feature of CRS in infants. Our findings indicate the importance of implementation of rubella vaccine in Indonesia. Conducting hospital-based surveillance of CRS in other hospitals in Indonesia may be appropriate. What is Known: •Congenital rubella syndrome (CRS) has serious consequences in infants resulting from rubella virus infection during pregnancy. •The incidence of CRS in most developed countries has greatly decreased since implementation of rubella vaccination. •Rubella vaccine has not yet been implemented in many developing countries. What is New: •The number of laboratory-confirmed CRS cases among Indonesian infants was high. •Implementation of rubella vaccine into immunization programs in Indonesia is important because of the high number of CRS cases. •Our study highlights the need for ongoing prospective surveillance of CRS in Indonesia.

Implementation of a Nutrition Program Reduced Post-Discharge Growth Restriction in Thai Very Low Birth Weight Preterm Infants.

PubMed

Japakasetr, Suchada; Sirikulchayanonta, Chutima; Suthutvoravut, Umaporn; Chindavijak, Busba; Kagawa, Masaharu; Nokdee, Somjai

2016-12-17

Very low birth weight (VLBW) preterm infants are vulnerable to growth restriction after discharge due to cumulative protein and energy deficits during their hospital stay and early post-discharge period. The current study evaluated the effectiveness of the preterm infant, post-discharge nutrition (PIN) program to reduce post-discharge growth restriction in Thai VLBW preterm infants. A prospective, non-randomized interventional cohort study was undertaken to assess the growth of 22 VLBW preterm infants who received the PIN program and compared them with 22 VLBW preterm infants who received conventional nutrition services. Infant's growth was recorded monthly until the infants reached six months' corrected age (6-moCA). Intervention infants had significantly greater body weights ( p = 0.013) and head circumferences ( p = 0.009). Also, a greater proportion of the intervention group recovered their weight to the standard weight at 4-moCA ( p = 0.027) and at 6-moCA ( p = 0.007) and their head circumference to the standard head circumference at 6-moCA ( p = 0.004) compared to their historical comparison counterparts. Enlistment in the PIN program thus resulted in significantly reduced post-discharge growth restriction in VLBW preterm infants. Further research on longer term effects of the program on infant's growth and development is warranted.

76 FR 16599 - Special Supplemental Nutrition Program for Women, Infants and Children (WIC): Income Eligibility...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-24

... DEPARTMENT OF AGRICULTURE Food and Nutrition Service Special Supplemental Nutrition Program for Women, Infants and Children (WIC): Income Eligibility Guidelines AGENCY: Food and Nutrition Service... Special Supplemental Nutrition Program for Women, Infants and Children Program (WIC). These income...

A National Survey of the Nursing Care of Infants With Prenatal Substance Exposure in Canadian NICUs.

PubMed

Marcellus, Lenora; Loutit, Tara; Cross, Shannon

2015-10-01

Many communities are reporting increases in the number of infants requiring NICU care. Practices continue to vary and there is limited available evidence about nursing care. The purpose of this study was to describe current nursing care practices for infants with prenatal substance exposure in the NICU setting and during transition to the community. Findings from this study were compared with an earlier Canadian survey (by Marcellus in 2002) to identify shifts in clinical nursing practice for this population. This was a cross-sectional descriptive survey design. A 68-item survey composed of multiple-choice and open-ended questions was administered through FluidSurveys online software. A convenience sample of 62 clinical managers or clinical educators in hospitals with active maternal-infant clinical units with 500 deliveries or more annually and/or pediatric hospitals with a separate designated neonatal service (ie, Level 2 and 3 units) was chosen. A greater number of NICUs are using clinical guidelines to support the standardization of quality care. Improvements in nursing practice were identified and these included the consistent use of a withdrawal scoring tool and provision of education for team members in orientation. A decline in routine discharge planning meetings and routine parent teaching plans was discovered. This survey has improved understanding of the current state of nursing care for infants with prenatal substance exposure and their families during this critical time of transition. The purpose of the survey was to compare findings with the 2002 study by Marcellus to identify any improved practices and describe current state nursing care practices in the NICU. Practice changes over the last decade have included keeping mothers and infants together, expanding concepts of the team, integrating programs and services across hospital and community settings, and creating opportunities for NICU teams to learn more about substance use, mental health, violence, and trauma. Focus on discharge planning, parent teaching, and creation and implementation of national/hospital guidelines is essential for consistent evidence-based quality patient care.

Flavor Programming During Infancy

PubMed Central

Griffin, Cara E.; Beauchamp, Gary K.

2005-01-01

Objective. Although individuals differ substantially in their flavor and food preferences, the source of such differences remains a mystery. The present experimental study was motivated by clinical observations that early experience with formulas establishes subsequent preferences. Design. Infants whose parents had chosen to formula-feed them were randomized into 1 of 4 groups by the second week of life. One group was assigned to be fed a milk-based formula (Enfamil), whereas another was assigned to be fed (Nutramigen), a particularly unpleasant-tasting protein hydrolysate formula. The remaining groups were assigned to be fed Nutramigen for 3 months and Enfamil for 4 months; the timing of exposure differed between the groups. After 7 months of exposure, infants were videotaped on 3 separate days while feeding, in counterbalanced order, Enfamil, Nutramigen, and Alimentum, a novel hydrolysate formula. Results. For each of the 4 interrelated measures of behavior (intake, duration of formula feeding, facial expressions, and mothers’ judgments of infant acceptance), previous exposure to Nutramigen significantly enhanced subsequent acceptance of both Nutramigen and Alimentum. Seven months of exposure led to greater acceptance than did 3 months. Conclusions. The bases for clinical difficulties in introducing hydrolysate formulas during older infancy are clarified in this study. More broadly, variation in formula flavor provided a useful model for demonstrating experimentally the effects of long-term exposure differences on later acceptance. Such early variation, under more species-typical circumstances (eg, via exposure to different flavors in amniotic fluid and mothers’ milk), may underlie individual differences in food acceptability throughout the life span. Pediatrics 2004;113:840–845; protein hydrolysate, formula, taste, flavor, infants, programming, development, nutrition. PMID:15060236

Dynamics of WIC Program Participation by Infants and Children, 2001 to 2003. Final Report

ERIC Educational Resources Information Center

Castner, Laura; Mabli, James; Sykes, Julie

2009-01-01

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides nutritious foods that promote the health of low-income pregnant women, new mothers, infants, and preschool children. This study examines WIC participation dynamics of infants and children from 2001 to 2003 using the Survey of Income and Program Participation…

Parenting self-efficacy: links with maternal depression, infant behaviour and adult attachment.

PubMed

Kohlhoff, Jane; Barnett, Bryanne

2013-04-01

This study examined predictors of parenting self-efficacy (PSE) in a sample of first-time mothers during the first year after childbirth and evaluated the effect of a brief, intensive, mother-infant residential intervention on PSE and infant behaviour. 83 primiparous women with infants aged 0-12 months admitted to a residential parent-infant program participated in a structured clinical interview for DSM-IV diagnosis of depressive and anxiety disorders and completed questionnaires assessing psychological distress, adult attachment and childhood parenting experiences. During their residential stay, nurses recorded infant behaviour using 24-hour charts. Results showed PSE to be inversely correlated with maternal depression, maternal anxiety and attachment insecurity. Low levels of parental abuse during childhood, avoidant attachment, male infant gender and depressive symptom severity were found to predict low PSE. Major depression mediated the relation between attachment insecurity and PSE, but there were no links between PSE and infant behaviour. After the intervention, there was a significant improvement in PSE, with abusive parenting during childhood and depressive symptom severity being predictive of change. This study highlights the links between maternal psychopathology and maternal background factors such as childhood parenting experiences and attachment style in the development of postnatal PSE. Directions for future research are discussed. Crown Copyright © 2013. Published by Elsevier Ireland Ltd. All rights reserved.

Effects of pre-feeding oral stimulation on oral feeding in preterm infants: a randomized clinical trial.

PubMed

Bache, Manon; Pizon, Emmanuelle; Jacobs, Julien; Vaillant, Michel; Lecomte, Aline

2014-03-01

To evaluate the effect of early oral stimulation before the introduction of oral feeding, over the duration of concomitant tube feeding ("transition period"), the length of hospital stay and the breastfeeding rates upon discharge in preterm infants. Preterm infants born between 26 and 33 weeks gestational age (n=86), were randomized into an intervention and control group. Infants in the intervention group received an oral stimulation program consisting in stimulation of the oral structures for 15 min at least for 10 days, before introduction of oral feeding. Oral feeding was introduced at 34 weeks GA in both groups. Breastfeeding rates upon discharge were significantly higher in the intervention than in the control group (70% versus 45.6%, p=0.02). There was no statistical difference between the two groups in terms of the length of the transition period or the length of the hospital stay. The need for prolonged CPAP support (HR=0.937, p=0.030) and small size for gestational age at birth (HR=0.338, p=0.016) were shown to be risk factors for a prolonged transition period. A pre-feeding oral stimulation program improves breastfeeding rates in preterm infants. The study results suggest that oral stimulation, as used in our specific population, does not shorten the transition period to full oral feeding neither the length of hospital stay. Copyright © 2014 Elsevier Ltd. All rights reserved.

77 FR 17006 - Special Supplemental Nutrition Program for Women, Infants and Children (WIC): Income Eligibility...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-23

... DEPARTMENT OF AGRICULTURE Food and Nutrition Service Special Supplemental Nutrition Program for Women, Infants and Children (WIC): Income Eligibility Guidelines AGENCY: Food and Nutrition Service (FNS... Special Supplemental Nutrition Program for Women, Infants and Children Program (WIC). These income...

Mother, Infant, and Household Factors Associated with the Type of Food Infants Receive in Developing Countries

PubMed Central

Yarnoff, Benjamin; Allaire, Benjamin; Detzel, Patrick

2014-01-01

Objectives: We explore the complex factors associated with infant feeding by analyzing what mother, infant, and household factors are associated with the types of food given to infants. We seek to quantify associations in order to inform public health policy about the importance of target populations for infant feeding programs. Methods: We used data from the Demographic Health Survey in 20 developing countries for multiple years to examine mother, infant, and household factors associated with six types of food given to infants (exclusive breastfeeding, non-exclusive breastfeeding, infant formula, milk liquids, non-milk liquids, and solid foods). We performed a seemingly unrelated regressions analysis with community-year fixed effects to account for correlation between food types and control for confounding factors associated with community resources, culture, time period, and geography in the pooled analysis. Results: We found that several mother, infant, and household characteristics were associated with each of the feeding types. Most notably, mother’s education, working status, and weight are significantly associated with the type of food given to infants. We provide quantified estimates of the association of each of these variables with six types of food given to infants. Conclusion: By identifying maternal characteristics associated with infant feeding and quantifying those associations, we help public health policymakers generate priorities for targeting infant feeding programs to specific populations that are at greatest risk. Higher educated, working mothers are best to target with exclusive breastfeeding programs for young infants. Mothers with lower education are best to target with complementary feeding programs in infants older than 1 year. Finally, while maternal weight is associated with higher levels of exclusive breastfeeding the association is too weak to merit targeting of breastfeeding programs to low-weight mothers. PMID:24616887

34 CFR 303.300 - State eligibility criteria and procedures.

Code of Federal Regulations, 2010 CFR

2010-07-01

... INFANTS AND TODDLERS WITH DISABILITIES Program and Service Components of a Statewide System of Early... procedures, including the use of informed clinical opinion, that will be used to measure a child's development; and (2) Stating the levels of functioning or other criteria that constitute a developmental delay...

34 CFR 303.300 - State eligibility criteria and procedures.

Code of Federal Regulations, 2011 CFR

2011-07-01

... INFANTS AND TODDLERS WITH DISABILITIES Program and Service Components of a Statewide System of Early... procedures, including the use of informed clinical opinion, that will be used to measure a child's development; and (2) Stating the levels of functioning or other criteria that constitute a developmental delay...

High-Risk Infants of Teenage Mothers: Later Candidates for Special Education Placements?

ERIC Educational Resources Information Center

Landerholm, Elizabeth

1982-01-01

The article reviews research on teenage pregnancy, the special educational needs of the infants of these teenage mothers, and current intervention programs for teenage mothers and infants. Research demonstrates that intervention programs can impact infant mortality, morbidity, and prematurity as well as infant social and cognitive development.…

A Family Oriented Enrichment Program for Handicapped Infants.

ERIC Educational Resources Information Center

Furuno, Setsu; O'Reilly, Kitty

This report describes a program for handicapped infants which emphasizes early treatment as a prime means of preventing more serious physical and behavioral problems later in life. Also, the program focuses on the entire family of the developmentally disabled, including infant, parents, and siblings. Program objectives include (1) increased…

Monitoring Prevention Impact of Mother-to-Child Transmission of HIV in Concentrated Epidemics With Program and Survey Data

PubMed Central

Sabin, Keith; Ho, Thi Quynh Trang; Le, Ai Kim Anh; Hayashi, Chika; Kato, Masaya

2017-01-01

Background The prevention of mother-to-child transmission (PMTCT) of HIV program was introduced in Vietnam in 2005. Despite the scaling up of PMTCT programs, the rate of mother-to-child HIV transmission in Vietnam was estimated as high as 20% in 2013. Objective The objective of this study was to assess the outcomes of PMTCT and identified factors associated with mother-to-child transmission and infant survival using survey and program data in a high HIV burden province in Vietnam. Methods This community-based retrospective cohort study observed pregnant women diagnosed with HIV infection in Thai Nguyen province from October 2008 to December 2012. Data were collected through interviews using a structured questionnaire and through reviews of log books and medical charts in antenatal care and HIV clinics. Logistic regression and survival analysis were used to analyze data using Stata (StataCorp). Results A total of 172 pregnant women living with HIV were identified between 2008 and 2012. Most of these women had acquired the HIV infection from their husband (77/119, 64.7%). Significant improvement in the PMTCT program was documented, including reduction in late diagnosis of HIV for pregnant women from 62.5% in 2008 to 30% in 2012. Access to antiretrovirals (ARVs) improved, increasing from a rate of 18.2% (2008) to 70.0% (2011) for mothers and from 36.4% (2008) to 93.3% (2012) for infants. For infants, early diagnosis within 2 months of birth reached 66.7% in 2012 compared with 16.7% in 2009. Transmission rate reduced from 27.3% in 2008 to 6.7% in 2012. Late diagnosis was associated with increased risk for HIV transmission (odds ratio [OR] 14.7, 95% CI 1.8-121.4, P=.01), whereas ARV therapy for mother and infant in combination with infant formula feeding were associated with reduced risk for HIV transmission (OR 0.01, 95% CI 0.001-0.1; P<.001). Overall survival rate for HIV-exposed infants at 12 months was 97.7%. Conclusions A combination of program and survey data measured the impact of prevention of HIV transmission from mother-to-child interventions. Significant improvement in access to the interventions was documented in Thai Nguyen province. However, factors that increased the risk of HIV transmission, such as late diagnosis, remain to be addressed. PMID:29263016

Babies (and Their Families) on Board! Directors Juggle the Key Elements of Infant/Toddler Care and Education

ERIC Educational Resources Information Center

McMullen, Mary Benson; Apple, Peggy

2012-01-01

Early childhood programs with infants and toddlers are bustling and alive in ways different from programs that have only preschoolers. Infants and toddlers can make group care environments more caring and family focused spaces, nurturing the well-being of all adults and children participating in the program. The number of infants and toddlers who…

Can typical US home visits affect infant attachment? Preliminary findings from a randomized trial of Healthy Families Durham.

PubMed

Berlin, Lisa J; Martoccio, Tiffany L; Appleyard Carmody, Karen; Goodman, W Benjamin; O'Donnell, Karen; Williams, Janis; Murphy, Robert A; Dodge, Kenneth A

2017-12-01

US government-funded early home visiting services are expanding significantly. The most widely implemented home visiting models target at-risk new mothers and their infants. Such home visiting programs typically aim to support infant-parent relationships; yet, such programs' effects on infant attachment quality per se are as yet untested. Given these programs' aims, and the crucial role of early attachments in human development, it is important to understand attachment processes in home visited families. The current, preliminary study examined 94 high-risk mother-infant dyads participating in a randomized evaluation of the Healthy Families Durham (HFD) home visiting program. We tested (a) infant attachment security and disorganization as predictors of toddler behavior problems and (b) program effects on attachment security and disorganization. We found that (a) infant attachment disorganization (but not security) predicted toddler behavior problems and (b) participation in HFD did not significantly affect infant attachment security or disorganization. Findings are discussed in terms of the potential for attachment-specific interventions to enhance the typical array of home visiting services.

Immunogenicity study to investigate the interchangeability among three different types of polio vaccine: A cohort study in Japan.

PubMed

Ohfuji, Satoko; Ito, Kazuya; Ishibashi, Motoki; Shindo, Shizuo; Takasaki, Yoshio; Yokoyama, Takashi; Yokoyama, Takato; Yamashita, Yuji; Shibao, Keigo; Nakano, Takashi; Tsuru, Tomomi; Irie, Shin; Hirota, Yoshio

2017-06-01

In Japan, the routine immunization program with oral polio vaccine (OPV) has been suspended since September 2012, when a program with 4 doses of inactivated monovalent polio vaccine (IPV) or quadrivalent vaccine against diphtheria, pertussis, and tetanus with IPV (DTaP-IPV) was introduced. The aim of this study was to examine the interchangeability among these 3 types of polio vaccines.We conducted a prospective cohort study at 5 pediatric clinics in Japan. A total of 153 infants were assigned to 1 of the 4 groups by considering the vaccination history of OPV and trivalent vaccine against DTaP. Eleven infants with a history of OPV received 3 doses of DTaP-IPV; 49 infants with a history of OPV and DTaP received 3 doses of IPV; 50 polio vaccine-naïve infants received 2 doses of IPV followed by 2 doses of DTaP-IPV; and 43 polio vaccine-naive infants received 2 doses of DTaP-IPV followed by IPV. The immunogenicity after polio vaccination was evaluated among these 4 groups.After 2 doses of polio vaccination, more than 80% of the infants exhibited a neutralization antibody titer ≥1:8 for all Sabin strains and wild strains in all groups. After the third dose, the seroprotection proportion (i.e., a neutralization antibody titer ≥1:8) reached about 100%. After the fourth dose, a neutralization antibody titer exceeded the required protective levels (i.e., a neutralization antibody titer ≥1:8) considerably in all groups.Four doses of polio vaccines induced a sufficient level of immunity in Japanese infants, irrespective of vaccine combinations or order.

Study protocol for the evaluation of an Infant Simulator based program delivered in schools: a pragmatic cluster randomised controlled trial

PubMed Central

2010-01-01

Background This paper presents the study protocol for a pragmatic randomised controlled trial to evaluate the impact of a school based program developed to prevent teenage pregnancy. The program includes students taking care of an Infant Simulator; despite growing popularity and an increasing global presence of such programs, there is no published evidence of their long-term impact. The aim of this trial is to evaluate the Virtual Infant Parenting (VIP) program by investigating pre-conceptual health and risk behaviours, teen pregnancy and the resultant birth outcomes, early child health and maternal health. Methods and Design Fifty-seven schools (86% of 66 eligible secondary schools) in Perth, Australia were recruited to the clustered (by school) randomised trial, with even randomisation to the intervention and control arms. Between 2003 and 2006, the VIP program was administered to 1,267 participants in the intervention schools, while 1,567 participants in the non-intervention schools received standard curriculum. Participants were all female and aged between 13-15 years upon recruitment. Pre and post-intervention questionnaires measured short-term impact and participants are now being followed through their teenage years via data linkage to hospital medical records, abortion clinics and education records. Participants who have a live birth are interviewed by face-to-face interview. Kaplan-Meier survival analysis and proportional hazards regression will test for differences in pregnancy, birth and abortion rates during the teenage years between the study arms. Discussion This protocol paper provides a detailed overview of the trial design as well as initial results in the form of participant flow. The authors describe the intervention and its delivery within the natural school setting and discuss the practical issues in the conduct of the trial, including recruitment. The trial is pragmatic and will directly inform those who provide Infant Simulator based programs in school settings. Trial registration ISRCTN24952438 PMID:20964860

Study protocol for the evaluation of an Infant Simulator based program delivered in schools: a pragmatic cluster randomised controlled trial.

PubMed

Brinkman, Sally A; Johnson, Sarah E; Lawrence, David; Codde, James P; Hart, Michael B; Straton, Judith A Y; Silburn, Sven

2010-10-21

This paper presents the study protocol for a pragmatic randomised controlled trial to evaluate the impact of a school based program developed to prevent teenage pregnancy. The program includes students taking care of an Infant Simulator; despite growing popularity and an increasing global presence of such programs, there is no published evidence of their long-term impact. The aim of this trial is to evaluate the Virtual Infant Parenting (VIP) program by investigating pre-conceptual health and risk behaviours, teen pregnancy and the resultant birth outcomes, early child health and maternal health. Fifty-seven schools (86% of 66 eligible secondary schools) in Perth, Australia were recruited to the clustered (by school) randomised trial, with even randomisation to the intervention and control arms. Between 2003 and 2006, the VIP program was administered to 1,267 participants in the intervention schools, while 1,567 participants in the non-intervention schools received standard curriculum. Participants were all female and aged between 13-15 years upon recruitment. Pre and post-intervention questionnaires measured short-term impact and participants are now being followed through their teenage years via data linkage to hospital medical records, abortion clinics and education records. Participants who have a live birth are interviewed by face-to-face interview. Kaplan-Meier survival analysis and proportional hazards regression will test for differences in pregnancy, birth and abortion rates during the teenage years between the study arms. This protocol paper provides a detailed overview of the trial design as well as initial results in the form of participant flow. The authors describe the intervention and its delivery within the natural school setting and discuss the practical issues in the conduct of the trial, including recruitment. The trial is pragmatic and will directly inform those who provide Infant Simulator based programs in school settings. ISRCTN24952438.

Clinicians guide for cue‐based transition to oral feeding in preterm infants: An easy‐to‐use clinical guide

PubMed Central

2017-01-01

Abstract Rationale, aims and objectives This article aims to provide evidence to guide multidisciplinary clinical practitioners towards successful initiation and long‐term maintenance of oral feeding in preterm infants, directed by the individual infant maturity. Method A comprehensive review of primary research, explorative work, existing guidelines, and evidence‐based opinions regarding the transition to oral feeding in preterm infants was studied to compile this document. Results Current clinical hospital practices are described and challenged and the principles of cue‐based feeding are explored. “Traditional” feeding regimes use criteria, such as the infant's weight, gestational age and being free of illness, and even caregiver intuition to initiate or delay oral feeding. However, these criteria could compromise the infant and increase anxiety levels and frustration for parents and caregivers. Cue‐based feeding, opposed to volume‐driven feeding, lead to improved feeding success, including increased weight gain, shorter hospital stay, fewer adverse events, without increasing staff workload while simultaneously improving parents' skills regarding infant feeding. Although research is available on cue‐based feeding, an easy‐to‐use clinical guide for practitioners could not be found. A cue‐based infant feeding regime, for clinical decision making on providing opportunities to support feeding success in preterm infants, is provided in this article as a framework for clinical reasoning. Conclusions Cue‐based feeding of preterm infants requires care providers who are trained in and sensitive to infant cues, to ensure optimal feeding success. An easy‐to‐use clinical guideline is presented for implementation by multidisciplinary team members. This evidence‐based guideline aims to improve feeding outcomes for the newborn infant and to facilitate the tasks of nurses and caregivers. PMID:28251754

The Effect of the Infant Behavioral Assessment and Intervention Program on Mother-Infant Interaction after Very Preterm Birth

ERIC Educational Resources Information Center

Meijssen, Dominique; Wolf, Marie-Jeanne; Koldewijn, Karen; Houtzager, Bregje A.; Van Wassenaer, Aleid; Tronick, Ed; Kok, Joke; Van Baar, Anneloes

2010-01-01

Background: Prematurity and perinatal insults lead to increased developmental vulnerability. The home-based Infant Behavioral Assessment and Intervention Program (IBAIP) was designed to improve development of preterm infants. In a multicenter randomized controlled trial the effect of IBAIP on mother-infant interaction was studied as a secondary…

An Evaluation of the Effects of a Breastfeeding Support Program on Health Outcomes

PubMed Central

Haider, Steven J; Chang, Lenisa V; Bolton, Tracie A; Gold, Jonathan G; Olson, Beth H

2014-01-01

Objective To estimate the causal effect of a Michigan peer counselor (PC) breastfeeding support program for low-income women on infant health outcomes. Data Sources Program referral forms, program forms (enrollment, birth, and exit data), and state administrative data from the Women Infants and Children program, Medicaid, and Vital Records. Study Design Quasi-random enrollment due to the excess demand for PC breastfeeding support services allowed us to compare the infants of women who requested services and were enrolled in the program (the treatment group, N = 274) to the infants of women who requested services and were not enrolled (the control group, N = 572). Data were analyzed using regression. Principal Findings The PC program increased the fraction breastfeeding at birth by 19.3 percent and breastfeeding duration by 2.84 weeks. Program participation also reduced the fraction of infants with gastrointestinal disorders by a statistically significant 7.9 percent. The program, if anything, increased the overall health care utilization. Conclusions This Michigan PC breastfeeding support program resulted in improvements in breastfeeding and infant health outcomes as measured by the diagnosis of ailments while increasing health care utilization. PMID:25039793

A Curriculum Program for Infants Six to Twelve Months.

ERIC Educational Resources Information Center

Dickinson, Barbara Gibello

This curriculum program was developed to serve as a guide or reference for those professionals wishing to implement or improve upon a current participation program for parents of 6- to 12-month-old infants. The curriculum program covers such topics as the importance of early stimulation, infants' gross and fine motor development, social/emotional…

7 CFR 246.4 - State plan.

Code of Federal Regulations, 2013 CFR

2013-01-01

... CHILD NUTRITION PROGRAMS SPECIAL SUPPLEMENTAL NUTRITION PROGRAM FOR WOMEN, INFANTS AND CHILDREN State... year by category of women, infants and children. (4) The State agency staffing pattern. (5) An... program benefits to unserved infants and children under the care of foster parents, protective services...

7 CFR 246.4 - State plan.

Code of Federal Regulations, 2014 CFR

2014-01-01

... CHILD NUTRITION PROGRAMS SPECIAL SUPPLEMENTAL NUTRITION PROGRAM FOR WOMEN, INFANTS AND CHILDREN State... year by category of women, infants and children. (4) The State agency staffing pattern. (5) An... program benefits to unserved infants and children under the care of foster parents, protective services...

7 CFR 246.4 - State plan.

Code of Federal Regulations, 2012 CFR

2012-01-01

... CHILD NUTRITION PROGRAMS SPECIAL SUPPLEMENTAL NUTRITION PROGRAM FOR WOMEN, INFANTS AND CHILDREN State... year by category of women, infants and children. (4) The State agency staffing pattern. (5) An... program benefits to unserved infants and children under the care of foster parents, protective services...

Continuity of midwifery care for rural women through caseload group practice: Delivering for almost 20 years.

PubMed

Haines, Helen M; Baker, Janet; Marshall, Diana

2015-12-01

To describe the clinical outcomes and sustainability factors of a long-standing midwifery led caseload model of rural maternity care. Retrospective clinical audit from 1998 to 2011 and autoethnographic narrative of the midwifery program told by the longest serving midwives under three key themes relating to sustainable practice. Regional Health Service with annual birth rate of 500. Maternity care is provided by either public antenatal clinic/GP shared care or midwife-led care. Women attending a rural caseload midwifery group practice between the period 1998-2011 and midwives working in the same group practice during that period. Antenatal attendance, maternal mortality, infant morbidity and mortality, mode of birth, known midwife at birth, initiation of breastfeeding. There were 1674 births between 1998 and 2011. Clinical outcomes for women and infants closely reflected national maternity indicator data. The group practice midwives attribute sustainability of the program to the enjoyment of flexibility in their working environment, to establishing trust amongst themselves, the women they care for, and with the obstetricians, GPs and health service executives. The rigorous application of midwifery principles including robust clinical governance have been hallmarks of success. This caseload midwifery group practice is a safe, satisfying and sustainable model of maternity care in a rural setting. Clinical outcomes are similar to standard care. Success can be attributed to strong leadership across all levels of policy, health service management and, most importantly, the rural midwives providing the service. © 2015 National Rural Health Alliance Inc.

Pride in Parenting: Training Curriculum for Lay Home Visitors. NIH-DC Initiative To Reduce Infant Mortality in Minority Populations.

ERIC Educational Resources Information Center

Diamond, Linda T., Ed.; Jarrett, Marion H., Ed.

The Pride in Parenting (PIP) program was developed for mothers 18 years of age or older who had little or no prenatal care and their infants from birth to one year. The major goals of the program were to promote effective use of health services by mothers and their infants and to enhance infant development. The intervention program consisted of…

Developing Self-Esteem in the Early Years

ERIC Educational Resources Information Center

Pawl, Jeree

2012-01-01

Jeree Pawl, PhD, former clinical professor, Department of Psychiatry, University of California at San Francisco and past director of the Infant-Parent Program located at San Francisco General Hospital responds to questions about how parents and caregivers can support the development of self-esteem in very young children. Contrary to the idea that…

Implementation of newborn screening for cystic fibrosis in Norway. Results from the first three years.

PubMed

Lundman, Emma; Gaup, H Junita; Bakkeheim, Egil; Olafsdottir, Edda J; Rootwelt, Terje; Storrøsten, Olav Trond; Pettersen, Rolf D

2016-05-01

Norway introduced newborn screening for cystic fibrosis (CF) March 1, 2012. We present results from the first three years of the national newborn CF screening program. Positive primary screening of immunoreactive trypsinogen (IRT) was followed by DNA testing of the Cystic fibrosis transmembrane conductance regulator (CFTR) gene. Infants with two CFTR mutations were reported for diagnostic follow-up. Of 181,859 infants tested, 1454 samples (0.80%) were assessed for CFTR mutations. Forty children (1:4546) had two CFTR mutations, of which only 21 (1:8660) were confirmed to have a CF diagnosis. The CFTR mutations differed from previously clinically diagnosed CF patients, and p.R117H outnumbered p.F508del as the most frequent mutation. One child with a negative IRT screening test was later clinically diagnosed with CF. The CF screening program identified fewer children with a conclusive CF diagnosis than expected. Our data suggest a revision of the IRT/DNA protocol. Copyright © 2016 European Cystic Fibrosis Society. Published by Elsevier B.V. All rights reserved.

78 FR 17631 - Special Supplemental Nutrition Program for Women, Infants and Children (WIC): Income Eligibility...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-22

... DEPARTMENT OF AGRICULTURE Food and Nutrition Service Special Supplemental Nutrition Program for Women, Infants and Children (WIC): Income Eligibility Guidelines AGENCY: Food and Nutrition Service... persons applying to participate in the Special Supplemental Nutrition Program for Women, Infants and...

Infant botulism.

PubMed

Fenicia, Lucia; Anniballi, Fabrizio

2009-01-01

Infant botulism is a rare disease that affects infant less than 12 months of age. The illness results from absorption of botulinum toxin produced in situ by neurotoxigenic clostridia that can temporarily colonize the intestinal tract of infants. To date, all inhabited continents except Africa have reported cases of infant botulism. Recognition of cases seem directly related to physician awareness and clinical suspicion. This review summarizes microbiological, clinical and epidemiological features of infant botulism.

7 CFR 246.16a - Infant formula cost containment.

Code of Federal Regulations, 2011 CFR

2011-01-01

..., DEPARTMENT OF AGRICULTURE CHILD NUTRITION PROGRAMS SPECIAL SUPPLEMENTAL NUTRITION PROGRAM FOR WOMEN, INFANTS AND CHILDREN State Agency Provisions § 246.16a Infant formula cost containment. (a) Who must use cost... 7 Agriculture 4 2011-01-01 2011-01-01 false Infant formula cost containment. 246.16a Section 246...

7 CFR 246.16a - Infant formula cost containment.

Code of Federal Regulations, 2010 CFR

2010-01-01

..., DEPARTMENT OF AGRICULTURE CHILD NUTRITION PROGRAMS SPECIAL SUPPLEMENTAL NUTRITION PROGRAM FOR WOMEN, INFANTS AND CHILDREN State Agency Provisions § 246.16a Infant formula cost containment. (a) Who must use cost... 7 Agriculture 4 2010-01-01 2010-01-01 false Infant formula cost containment. 246.16a Section 246...

7 CFR 246.16a - Infant formula and authorized foods cost containment.

Code of Federal Regulations, 2014 CFR

2014-01-01

... NUTRITION SERVICE, DEPARTMENT OF AGRICULTURE CHILD NUTRITION PROGRAMS SPECIAL SUPPLEMENTAL NUTRITION PROGRAM FOR WOMEN, INFANTS AND CHILDREN State Agency Provisions § 246.16a Infant formula and authorized foods... 7 Agriculture 4 2014-01-01 2014-01-01 false Infant formula and authorized foods cost containment...

7 CFR 246.16a - Infant formula and authorized foods cost containment.

Code of Federal Regulations, 2013 CFR

2013-01-01

... NUTRITION SERVICE, DEPARTMENT OF AGRICULTURE CHILD NUTRITION PROGRAMS SPECIAL SUPPLEMENTAL NUTRITION PROGRAM FOR WOMEN, INFANTS AND CHILDREN State Agency Provisions § 246.16a Infant formula and authorized foods... 7 Agriculture 4 2013-01-01 2013-01-01 false Infant formula and authorized foods cost containment...

7 CFR 246.16a - Infant formula and authorized foods cost containment.

Code of Federal Regulations, 2012 CFR

2012-01-01

... NUTRITION SERVICE, DEPARTMENT OF AGRICULTURE CHILD NUTRITION PROGRAMS SPECIAL SUPPLEMENTAL NUTRITION PROGRAM FOR WOMEN, INFANTS AND CHILDREN State Agency Provisions § 246.16a Infant formula and authorized foods... 7 Agriculture 4 2012-01-01 2012-01-01 false Infant formula and authorized foods cost containment...

76 FR 71979 - Advisory Committee on the Maternal, Infant and Early Childhood Home Visiting Program Evaluation...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-21

... and Services Administration Advisory Committee on the Maternal, Infant and Early Childhood Home...: Name: Advisory Committee on the Maternal, Infant and Early Childhood Home Visiting Program Evaluation..., DC 20005. (202) 289-7600. The Advisory Committee on the Maternal, Infant and Early Childhood Home...

Development, implementation, and evaluation of a community- and hospital-based respiratory syncytial virus prophylaxis program.

PubMed

Bracht, Marianne; Heffer, Michael; O'Brien, Karel

2005-02-01

To implement and deliver a respiratory syncytial virus prophylaxis (RSVP) program in response to the Canadian Pediatric Society recommendations. A novel program was designed to provide inpatient RSVP for at-risk infants cared for in 1 tertiary care newborn intensive care unit (NICU). This inpatient program was part of a coordinated approach to RSVP, designed and implemented by 3 hospitals. An RSVP program logic model was created and used by a multidisciplinary team to evaluate the in-house program and identify areas of program activity requiring improvement. Following the 2000 to 2001 RSV season, a compliance and outcomes audit was performed in the tertiary center; 193 infants were enrolled in the RSVP program and 162 infants had received RSVP in the NICU [Mean = 1.64 doses]. Telephone follow-up with the parents of discharged infants identified that 159 infants (98%) had successfully completed their full course of RSVP. Using the RSVP program logic model, 5 areas for program improvement were identified including infant recruitment, patient transfer/discharge processes, product procurement, preparation/distribution/administration of doses, and healthcare team communication. Interdisciplinary collaboration is an important factor in the success of the RSVP program and has supported a consistent model of care for the delivery of RSVP. The program logic model provided a useful structure to systematically review the RSVP program in this organization.

Nurse-Moderated Internet-Based Support for New Mothers: Non-Inferiority, Randomized Controlled Trial

PubMed Central

Reece, Christy E; Bowering, Kerrie; Jeffs, Debra; Sawyer, Alyssa C P; Mittinty, Murthy; Lynch, John W

2017-01-01

Background Internet-based interventions moderated by community nurses have the potential to improve support offered to new mothers, many of whom now make extensive use of the Internet to obtain information about infant care. However, evidence from population-based randomized controlled trials is lacking. Objective The aim of this study was to test the non-inferiority of outcomes for mothers and infants who received a clinic-based postnatal health check plus nurse-moderated, Internet-based group support when infants were aged 1-7 months as compared with outcomes for those who received standard care consisting of postnatal home-based support provided by a community nurse. Methods The design of the study was a pragmatic, preference, non-inferiority randomized control trial. Participants were recruited from mothers contacted for their postnatal health check, which is offered to all mothers in South Australia. Mothers were assigned either (1) on the basis of their preference to clinic+Internet or home-based support groups (n=328), or (2) randomly assigned to clinic+Internet or home-based groups if they declared no strong preference (n=491). The overall response rate was 44.8% (819/1827). The primary outcome was parenting self-competence, as measured by the Parenting Stress Index (PSI) Competence subscale, and the Karitane Parenting Confidence Scale scores. Secondary outcome measures included PSI Isolation, Interpersonal Support Evaluation List–Short Form, Maternal Support Scale, Ages and Stages Questionnaire–Social-Emotional and MacArthur Communicative Development Inventory (MCDI) scores. Assessments were completed offline via self-assessment questionnaires at enrolment (mean child age=4.1 weeks, SD 1.3) and again when infants were aged 9, 15, and 21 months. Results Generalized estimating equations adjusting for post-randomization baseline imbalances showed that differences in outcomes between mothers in the clinic+Internet and home-based support groups did not exceed the pre-specified margin of inferiority (0.25 of a SD) on any outcome measure at any follow-up assessment, with the exception of MCDI scores assessing children’s language development at 21 months for randomized mothers, and PSI Isolation scores at 9 months for preference mothers. Conclusion Maternal and child outcomes from a clinic-based postnatal health check plus nurse-moderated Internet-based support were not inferior to those achieved by a universal home-based postnatal support program. Postnatal maternal and infant support using the Internet is a promising alternative to home-based universal support programs. Trial Registration Australian New Zealand Clinical Trials Registry Number (ANZCTR): ACTRN12613000204741; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=363712&isReview=true (Archived by WebCite at http://www.webcitation.org/6rZeCJ3k1) PMID:28739559

[Sensory oral motor and global motor development of preterm infants].

PubMed

de Castro, Adriana Guerra; Lima, Marilia de Carvalho; de Aquino, Rebeca Raposo; Eickmann, Sophie Helena

2007-01-01

development assessment of preterm infants. to evaluate the association between the gestational ages (GA) of premature infants with the global motor development as well as with early signs of sensory oral motor development delay, and to verify a possible association between them. an exploratory study that assessed the development of 55 infants with corrected chronological ages between four to five months, born preterm at the Instituto Materno Infantil Professor Fernando Figueira (IMIP) and who were followed at the Kangaroo Mother Program Clinic between March and August of 2004. The assessment of the sensory oral motor development was performed through pre-selected indicators and of the global motor development through the Alberta Infant Motor Scale (AIMS). infants with lower GA (29 to 34 weeks) presented a higher median of risk signs in the sensory oral motor development assessment when compared to those with higher GA (35 to 36 weeks). Regarding the global motor development, infants born with lower GA presented a higher number of scores in the AIMS below percentile 10 (26%) when compared to those with a higher GA (4%) (p=0.009). The median index of the risk signs for the sensory oral motor development were significantly higher among infants with total AIMS scores below percentile 25 when compared to those with scores equal to or above percentile 25. the gestational age of infants at birth influenced the sensory oral motor and global motor development - infants with lower gestational ages presented worse performances. These findings suggest a possible association between both aspects of infant development.

Improving Aboriginal maternal and infant health services in the 'Top End' of Australia; synthesis of the findings of a health services research program aimed at engaging stakeholders, developing research capacity and embedding change.

PubMed

Barclay, Lesley; Kruske, Sue; Bar-Zeev, Sarah; Steenkamp, Malinda; Josif, Cathryn; Narjic, Concepta Wulili; Wardaguga, Molly; Belton, Suzanne; Gao, Yu; Dunbar, Terry; Kildea, Sue

2014-06-02

Health services research is a well-articulated research methodology and can be a powerful vehicle to implement sustainable health service reform. This paper presents a summary of a five-year collaborative program between stakeholders and researchers that led to sustainable improvements in the maternity services for remote-dwelling Aboriginal women and their infants in the Top End (TE) of Australia. A mixed-methods health services research program of work was designed, using a participatory approach. The study area consisted of two large remote Aboriginal communities in the Top End of Australia and the hospital in the regional centre (RC) that provided birth and tertiary care for these communities. The stakeholders included consumers, midwives, doctors, nurses, Aboriginal Health Workers (AHW), managers, policy makers and support staff. Data were sourced from: hospital and health centre records; perinatal data sets and costing data sets; observations of maternal and infant health service delivery and parenting styles; formal and informal interviews with providers and women and focus groups. Studies examined: indicator sets that identify best care, the impact of quality of care and remoteness on health outcomes, discrepancies in the birth counts in a range of different data sets and ethnographic studies of 'out of hospital' or health centre birth and parenting. A new model of maternity care was introduced by the health service aiming to improve care following the findings of our research. Some of these improvements introduced during the five-year research program of research were evaluated. Cost effective improvements were made to the acceptability, quality and outcomes of maternity care. However, our synthesis identified system-wide problems that still account for poor quality of infant services, specifically, unacceptable standards of infant care and parent support, no apparent relationship between volume and acuity of presentations and staff numbers with the required skills for providing care for infants, and an 'outpatient' model of care. Services were also characterised by absent Aboriginal leadership and inadequate coordination between remote and tertiary services that is essential to improve quality of care and reduce 'system-introduced' risk. Evidence-informed redesign of maternity services and delivery of care has improved clinical effectiveness and quality for women. However, more work is needed to address substandard care provided for infants and their parents.

Safe sleeping positions: practice and policy for babies with cleft palate.

PubMed

Davies, Karen; Bruce, Iain A; Bannister, Patricia; Callery, Peter

2017-05-01

Guidance recommends 'back to sleep' positioning for infants from birth in order to reduce the risk of sudden infant death. Exceptions have been made for babies with severe respiratory difficulties where lateral positioning may be recommended, although uncertainty exists for other conditions affecting the upper airway structures, such as cleft palate. This paper presents research of (i) current advice on sleep positioning provided to parents of infants with cleft palate in the UK; and (ii) decision making by clinical nurse specialists when advising parents of infants with cleft palate. A qualitative descriptive study used data from a national survey with clinical nurse specialists from 12 regional cleft centres in the UK to investigate current practice. Data were collected using semi-structured telephone interviews and analysed using content analysis. Over half the regional centres used lateral sleep positioning based on clinical judgement of the infants' respiratory effort and upper airway obstruction. Assessment relied upon clinical judgement augmented by a range of clinical indicators, such as measures of oxygen saturation, heart rate and respiration. Specialist practitioners face a clinical dilemma between adhering to standard 'back to sleep' guidance and responding to clinical assessment of respiratory effort for infants with cleft palate. In the absence of clear evidence, specialist centres rely on clinical judgement regarding respiratory problems to identify what they believe is the most appropriate sleeping position for infants with cleft palate. Further research is needed to determine the best sleep position for an infant with cleft palate. What is Known • Supine sleep positioning reduces the risk of sudden infant death in new born infants. • There is uncertainty about the benefits or risks of lateral sleep positioning for infants with upper airway restrictions arising from cleft palate. What is New • Variability exists in the information/advice provided to parents of infants with cleft palate regarding sleep positioning. • Over half the national specialist centres for cleft palate in the UK advise positioning infants with CP in the lateral position as a routine measure to reduce difficulties with respiration.

Infant Television and Video Exposure Associated With Limited Parent-Child Verbal Interactions in Low Socioeconomic Status Households

PubMed Central

Mendelsohn, Alan L.; Berkule, Samantha B.; Tomopoulos, Suzy; Tamis-LeMonda, Catherine S.; Huberman, Harris S.; Alvir, Jose; Dreyer, Benard P.

2011-01-01

Objective To assess verbal interactions related to television and other electronic media exposure among mothers and 6 month-old-infants. Design Cross-sectional analysis of 154 mother-infant dyads participating in a long-term study related to early child development. Setting Urban public hospital. Participants Low socioeconomic status mothers of 6-month-old infants. Main Exposure Media exposure and content. Main Outcome Measures Mother-infant verbal interaction associated with media exposure and maternal coviewing. Results Of 154 low socioeconomic status mothers, 149 (96.8%) reported daily media exposure in their infants, with median exposure of 120 (interquartile range, 60-210) minutes in a 24-hour period. Among 426 program exposures, mother-infant interactions were reported during 101 (23.7%). Interactions were reported most frequently with educational young child–oriented media (42.8% of programs), compared with 21.3% of noneducational young child–oriented programs (adjusted odds ratio, 0.4; 95% confidence interval, 0.1-0.98) and 14.7% of school-age/teenage/adult–oriented programs (adjusted odds ratio, 0.2; 95% confidence interval, 0.1-0.3). Among coviewed programs with educational content, mothers reported interactions during 62.7% of exposures. Coviewing was not reported more frequently for educational young child–oriented programs. Conclusions We found limited verbal interactions during television exposure in infancy, with interactions reported for less than one-quarter of exposures. Although interactions were most commonly reported among programs with educational content that had been coviewed, programs with educational content were not more likely to be coviewed than were other programs. Our findings do not support development of infant-directed educational programming in the absence of strategies to increase coviewing and interactions. PMID:18458186

Infant television and video exposure associated with limited parent-child verbal interactions in low socioeconomic status households.

PubMed

Mendelsohn, Alan L; Berkule, Samantha B; Tomopoulos, Suzy; Tamis-LeMonda, Catherine S; Huberman, Harris S; Alvir, Jose; Dreyer, Benard P

2008-05-01

To assess verbal interactions related to television and other electronic media exposure among mothers and 6 month-old-infants. Cross-sectional analysis of 154 mother-infant dyads participating in a long-term study related to early child development. Urban public hospital. Low socioeconomic status mothers of 6-month-old infants. Main Exposure Media exposure and content. Mother-infant verbal interaction associated with media exposure and maternal coviewing. Of 154 low socioeconomic status mothers, 149 (96.8%) reported daily media exposure in their infants, with median exposure of 120 (interquartile range, 60-210) minutes in a 24-hour period. Among 426 program exposures, mother-infant interactions were reported during 101 (23.7%). Interactions were reported most frequently with educational young child-oriented media (42.8% of programs), compared with 21.3% of noneducational young child-oriented programs (adjusted odds ratio, 0.4; 95% confidence interval, 0.1-0.98) and 14.7% of school-age/teenage/adult-oriented programs (adjusted odds ratio, 0.2; 95% confidence interval, 0.1-0.3). Among coviewed programs with educational content, mothers reported interactions during 62.7% of exposures. Coviewing was not reported more frequently for educational young child-oriented programs. We found limited verbal interactions during television exposure in infancy, with interactions reported for less than one-quarter of exposures. Although interactions were most commonly reported among programs with educational content that had been coviewed, programs with educational content were not more likely to be coviewed than were other programs. Our findings do not support development of infant-directed educational programming in the absence of strategies to increase coviewing and interactions.

Observations on kangaroo baby care.

PubMed

Mukasa, G K

1992-01-01

The author's visit to "kangaroo care" programs in Guatemala and Colombia has led Uganda's University of Kampala to consider the introduction of this innovation in its neonatal special care unit. Such programs, which place premature infants in direct contact with their mother's skin during breastfeeding, represents a simple, inexpensive strategy for infant survival in developing countries and eliminates the need for mechanical incubators. Research conducted at the Hospital Universitario de Valle in Cali, Colombia, found that falls in the infant's body temperature. In the Latin American programs, premature infants are entered into the breastfeeding program immediately after delivery.

Consequences of the "back to sleep" program in infants.

PubMed

Miller, Lauren C; Johnson, Arlene; Duggan, Lisa; Behm, Melissa

2011-08-01

Sudden infant death syndrome (SIDS) is the third leading cause of infant mortality in the United States and the leading cause of death among infants 28-364 days of age. The "Back to Sleep" program was implemented in 1992 to promote supine sleeping in efforts to prevent SIDS. Along with this implementation came several consequences that are avoidable in infants. The purposes of this article are to describe the Back to Sleep program and its intended purpose, to identify the adverse consequences, and to develop a teaching program for nurse practitioners to use with parents that will both promote safe sleeping and reduce the untoward consequences of the back to sleep program while maintaining the integrity of the SIDS prevention advice. Copyright © 2011 Elsevier Inc. All rights reserved.

Competing infant feeding information in mothers' networks: advice that supports v. undermines clinical recommendations.

PubMed

Ashida, Sato; Lynn, Freda B; Williams, Natalie A; Schafer, Ellen J

2016-05-01

To identify the social contextual factors, specifically the presence of information that supports v. undermines clinical recommendations, associated with infant feeding behaviours among mothers in low-income areas. Cross-sectional survey evaluating social support networks and social relationships involved in providing care to the infant along with feeding beliefs and practices. Out-patient paediatric and government-funded (Women, Infants, and Children) clinics in an urban, low-income area of the south-eastern USA. Eighty-one low-income mothers of infants between 0 and 12 months old. Most mothers reported receiving both supportive and undermining advice. The presence of breast-feeding advice that supports clinical recommendations was associated with two infant feeding practices that are considered beneficial to infant health: ever breast-feeding (OR=6·7; 95% CI 1·2, 38·1) and not adding cereal in the infant's bottle (OR=15·9; 95% CI 1·1, 227·4). Advice that undermines clinical recommendations to breast-feed and advice about solid foods were not associated with these behaviours. Efforts to facilitate optimal infant feeding practices may focus on increasing information supportive of clinical recommendations while concentrating less on reducing the presence of undermining information within mothers' networks. Cultural norms around breast-feeding may be stronger than the cultural norms around the introduction of solid foods in mothers' social environments; thus, additional efforts to increase information regarding introduction of solid foods earlier in mothers' infant care career may be beneficial.

[Neuroprotection with hypothermia in the newborn with hypoxic-ischaemic encephalopathy. Standard guidelines for its clinical application].

PubMed

Blanco, D; García-Alix, A; Valverde, E; Tenorio, V; Vento, M; Cabañas, F

2011-11-01

Standardisation of hypothermia as a treatment for perinatal hypoxic-ischaemic encephalopathy is supported by current scientific evidence. The following document was prepared by the authors on request of the Spanish Society of Neonatology and is intended to be a guide for the proper implementation of this therapy. We discuss the difficulties that may arise when moving from the strict framework of clinical trials to clinical daily care: early recognition of clinical encephalopathy, inclusion and exclusion criteria, hypothermia during transport, type of hypothermia (selective head or systemic cooling) and side effects of therapy. The availability of hypothermia therapy has changed the prognosis of children with hypoxic-ischaemic encephalopathy and our choices of therapeutic support. In this sense, it is especially important to be aware of the changes in the predictive value of the neurological examination and the electroencephalographic recording in cooled infants. In order to improve neuroprotection with hypothermia we need earlier recognition of to recognise earlier the infants that may benefit from cooling. Biomarkers of brain injury could help us in the selection of these patients. Every single infant treated with hypothermia must be included in a follow up program in order to assess neurodevelopmental outcome. Copyright © 2011 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.

Improving maternal care with a continuous quality improvement strategy: a report from the Interventions to Minimize Preterm and Low Birth Weight Infants through Continuous Improvement Techniques (IMPLICIT) Network.

PubMed

Bennett, Ian M; Coco, Andrew; Anderson, Janice; Horst, Michael; Gambler, Angela S; Barr, Wendy Brooks; Ratcliffe, Stephen

2009-01-01

Maternal medical care (prenatal and postpartum) involves a set of clinical interventions addressing risk factors associated with important maternal and infant outcomes. Programs to increase the rate of delivery of these interventions in clinical practice have not been widely implemented. A practice-based research network focused on developing continuous quality improvement (CQI) processes for maternal care among 10 family medicine residency training sites in the northeastern United States (the IMPLICIT Network) from January 2003 through September 2007. Documented delivery of 5 standard maternal care interventions was assessed before and after initiating a program to increase their frequency. Proportion chart analyses were conducted comparing the period before and after implementation of the CQI interventions. Data were available for 3936 pregnancies during the course of the study period. Results varied across the clinical interventions. Significant improvement in care processes was seen for 3 screening activities: (1) prenatal depression symptomatology (by 15 weeks' gestation); (2) screening for smoking at 30 weeks' gestation; (3) and postpartum contraception planning. Screening for smoking by 15 weeks' gestation and testing for asymptomatic bacteriuria were already conducted >90% of the time during the baseline period and did not increase significantly after initiating the CQI program. Screening for postpartum depression symptomatology was recorded in 50% to 60% of women before the CQI program and did not increase significantly. A practice-based research network of family medicine residency practices focused on CQI outcomes was successful in increasing the delivery of some maternal care interventions.

Infants and Toddlers, 2001-2002.

ERIC Educational Resources Information Center

Kroenke, Lillian DeVault, Ed.

2002-01-01

This document is comprised of the 2001-2002 issues of a quarterly journal for teachers and parents of children in Montessori infant and toddler programs. The spring 2001 issue presents articles on the history of infant and toddler programs in Italy and how to fulfill infant needs in Montessori child care, and on learning activities in the kitchen…

Effects of mother-infant skin-to-skin contact on severe latch-on problems in older infants: a randomized trial.

PubMed

Svensson, Kristin E; Velandia, Marianne I; Matthiesen, Ann-Sofi T; Welles-Nyström, Barbara L; Widström, Ann-Marie E

2013-03-11

Infants with latch-on problems cause stress for parents and staff, often resulting in early termination of breastfeeding. Healthy newborns experiencing skin-to-skin contact at birth are pre-programmed to find the mother's breast. This study investigates if skin-to-skin contact between mothers with older infants having severe latching on problems would resolve the problem. Mother-infant pairs with severe latch-on problems, that were not resolved during screening procedures at two maternity hospitals in Stockholm 1998-2004, were randomly assigned to skin-to-skin contact (experimental group) or not (control group) during breastfeeding. Breastfeeding counseling was given to both groups according to a standard model. Participants were unaware of their treatment group. Objectives were to compare treatment groups concerning the proportion of infants regularly latching on, the time from intervention to regular latching on and maternal emotions and pain before and during breastfeeding. On hundred and three mother-infant pairs with severe latch-on problems 1-16 weeks postpartum were randomly assigned and analyzed. There was no significant difference between the groups in the proportion of infants starting regular latching-on (75% experimental group, vs. 86% control group). Experimental group infants, who latched on, had a significantly shorter median time from start of intervention to regular latching on than control infants, 2.0 weeks (Q1 = 1.0, Q3 = 3.7) vs. 4.7 weeks (Q1 = 2.0, Q3 = 8.0), (p-value = 0.020). However, more infants in the experimental group (94%), with a history of "strong reaction" during "hands-on latch intervention", latched-on within 3 weeks compared to 33% in the control infants (Fisher Exact test p-value = 0.0001). Mothers in the experimental group (n = 53) had a more positive breastfeeding experience according to the Breastfeeding Emotional Scale during the intervention than mothers in the control group (n = 50) (p-value = 0.022). Skin-to-skin contact during breastfeeding seems to immediately enhance maternal positive feelings and shorten the time it takes to resolve severe latch-on problems in the infants who started to latch. An underlying mechanism may be that skin-to-skin contact with the mother during breastfeeding may calm infants with earlier strong reaction to "hands on latch intervention" and relieve the stress which may have blocked the infant's inborn biological program to find the breast and latch on. Karolinska Clinical Trial Registration number CT20100055.

[Follow-up of newborns with hypoxic-ischaemic encephalopathy].

PubMed

Martínez-Biarge, M; Blanco, D; García-Alix, A; Salas, S

2014-07-01

Hypothermia treatment for newborn infants with hypoxic-ischemic encephalopathy reduces the number of neonates who die or have permanent neurological deficits. Although this therapy is now standard of care, neonatal hypoxic-ischaemic encephalopathy still has a significant impact on the child's neurodevelopment and quality of life. Infants with hypoxic-ischaemic encephalopathy should be enrolled in multidisciplinary follow-up programs in order to detect impairments, to initiate early intervention, and to provide counselling and support for families. This article describes the main neurodevelopmental outcomes after term neonatal hypoxic-ischaemic encephalopathy. We offer recommendations for follow-up based on the infant's clinical condition and other prognostic indicators, mainly neonatal neuroimaging. Other aspects, such as palliative care and medico-legal issues, are also briefly discussed. Copyright © 2013 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.

Insightfulness and later infant attachment in clinically depressed and nonclinical mothers.

PubMed

Ramsauer, Brigitte; Lotzin, Annett; Quitmann, Julia H; Becker-Stoll, Fabienne; Tharner, Anne; Romer, Georg

2014-01-01

The aim of this pilot study was to investigate the relationship between maternal insightfulness and sensitivity and subsequent infant attachment security and disorganization in clinically depressed and nonclinical mother-infant groups. Nineteen depressed mothers with infants ages 3 to 11 months participated in this study. Twenty nonclinical mother-infant dyads were matched to the clinical sample according to infant sex and age. Maternal depression was assessed using the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (American Psychiatric Association, 1994), insightfulness using the Insightfulness Assessment (IA), and sensitivity using the Maternal Sensitivity Scales (M.D.S. Ainsworth, 1969). IA classifications and subscales were considered separately. Later infant attachment was assessed by the Strange Situation Procedure (M.D.S. Ainsworth, M.C. Blehar, E. Waters, & S. Wall, 1978). Depressed mothers tended to have less securely attached children than did nonclinical mothers. Within the clinical sample, the insightfulness categories correlated slightly moderately with attachment security, but were not related to attachment disorganization. Within the nonclinical sample, the IA categories were slightly moderately associated with attachment security and with disorganization. On IA subscales, relationship patterns differed in clinically depressed and nonclinical mother-infant dyads. These findings provide the first evidence of the predictive power of the IA categorization and subscales on subsequent infant attachment. They also may allow the development of different foci of intervention for enhancing insightful caregiving. © 2014 Michigan Association for Infant Mental Health.

The New York City Infant Day Care Study: A Comparative Study of Licensed Group and Family Infant Day Care Programs and the Effects of These Programs on Children and Their Families. Final Report.

ERIC Educational Resources Information Center

New York City Dept. of Health, NY.

This paper describes a longitudinal comparative study of group and family day care for infants in New York City. Approximately 400 infants from low income, predominantly Black or Hispanic families enrolled in publicly or privately funded, community-sponsored day care programs participated in the study from the time they entered the programs…

Association Between Bottle Size and Formula Intake in 2-Month-Old Infants.

PubMed

Wood, Charles T; Skinner, Asheley C; Yin, H Shonna; Rothman, Russell L; Sanders, Lee M; Delamater, Alan; Ravanbakht, Sophie N; Perrin, Eliana M

2016-04-01

To determine range of bottle sizes used and examine the relationship between bottle size and total daily consumption of infant formula. Cross-sectional analysis of baseline data collected as part of Greenlight, a cluster randomized trial to prevent childhood obesity at 4 pediatric resident clinics. The Greenlight study included healthy, term infants. For our analysis, parents of exclusively formula-fed infants reported volume per feed, number of feeds per day, and bottle size, which was dichotomized into small (<6 oz) or large (≥6 oz). We identified determinants of bottle size, and then examined relationships between bottle size and volume fed with log-transformed ordinary least squares regression, adjusting for infant age, sex, birth weight, current weight, race/ethnicity, and enrollment in Special Supplemental Nutrition Program for Women, Infants, and Children. Of 865 participants in the Greenlight study, 44% (n = 378; 21.8% white, 40.6% black, 35.3% Hispanic, 2.4% other) of infants were exclusively formula fed at 2 months. Median volume per day was 30 oz (interquartile range 12), and 46.0% of infants were fed with large bottles. Adjusted for covariates, parents using larger bottles reported feeding 4 oz more formula per day (34.2 oz, 95% confidence interval 33.5-34.9 vs 29.7 oz, 95% confidence interval 29.2-30.3, P = .03). Among exclusively formula-fed infants, use of a larger bottle is associated with parental report of more formula intake compared to infants fed with smaller bottles. If infants fed with larger bottles receive more formula, these infants may be overfed and consequently at risk for obesity. Copyright © 2016 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

Reference values of amino acids and of common clinical chemistry in plasma of healthy infants aged 1 and 4 months.

PubMed

Haschke-Becher, Elisabeth; Kainz, Alexander; Bachmann, Claude

2016-01-01

To compare plasma levels of amino acids and clinical chemistry parameters in healthy infants at 1 and 4 months of age and to establish corresponding reference limits. Data of three multicenter studies assessing the safety of new infant formulas were used. During these studies infants of both age-groups were either breast-fed or received formulas of low or high protein content. All samples were analyzed centrally in the same accredited laboratory. Plasma was collected from 521 infants in total, 157 boys and 135 girls aged 1 month and 121 boys and 108 girls aged 4 months. At the age of 1 month, 62 infants had received exclusively breast milk, 198 exclusively formula, and 27 both; in the 4-months age group corresponding numbers were 49, 158 and 18, respectively; for 9 infants, diet was unknown. Concentrations of most amino acids and clinical chemistry parameters differed significantly between both ages. Regardless of age, most plasma amino acid levels were comparable or lower in breast-fed than in formula-fed infants whereas at 1 month of age most clinical chemistry parameters were higher. While in breast-fed infants the plasma urea concentration decreased over 4 months of age, it increased in formula-fed infants. There were significant differences between infants fed a low and high protein formula. At both ages, high protein formulas resulted in significantly higher threonine, 2-aminobutyrate, and urea concentrations. For clinical use, age- and diet specific reference limits in infants are warranted.

76 FR 12978 - Advisory Committee on the Maternal, Infant and Early Childhood Home Visiting Program Evaluation...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-09

... Administration for Children and Families Advisory Committee on the Maternal, Infant and Early Childhood Home...: Advisory Committee on the Maternal, Infant and Early Childhood Home Visiting Program Evaluation. Date and... and Early Childhood Home Visiting Program Evaluation will meet for its first session on Wednesday...

A blinded randomised placebo-controlled trial investigating the efficacy of morphine analgesia for procedural pain in infants: Trial protocol.

PubMed

Slater, Rebeccah; Hartley, Caroline; Moultrie, Fiona; Adams, Eleri; Juszczak, Ed; Rogers, Richard; Norman, Jane E; Patel, Chetan; Stanbury, Kayleigh; Hoskin, Amy; Green, Gabrielle

2016-11-15

Infant pain has both immediate and long-term negative consequences, yet in clinical practice it is often undertreated. To date, few pain-relieving drugs have been tested in infants. Morphine is a potent analgesic that provides effective pain relief in adults, but there is inconclusive evidence for its effectiveness in infants. The purpose of this study is to establish whether oral morphine provides effective analgesia for procedural pain in infants. A blinded, placebo-controlled, parallel-group randomized, phase II, clinical trial will be undertaken to determine whether morphine sulphate administered orally prior to clinically-required retinopathy of prematurity (ROP) screening and heel lancing provides effective analgesia. 
156 infants between 34 and 42 weeks' gestational age who require a clinical heel lance and ROP screening on the same test occasion will be included in the trial. Infants will be randomised to receive either a single dose of morphine sulphate (100 μg/kg) or placebo. Each infant will be monitored for 48 hours and safety data will be collected during the 24 hours following drug administration. The primary outcome will be the Premature Infant Pain Profile-revised (PIPP-R) score 30 seconds after ROP screening. The co-primary outcome will be the magnitude of nociceptive-specific brain activity evoked by a clinically-required heel lance. Infant clinical stability will be assessed by comparing the number of episodes of bradycardia, tachycardia, desaturation and apnoea, and changes in respiratory support requirements in the 24-hour periods before and after the clinical intervention. In addition, drug safety will be assessed by considering the occurrence of apnoeic and hypotensive episodes requiring intervention in the 24-hour period following drug administration. This study has been published as an Accepted Protocol Summary by The Lancet .

Emotional availability and attachment across generations: variations in patterns associated with infant health risk status.

PubMed

Cassibba, R; van IJzendoorn, M H; Coppola, G

2012-07-01

The presence of limits or distortions in the children's communicative behaviours (due to a chronic illness) may interfere with the possibility to build secure attachment relationships. Moreover, the distress that the atypical chronic illness condition brings to family life may interfere the intergenerational transmission of attachment. This study evaluated the associations between maternal attachment representations, emotional availability and mother-child attachment in a clinical and in a comparison group. Forty infants (23 female) in their 14th month of life and their mothers participated in this study, 20 dyads with clinical infants (10 premature infants and 10 infants affected by atopic dermatitis) and 20 full-term and healthy comparison infants. The Adult Attachment Interview, the Emotional Availability Scales (EAS) and the Strange Situation Procedure were used to assess, respectively, the security of mothers' attachment representations, the emotional availability and the quality of mother-child attachment. We found that the two groups (clinical vs. comparison) did not differ with respect to the Adult Attachment Interview and the Emotional Availability Scales measures. A significant difference was found in the distribution of the infant-mother attachment patterns, with a higher incidence of insecure infants in the clinical group. In the typically developing group, more secure maternal attachment representations predicted more emotional availability in mother-infant interactions, which predicted more secure infant-mother attachments. However, we did not find similar support for intergenerational transmission of attachment in the clinical group. We speculate that constant concerns about the child's health condition and communicative difficulties of clinical infants may hamper or even mitigate the intergenerational transmission of attachment. © 2011 Blackwell Publishing Ltd.

7 CFR 246.2 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-01-01

... CHILD NUTRITION PROGRAMS SPECIAL SUPPLEMENTAL NUTRITION PROGRAM FOR WOMEN, INFANTS AND CHILDREN General... systems. Applicants means pregnant women, breastfeeding women, postpartum women, infants, and children who..., postpartum women, or infants or children. Certification means the implementation of criteria and procedures...

7 CFR 246.2 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-01-01

... CHILD NUTRITION PROGRAMS SPECIAL SUPPLEMENTAL NUTRITION PROGRAM FOR WOMEN, INFANTS AND CHILDREN General... systems. Applicants means pregnant women, breastfeeding women, postpartum women, infants, and children who..., postpartum women, or infants or children. Certification means the implementation of criteria and procedures...

7 CFR 246.2 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-01-01

... CHILD NUTRITION PROGRAMS SPECIAL SUPPLEMENTAL NUTRITION PROGRAM FOR WOMEN, INFANTS AND CHILDREN General... systems. Applicants means pregnant women, breastfeeding women, postpartum women, infants, and children who..., postpartum women, or infants or children. Certification means the implementation of criteria and procedures...

7 CFR 246.2 - Definitions.

Code of Federal Regulations, 2014 CFR

2014-01-01

... CHILD NUTRITION PROGRAMS SPECIAL SUPPLEMENTAL NUTRITION PROGRAM FOR WOMEN, INFANTS AND CHILDREN General... systems. Applicants means pregnant women, breastfeeding women, postpartum women, infants, and children who..., postpartum women, or infants or children. Certification means the implementation of criteria and procedures...

7 CFR 246.2 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-01-01

... CHILD NUTRITION PROGRAMS SPECIAL SUPPLEMENTAL NUTRITION PROGRAM FOR WOMEN, INFANTS AND CHILDREN General... systems. Applicants means pregnant women, breastfeeding women, postpartum women, infants, and children who..., postpartum women, or infants or children. Certification means the implementation of criteria and procedures...

Maternal Locus of Control and Developmental Gain Demonstrated by High Risk Infants: A Longitudinal Analysis.

ERIC Educational Resources Information Center

Maisto, Albert A.; German, Michael L.

1981-01-01

Short- and long-term effects of a parent-infant training program for biologically handicapped infants was evaluated in terms of maternal locus of control. Results indicated that maternal locus of control accounted for a substantial portion of the variance in the infants' developmental gains following the program intervention period. (Author/RH)

Toward automating Hammersmith pulled-to-sit examination of infants using feature point based video object tracking.

PubMed

Dogra, Debi P; Majumdar, Arun K; Sural, Shamik; Mukherjee, Jayanta; Mukherjee, Suchandra; Singh, Arun

2012-01-01

Hammersmith Infant Neurological Examination (HINE) is a set of tests used for grading neurological development of infants on a scale of 0 to 3. These tests help in assessing neurophysiological development of babies, especially preterm infants who are born before (the fetus reaches) the gestational age of 36 weeks. Such tests are often conducted in the follow-up clinics of hospitals for grading infants with suspected disabilities. Assessment based on HINE depends on the expertise of the physicians involved in conducting the examinations. It has been noted that some of these tests, especially pulled-to-sit and lateral tilting, are difficult to assess solely based on visual observation. For example, during the pulled-to-sit examination, the examiner needs to observe the relative movement of the head with respect to torso while pulling the infant by holding wrists. The examiner may find it difficult to follow the head movement from the coronal view. Video object tracking based automatic or semi-automatic analysis can be helpful in this case. In this paper, we present a video based method to automate the analysis of pulled-to-sit examination. In this context, a dynamic programming and node pruning based efficient video object tracking algorithm has been proposed. Pulled-to-sit event detection is handled by the proposed tracking algorithm that uses a 2-D geometric model of the scene. The algorithm has been tested with normal as well as marker based videos of the examination recorded at the neuro-development clinic of the SSKM Hospital, Kolkata, India. It is found that the proposed algorithm is capable of estimating the pulled-to-sit score with sensitivity (80%-92%) and specificity (89%-96%).

76 FR 35095 - Special Supplemental Nutrition Program for Women, Infants and Children (WIC): Exclusion of Combat...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-16

... Nutrition Program for Women, Infants and Children (WIC): Exclusion of Combat Pay From WIC Income Eligibility... Children (WIC) a statutory provision set forth in Section 734(b) of the Agriculture, Rural Development... NUTRITION PROGRAM FOR WOMEN, INFANTS AND CHILDREN (WIC) 0 1. The authority citation for part 246 continues...

Leadership Program in the Care of Infants and Toddlers: A Training Model. Final Report.

ERIC Educational Resources Information Center

Shigaki, Irene S.; Zorn, Vera

New York University's Leadership Program in the Care of Infants and Toddlers, an interdisciplinary training model, is described in this final report covering the program's three-year grant period from the National Institute of Mental Health. Focusing primarily on training individuals for leadership positions in the area of infant and toddler care,…

Volvulus in term and preterm infants - clinical presentation and outcome.

PubMed

Horsch, Sandra; Albayrak, Bilge; Tröbs, Ralf-Bodo; Roll, Claudia

2016-06-01

Our aim was to assess if term and preterm infants with volvulus showed different patterns with regard to pathogenesis, clinical presentation and outcome. We reviewed the medical records and imaging data of infants aged less than six months with volvulus treated in a single surgical referral centre from 2006-2013. Volvulus was diagnosed in 19 infants, with no anatomical anomaly in three of the 12 preterm infants and one of the seven term infants. Most cases (74%) presented during the first eight days of life. Later presentations occurred exclusively in preterm infants, with only one of the five having no anatomic anomalies. Bilious vomiting was the leading symptom in six of the seven term infants, while the symptoms in preterm infants were rather nonspecific. Intestinal necrosis, with the need for bowel resection, occurred in one term (14%) infant and nine (75%) preterm infants. The clinical presentation and outcome of volvulus differed between preterm and term infants, but the rate and distribution of underlying anomalies did not differ. Symptoms in preterm infants were often nonspecific and led to a delay in diagnosis. This might have contributed to the higher rate of intestinal necrosis in preterm infants. ©2016 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

Infant botulism: review and clinical update.

PubMed

Rosow, Laura K; Strober, Jonathan B

2015-05-01

Botulism is a rare neuromuscular condition, and multiple clinical forms are recognized. Infant botulism was first identified in the 1970s, and it typically occurs in infants younger than 1 year of age who ingest Clostridium botulinum spores. A specific treatment for infant botulism, intravenous botulism immunoglobulin (BIG-IV or BabyBIG®), was developed in 2003, and this treatment has substantially decreased both morbidity and hospital costs associated with this illness. This article will review the pathogenesis of infant botulism as well as the epidemiology, clinical manifestations, diagnosis, and treatment of this condition. Copyright © 2015 Elsevier Inc. All rights reserved.

Understanding the feasibility and implications of implementing early peanut introduction for prevention of peanut allergy.

PubMed

Koplin, Jennifer J; Peters, Rachel L; Dharmage, Shyamali C; Gurrin, Lyle; Tang, Mimi L K; Ponsonby, Anne-Louise; Matheson, Melanie; Togias, Alkis; Lack, Gideon; Allen, Katrina J

2016-10-01

A recent randomized trial (the Learning Early About Peanut Allergy [LEAP] study) provided evidence that earlier dietary peanut introduction reduces peanut allergy prevalence in high-risk infants. However, questions remain as to how to identify and target the "at-risk" population to facilitate timely introduction of peanut. We sought to use population-based infant peanut allergy data to understand feasibility and implications of implementing the LEAP trial intervention. Using the HealthNuts study cohort (n = 5276) of 1-year-old infants, we explored the impact of using various criteria to identify infants at high risk of developing peanut allergy, and the implications of skin prick test (SPT) screening before peanut introduction. Screening all infants with early onset eczema and/or egg allergy could require testing 16% of the population and would still miss 23% of peanut allergy cases; 29% of screened infants would require clinical follow-up because of being SPT-positive. Around 11% of high-risk infants were excluded from the LEAP study because of an SPT wheal size of more than 4 mm to peanut at baseline; data from the HealthNuts study suggest that 80% of these would be peanut allergic on food challenge. There were no life-threatening events among either low- or high-risk infants whose parents chose to introduce peanut at home in the first year of life, or in 150 peanut-allergic infants during hospital-based challenges. Based on this large epidemiological study, a population program aiming to identify and screen all infants at risk of peanut allergy would pose major cost and logistic challenges that need to be carefully considered. Further research might be required to provide data for low-risk infants. Copyright © 2016. Published by Elsevier Inc.

Non-governmental organization facilitation of a community-based nutrition and health program: Effect on program exposure and associated infant feeding practices in rural India.

PubMed

Singh, Veena; Ahmed, Saifuddin; Dreyfuss, Michele L; Kiran, Usha; Chaudhery, Deepika N; Srivastava, Vinod K; Ahuja, Ramesh C; Baqui, Abdullah H; Darmstadt, Gary L; Santosham, Mathuram; West, Keith P

2017-01-01

Integrated nutrition and health programs seek to reduce undernutrition by educating child caregivers about infant feeding and care. Data on the quality of program implementation and consequent effects on infant feeding practices are limited. This study evaluated the effectiveness of enhancing a nutrition and health program on breastfeeding and complementary-feeding practices in rural India. Utilizing a quasi-experimental design, one of the implementing districts of a Cooperative for Assistance and Relief Everywhere (CARE) nutrition and health program was randomly selected for enhanced services and compared with a district receiving the Government of India's standard nutrition and health package alone. A cohort of 942 mother-child dyads was longitudinally followed from birth to 18 months. In both districts, the evaluation focused on responses to services delivered by community-based nutrition and health care providers [anganwadi workers (AWWs) and auxiliary nurse midwives (ANMs)]. The CARE enhanced program district showed an improvement in program coverage indicators (e.g., contacts, advice) through outreach visits by both AWWs (28.8-59.8% vs. 0.7-12.4%; all p<0.05) and ANMs (8.6-46.2% vs. 6.1-44.2%; <0.05 for ages ≥6 months). A significantly higher percentage of child caregivers reported being contacted by the AWWs in the CARE program district (20.5-45.6% vs. 0.3-21.6%; p<0.05 for all ages except at 6months). No differences in ANM household contacts were reported. Overall, coverage remained low in both areas. Less than a quarter of women received any infant feeding advice in the intervention district. Earlier and exclusive breastfeeding improved with increasing number or quality of visits by either level of health care provider (OR: 2.04-3.08, p = <0.001), after adjusting for potentially confounding factors. Socio-demographic indicators were the major determinants of exclusive breastfeeding up to 6 month and age-appropriate complementary-feeding practices thereafter in the program-enhanced but not comparison district. An enhanced nutrition and health intervention package improved program exposure and associated breastfeeding but not complementary-feeding practices, compared to standard government package. ClinicalTrials.gov NCT00198835.

Office-based treatment and outcomes for febrile infants with clinically diagnosed bronchiolitis.

PubMed

Luginbuhl, Lynn M; Newman, Thomas B; Pantell, Robert H; Finch, Stacia A; Wasserman, Richard C

2008-11-01

The goals were to describe the (1) frequency of sepsis evaluation and empiric antibiotic treatment, (2) clinical predictors of management, and (3) serious bacterial illness frequency for febrile infants with clinically diagnosed bronchiolitis seen in office settings. The Pediatric Research in Office Settings network conducted a prospective cohort study of 3066 febrile infants (<3 months of age with temperatures >or=38 degrees C) in 219 practices in 44 states. We compared the frequency of sepsis evaluation, parenteral antibiotic treatment, and serious bacterial illness in infants with and without clinically diagnosed bronchiolitis. We identified predictors of sepsis evaluation and parenteral antibiotic treatment in infants with bronchiolitis by using logistic regression models. Practitioners were less likely to perform a complete sepsis evaluation, urine testing, and cerebrospinal fluid culture and to administer parenteral antibiotic treatment for infants with bronchiolitis, compared with those without bronchiolitis. Significant predictors of sepsis evaluation in infants with bronchiolitis included younger age, higher maximal temperature, and respiratory syncytial virus testing. Predictors of parenteral antibiotic use included initial ill appearance, age of <30 days, higher maximal temperature, and general signs of infant distress. Among infants with bronchiolitis (N = 218), none had serious bacterial illness and those with respiratory distress signs were less likely to receive parenteral antibiotic treatment. Diagnoses among 2848 febrile infants without bronchiolitis included bacterial meningitis (n = 14), bacteremia (n = 49), and urinary tract infection (n = 167). In office settings, serious bacterial illness in young febrile infants with clinically diagnosed bronchiolitis is uncommon. Limited testing for bacterial infections seems to be an appropriate management strategy.

[Development and evaluation of an e-learning program for mothers of premature infants].

PubMed

Lee, Nae-Young; Kim, Young-Hae

2008-02-01

It has been attempted to support mother of premature infants by providing information of premature infant care using e-learning because premature infants need continuous care from birth to after discharge. The e-Learning Program for mother of premature was developed with Xpert, Namo web editor, Adobe Photoshop, and PowerPoint and applied for 4 weeks from 4 to 30 September 2006. 1) We found that the contents of information which premature infants' need when being in the hospital and after discharge were the definition of a premature infant, orientation of NICU, care of premature infants, care of premature infants' common diseases, the connection of healthcare resources, exchange of information, and the management of rearing stress. 2) The program content consisted of cause of premature birth, comparison to full-term baby, physiology character, orientation of NICU, common health problems, follow up care, infection control, feeding, normal development physically and mentally, weaning method, and vaccination. Considering the results, this program for mother of premature is a useful means to provide premature-care information to mothers. This information can be readily accessible and can be varied and complex enough to be able to help mothers to the information and assistance they require.

Evaluation and Referral for Developmental Dysplasia of the Hip in Infants.

PubMed

Shaw, Brian A; Segal, Lee S

2016-12-01

Developmental dysplasia of the hip (DDH) encompasses a wide spectrum of clinical severity, from mild developmental abnormalities to frank dislocation. Clinical hip instability occurs in 1% to 2% of full-term infants, and up to 15% have hip instability or hip immaturity detectable by imaging studies. Hip dysplasia is the most common cause of hip arthritis in women younger than 40 years and accounts for 5% to 10% of all total hip replacements in the United States. Newborn and periodic screening have been practiced for decades, because DDH is clinically silent during the first year of life, can be treated more effectively if detected early, and can have severe consequences if left untreated. However, screening programs and techniques are not uniform, and there is little evidence-based literature to support current practice, leading to controversy. Recent literature shows that many mild forms of DDH resolve without treatment, and there is a lack of agreement on ultrasonographic diagnostic criteria for DDH as a disease versus developmental variations. The American Academy of Pediatrics has not published any policy statements on DDH since its 2000 clinical practice guideline and accompanying technical report. Developments since then include a controversial US Preventive Services Task Force "inconclusive" determination regarding usefulness of DDH screening, several prospective studies supporting observation over treatment of minor ultrasonographic hip variations, and a recent evidence-based clinical practice guideline from the American Academy of Orthopaedic Surgeons on the detection and management of DDH in infants 0 to 6 months of age. The purpose of this clinical report was to provide literature-based updated direction for the clinician in screening and referral for DDH, with the primary goal of preventing and/or detecting a dislocated hip by 6 to 12 months of age in an otherwise healthy child, understanding that no screening program has eliminated late development or presentation of a dislocated hip and that the diagnosis and treatment of milder forms of hip dysplasia remain controversial. Copyright © 2016 by the American Academy of Pediatrics.

Safety of milrinone use in neonatal intensive care units

PubMed Central

Samiee-Zafarghandy, Samira; Raman, Sudha R.; van den Anker, John N.; McHutchison, Kerstin; Hornik, Christoph P.; Clark, Reese H.; Smith, P. Brian

2014-01-01

Background Milrinone use in the neonatal intensive care unit has increased over the last 10 years despite a paucity of published safety data in infants. We sought to determine the safety of milrinone therapy among infants in the neonatal intensive care unit. Methods We conducted a retrospective data analysis, identifying all infants exposed to milrinone discharged from 322 neonatal intensive care units managed by the Pediatrix Medical Group from 1997–2010. We identified adverse events (AEs) during milrinone exposure. The unit of observation for clinical AEs was the first course of milrinone and for laboratory AEs was an infant-day of exposure to milrinone. Results Overall, 1446 of 716,821 (0.2%) infants received milrinone for a total of 6894 infant-days. The proportion of infants exposed to milrinone increased from 0 in 1997 to 4/1000 infant cases in 2010. Persistent pulmonary hypertension (40%) was the most commonly reported diagnosis at the start of milrinone administration. Overall, 606/1446 (42%) of infants had at least 1 clinical AE recorded during milrinone therapy. Hypotension requiring pressors and thrombocytopenia (<100,000/mm3) were the most commonly reported clinical and laboratory AEs, respectively. Death was reported in 8% of infants during the first course of milrinone therapy. Conclusion Among infants hospitalized in the neonatal intensive care unit, there was an increase in the use of milrinone over the past 13 years. The safety, dosing, and efficacy of milrinone in infants should be determined in prospective clinical trials. PMID:25460254

Safety of milrinone use in neonatal intensive care units.

PubMed

Samiee-Zafarghandy, Samira; Raman, Sudha R; van den Anker, John N; McHutchison, Kerstin; Hornik, Christoph P; Clark, Reese H; Brian Smith, P

2015-01-01

Milrinone use in the neonatal intensive care unit has increased over the last 10 years despite a paucity of published safety data in infants. We sought to determine the safety of milrinone therapy among infants in the neonatal intensive care unit. We conducted a retrospective data analysis, identifying all infants who were exposed to milrinone and discharged from 322 neonatal intensive care units managed by the Pediatrix Medical Group from 1997-2010. We identified adverse events (AEs) during milrinone exposure. The unit of observation for clinical AEs was the first course of milrinone and for laboratory AEs it was an infant-day of exposure to milrinone. Overall, 1446 of 716,821 (0.2%) infants received milrinone for a total of 6894 infant-days. The proportion of infants exposed to milrinone increased from 0 in 1997 to 4/1000 infant cases in 2010. Persistent pulmonary hypertension (40%) was the most commonly reported diagnosis at the start of milrinone administration. Overall, 606/1446 (42%) of infants had at least 1 clinical AE recorded during milrinone therapy. Hypotension requiring pressors and thrombocytopenia (<100,000/mm(3)) were the most commonly reported clinical and laboratory AEs, respectively. Death was reported in 8% of infants during the first course of milrinone therapy. Among infants hospitalized in the neonatal intensive care unit, there was an increase in the use of milrinone over the past 13 years. The safety, dosing, and efficacy of milrinone in infants should be determined in prospective clinical trials. Copyright © 2014 Elsevier Ltd. All rights reserved.

Outcomes of infants with indeterminate diagnosis detected by cystic fibrosis newborn screening.

PubMed

Ren, Clement L; Fink, Aliza K; Petren, Kristofer; Borowitz, Drucy S; McColley, Susanna A; Sanders, Don B; Rosenfeld, Margaret; Marshall, Bruce C

2015-06-01

Cystic fibrosis transmembrane conductance regulator-related metabolic syndrome (CRMS) describes asymptomatic infants with a positive cystic fibrosis (CF) newborn screen (NBS) but inconclusive diagnostic testing for CF. Little is known about the epidemiology and outcomes of CRMS. The goal of this study was to determine the prevalence, clinical features, and short-term outcomes of infants with CRMS. We analyzed data from the US CF Foundation Patient Registry (CFFPR) from 2010 to 2012. We compared demographic, diagnostic, anthropometric, health care utilization, microbiology, and treatment characteristics between infants with CF and infants with CRMS. There were 1983 infants diagnosed via NBS between 2010 and 2012 reported to the CFFPR. By using the CF Foundation guideline definitions, 1540 and 309 infants met the criteria for CF and CRMS, respectively (CF:CRMS ratio = 5.0:1.0). Of note, 40.8% of infants with CRMS were entered into the registry with a clinical diagnosis of CF. Infants with CRMS tended to have normal nutritional indices. However, 11% of infants with CRMS had a positive Pseudomonas aeruginosa respiratory tract culture in the first year of life. CRMS is a common outcome of CF NBS, and some infants with CRMS may develop features concerning for CF disease. A substantial proportion of infants with CRMS were assigned a clinical diagnosis of CF, which may reflect misclassification or clinical features not collected in the CFFPR. Copyright © 2015 by the American Academy of Pediatrics.

An Early Look at Families and Local Programs in the Mother and Infant Home Visiting Program Evaluation-Strong Start: Third Annual Report. OPRE Report 2016-37

ERIC Educational Resources Information Center

Lee, Helen; Crowne, Sarah; Faucetta, Kristen; Hughes, Rebecca

2016-01-01

The Mother and Infant Home Visiting Program Evaluation-Strong Start (MIHOPE-Strong Start) is the largest random assignment study to date to examine the effectiveness of home visiting services on improving birth outcomes and infant and maternal health care use for expectant mothers. The study includes local home visiting programs that use one of…

Impact of domestic violence and drug abuse in pregnancy on maternal attachment and infant temperament in teenage mothers in the setting of best clinical practice.

PubMed

Quinlivan, J A; Evans, S F

2005-09-01

We examined whether the prenatal detection of family violence and initiation of a comprehensive prenatal individualised care program could ameliorate the impact of family violence on maternal attachment to her infant at 6-months of age. An assessment of domestic violence was established for each subject at the 1(st) antenatal visit and women were classified as being exposed to domestic violence in pregnancy (EDV) or as being not exposed to domestic violence. Outcomes were determined 6 months postpartum. Of 173 consecutive women who met the eligibility criteria, consent was obtained from 150 (87% response). Women who had been subjected to domestic violence showed reduced overall attachment scores to their infants. Following multivariate analysis, drug use in pregnancy and domestic violence showed a significant independent effect on maternal attachment. Drug abuse and domestic violence were also associated with an increase in the easy-difficult scale of infant temperament. Thus, despite excellence in prenatal care, drug abuse and domestic violence were associated with poorer maternal attachment and assessment of infant temperament, suggesting that additional interventions are still required.

Severe congenital toxoplasmosis in the United States: clinical and serologic findings in untreated infants.

PubMed

Olariu, Tudor Rares; Remington, Jack S; McLeod, Rima; Alam, Ambereen; Montoya, Jose G

2011-12-01

Congenital toxoplasmosis can cause significant neurologic manifestations and other untoward sequelae. The Palo Alto Medical Foundation Toxoplasma Serology Laboratory database was searched for data on infants 0 to 180 days old, in whom congenital toxoplasmosis had been confirmed and who had been tested for Toxoplasma gondii-specific immunoglobulin G (IgG), IgM, and IgA antibodies, between 1991 and 2005. Their clinical findings were confirmed at the National Collaborative Chicago-based Congenital Toxoplasmosis Study center. We reviewed available clinical data and laboratory profiles of 164 infants with congenital toxoplasmosis whose mothers had not been treated for the parasite during gestation. One or more severe clinical manifestations of congenital toxoplasmosis were reported in 84% of the infants and included eye disease (92.2%), brain calcifications (79.6%), and hydrocephalus (67.7%). In 61.6% of the infants, eye disease, brain calcifications, and hydrocephalus were present concurrently. T. gondii-specific IgM, IgA, and IgE antibodies were demonstrable in 86.6%, 77.4%, and 40.2% of the infants, respectively. Testing for IgM and IgA antibodies increased the sensitivity of making the diagnosis of congenital toxoplasmosis to 93% compared with testing for IgM or IgA individually. IgM and IgA antibodies were still present in 43.9% of infants diagnosed between 1 and 6 months of life. Our study reveals that severe clinical signs of congenital toxoplasmosis including hydrocephalus, eye disease, or intracranial calcifications occurred in 85% infants whose sera were referred to our reference Toxoplasma Serology Laboratory during a period of 15 years. Laboratory tests, including serologic and polymerase chain reaction tests, were critical for diagnosis in the infants. Our results contrast remarkably with those of European investigators who rarely observe severe clinical signs in infants with congenital toxoplasmosis.

Shortened lengths of stay: ensuring continuity of care for mothers and babies.

PubMed

Welsh, C; Ludwig-Beymer, P

1998-01-01

Hospital discharge on the day after an uncomplicated vaginal delivery may be appropriate if clinical criteria are used for the selection of patients and post-discharge follow-up plans are in place. To ensure safety for these patients, Advocate Health Care developed a mother/baby philosophy statement, guidelines for maternal and infant discharge in less than 48 hours, and an algorithm to assure that appropriate follow-up care takes place after discharge. To evaluate the Mother/Baby Home Transition Program, home health follow up, readmission rates, and sentinel events were tracked. Most home health visits occurred within 48 hours. Infant readmission rates ranged from 1.1-2.6%, whereas maternal readmission rates ranged from 0-0.52%. Three sentinel events in 1996 and three in 1997 required readmissions to an ICU. Data continue to be monitored and shared monthly with clinical leaders.

Neonatology/Paediatrics – Guidelines on Parenteral Nutrition, Chapter 13

PubMed Central

Fusch, C.; Bauer, K.; Böhles, H. J.; Jochum, F.; Koletzko, B.; Krawinkel, M.; Krohn, K.; Mühlebach, S.

2009-01-01

There are special challenges in implementing parenteral nutrition (PN) in paediatric patients, which arises from the wide range of patients, ranging from extremely premature infants up to teenagers weighing up to and over 100 kg, and their varying substrate requirements. Age and maturity-related changes of the metabolism and fluid and nutrient requirements must be taken into consideration along with the clinical situation during which PN is applied. The indication, the procedure as well as the intake of fluid and substrates are very different to that known in PN-practice in adult patients, e.g. the fluid, nutrient and energy needs of premature infants and newborns per kg body weight are markedly higher than of older paediatric and adult patients. Premature infants <35 weeks of pregnancy and most sick term infants usually require full or partial PN. In neonates the actual amount of PN administered must be calculated (not estimated). Enteral nutrition should be gradually introduced and should replace PN as quickly as possible in order to minimise any side-effects from exposure to PN. Inadequate substrate intake in early infancy can cause long-term detrimental effects in terms of metabolic programming of the risk of illness in later life. If energy and nutrient demands in children and adolescents cannot be met through enteral nutrition, partial or total PN should be considered within 7 days or less depending on the nutritional state and clinical conditions. PMID:20049070

Impact of elevated maternal HIV viral load at delivery on T-cell populations in HIV exposed uninfected infants in Mozambique.

PubMed

de Deus, Nilsa; Moraleda, Cinta; Serna-Bolea, Celia; Renom, Montse; Menendez, Clara; Naniche, Denise

2015-02-03

HIV-uninfected infants born to HIV-infected mothers (HIV-exposed uninfected, HEU) have been described to have immune alterations as compared to unexposed infants. This study sought to characterize T-cell populations after birth in HEU infants and unexposed infants living in a semirural area in southern Mozambique. Between August 2008 and June 2009 mother-infant pairs were enrolled at the Manhiça District Hospital at delivery into a prospective observational analysis of immunological and health outcomes in HEU infants. Infants were invited to return at one month of age for a clinical examination, HIV DNA-PCR, and immunophenotypic analyses. The primary analysis sought to assess immunological differences between HEU and unexposed groups, whereas the secondary analysis assessed the impact of maternal HIV RNA viral load in the HEU group. Infants who had a positive HIV DNA-PCR test were not included in the analysis. At one month of age, the 74 HEU and the 56 unexposed infants had similar median levels of naïve, memory and activated CD8 and CD4 T-cells. Infant naïve and activated CD8 T-cells were found to be associated with maternal HIV-RNA load at delivery. HEU infants born to women with HIV-RNA loads above 5 log10 copies/mL had lower median levels of naïve CD8 T-cells (p = 0.04), and higher median levels of memory CD8 T-cells, (p = 0.014). This study suggests that exposure to elevated maternal HIV-RNA puts the infant at higher risk of having early T-cell abnormalities. Improving prophylaxis of mother to child HIV programs such that more women have undetectable viral load is crucial to decrease vertical transmission of HIV, but may also be important to reduce the consequences of HIV virus exposure in HEU infants.

Update: new guidelines for the treatment of infants with sickle cell disease. Agency for Health Care Policy and Research.

PubMed

Selekman, J

1993-01-01

These clinical practice guidelines set forth a comprehensive program for identifying, diagnosing, and treating newborns and infants with sickle cell disease and recommend education and counseling strategies for their parents. Sickle cell disease comprises a group of genetic disorders characterized by the production of hemoglobin S, anemia, and acute and chronic tissue damage secondary to the blockage of blood flow by abnormally shaped red cells. Sickle cell anemia is the most common form of the disease, and it affects approximately 1 in 375 African-American infants. Although in the United States sickle cell disease is most commonly found in persons of African ancestry, it also affects other populations. The panel recommends screening of all newborns for sickle cell disease, since targeting specific groups will miss some infected infants. Samples of dried blood on filter paper or liquid blood samples should be used for hemoglobinopathy screening. Hemoglobin electrophoresis, isoelectric focusing, and high performance liquid chromatography are acceptable, reliable, and accurate testing methods. Infants identified on initial screening must be retested to establish a definitive diagnosis. Affected infants must be given twice-daily oral penicillin beginning at 2 months of age to reduce pneumococcal, conjugated Haemophilus influenzae, and hepatitis B vaccines. Infants with sickle cell disease require the same well-child care as infants without the disease. Education and nondirective genetic counseling should be offered to all parents of infants with sickle cell disease. The guidelines stress the need for a comprehensive and fully integrated approach to reduce morbidity and mortality from sickle cell disease.(ABSTRACT TRUNCATED AT 250 WORDS)

When to perform urine cultures in respiratory syncytial virus-positive febrile older infants?

PubMed

Kaluarachchi, Dinushan; Kaldas, Virginia; Erickson, Evelyn; Nunez, Randolph; Mendez, Magda

2014-09-01

Respiratory syncytial virus (RSV) infections are associated with clinically significant rate of urinary tract infections (UTIs) in young infants. Previous research investigating RSV infections and UTIs has been performed mainly in infants younger than 2 to 3 months and has not focused on the risk of UTI in infants 3 to 12 months. This study aimed to assess the rate of UTIs in febrile RSV-positive older infants admitted as inpatients and identify predictors of UTI in febrile RSV-positive older infants. This is a retrospective comparative study of febrile RSV-positive infants 0 to 12 months of age admitted to the inpatient pediatric unit of Lincoln Medical and Mental Health Center, Bronx, from September through April 2006 to 2012. Infants 3 to 12 months were considered the cases, and infants 0 to 3 months were the comparative group. The rate of UTIs between the 2 groups was compared. Univariate tests and multiple logistic regression were used to identify demographic/clinical factors associated with UTI in febrile RSV-positive older infants. A total of 414 RSV-positive febrile infants were enrolled including 297 infants 3 to 12 months of age. The rate of UTI in older infants was 6.1% compared with 6.8% in infants younger than 3 months. Positive urinalysis finding was an independent predictor of UTI (P = 0.003) in older infants. All 11 boys with UTI were uncircumcised, and none of the 51 circumcised boys had UTI. Demographic (race, sex, and age) and clinical factors (temperature, white blood cell count, and absolute neutrophil count) were not associated with UTI. Febrile older infants who are RSV positive have a clinically significant rate of UTIs. It seems prudent to examine the urine of these older infants. Positive urinalysis finding was a predictive factor of UTI. Circumcised boys are at a decreased risk of UTI, compared with uncircumcised boys.

Infants' Visual Attention to Baby DVDs as a Function of Program Pacing

ERIC Educational Resources Information Center

Gola, Alice Ann Howard; Calvert, Sandra L.

2011-01-01

This study examined the effects of program pacing, defined as the rate of scene and character change per minute, on infants' visual attention to video presentations. Seventy-two infants (twenty-four 6-month-olds, twenty-four 9-month-olds, twenty-four 12-month-olds) were exposed to one of two sets of high- and low-paced commercial infant DVDs. Each…

Infant and toddlers' feeding practices and obesity amongst low-income families in Mexico.

PubMed

Jimenez-Cruz, Arturo; Bacardi-Gascon, Montserrat; Pichardo-Osuna, Alexandra; Mandujano-Trujillo, Zally; Castillo-Ruiz, Octelina

2010-01-01

The aim of this study was to determine the risk factors of childhood obesity among infants and toddlers from low-income families from three cities in Mexico. This is a cross-sectional study of mothers and their infants and toddlers attending a vaccination centre at three primary care clinics in Tijuana, Tuxtla, and Reynosa. Anthropometric measurements of the mothers and children were conducted at the clinic and a questionnaire was administered to the mother. Eight-hundred and ten mothers and their 5 to 24 months old infants participated in the study. Average age for the mothers was 24 (21-28) years, and 57% of them were either overweight or obese. The children's average age was 12.7 (5-24) months. Overall overweight prevalence in this sample was 11% and obesity 8%, these increased with age, from 3% for overweight and 6 % for obesity before 6 months, to 13 and 10% between 12 to 24 months respectively. Thirty-five percent of infants were breastfed>or=6 month and 92% were introduced to other solid foods before 6 months. Introduction of high-fat content snacks (HFS) and carbonated and non-carbonated sweetened (CSD) drinks starts before 6 months and more than sixty percent of the children between 12 to 24 months of age were eating HFS and CSD sweetened drinks at least once a week. Consumption of snacks and CSD sweetened drinks (>or=1 week) was associated with being overweight and obese (crude), OR, 1.82; 95% CI=1.24-2.65 (p=0.002). These results suggest that preventive programs should be initiated during pregnancy and continued.

77 FR 60965 - Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-05

... education to nutritionally at-risk, low-income pregnant women, new mothers, their infants, and children up... number. Food and Nutrition Service Title: Special Supplemental Nutrition Program for Women, Infants, and... applies to Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) agencies. The...

Nurse-Moderated Internet-Based Support for New Mothers: Non-Inferiority, Randomized Controlled Trial.

PubMed

Sawyer, Michael G; Reece, Christy E; Bowering, Kerrie; Jeffs, Debra; Sawyer, Alyssa C P; Mittinty, Murthy; Lynch, John W

2017-07-24

Internet-based interventions moderated by community nurses have the potential to improve support offered to new mothers, many of whom now make extensive use of the Internet to obtain information about infant care. However, evidence from population-based randomized controlled trials is lacking. The aim of this study was to test the non-inferiority of outcomes for mothers and infants who received a clinic-based postnatal health check plus nurse-moderated, Internet-based group support when infants were aged 1-7 months as compared with outcomes for those who received standard care consisting of postnatal home-based support provided by a community nurse. The design of the study was a pragmatic, preference, non-inferiority randomized control trial. Participants were recruited from mothers contacted for their postnatal health check, which is offered to all mothers in South Australia. Mothers were assigned either (1) on the basis of their preference to clinic+Internet or home-based support groups (n=328), or (2) randomly assigned to clinic+Internet or home-based groups if they declared no strong preference (n=491). The overall response rate was 44.8% (819/1827). The primary outcome was parenting self-competence, as measured by the Parenting Stress Index (PSI) Competence subscale, and the Karitane Parenting Confidence Scale scores. Secondary outcome measures included PSI Isolation, Interpersonal Support Evaluation List-Short Form, Maternal Support Scale, Ages and Stages Questionnaire-Social-Emotional and MacArthur Communicative Development Inventory (MCDI) scores. Assessments were completed offline via self-assessment questionnaires at enrolment (mean child age=4.1 weeks, SD 1.3) and again when infants were aged 9, 15, and 21 months. Generalized estimating equations adjusting for post-randomization baseline imbalances showed that differences in outcomes between mothers in the clinic+Internet and home-based support groups did not exceed the pre-specified margin of inferiority (0.25 of a SD) on any outcome measure at any follow-up assessment, with the exception of MCDI scores assessing children's language development at 21 months for randomized mothers, and PSI Isolation scores at 9 months for preference mothers. Maternal and child outcomes from a clinic-based postnatal health check plus nurse-moderated Internet-based support were not inferior to those achieved by a universal home-based postnatal support program. Postnatal maternal and infant support using the Internet is a promising alternative to home-based universal support programs. Australian New Zealand Clinical Trials Registry Number (ANZCTR): ACTRN12613000204741; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=363712&isReview=true (Archived by WebCite at http://www.webcitation.org/6rZeCJ3k1). ©Michael G Sawyer, Christy E Reece, Kerrie Bowering, Debra Jeffs, Alyssa C P Sawyer, Murthy Mittinty, John W Lynch. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 24.07.2017.

Early participation in a prenatal food supplementation program ameliorates the negative association of food insecurity with quality of maternal-infant interaction.

PubMed

Frith, Amy L; Naved, Ruchira T; Persson, Lars Ake; Rasmussen, Kathleen M; Frongillo, Edward A

2012-06-01

Food insecurity is detrimental to child development, yet little is known about the combined influence of food insecurity and nutritional interventions on child development in low-income countries. We proposed that women assigned to an early invitation time to start a prenatal food supplementation program could reduce the negative influence of food insecurity on maternal-infant interaction. A cohort of 180 mother-infant dyads were studied (born between May and October 2003) from among 3267 in the randomized controlled trial Maternal Infant Nutritional Interventions Matlab, which was conducted in Matlab, Bangladesh. At 8 wk gestation, women were randomly assigned an invitation time to start receiving food supplements (2.5 MJ/d; 6 d/wk) either early (~9 wk gestation; early-invitation group) or at the usual start time (~20 wk gestation; usual-invitation group) for the government program. Maternal-infant interaction was observed in homes with the use of the Nursing Child Assessment Satellite Training Feeding Scale, and food-insecurity status was obtained from questionnaires completed when infants were 3.4-4.0 mo old. By using a general linear model for maternal-infant interaction, we found a significant interaction (P = 0.012) between invitation time to start a prenatal food supplementation program and food insecurity. Those in the usual-invitation group with higher food insecurity scores (i.e., more food insecure) had a lower quality of maternal-infant interaction, but this relationship was ameliorated among those in the early-invitation group. Food insecurity limits the ability of mothers and infants to interact well, but an early invitation time to start a prenatal food supplementation program can support mother-infant interaction among those who are food insecure.

First-Time Mothers' Use of Music and Movement with Their Young Infants: The Impact of a Teaching Program.

ERIC Educational Resources Information Center

Vlismas, Wendy; Bowes, Jennifer

1999-01-01

Examined impact of a 5-week music/movement program involving relaxation, kinesics, singing, visual contact, and tactile stimulation on first-time mothers' use of music and movement with their infants. Found that the program extended mothers' use of relaxation to music and rhythmical movement with their infants but not the use of song and massage…

Improving outcomes in infants of HIV-infected women in a developing country setting.

PubMed

Noel, Francine; Mehta, Sapna; Zhu, Yuwei; Rouzier, Patricia De Matteis; Marcelin, Abdias; Shi, Jian R; Nolte, Claudine; Severe, Linda; Deschamps, Marie Marcelle; Fitzgerald, Daniel W; Johnson, Warren D; Wright, Peter F; Pape, Jean W

2008-01-01

Since 1999 GHESKIO, a large voluntary counseling and HIV testing center in Port-au-Prince, Haiti, has had an ongoing collaboration with the Haitian Ministry of Health to reduce the rate of mother to child HIV transmission. There are limited data on the ability to administer complex regimens for reducing mother to child transmission and on risk factors for continued transmission and infant mortality within programmatic settings in developing countries. We analyzed data from 551 infants born to HIV-infected mothers seen at GHESKIO, between 1999 and 2005. HIV-infected mothers and their infants were given "short-course" monotherapy with antiretrovirals for prophylaxis; and, since 2003, highly active antiretroviral therapy (HAART) when clinical or laboratory indications were met. Infected women seen in the pre-treatment era had 27% transmission rates, falling to 10% in this cohort of 551 infants, and to only 1.9% in infants of women on HAART. Mortality rate after HAART introduction (0.12 per year of follow-up [0.08-0.16]) was significantly lower than the period before the availability of such therapy (0.23 [0.16-0.30], P<0.0001). The effects of maternal health, infant feeding, completeness of prophylaxis, and birth weight on mortality and transmission were determined using univariate and multivariate analysis. Infant HIV-1 infection and low birth weight were associated with infant mortality in less than 15 month olds in multivariate analysis. Our findings demonstrate success in prevention of mother-to-child HIV transmission and mortality in a highly resource constrained setting. Elements contributing to programmatic success include provision of HAART in the context of a comprehensive program with pre and postnatal care for both mother and infant.

Improving Aboriginal maternal and infant health services in the ‘Top End’ of Australia; synthesis of the findings of a health services research program aimed at engaging stakeholders, developing research capacity and embedding change

PubMed Central

2014-01-01

Background Health services research is a well-articulated research methodology and can be a powerful vehicle to implement sustainable health service reform. This paper presents a summary of a five-year collaborative program between stakeholders and researchers that led to sustainable improvements in the maternity services for remote-dwelling Aboriginal women and their infants in the Top End (TE) of Australia. Methods A mixed-methods health services research program of work was designed, using a participatory approach. The study area consisted of two large remote Aboriginal communities in the Top End of Australia and the hospital in the regional centre (RC) that provided birth and tertiary care for these communities. The stakeholders included consumers, midwives, doctors, nurses, Aboriginal Health Workers (AHW), managers, policy makers and support staff. Data were sourced from: hospital and health centre records; perinatal data sets and costing data sets; observations of maternal and infant health service delivery and parenting styles; formal and informal interviews with providers and women and focus groups. Studies examined: indicator sets that identify best care, the impact of quality of care and remoteness on health outcomes, discrepancies in the birth counts in a range of different data sets and ethnographic studies of ‘out of hospital’ or health centre birth and parenting. A new model of maternity care was introduced by the health service aiming to improve care following the findings of our research. Some of these improvements introduced during the five-year research program of research were evaluated. Results Cost effective improvements were made to the acceptability, quality and outcomes of maternity care. However, our synthesis identified system-wide problems that still account for poor quality of infant services, specifically, unacceptable standards of infant care and parent support, no apparent relationship between volume and acuity of presentations and staff numbers with the required skills for providing care for infants, and an ‘outpatient’ model of care. Services were also characterised by absent Aboriginal leadership and inadequate coordination between remote and tertiary services that is essential to improve quality of care and reduce ‘system-introduced’ risk. Conclusion Evidence-informed redesign of maternity services and delivery of care has improved clinical effectiveness and quality for women. However, more work is needed to address substandard care provided for infants and their parents. PMID:24890910

Prenatal exposure to Plasmodium falciparum increases frequency and shortens time from birth to first clinical malaria episodes during the first two years of life: prospective birth cohort study.

PubMed

Sylvester, Boniphace; Gasarasi, Dinah B; Aboud, Said; Tarimo, Donath; Massawe, Siriel; Mpembeni, Rose; Swedberg, Gote

2016-07-22

Prenatal exposure to Plasmodium falciparum affects development of protective immunity and susceptibility to subsequent natural challenges with similar parasite antigens. However, the nature of these effects has not been fully elucidated. The aim of this study was to determine the effect of prenatal exposure to P. falciparum on susceptibility to natural malaria infection, with a focus on median time from birth to first clinical malaria episode and frequency of clinical malaria episodes in the first 2 years of life. A prospective birth cohort study was conducted in Rufiji district in Tanzania, between January 2013 and December 2015. Infants born to mothers with P. falciparum in the placenta at time of delivery were defined as exposed, and infants born to mothers without P. falciparum parasites in placenta were defined as unexposed. Placental infection was established by histological techniques. Out of 206 infants recruited, 41 were in utero exposed to P. falciparum and 165 infants were unexposed. All infants were monitored for onset of clinical malaria episodes in the first 2 years of life. The outcome measure was time from birth to first clinical malaria episode, defined by fever (≥37 °C) and microscopically determined parasitaemia. Median time to first clinical malaria episode between exposed and unexposed infants was assessed using Kaplan-Meier survival analysis and comparison was done by log rank. Association of clinical malaria episodes with prenatal exposure to P. falciparum was assessed by multivariate binary logistic regression. Comparative analysis of mean number of clinical malaria episodes between exposed and unexposed infants was done using independent sample t test. The effect of prenatal exposure to P. falciparum infection on clinical malaria episodes was statistically significant (Odds Ratio of 4.79, 95 % CI 2.21-10.38, p < 0.01) when compared to other confounding factors. Median time from birth to first clinical malaria episode for exposed and unexposed infants was 32 weeks (95 % CI 30.88-33.12) and 37 weeks (95 % CI 35.25-38.75), respectively, and the difference was statistically significant (p = 0.003). The mean number of clinical malaria episodes in exposed and unexposed infants was 0.51 and 0.30 episodes/infant, respectively, and the difference was statistically significant (p = 0.038). Prenatal exposure to P. falciparum shortens time from birth to first clinical malaria episode and increases frequency of clinical malaria episodes in the first 2 years of life.

ALLERGIC PROCTOCOLITIS IN INFANTS: analysis of the evolution of the nutritional status.

PubMed

Camargo, Ludmilla S; Silveira, Jonas Ac; Taddei, José Aac; Fagundes, Ulysses

2016-01-01

Allergic proctocolitis is a disease that affects infants in the first months. The change in feed is the primary factor for clinical improvement and maintenance of the nutritional status of the infant. Study the anthropometric evolution of infants with allergic proctocolitis at diagnosis and 1 to 6 months after nutritional intervention. A retrospective cohort of infants with allergic proctocolitis diagnosis followed at the Pediatric Gastroenterology Institute of São Paulo (IGASTROPED), Brazil. The database with clinical, therapeutic and anthropometric data was obtained from medical records of outpatient infants. The therapeutic intervention was characterized by 1) exclusive breastfeeding with maternal exclusion diet of the six allergens (EBF-MED) or 2) no breastfeeding and use of hypoallergenic formulas. Of the 44 infants diagnosed with allergic proctocolitis, 23 were female. The median age of the infants was 3.5 months at the time of admission and 6 months after the intervention. The main clinical complaint was hematochezia with or without other symptoms of allergic proctocolitis. No difference was shown in the infants anthropometric evaluation between the two diets. The duration of the allergic proctocolitis did not induce worsening of the infants nutritional status. Importantly, both nutritional interventions were able to keep the infants within the growth channel and resulted in the total clinical symptoms remission. Considering the fundamental mother-child link promoted by breastfeeding, the present data highlights the beneficial role of EBF-MED on the nutritional status of infants diagnosed with allergic proctocolitis in addition to the lower cost that breastfeeding brings compared the use of hypoallergenic formulas.

The effect of adding a home program to weekly institutional-based therapy for children with undefined developmental delay: a pilot randomized clinical trial.

PubMed

Tang, Mei-Hua; Lin, Chin-Kai; Lin, Wen-Hsien; Chen, Chao-Huei; Tsai, Sen-Wei; Chang, Yin-Yi

2011-06-01

Early rehabilitation for children with developmental delay without a defined etiology have included home and clinic programs, but no comparisons have been made and efficacy is uncertain. We compared a weekly visit for institutional-based therapy (IT) to IT plus a structured home activity program (HAP). Seventy children who were diagnosed with motor or global developmental delay (ages 6-48 months and mean developmental age 12.5 months) without defined etiology were recruited (including 45 males and 23 females). The outcomes included the comprehensive developmental inventory for infants and toddlers test and the pediatric evaluation of disability inventory. Children who received only IT improved in developmental level by 2.11 months compared with 3.11 months for those who received a combination of IT and HAP (p = 0.000). On all domains of the comprehensive developmental inventory for infants and toddlers test, except for self-help, children who participated in HAP showed greater improvements, including in cognition (p = 0.015), language (p = 0.010), motor (p = 0.000), and social (p = 0.038) domains. Except on the subdomain of self-care with caregiver assistance, the HAP group showed greater improvement in all the pediatric evaluation of disability inventory subdomains (p < 0.05). Early intervention programs are helpful for these children, and the addition of structured home activity programs may augment the effects on developmental progression. Copyright © 2011. Published by Elsevier B.V.

7 CFR 246.15 - Program income other than grants.

Code of Federal Regulations, 2011 CFR

2011-01-01

... government on rebate funds for infant formula or other foods, provided that all interest earned on such funds..., DEPARTMENT OF AGRICULTURE CHILD NUTRITION PROGRAMS SPECIAL SUPPLEMENTAL NUTRITION PROGRAM FOR WOMEN, INFANTS...

34 CFR 303.209 - Transition to preschool and other programs.

Code of Federal Regulations, 2014 CFR

2014-07-01

... INFANTS AND TODDLERS WITH DISABILITIES State Application and Assurances Application Requirements § 303.209... smooth transition for infants and toddlers with disabilities under the age of three and their families... services (for toddlers with disabilities); or (ii) Exiting the program for infants and toddlers with...

34 CFR 303.209 - Transition to preschool and other programs.

Code of Federal Regulations, 2013 CFR

2013-07-01

... INFANTS AND TODDLERS WITH DISABILITIES State Application and Assurances Application Requirements § 303.209... smooth transition for infants and toddlers with disabilities under the age of three and their families... services (for toddlers with disabilities); or (ii) Exiting the program for infants and toddlers with...

34 CFR 303.209 - Transition to preschool and other programs.

Code of Federal Regulations, 2012 CFR

2012-07-01

... INFANTS AND TODDLERS WITH DISABILITIES State Application and Assurances Application Requirements § 303.209... smooth transition for infants and toddlers with disabilities under the age of three and their families... services (for toddlers with disabilities); or (ii) Exiting the program for infants and toddlers with...

Preterm birth-associated cost of early intervention services: an analysis by gestational age.

PubMed

Clements, Karen M; Barfield, Wanda D; Ayadi, M Femi; Wilber, Nancy

2007-04-01

Characterizing the cost of preterm birth is important in assessing the impact of increasing prematurity rates and evaluating the cost-effectiveness of therapies to prevent preterm delivery. To assess early intervention costs that are associated with preterm births, we estimated the program cost of early intervention services for children who were born in Massachusetts, by gestational age at birth. Using the Pregnancy to Early Life Longitudinal Data Set, birth certificates for infants who were born in Massachusetts between July 1999 and June 2000 were linked to early intervention claims through 2003. We determined total program costs, in 2003 dollars, of early intervention and mean cost per surviving infant by gestational age. Costs by plurality, eligibility criteria, provider discipline, and annual costs for children's first 3 years also were examined. Overall, 14,033 of 76,901 surviving infants received early intervention services. Program costs totaled almost $66 million, with mean cost per surviving infant of $857. Mean cost per infant was highest for children who were 24 to 31 weeks' gestational age ($5393) and higher for infants who were 32 to 36 weeks' gestational age ($1578) compared with those who were born at term ($725). Cost per surviving infant generally decreased with increasing gestational age. Among children in early intervention, mean cost per child was higher for preterm infants than for term infants. At each gestational age, mean cost per surviving infant was higher for multiples than for singletons, and annual early intervention costs were higher for toddlers than for infants. Compared with their term counterparts, preterm infants incurred higher early intervention costs. This information along with data on birth trends will inform budget forecasting for early intervention programs. Costs that are associated with early childhood developmental services must be included when considering the long-term costs of prematurity.

Influence of Clinical Status on the Association Between Plasma Total and Unbound Bilirubin and Death or Adverse Neurodevelopmental Outcomes in Extremely Low Birth Weight Infants

PubMed Central

Oh, William; Stevenson, David K.; Tyson, Jon E.; Morris, Brenda H.; Ahlfors, Charles E.; Bender, G. Jesse; Wong, Ronald J.; Perritt, Rebecca; Vohr, Betty R.; Van Meurs, Krista P.; Vreman, Hendrik J.; Das, Abhik; Phelps, Dale L.; O’Shea, T. Michael; Higgins, Rosemary D.

2010-01-01

Objectives To assess the influence of clinical status on the association between total plasma bilirubin and unbound bilirubin on death or adverse neurodevelopmental outcomes at 18–22 months corrected age in extremely low birth weight infants. Method Total plasma biirubin and unbound biirubin were measured in 1,101 extremely low birth weight infants at 5±1 day of age. Clinical criteria were used to classify infants as clinically stable or unstable. Survivors were examined at 18–22 months corrected age by certified examiners. Outcome variables were death or neurodevelopmental impairment, death or cerebral palsy, death or hearing loss, and death prior to follow-up. For all outcomes, the interaction between bilirubin variables and clinical status was assessed in logistic regression analyses adjusted for multiple risk factors. Results Regardless of clinical status, an increasing level of unbound bilirubin was associated with higher rates of death or neurodevelopmental impairment, death or cerebral palsy, death or hearing loss and death before follow-up. Total plasma bilirubin values were directly associated with death or neurodevelopmental impairment, death or cerebral palsy, death or hearing loss, and death before follow-up in unstable infants, but not in stable infants. An inverse association between total plasma bilirubin and death or cerebral palsy was found in stable infants. Conclusions In extremely low birth weight infants, clinical status at 5 days of age affects the association between total plasma and unbound bilirubin and death or adverse neurodevelopmental outcomes at 18–22 months of corrected age. An increasing level of UB is associated a higher risk of death or adverse neurodevelopmental outcomes regardless of clinical status. Increasing levels of total plasma bilirubin are directly associated with increasing risk of death or adverse neurodevelopmental outcomes in unstable, but not in stable infants. PMID:20105142

Infant nutrition in Saskatoon: barriers to infant food security.

PubMed

Partyka, Brendine; Whiting, Susan; Grunerud, Deanna; Archibald, Karen; Quennell, Kara

2010-01-01

We explored infant nutrition in Saskatoon by assessing current accessibility to all forms of infant nourishment, investigating challenges in terms of access to infant nutrition, and determining the use and effectiveness of infant nutrition programs and services. We also examined recommendations to improve infant food security in Saskatoon. Semi-structured community focus groups and stakeholder interviews were conducted between June 2006 and August 2006. Thematic analysis was used to identify themes related to infant feeding practices and barriers, as well as recommendations to improve infant food security in Saskatoon. Our study showed that infant food security is a concern among lower-income families in Saskatoon. Barriers that limited breastfeeding sustainability or nourishing infants through other means included knowledge of feeding practices, lack of breastfeeding support, access and affordability of infant formula, transportation, and poverty. Infant nutrition and food security should be improved by expanding education and programming opportunities, increasing breastfeeding support, and identifying acceptable ways to provide emergency formula. If infant food security is to be addressed successfully, discussion and change must occur in social policy and family food security contexts.

Response to Infant Cry in Clinically Depressed and Non-Depressed Mothers

PubMed Central

Manian, Nanmathi; Truzzi, Anna; Bornstein, Marc H.

2017-01-01

Background Bowlby and Ainsworth hypothesized that maternal responsiveness is displayed in the context of infant distress. Depressed mothers are less responsive to infant distress vocalizations (cry) than non-depressed mothers. The present study focuses on acoustical components of infant cry that give rise to responsive caregiving in clinically depressed (n = 30) compared with non-depressed mothers (n = 30) in the natural setting of the home. Methods Analyses of infant and mother behaviors followed three paths: (1) tests of group differences in acoustic characteristics of infant cry, (2) tests of group differences of mothers’ behaviors during their infant’s crying, and (3) tree-based modeling to ascertain which variable(s) best predict maternal behaviors during infant cry. Results (1) Infants of depressed mothers cried as frequently and for equal durations as infants of non-depressed mothers; however, infants of depressed mothers cried with a higher fundamental frequency (f0) and in a more restricted range of f0. (2) Depressed mothers fed, rocked, and touched their crying infants less than non-depressed mothers, and depressed mothers were less responsive to their infants overall. (3) Novel tree-based analyses confirmed that depressed mothers engaged in less caregiving during their infants’ cry and indicated that depressed mothers responded only to cries at higher f0s and shorter durations. Older non-depressed mothers were the most interactive with infants. Conclusions Clinical depression affects maternal responsiveness during infant cry, leading to patterns of action that appear poorly attuned to infant needs. PMID:28046020

Health departments do it better: prenatal care site and prone infant sleep position.

PubMed

Lahr, Martin B; Rosenberg, Kenneth D; Lapidus, Jodi A

2005-06-01

Reduction of prone infant sleep position has been the main public health effort to reduce the incidence of Sudden Infant Death Syndrome (SIDS). Oregon Pregnancy Risk Assessment Monitoring System (PRAMS) surveys a stratified random sample of women after a live birth. In 1998-1999, 1867 women completed the survey (64.0% unweighted response; 73.5% weighted response). Overall, 9.2% of all women "usually" chose prone infant sleep position, while 24.2% chose side and 66.5% chose supine position. Women receiving care from private physicians or HMOs more often chose prone position (10.6%) than women receiving prenatal care from health department clinics (2.5%), hospital clinics (6.1%) or other sites (8.3%). Compared to health department prenatal clinic patients, private prenatal patients were more likely to choose prone infant sleep position, adjusted odds ratio = 4.78 (95% confidence interval [CI] 1.64-13.92). Health Department clinics have done a better job than private physicians in educating mothers about putting infants to sleep on their backs. Providers-especially private providers-should continue to stress the importance of supine sleep position for infants.

[Infants' attachment security in a vulnerable French sample].

PubMed

Tereno, S; Guedeney, N; Dugravier, R; Greacen, T; Saïas, T; Tubach, F; Ulgen, S; Matos, I; Guédeney, A

2017-04-01

Attachment is a long lasting emotional link established between infants and their caregivers. The quality of early relationships allows infants to safely explore their environment and contribute to the establishment of a broad range of social skills. Several intervention programs targeting infant attachment have been implemented in different contexts, showing diverse degrees of efficacy. The present paper describes, for the first time, children's attachment quality distributions in a French multi-risk population, with a preventive intervention, usual or reinforced. In the CAPEDP study (Parenting and Attachment in Early Childhood: reducing mental health disorder risks and promoting resilience), a sub-sample of 117 women was recruited to assess the effects of this home-visiting program on children's attachment security. With that intent, the Strange Situation Paradigm was used when infants were between 12 and 16 months of age. In the intervention group, 63% (n=41) of the infants were coded as secure, while 15% (n=10) of them were coded as insecure-avoidant and 22% (n=14) as insecure-ambivalent/resistant. 56% (n=29) of control group infants (usual care) were coded as secure, while 27% (n=14) were coded as insecure-avoidant and 17% (n=9) as insecure-ambivalent/resistant. Even if the percentage of children with a secure attachment in the reinforced intervention group was higher than that of the control group, this difference did not reach the threshold of significance [Chi 2 (2)=2.40, P=0.30]. Intervention group distributions were closer to normative samples, and these distributions show the clinical impact of our program. In general, preventive interventions focused on attachment quality have moderate effects but, in our case, several factors might have contributed to lower the statistical impact of the program. Firstly, the control group cannot be considered has having received zero intervention for two reasons: (a) the French usual perinatal health system (Maternal and Infant Protection System) is particularly generous and (b) the effect of this usual system might have been increased by the project intensive assessment protocol (6 visits during 28 months). Secondly, it is possible that the full effect of the intervention had not yet been detected because, when a child's attachment was assessed, only two thirds of the intervention visits had been performed (29 of 44 visits). A "sleeper effect" is still possible: we hope that a more clear result will be seen when children are assessed again, at 48 months, in our follow-up study (CAPEDP-A II). By clarifying the mechanisms involved in the development of a secure attachment, our study aims to contribute and refine the development of early preventive intervention strategies in high perinatal and psychosocial vulnerability contexts. Copyright © 2016 L’Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.

The Early Childhood Obesity Prevention Program (ECHO): an ecologically-based intervention delivered by home visitors for newborns and their mothers.

PubMed

Cloutier, Michelle M; Wiley, James; Wang, Zhu; Grant, Autherene; Gorin, Amy A

2015-06-24

Obesity is a major problem in the United States, particularly among socio-economically disadvantaged Latino and Black children. Effective interventions that can be disseminated to large numbers of at-risk children and their families are needed. The goals of the Early Childhood Obesity Prevention Program (ECHO) are to examine the 12-month efficacy of a primary obesity prevention program targeting the first year of life that is delivered by home visitors and that engages mothers as agents of change to modify their own behavior and their infant's behavior through education and skill-building around nutrition, physical activity, and wellness, and then "echoes" her training with linkages to neighborhood programs and resources. Six family centers located in low-income neighborhoods in Hartford, CT were randomized into control and intervention neighborhoods. Fifty-seven mothers were recruited either prenatally or shortly after delivery into the Nurturing Families Network home visitation program; 27 lived in a control neighborhood and received the standard home visitation program and 30 lived in an intervention neighborhood and received both the standard home visitation program and the ECHO intervention. The intervention increases maternal skills in goal-setting, stimulus control and problem-solving, engages family members to support changes, links mothers to neighborhood resources and is embedded in the standard home visitation program. ECHO targets include breastfeeding, solids, juice and sugar-sweetened beverages, routines for sleep and responding to infant cues, television/screen time, and maternal diet and physical activity. We hypothesize that infants in ECHO will have been breastfed longer and exclusively, will have delayed introduction of solids and juice, have longer sleep duration, decreased television/screen time and a lower weight for length z-score at 12 months, and their mothers will have greater fruit and vegetable consumption and higher levels of physical activity. ECHO will provide important information about whether an enhanced behavior change curriculum integrated into an existing home visitation program, focused on the mother as the agent of change and linked to neighborhood resources is effective in changing energy balance behaviors in the infant and in the mother. If effective, the intervention could be widely disseminated to prevent obesity in young children. ClinicalTrials.gov NCT02052518 January 30, 2014.

Pediatric HIV Clinical Care Resources and Management Practices in Asia: A Regional Survey of the TREAT Asia Pediatric Network

PubMed Central

Bowen, Asha C.; Pang, Joselyn; Hesp, Cees; Kariminia, Azar; Sohn, Annette H.

2010-01-01

Abstract Characterizing intraregional differences in current pediatric HIV care and treatment in Asia can guide the development of clinical practice guidelines and improve the understanding of local resource availability. The Therapeutics Research, Education, and AIDS Training in Asia (TREAT Asia) Pediatric Program is a collaboration of clinics and referral hospitals studying pediatric HIV outcomes in the region. A Web-based survey to characterize clinical management practices and monitoring resources was developed and distributed to 20 sites in January 2008. Seventeen (85%) sites from 6 countries responded through April 2008; 14 (82%) were hospital-based and 16 (94%) were public facilities. Of 4050 HIV-infected children under care, 3606 (89%) were on antiretroviral treatment; 80% were on their first mono-, dual-, or triple-drug regimen and 74% were on nevirapine- or efavirenz-based regimens. Fifteen (88%) sites had consistent access to polymerase chain reaction (PCR) testing for infant diagnosis. All sites had access to CD4 testing, with 13 (76%) routinely monitoring patients every 3–6 months; 7 (41%) sites monitored viral load at 6- to 12-month intervals. Although there is some variation in clinical practices, high levels of treatment and monitoring resources were available at these sites. The availability of PCR for early infant diagnosis positions them to implement recent WHO recommendations to treat HIV-infected children younger than 1 year of age. This information will be used to develop future research and programs to support children with HIV in Asia. PMID:20059355

Quality Details: A Close-Up Look at Child Care Program Strengths and Weaknesses.

ERIC Educational Resources Information Center

Cryer, Debby; Phillipsen, Leslie

1997-01-01

Examined quality of infant/toddler and preschool child care centers. Found that although overall program quality was mediocre at best, accredited programs scored better than nonaccredited programs. Preschool classrooms needed improvements in cultural awareness, child privacy, and furnishings for relaxation. For infant/toddler programs,…

The CCH Vision Stimulation Program for Infants with Low Vision: Preliminary Results.

ERIC Educational Resources Information Center

Leguire, L. E.; And Others

1992-01-01

This study evaluated the Columbus (Ohio) Children's Hospital vision stimulation program, involving in-home intervention with 15 visually impaired infants. Comparison with controls indicated benefits of appropriate vision stimulation in increasing the neural foundation for vision and visual-motor function in visually impaired infants. (Author/DB)

Long-term mother and child mental health effects of a population-based infant sleep intervention: cluster-randomized, controlled trial.

PubMed

Hiscock, Harriet; Bayer, Jordana K; Hampton, Anne; Ukoumunne, Obioha C; Wake, Melissa

2008-09-01

Maternal depression is an established risk for adverse child development. Two thirds of clinically significant depressive symptoms occur in mothers reporting an infant sleep problem. We aimed to determine the long-term effects of a behavioral intervention for infant sleep problems on maternal depression and parenting style, as well as on child mental health and sleep, when the children reached 2 years of age. We conducted a cluster-randomized trial in well-child centers across 6 government areas of Melbourne, Australia. Participants included 328 mothers reporting an infant sleep problem at 7 months, drawn from a population sample (N = 739) recruited at 4 months. We compared the usual well-child care (n = 154) versus a brief behavior-modification program designed to improve infant sleep (n = 174) delivered by well-child nurses at ages 8 to 10 months and measured maternal depression symptoms (Edinburgh Postnatal Depression Scale); parenting practices (Parent Behavior Checklist); child mental health (Child Behavior Checklist); and maternal report of a sleep problem (yes or no). At 2 years, mothers in the intervention group were less likely than control mothers to report clinical depression symptoms: 15.4% vs 26.4% (Edinburgh Postnatal Depression Scale community cut point) and 4.2% vs 13.2% (Edinburgh Postnatal Depression Scale clinical cut point). Neither parenting style nor child mental health differed markedly between the intervention and control groups. A total of 27.3% of children in the intervention group versus 32.6% of control children had a sleep problem. The sleep intervention in infancy resulted in sustained positive effects on maternal depression symptoms and found no evidence of longer-term adverse effects on either mothers' parenting practices or children's mental health. This intervention demonstrated the capacity of a functioning primary care system to deliver effective, universally offered secondary prevention.

[Morbidity among mothers and infants after ambulatory deliveries].

PubMed

Kierkegaard, O

1991-07-29

Postpartum early discharge programs are reviewed. Few programs were mandatory and both primi- and multiparae were included. Discharge varied from two to 72 hours after delivery. Nearly all programs had prenatal preparation and all patients had postpartum follow-up at home. Approximately one per cent of the infants were readmitted mostly on account of hyperbilirubinemia and infections, and half as many mothers were readmitted mostly for hemorrhage and endometritis. Infants discharged very early were readmitted more frequently than others. There were no statistical significant difference in mortality or morbidity between mothers or infants in early discharge groups and control groups.

Washington's Infant Toddler Early Intervention Program Study: Enrollment of Washington Children with Disabilities and Special Health Care Needs in Washington State Public Programs on December 1, 1995.

ERIC Educational Resources Information Center

Keenan, Trisha; And Others

This document presents tables, graphs, and narrative text providing information on the number and characteristics of infants and toddlers, under the age of 3, with disabilities and special health problems who were enrolled in Washington State's infant and toddler early intervention program in 1995. Major findings of the report include the…

Healthy late preterm infants and supplementary artificial milk feeds: effects on breast feeding and associated clinical parameters.

PubMed

Mattsson, Elisabet; Funkquist, Eva-Lotta; Wickström, Maria; Nyqvist, Kerstin H; Volgsten, Helena

2015-04-01

to compare the influence of supplementary artificial milk feeds on breast feeding and certain clinical parameters among healthy late preterm infants given regular supplementary artificial milk feeds versus being exclusively breast fed from birth. a comparative study using quantitative methods. Data were collected via a parental diary and medical records. parents of 77 late preterm infants (34 5/7-36 6/7 weeks), whose mothers intended to breast feed, completed a diary during the infants׳ hospital stay. infants who received regular supplementary artificial milk feeds experienced a longer delay before initiation of breast feeding, were breast fed less frequently and had longer hospital stays than infants exclusively breast fed from birth. Exclusively breast-fed infants had a greater weight loss than infants with regular artificial milk supplementation. A majority of the mothers (65%) with an infant prescribed artificial milk never expressed their milk and among the mothers who used a breast-pump, milk expression commenced late (10-84 hours after birth). At discharge, all infants were breast fed to some extent, 43% were exclusively breast fed. clinical practice and routines influence the initiation of breast feeding among late preterm infants and may act as barriers to the mothers׳ establishment of exclusive breast feeding. Copyright © 2015 Elsevier Ltd. All rights reserved.

Bottlenecks and opportunities for delivering integrated pediatric HIV services in Nepal

PubMed Central

Diese, Mulamba; Shrestha, Lexman; Pradhan, Birendra; Singh, Dipendra; Raaijmakers, Hendrikus; Kisesa, Annefrida; Chamla, Dick; Ntambue, Mukengeshayi Abel

2016-01-01

Background In children, integration of HIV in MNCH services has been shown to incr. ease uptake of early infant diagnosis. This article examines bottlenecks and opportunities for scaling up integrated pediatric HIV services in Nepal. Methods This is a descriptive study using both mixed qualitative and quantitative methods, conducted in January 2015 in 19 facilities in five regions of Nepal most affected by HIV epidemic. The qualitative methods comprised in-depth structured interviews with key informants (leadership of The National Center for AIDS and STD Control and National Public Health Laboratory, district management teams, medical officers in charge of health facilities and HIV clinics, frontline staff at antenatal care and HIV clinics and laboratory). The quantitative methods were used to abstract data of HIV-infected pregnant women seen between January and December 2014, HIV-exposed infants aged less than 12 months, and HIV infected children aged less than 15 years who were initiated HIV treatment from 2010 to 2014. Structured tools were used to collect data which were analysed using IBM SPSS. Results Of the 19 facilities assessed, 18(98%), 18(98%), 14(75%), and 11(58%) provided prevention of mother-to-child transmission (PMTCT), Expanded Program on Immunization (EPI), pediatric ART and nutrition rehabilitation services, respectively. However, only 1(5%) facility collected onsite dried blood spots (DBS) for PCR HIV testing and 6(32%) facilities provided counselling and referral for DBS. In 2014, of the 121 HIV-exposed infants recorded, only 21(17%) received PCR test. The median turnaround time of the PCR test results was 54 days. Of the 21 records with PCR test, 11(52.5%) were from PMTCT clinics, 7(33%) from Nutritional rehabilitation clinics, and 3(14.5%) from pediatric outpatient clinic. Conversely, 934 children were initiated ART between 2010 and 2014, of which 5% were infants and 29% aged between 1 and 5 years. 298(32%) had comorbidities of which 64% had malnutrition. A total of 534(57%) had tuberculosis (TB) status assessed of which 58(11%) had active TB. Infants had lowest retention (63%), high mortality (17.4%), and loss to follow-up (10.9%). Conclusion Few facilities collect DBS and few children receive PCR tests with limited linkage to ART. This has led to late ART initiation, comorbidities, including TB coinfections and poor outcomes. The results indicate that there are opportunities for improving HIV case finding among HIV-exposed infants in PMTCT, EPI, TB, and nutrition services if provider initiated testing and counselling at the point of service delivery is institutionalized in these settings. PMID:26945139

Factors Influencing Engagement and Behavioral Determinants of Infant Feeding in an mHealth Program: Qualitative Evaluation of the Growing Healthy Program

PubMed Central

Litterbach, Eloise-Kate; Russell, Catherine G; Taki, Sarah; Denney-Wilson, Elizabeth; Campbell, Karen J

2017-01-01

Background Infant feeding practices, including breastfeeding and optimal formula feeding practices, can play a role in the prevention of childhood obesity. The ubiquity of smartphone ownership among women of childbearing age provides important opportunities for the delivery of low-cost, broad reach parenting interventions delivered by mobile phone (mHealth or mobile health interventions). Little is known about how parents engage with mHealth programs targeting infant feeding and how such programs might influence infant feeding practices. Objective The objectives of this study were to explore participant views on (1) factors influencing engagement with the Growing healthy program, an mHealth program targeting healthy infant feeding practices from birth to 9 months of age, and (2) the ways in which the program influenced behavioral determinants of capability, opportunity, and motivation for breastfeeding and optimal formula feeding behaviors. Methods Semistructured, telephone interviews were conducted with a purposeful sample (n=24) of mothers participating in the Growing healthy program. Interviews explored participants’ views about engagement with the program and its features, and the ways the program influenced determinants of infant feeding behaviors related to breastfeeding and optimal formula feeding. The interview schedule was informed by the Capability, Opportunity, Motivation, and Behavior (COM-B) model. Results Participants reported that engagement fluctuated depending on need and the degree to which the program was perceived to fit with existing parenting beliefs and values. Participants identified that the credibility of the program source, the user friendly interface, and tailoring of content and push notifications to baby’s age and key transition points promoted engagement, whereas technical glitches were reported to reduce engagement. Participants discussed that the program increased confidence in feeding decisions. For breastfeeding mothers, this was achieved by helping them to overcome doubts about breast milk supply, whereas mothers using formula reported feeling more confident to feed to hunger and satiety cues rather than encouraging infants to finish the bottle. Participants discussed that the program provided around-the-clock, readily accessible, nonjudgmental information and support on infant feeding and helped to reinforce information received by health professionals or encouraged them to seek additional help if needed. Participants reflected that their plans for feeding were typically made before joining the program, limiting the potential for the program to influence this aspect of motivation. Rather, the program provided emotional reassurance to continue with current feeding plans. Conclusions Our findings suggest that engagement with the program was influenced by an interplay between the program features and needs of the user. Participants reported that the program enhanced confidence in feeding decisions by providing a 24/7 accessible, expert, nonjudgmental support for infant feeding that complemented health professional advice. It is likely that interventions need to commence during pregnancy to maximize the impact on breastfeeding intentions and plans. PMID:29254908

Update: Interim Guidance for the Diagnosis, Evaluation, and Management of Infants with Possible Congenital Zika Virus Infection - United States, October 2017.

PubMed

Adebanjo, Tolulope; Godfred-Cato, Shana; Viens, Laura; Fischer, Marc; Staples, J Erin; Kuhnert-Tallman, Wendi; Walke, Henry; Oduyebo, Titilope; Polen, Kara; Peacock, Georgina; Meaney-Delman, Dana; Honein, Margaret A; Rasmussen, Sonja A; Moore, Cynthia A

2017-10-20

CDC has updated its interim guidance for U.S. health care providers caring for infants with possible congenital Zika virus infection (1) in response to recently published updated guidance for health care providers caring for pregnant women with possible Zika virus exposure (2), unknown sensitivity and specificity of currently available diagnostic tests for congenital Zika virus infection, and recognition of additional clinical findings associated with congenital Zika virus infection. All infants born to mothers with possible Zika virus exposure* during pregnancy should receive a standard evaluation at birth and at each subsequent well-child visit including a comprehensive physical examination, age-appropriate vision screening and developmental monitoring and screening using validated tools (3-5), and newborn hearing screen at birth, preferably using auditory brainstem response (ABR) methodology (6). Specific guidance for laboratory testing and clinical evaluation are provided for three clinical scenarios in the setting of possible maternal Zika virus exposure: 1) infants with clinical findings consistent with congenital Zika syndrome regardless of maternal testing results, 2) infants without clinical findings consistent with congenital Zika syndrome who were born to mothers with laboratory evidence of possible Zika virus infection, † and 3) infants without clinical findings consistent with congenital Zika syndrome who were born to mothers without laboratory evidence of possible Zika virus infection. Infants in the first two scenarios should receive further testing and evaluation for Zika virus, whereas for the third group, further testing and clinical evaluation for Zika virus are not recommended. Health care providers should remain alert for abnormal findings (e.g., postnatal-onset microcephaly and eye abnormalities without microcephaly) in infants with possible congenital Zika virus exposure without apparent abnormalities at birth.

Practical application of kangaroo mother care in preterm infants: clinical characteristics and safety of kangaroo mother care.

PubMed

Park, Hyun-kyung; Choi, Byeong Seon; Lee, Seung Jin; Son, In-A; Seol, In-Joon; Lee, Hyun Ju

2014-03-01

To determine the clinical characteristics and safety of kangaroo mother care (KMC) according to the gestational age (GA) or postmenstrual age (PMA). We conducted a prospective clinical study in 31 infants between 25 and 32 weeks' GA. The subjects were categorized into two groups (25-28 weeks' and 29-32 weeks' GA groups) to compare the clinical characteristics associated with KMC. Heart rate, respiratory rate, oxygen saturation, blood pressure and body temperature (BT) were longitudinally assessed for 60 min with respect to the PMA group (29-32 weeks' and 33-36 weeks' PMA groups). The authors analyzed 70 sessions with 31 infants (25-32 weeks' GA, birth weight 760-1740 g, 29-36 weeks' PMA). All infants had statistically significant higher temperatures during KMC than before KMC within clinically acceptable limits (P<0.001). We found a significantly lower variation of BT in the 25-28 weeks' GA group compared with the 29-32 weeks' GA group at 33-36 weeks' PMA, suggesting accelerated skin maturation in more premature infants (P<0.001). Our intermittent KMC was a safe and feasible method for preterm infants. Notably, at the same PMA, preterm infants in the lower at-birth GA group showed an advanced maturation of thermoregulation compared with those in the higher GA group.

Comparisons and Limitations of Current Definitions of Bronchopulmonary Dysplasia for the Prematurity and Respiratory Outcomes Program.

PubMed

Poindexter, Brenda B; Feng, Rui; Schmidt, Barbara; Aschner, Judy L; Ballard, Roberta A; Hamvas, Aaron; Reynolds, Anne Marie; Shaw, Pamela A; Jobe, Alan H

2015-12-01

Bronchopulmonary dysplasia is the most common morbidity of prematurity, but the validity and utility of commonly used definitions have been questioned. To compare three commonly used definitions of bronchopulmonary dysplasia in a contemporary prospective, multicenter observational cohort of extremely preterm infants. At 36 weeks postmenstrual age, the following definitions of bronchopulmonary dysplasia were applied to surviving infants with and without imputation: need for supplemental oxygen (Shennan definition), National Institutes of Health Workshop definition, and "physiologic" definition after a room-air challenge. Of 765 survivors assessed at 36 weeks, bronchopulmonary dysplasia was diagnosed in 40.8, 58.6, and 32.0% of infants, respectively, with the Shennan, workshop and physiologic definitions. The number of unclassified infants was lowest with the workshop definition (2.1%) and highest with the physiologic definition (16.1%). After assigning infants discharged home in room air before 36 weeks as no bronchopulmonary dysplasia, the modified Shennan definition compared favorably to the workshop definition, with 2.9% unclassified infants. Newer management strategies with nasal cannula flows up to 4 L/min or more and 0.21 FiO2 at 36 weeks obscured classification of bronchopulmonary dysplasia status in 12.4% of infants. Existing definitions of bronchopulmonary dysplasia differ with respect to ease of data collection and number of unclassifiable cases. Contemporary changes in management of infants, such as use of high-flow nasal cannula, limit application of existing definitions and may result in misclassification. A contemporary definition of bronchopulmonary dysplasia that correlates with respiratory morbidity in childhood is needed. Clinical trial registered with www.clinicaltrials.gov (NCT01435187).

Early nutrition, growth and cognitive development of infants from birth to 2 years in Malaysia: a study protocol.

PubMed

Nurliyana, Abdul Razak; Mohd Shariff, Zalilah; Mohd Taib, Mohd Nasir; Gan, Wan Ying; Tan, Kit-Aun

2016-09-29

The first 2 years of life is a critical period of rapid growth and brain development. During this period, nutrition and environmental factors play important roles in growth and cognitive development of a child. This report describes the study protocol of early nutrition, growth and cognitive development of infants from birth to 2 years of age. This is a prospective cohort study of mothers and infants recruited from government health clinics in Seremban district in Negeri Sembilan, Malaysia. Infants are followed-up at 6, 12, 18 and 24 months of age. Pre-natal factors that include mother's pre-pregnancy body mass index, gestational weight gain, blood glucose and blood pressure during pregnancy, infant's gestational age, birth weight and head circumference at birth are obtained from patient card. Post-natal factors assessed at each follow-up are feeding practices, dietary intake, anthropometric measurements and cognitive development of infants. Iron status is assessed at 6 months, while infant temperament and home environment are assessed at 12 months. Maternal intelligence is assessed at 18 months. Early life nutritional programming is of current interest as many longitudinal studies are actively being conducted in developed countries to investigate this concept. The concept however is relatively new in developing countries such as Malaysia. This study will provide useful information on early nutrition and infant development in the first two years of life which can be further followed up to identify factors that track into childhood and contribute to growth and cognitive deviations.

The Effects of Cotrimoxazole Prophylactic Treatment on Adverse Health Outcomes among Human Immunodeficiency Virus-Exposed, Uninfected Infants

PubMed Central

Dow, Anna; Kayira, Dumbani; Hudgens, Michael; Van Rie, Annelies; King, Caroline C.; Ellington, Sascha; Kourtis, Athena; Turner, Abigail Norris; Meshnick, Steven; Kacheche, Zebrone; Jamieson, Denise J.; Chasela, Charles; van der Horst, Charles

2012-01-01

Background The World Health Organization guidelines recommend cotrimoxazole prophylactic treatment (CPT) for all HIV-exposed infants from age 6 weeks to the cessation of breastfeeding and the exclusion of HIV infection. There are limited data about the effects of CPT among this population of infants. We examined the effects of CPT on adverse health outcomes among HIV-exposed infants during the first 36 weeks of life by using data from the Breastfeeding, Antiretrovirals, and Nutrition (BAN) study, a large clinical trial of antiretroviral drugs given to the mother or infant for prevention of HIV transmission during breastfeeding. Methods For the analysis, we assigned a status of CPT-exposed to infants who were participating in the study after the CPT program started. We estimated unadjusted and adjusted hazard ratios (HRs) for the effect of CPT status on time to incident malaria, severe illness or death, anemia, and weight-for-age Z score < −2.0. Participation in the study was limited to focus exclusively on HIV-exposed, uninfected infants. Results The HR for the effect of CPT on incident malaria was 0.35 (95% confidence interval [CI]: 0.21, 0.57) during the first 10 weeks of CPT exposure, and 0.93 (95% CI: 0.67, 1.29) for the remaining 20 weeks. CPT was not associated with the other outcomes examined. Conclusions CPT offered temporary protection against malaria among HIV-exposed, uninfected infants. However, CPT offered no protection against anemia, low weight for age, or the collapsed outcome of severe illness or death. PMID:22801093

Comparison of the Mortality and In-Hospital Outcomes of Preterm Infants Treated with Ibuprofen for Patent Ductus Arteriosus with or without Clinical Symptoms Attributable to the Patent Ductus Arteriosus at the Time of Ibuprofen Treatment

PubMed Central

2017-01-01

The aim of this study was to assess the differences in the mortality and in-hospital outcomes of preterm infants with < 28 weeks of gestation who received ibuprofen treatment according to the presence of clinical symptoms (any of oliguria, hypotension, or moderate to severe respiratory difficulty) attributable to hemodynamically-significant patent ductus arteriosus (hsPDA) at the time of first ibuprofen treatment. In total, 91 infants born from April 2010 to March 2015 were included. Fourteen infants (15.4%) received ibuprofen treatment when there were clinical symptoms due to hsPDA (clinical symptoms group). In clinical symptoms group, infants were younger (25 [23–27] vs. 26 [23–27] weeks; P = 0.012) and lighter (655 [500–930] vs. 880 [370–1,780] grams; P < 0.001). Also, the clinical risk index for babies (CRIB)-II scores were higher and more infants received invasive ventilator care ≤ 2 postnatal days. More infants received multiple courses of ibuprofen in clinical symptoms group. Although the frequency of secondary patent ductus arteriosus (PDA) ligation and the incidence of bronchopulmonary dysplasia (BPD) was higher in the clinical symptoms group in the univariate analysis, after multivariate logistic regression analysis adjusting for the CRIB-II score, birthweight, birth year, and the invasive ventilator care ≤ 2 postnatal days, there were no significant differences in mortality, frequency of secondary ligation and in-hospital outcomes including necrotizing enterocolitis (NEC), intraventricular hemorrhage (IVH), BPD or death. Our data suggest that we can hold off on PDA treatment until the clinical symptoms become prominent. PMID:27914140

Infants' social withdrawal symptoms assessed with a direct infant observation method in primary health care.

PubMed

Puura, Kaija; Mäntymaa, Mirjami; Luoma, Ilona; Kaukonen, Pälvi; Guedeney, Antoine; Salmelin, Raili; Tamminen, Tuula

2010-12-01

Distressed infants may withdraw from social interaction, but recognising infants' social withdrawal is difficult. The aims of the study were to see whether an infant observation method can be reliably used by front line workers, and to examine the prevalence of infants' social withdrawal symptoms. A random sample of 363 families with four, eight or 18-month-old infants participated in the study. The infants were examined by general practitioners (GPs) in well-baby clinics with the Alarm Distress BaBy Scale (ADBB), an observation method developed for clinical settings. A score of five or more on the ADBB Scale in two subsequent assessments at a two-week interval was regarded as a sign of clinically significant infant social withdrawal. Kappas were calculated for the GPs' correct rating of withdrawn/not withdrawn against a set of videotapes rated by developer of the method, Professor Guedeney and his research group. The kappas for their ratings ranged from 0.5 to 1. The frequency of infants scoring above the cut off in two subsequent assessments was 3%. The ADBB Scale is a promising method for detecting infant social withdrawal in front line services. Three percents of infants were showing sustained social withdrawal as a sign of distress in this normal population sample. Copyright © 2010 Elsevier Inc. All rights reserved.

Knowledge, attitude and practice of infant feeding in the first 6 months among HIV-positive mothers at the Queen Mamohato Memorial hospital clinics, Maseru, Lesotho

PubMed Central

Dudley, Lilian

2018-01-01

Background The balance between the risks of transmission of human immunodeficiency virus (HIV) through breastfeeding and its life-saving benefits complicates decisions about infant feeding among HIV-positive mothers in the first 6 months. Objective The aim of this study was to assess the knowledge, attitude and practice of infant feeding among HIV-positive mothers attending the prevention of mother-to-child transmission services in Maseru, Lesotho. Method and setting This observational cross-sectional study was done by collecting data from HIV-positive mothers attending the filter clinics of Queen Mamohato Memorial hospital in Maseru, Lesotho. HIV-positive mothers with infants below the age of 6 months attending the clinics at the time of the study were interviewed using a standardised questionnaire. We described the sociodemographic profile of the mothers, the information and education received on prevention of mother-to-child transmission (PMTCT) infant feeding options, the mothers’ knowledge, attitudes and practices of infant feeding, and assessed risk factors for improved knowledge, attitudes and practices. Results The majority (96%) of the 191 HIV-positive mothers who participated in the survey knew about the PMTCT programme and related breastfeeding services. Most of the participants chose to breastfeed (89%), while only 8% formula-fed their infants. Knowledge received during the PMTCT programme was significantly associated with the decision to exclusively breastfeed their infants. Earlier infant feeding counselling and education was associated with more exclusively breastfeeding as compared to late infant feeding counselling (p < 0.001). Conclusion The study found that HIV-positive mothers attending health clinics in Maseru, Lesotho, had high knowledge, and appropriate attitudes and practices with respect to infant feeding; and that early counselling and education improved infant feeding methods among these mothers. PMID:29781690

Results From the New Jersey Statewide Critical Congenital Heart Defects Screening Program

PubMed Central

Garg, Lorraine F.; Van Naarden Braun, Kim; Knapp, Mary M.; Anderson, Terry M.; Koppel, Robert I.; Hirsch, Daniel; Beres, Leslie M.; Hyg, MS; Sweatlock, Joseph; Olney, Richard S.; Glidewell, Jill; Hinton, Cynthia F.; Kemper, Alex R.

2015-01-01

BACKGROUND AND OBJECTIVE New Jersey was the first state to implement legislatively mandated newborn pulse oximetry screening (POxS) in all licensed birthing facilities to detect critical congenital heart defects (CCHDs). The objective of this report was to evaluate implementation of New Jersey’s statewide POxS mandate. METHODS A 2-pronged approach was used to collect data on infants screened in all New Jersey birthing facilities from August 31, 2011, through May 31, 2012. Aggregate screening results were submitted by each birthing facility. Data on failed screens and clinical characteristics of those newborns were reported to the New Jersey Birth Defects Registry (NJBDR). Three indicators were used to distinguish the added value of mandated POxS from standard clinical care: prenatal congenital heart defect diagnosis, cardiology consultation or echocardiogram indicated or performed before PoxS, or clinical findings at the time of POxS warranting a pulse oximetry measurement. RESULTS Of 75 324 live births in licensed New Jersey birthing facilities, 73 320 were eligible for screening, of which 99% were screened. Forty-nine infants with failed POxS were reported to the NJBDR, 30 of whom had diagnostic evaluations solely attributable to the mandated screening. Three of the 30 infants had previously unsuspected CCHDs and 17 had other diagnoses or non-CCHD echocardiogram findings. CONCLUSIONS In the first 9 months after implementation, New Jersey achieved a high statewide screening rate and established surveillance mechanisms to evaluate the unique contribution of POxS. The screening mandate identified 3 infants with previously unsuspected CCHDs that otherwise might have resulted in significant morbidity and mortality and also identified other significant secondary targets such as sepsis and pneumonia. PMID:23858425

Neonatal Magnetic Resonance Imaging Without Sedation Correlates With Injury Severity in Brachial Plexus Birth Palsy.

PubMed

Bauer, Andrea S; Shen, Peter Y; Nidecker, Anna E; Lee, Paul S; James, Michelle A

2017-05-01

Which infants with brachial plexus birth palsy (BPBP) should undergo microsurgical plexus reconstruction remains controversial. The current gold standard for the decision for plexus reconstruction is serial clinical examinations, but this approach obviates the possibility of early surgical treatment. We hypothesize that a new technique using 3-dimensional volumetric proton density magnetic resonance imaging (MRI) without sedation can evaluate the severity of BPBP injury earlier than serial clinical examinations. Infants were prospectively enrolled prior to 12 weeks of age and imaged using 3 Tesla MRI without sedation. Clinical scores were collected at all visits. The imaging findings were graded based on the number of injured levels and the severity of each injury, and a radiological score was calculated. All infants were followed at least until the decision for surgery was made based on clinical examination. Nine infants completed the MRI scan and clinical follow-up. The average Toronto score at presentation was 4.4 out of 10 (range, 0-8.2); the average Active Movement Scale score was 50 out of 105 (range, 0-86). Four infants required surgery: 2 because of a flail limb and Horner syndrome and 2 owing to failure to recover antigravity elbow flexion by age 6 months. Radiological scores ranged from 0 to 18 out of a maximum score of 25. The average radiological score for those infants who required surgery was 12 (range, 6.5-18), whereas the average score for infants who did not require surgery was 3.5 (range, 0-8). Three-dimensional proton density MRI can evaluate spinal nerve roots in infants without the need for radiation, contrast agents, or sedation. These data suggest that MRI can help determine the severity of injury earlier than clinical examination in infants with BPBP, although further study of a larger sample of infants with varying severity of disease is necessary. Diagnostic II. Copyright © 2017 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

7 CFR 246.1 - General purpose and scope.

Code of Federal Regulations, 2014 CFR

2014-01-01

... AGRICULTURE CHILD NUTRITION PROGRAMS SPECIAL SUPPLEMENTAL NUTRITION PROGRAM FOR WOMEN, INFANTS AND CHILDREN... Agriculture shall carry out the Special Supplemental Nutrition Program for Women, Infants and Children (WIC Program). Section 17 of the Child Nutrition Act of 1966, as amended, states in part that the Congress...

7 CFR 246.1 - General purpose and scope.

Code of Federal Regulations, 2010 CFR

2010-01-01

... AGRICULTURE CHILD NUTRITION PROGRAMS SPECIAL SUPPLEMENTAL NUTRITION PROGRAM FOR WOMEN, INFANTS AND CHILDREN... Agriculture shall carry out the Special Supplemental Nutrition Program for Women, Infants and Children (WIC Program). Section 17 of the Child Nutrition Act of 1966, as amended, states in part that the Congress...

7 CFR 246.1 - General purpose and scope.

Code of Federal Regulations, 2012 CFR

2012-01-01

... AGRICULTURE CHILD NUTRITION PROGRAMS SPECIAL SUPPLEMENTAL NUTRITION PROGRAM FOR WOMEN, INFANTS AND CHILDREN... Agriculture shall carry out the Special Supplemental Nutrition Program for Women, Infants and Children (WIC Program). Section 17 of the Child Nutrition Act of 1966, as amended, states in part that the Congress...

7 CFR 246.1 - General purpose and scope.

Code of Federal Regulations, 2011 CFR

2011-01-01

... AGRICULTURE CHILD NUTRITION PROGRAMS SPECIAL SUPPLEMENTAL NUTRITION PROGRAM FOR WOMEN, INFANTS AND CHILDREN... Agriculture shall carry out the Special Supplemental Nutrition Program for Women, Infants and Children (WIC Program). Section 17 of the Child Nutrition Act of 1966, as amended, states in part that the Congress...

7 CFR 246.1 - General purpose and scope.

Code of Federal Regulations, 2013 CFR

2013-01-01

... AGRICULTURE CHILD NUTRITION PROGRAMS SPECIAL SUPPLEMENTAL NUTRITION PROGRAM FOR WOMEN, INFANTS AND CHILDREN... Agriculture shall carry out the Special Supplemental Nutrition Program for Women, Infants and Children (WIC Program). Section 17 of the Child Nutrition Act of 1966, as amended, states in part that the Congress...

Pain-related stress in the Neonatal Intensive Care Unit and salivary cortisol reactivity to socio-emotional stress in 3-month-old very preterm infants.

PubMed

Provenzi, Livio; Giusti, Lorenzo; Fumagalli, Monica; Tasca, Hilarj; Ciceri, Francesca; Menozzi, Giorgia; Mosca, Fabio; Morandi, Francesco; Borgatti, Renato; Montirosso, Rosario

2016-10-01

Very preterm (VPT) infants are hospitalized in the Neonatal Intensive Care Unit (NICU) and exposed to varying levels of skin-breaking procedures (pain-related stress), even in absence of severe clinical conditions. Repeated and prolonged pain exposure may alter hypothalamic-pituitary-adrenal (HPA) axis reactivity in VPT infants. During the post-discharge period, altered HPA axis reactivity has been documented in response to non-social stressors, using salivary cortisol as a biomarker. However, little is known about the effects of NICU pain-related stress on subsequent HPA axis reactivity to socio-emotional stress in infants. We examined the relationship between pain-related stress in NICU and HPA axis reactivity (i.e., salivary cortisol reactivity) to an age-appropriate socio-emotional condition in 37 healthy VPT infants compared to 53 full-term (FT) controls. The number of skin-breaking procedures was obtained across NICU stay for VPT infants. At 3 months (corrected age for prematurity), all infants participated in the maternal Face-to-Face Still-Face (FFSF) procedure, in order to assess HPA axis reactivity to socio-emotional stress (i.e., maternal unresponsiveness). VPT infants exhibited a blunted salivary cortisol reactivity, which was associated with the amount of skin-breaking procedures during NICU: greater pain-related stress predicted lower salivary cortisol reactivity, adjusting for neonatal confounders. These findings further advance our knowledge of how early exposure to pain-related stress in NICU contributes to the programming of an altered HPA axis reactivity to socio-emotional stress in 3-month-old VPT infants, even in the absence of major perinatal complications. Copyright © 2016 Elsevier Ltd. All rights reserved.

Male Sex Associated With Increased Risk of Neonatal Abstinence Syndrome.

PubMed

Charles, M Katherine; Cooper, William O; Jansson, Lauren M; Dudley, Judith; Slaughter, James C; Patrick, Stephen W

2017-06-01

Neonatal abstinence syndrome (NAS) is a postnatal opioid withdrawal syndrome. Factors associated with development of the syndrome are poorly understood; however, infant sex may influence the risk of NAS. Our objective was to determine if infant sex was associated with the development or severity of the syndrome in a large population-based cohort. This retrospective cohort study used vital statistics and prescription, outpatient, and inpatient administrative data for mothers and infants enrolled in the Tennessee Medicaid program between 2009 and 2011. Multivariable logistic regression models were used to evaluate the association between male sex and diagnosis of NAS, accounting for potential demographic and clinical confounders. NAS severity, as evidenced by hospital length of stay, was modeled by using negative binomial regression. Of 102 695 infants, 927 infants were diagnosed with NAS (484 male subjects and 443 female subjects). Adjustments were made for the following: maternal age, race, and education; maternal hepatitis C infection, anxiety, or depression; in utero exposure to selective serotonin reuptake inhibitors and cigarettes; infant birth weight, small for gestational age, and year; and the interaction between opioid type and opioid amount. Male infants were more likely than female infants to be diagnosed with NAS (adjusted odds ratio, 1.18 [95% confidence interval, 1.05-1.33]) and NAS requiring treatment (adjusted odds ratio, 1.24 [95% confidence interval, 1.04-1.47]). However, there was no sex-based difference in severity for those diagnosed with NAS. Treatment of NAS should be tailored to an infant's individual risk for the syndrome. Clinicians should be mindful that male sex is an important risk factor in the diagnosis of NAS. Copyright © 2017 by the American Academy of Pediatrics.

Melding Infant Mental Health and Multisystemic Therapy Approaches to Community-Based Treatment

ERIC Educational Resources Information Center

Willoughby, Jay C.; Carubia, Beau A.; Murgolo, Marisa A.; Carter, Debbie R.; Frankel, Karen A.

2013-01-01

A recent partnership between the Irving Harris Program in Child Development and Infant Mental Health and the Community Based Psychiatry Program at University of Colorado Hospital joined two different approaches to child mental health treatment: infant mental health and multisystemic therapy (MST). This article illustrates the compatibility of…

78 FR 23941 - Advisory Committee on Infant Mortality; Notice of Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-23

... infant mortality; and the implementation of the Healthy Start program and Healthy People 2020 infant... organizations; and, ACIM's recommendations for the HHS National Strategy to Address Infant Mortality. Proposed...

Knowledge, attitudes, beliefs, and behaviors of parents and healthcare providers before and after implementation of a universal rotavirus vaccination program.

PubMed

MacDougall, Donna M; Halperin, Beth A; Langley, Joanne M; MacKinnon-Cameron, Donna; Li, Li; Halperin, Scott A

2016-01-27

In Canada, rotavirus vaccine is recommended for all infants, but not all provinces/territories have publicly funded programs. We compared public and healthcare provider (HCP) knowledge, attitudes, beliefs, and behaviors in a province with a public health nurse-delivered, publicly funded rotavirus vaccination program to a province with a publicly funded, physician-delivered program. A third province with no vaccination program acted as a control. Information about knowledge, attitudes, beliefs, and behaviors of parents whose children were eligible for the universal program and healthcare providers responsible for administering the vaccine were collected through the use of two validated surveys distributed in public health clinics, physicians' offices, and via e-mail. Early and postvaccine-program survey results were compared. A total of 722 early implementation and 709 postimplementation parent surveys and 180 early and 141 postimplementation HCP surveys were analyzed. HCP and public attitudes toward rotavirus vaccination were generally positive and didn't change over time. More parents postprogram were aware of the NACI recommendation and the vaccination program and reported that their healthcare provider discussed rotavirus infection and vaccine with them. Prior to the program across all sites, more physicians than nurses were aware of the national recommendation regarding rotavirus vaccine. In the postprogram survey, however, more nurses were aware of the national recommendation and their provincial universal rotavirus vaccination program. Nurses had higher knowledge scores than physicians in the postprogram survey (p<0.001). Parents of young infants were also more knowledgeable about rotavirus and rotavirus vaccine in the two areas where universal programs were in place (p<0.001). Implementation of a universal rotavirus vaccination program was associated with an increase in knowledge and more positive attitudes toward rotavirus vaccine amongst parents of eligible infants. Nurses involved in a public health-delivered vaccination program were more knowledgeable and had more positive attitudes toward the vaccine than physicians in a jurisdiction where vaccine was physician-delivered. Copyright © 2015 Elsevier Ltd. All rights reserved.

Clinical and Molecular Characterization of Children with Neonatal Diabetes Mellitus at a Tertiary Care Center in Northern India.

PubMed

Jain, Vandana; Satapathy, Amit; Yadav, Jaivinder; Sharma, Rajni; Radha, Venkatesan; Mohan, Viswanathan; De Franco, Elisa; Ellard, Sian

2017-06-15

To study the genetic mutations and clinical profile in children with neonatal diabetes mellitus. Genetic evaluation, clinical management and follow-up of infants with neonatal diabetes. Eleven infants were studied of which eight had permanent neonatal diabetes. Median age at presentation was 8 weeks and mean (SD) birth weight was 2.4 (0.5) kg. Pathogenic genetic mutations were identified in 7 (63.6%) children; 3 infants with mutations in KCNJ11 gene and 1 in ABCC8 were switched to oral sulfonylureas; 2 infants had mutations in INS and 1 in ZFP57. Neonatal diabetes mellitus is a heterogeneous disorder. Identification of genetic cause guides clinical management.

[Experience in the use of anti-colibacillus and Proteus lactoglobulin as a supplement to milk products in diet therapy at a specialized childrens' collective].

PubMed

Soboleva, S V; Zlatnik, E Ia; Mineeva, L D; Kaplin, M M; Shamanova, G P

1989-01-01

A new biologically active supplement (BAS) for infant food was tested at an Infant's Home. BAS-IG contains lactoglobulin, an immune preparation against colibacillus and Proteus. During the primary examination of the infants in the Infant's Home intestinal dysbacteriosis was revealed in 100% of the infants, clinical signs of dysbacteriosis were detected in 88.4% of the infants. Two successive courses of feeding the infants with products enriched with the new supplement resulted in a significant improvement of the microflora composition in them and in normalizing their clinical condition. At the same time positive changes in a number of immunological factors were recorded. The authors have recommended using BAS-IG for correction of dysbacteriosis in children at Infant's Homes.

Methicillin-resistant Staphylococcus aureus nasal colonization in a level III neonatal intensive care unit: Incidence and risk factors.

PubMed

Giuffrè, Mario; Amodio, Emanuele; Bonura, Celestino; Geraci, Daniela M; Saporito, Laura; Ortolano, Rita; Corsello, Giovanni; Mammina, Caterina

2015-05-01

To describe epidemiologic features and identify risk factors for methicillin-resistant Staphylococcus aureus (MRSA) acquisition in a level III neonatal intensive care unit (NICU). A prospective, cohort study in a university-affiliated NICU with an infection control program including weekly nasal cultures of all neonates. Demographic, clinical, and microbiologic data were prospectively collected between June 2009 and June 2013. Molecular characterization of MRSA isolates was done by multilocus variable number tandem repeat fingerprinting, staphylococcal cassette chromosome mec typing, and on representative isolates by multilocus sequence typing and spa typing. Of 949 neonates, 217 (22.87%) had a culture growing MRSA, including 117 neonates testing positive at their first sampling. Of these latter infants, 96 (82.05%) were inborn and 59 (50.43%) had been transferred from the nursery. Length of stay and colonization pressure were strong independent predictors of MRSA acquisition. Among MRSA isolates, 7 sequence types were identified, with ST22-IVa, spa type t223, being the predominant strain. In an endemic area, early MRSA acquisition and high colonization pressure, likely related to an influx of colonized infants from a well-infant nursery, can support persistence of MRSA in NICUs. Surveillance, molecular tracking of strains, and reinforcement of infection control practices, involving well-infant nurseries in a comprehensive infection control program, could be helpful in containing MRSA transmission. Copyright © 2015 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

[Clinical features and magnetic resonance imaging evaluation of encephalopathy in high-risk late preterm infants].

PubMed

Zhu, Yan; Zhang, Ke; Hu, Lan; Xiao, Mi-Li; Li, Zhi-Hua; Chen, Chao

2017-05-01

To investigate the risk factors, clinical features, and magnetic resonance imaging (MRI) changes of encephalopathy in high-risk late preterm infants. Head MRI scan was performed for late preterm infants with high-risk factors for brain injury who were hospitalized between January 2009 and December 2014. The risk factors, clinical features, and head MRI features of encephalopathy in late preterm infants were analyzed. A total of 1 007 late preterm infants underwent MRI scan, among whom 313 (31.1%) had imaging features in accordance with the features of encephalopathy of prematurity. Of all infants, 76.7% had white matter damage. There was no association between the development of encephalopathy and gestational age in late preterm infants, but the detection rate of encephalopathy gradually increased with the increasing birth weight (P<0.05). The logistic regression analysis showed that a history of resuscitation was an independent risk factor for encephalopathy of prematurity (P<0.01). Encephalopathy of prematurity is commonly seen in high-risk late preterm infants, especially white matter damage. A history of resuscitation is an independent risk factor for encephalopathy in late preterm infants.

7 CFR 250.66 - Special Supplemental Nutrition Program for Women, Infants and Children.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 4 2010-01-01 2010-01-01 false Special Supplemental Nutrition Program for Women... (Continued) FOOD AND NUTRITION SERVICE, DEPARTMENT OF AGRICULTURE GENERAL REGULATIONS AND POLICIES-FOOD... ITS JURISDICTION Household Programs § 250.66 Special Supplemental Nutrition Program for Women, Infants...

7 CFR 250.66 - Special Supplemental Nutrition Program for Women, Infants and Children.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 4 2011-01-01 2011-01-01 false Special Supplemental Nutrition Program for Women... (Continued) FOOD AND NUTRITION SERVICE, DEPARTMENT OF AGRICULTURE GENERAL REGULATIONS AND POLICIES-FOOD... ITS JURISDICTION Household Programs § 250.66 Special Supplemental Nutrition Program for Women, Infants...

7 CFR 250.66 - Special Supplemental Nutrition Program for Women, Infants and Children.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 7 Agriculture 4 2013-01-01 2013-01-01 false Special Supplemental Nutrition Program for Women... (Continued) FOOD AND NUTRITION SERVICE, DEPARTMENT OF AGRICULTURE GENERAL REGULATIONS AND POLICIES-FOOD... ITS JURISDICTION Household Programs § 250.66 Special Supplemental Nutrition Program for Women, Infants...

7 CFR 250.66 - Special Supplemental Nutrition Program for Women, Infants and Children.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 7 Agriculture 4 2014-01-01 2014-01-01 false Special Supplemental Nutrition Program for Women... (Continued) FOOD AND NUTRITION SERVICE, DEPARTMENT OF AGRICULTURE GENERAL REGULATIONS AND POLICIES-FOOD... ITS JURISDICTION Household Programs § 250.66 Special Supplemental Nutrition Program for Women, Infants...

7 CFR 250.66 - Special Supplemental Nutrition Program for Women, Infants and Children.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 7 Agriculture 4 2012-01-01 2012-01-01 false Special Supplemental Nutrition Program for Women... (Continued) FOOD AND NUTRITION SERVICE, DEPARTMENT OF AGRICULTURE GENERAL REGULATIONS AND POLICIES-FOOD... ITS JURISDICTION Household Programs § 250.66 Special Supplemental Nutrition Program for Women, Infants...

77 FR 47855 - Agency Information Collection Activities: Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-10

... development outcomes for at- risk children through evidence-based home visiting programs. Under this program...: Proposed Project: Maternal, Infant and Early Childhood Home Visiting Program FY 2012 Non-Competing... Maternal, Infant, and Early Childhood Home Visiting Program, ( http://frwebgate.access.gpo.gov/cgi-bin...

Developing content for a mHealth intervention to promote postpartum retention in prevention of mother-to-child HIV transmission programs and early infant diagnosis of HIV: a qualitative study.

PubMed

Odeny, Thomas A; Newman, Maya; Bukusi, Elizabeth A; McClelland, R Scott; Cohen, Craig R; Camlin, Carol S

2014-01-01

Maternal attendance at postnatal clinic visits and timely diagnosis of infant HIV infection are important steps for prevention of mother-to-child transmission (PMTCT) of HIV. We aimed to use theory-informed methods to develop text messages targeted at facilitating these steps. We conducted five focus group discussions with health workers and women attending antenatal, postnatal, and PMTCT clinics to explore aspects of women's engagement in postnatal HIV care and infant testing. Discussion topics were informed by constructs of the Health Belief Model (HBM) and prior empirical research. Qualitative data were coded and analyzed according to the construct of the HBM to which they related. Themes were extracted and used to draft intervention messages. We carried out two stages of further messaging development: messages were presented in a follow-up focus group in order to develop optimal phrasing in local languages. We then further refined the messages, pretested them in individual cognitive interviews with selected health workers, and finalized the messages for the intervention. Findings indicated that brief, personalized, caring, polite, encouraging, and educational text messages would facilitate women bringing their children to clinic after delivery, suggesting that text messages may serve as an important "cue to action." Participants emphasized that messages should not mention HIV due to fear of HIV testing and disclosure. Participants also noted that text messages could capitalize on women's motivation to attend clinic for childhood immunizations. Applying a multi-stage content development approach to crafting text messages--informed by behavioral theory--resulted in message content that was consistent across different focus groups. This approach could help answer "why" and "how" text messaging may be a useful tool to support maternal and child health. We are evaluating the effect of these messages on improving postpartum PMTCT retention and infant HIV testing in a randomized trial.

A pilot randomized controlled trial of EKG for neonatal resuscitation

PubMed Central

Katheria, Anup; Arnell, Kathy; Brown, Melissa; Hassen, Kasim; Maldonado, Mauricio; Finer, Neil

2017-01-01

Background The seventh edition of the American Academy of Pediatrics Neonatal Resuscitation Program recommends the use of a cardiac monitor in infants that need resuscitation. Previous trials have shown that EKG heart rate is available before pulse rate from a pulse oximeter. To date no trial has looked at how the availability of electrocardiogram (EKG) affects clinical interventions in the delivery room. Objective To determine whether the availability of an EKG heart rate value and tracing to the clinical team has an effect on physiologic measures and related interventions during the stabilization of preterm infants. Design/Methods Forty (40) premature infants enrolled in a neuro-monitoring study (The Neu-Prem Trial: NCT02605733) who had an EKG monitor available were randomized to have the heart rate information from the bedside EKG monitor either displayed or not displayed to the clinical team. Heart rate, oxygen saturation, FiO2 and mean airway pressure from a data acquisition system were recorded every 2 seconds. Results were averaged over 30 seconds and the differences analyzed using two-tailed t-test. Interventions analyzed included time to first change in FiO2, first positive pressure ventilation, first increase in airway pressure, and first intubation. Results There were no significant differences in time to clinical interventions between the blinded and unblinded group, despite the unblinded group having access to a visible heart rate at 66 +/- 20 compared to 114 +/- 39 seconds for the blinded group (p < .0001). Pulse rate from oximeter was lower than EKG heart rate during the first 2 minutes of life, but this was not significant. Conclusion(s) EKG provides an earlier, and more accurate heart rate than pulse rate from an oximeter during stabilization of preterm infants, allowing earlier intervention. All interventions were started earlier in the unblinded EKG group but these numbers were not significant in this small trial. Earlier EKG placement before pulse oximeter placement may affect other interventions, but this needs further study. PMID:29099872

Disparities in infant mortality and effective, equitable care: are infants suffering from benign neglect?

PubMed

Rowley, Diane L; Hogan, Vijaya

2012-04-01

Quality care for infant mortality disparity elimination requires services that improve health status at both the individual and the population level. We examine disparity reduction due to effective care and ask the following question: Has clinical care ameliorated factors that make some populations more likely to have higher rates of infant mortality compared with other populations? Disparities in postneonatal mortality due to birth defects have emerged for non-Hispanic black and Hispanic infants. Surfactant and antenatal steroid therapy have been accompanied by growing disparities in respiratory distress syndrome mortality for black infants. Progesterone therapy has not reduced early preterm birth, the major contributor to mortality disparities among non-Hispanic black and Puerto Rican infants. The Back to Sleep campaign has minimally reduced SIDS disparities among American Indian/Alaska Native infants, but it has not reduced disparities among non-Hispanic black infants. In general, clinical care is not equitable and contributes to increasing disparities.

An overview of clinical tools used to assess neonatal abstinence syndrome.

PubMed

Orlando, Susan

2014-01-01

Several clinical tools have been developed to quantify the severity of withdrawal signs and symptoms exhibited by infants born to substance-using mothers. Scores from the systematic assessments are used to guide treatment of infants with moderate to severe clinical signs. This article provides an overview of published assessment tools developed for infants with neonatal abstinence syndrome. Nurses caring for infants at risk for neonatal abstinence syndrome should be knowledgeable about the tools used to evaluate these infants and guide their treatment. The ideal assessment tool should be published and include item definitions and a protocol for administering the tool. Nurses need education and training to achieve competency and interobserver reliability in the use of a selected tool. Tool-specific materials should be used to standardize training and improve accuracy in assessments. Competent and knowledgeable nurses play a critical role in improving outcomes for infants with neonatal abstinence syndrome.

Conductive hearing loss and middle ear pathology in young infants referred through a newborn universal hearing screening program in Australia.

PubMed

Aithal, Sreedevi; Aithal, Venkatesh; Kei, Joseph; Driscoll, Carlie

2012-10-01

Although newborn hearing screening programs have been introduced in most states in Australia, the prevalence of conductive hearing loss and middle ear pathology in the infants referred through these programs is not known. This study was designed to (1) evaluate the prevalence of conductive hearing loss and middle ear pathology in infants referred by a newborn hearing screening program in north Queensland, (2) compare prevalence rates of conductive hearing loss and middle ear pathology in indigenous and nonindigenous infants, and (3) review the outcomes of those infants diagnosed with conductive hearing loss and middle ear pathology. Retrospective chart review of infants referred to the Audiology Department of The Townsville Hospital was conducted. Chart review of 234 infants referred for one or both ears from a newborn hearing screening program in north Queensland was conducted. A total of 211 infants attended the diagnostic appointment. Review appointments to monitor hearing status were completed for 46 infants with middle ear pathology or conductive hearing loss. Diagnosis of hearing impairment was made using an age-appropriate battery of audiological tests. Results were analyzed for both initial and review appointments. Mean age at initial diagnostic assessment was 47.5 days (SD = 31.3). Of the 69 infants with middle ear pathology during initial diagnostic assessment, 18 had middle ear pathology with normal hearing, 47 had conductive hearing loss, and 4 had mixed hearing loss. Prevalence of conductive hearing loss in the newborns was 2.97 per 1,000 while prevalence of middle ear pathology (with or without conductive hearing loss) was 4.36 per 1,000. Indigenous Australians or Aboriginal and Torres Strait Islander (ATSI) infants had a significantly higher prevalence of conductive hearing loss and middle ear pathology than non-ATSI infants (35.19 and 44.45% vs 17.83 and 28.66%, respectively). ATSI infants also showed poor resolution of conductive hearing loss over time with 66.67% of ATSI infants reviewed showing persistent conductive hearing loss compared to 17.86% of non-ATSI infants. Medical management of 17 infants with persistent conductive hearing loss included monitoring, antibiotic treatment, examination under anesthesia, and grommet insertion. Conductive hearing loss was found to be a common diagnosis among infants referred through screening. ATSI infants had significantly higher rates of middle ear pathology and conductive hearing loss at birth and showed poor resolution of middle ear pathology over time compared to non-ATSI infants. Future research using a direct measure of middle ear function as an adjunct to the automated auditory brainstem response screening tool to distinguish conductive from sensorineural hearing loss may facilitate prioritization of infants for assessment, thus reducing parental anxiety and streamlining the management strategies for the respective types of hearing loss. American Academy of Audiology.

Trends in Breastfeeding Among Infants Enrolled in the Special Supplemental Nutrition Program for Women, Infants and Children - New York, 2002-2015.

PubMed

Lee, Furrina; Edmunds, Lynn S; Cong, Xiao; Sekhobo, Jackson P

2017-06-16

Breastfeeding is widely accepted as the optimal method of infant feeding (1,2). New York Special Supplemental Nutrition Program for Women, Infants and Children (WIC) has prioritized the promotion of breastfeeding. To assess breastfeeding trends among New York WIC infants, indicators for measuring breastfeeding practices reported by the New York Pediatric Nutrition Surveillance System (PedNSS) during 2002-2015 were examined. The prevalence of breastfeeding initiation increased from 62.0% (2002) to 83.4% (2015), exceeding the Healthy People 2020 (HP2020)* objective of 81.9% in 2014, with improvements among all racial/ethnic groups. The percentage of New York WIC infants who breastfed for ≥6 and ≥12 months increased from 30.2% and 15.0% (2002) to 39.5% and 22.8% (2015), respectively. The prevalence of exclusive breastfeeding for ≥3 and ≥6 months increased from 8.9% and 2.9% (2006) to 14.3% and 8.0% (2015), respectively. Despite improvements in breastfeeding initiation, increasing the duration of breastfeeding and of exclusive breastfeeding among infants enrolled in the New York WIC program remains challenging. Identifying targeted strategies to support continued and exclusive breastfeeding should remain priorities for the New York WIC program.

In-Service Infant Teachers Re-Envision Their Practice through a Professional Development Program

ERIC Educational Resources Information Center

Loizou, Eleni; Recchia, Susan L.

2018-01-01

Research Findings: Most infant teachers have been prepared to be early childhood educators with minimal theoretical or practical exposure to infancy. This study highlights the outcomes of a professional development program (PDP) designed to support a group of infant teachers who lacked specific infancy preparation to re-envision their roles. Data…

University-Community Collaboration to Promote Healthy Mothers and Infants: The Relationships and Parenting Support (RAPS) Program

ERIC Educational Resources Information Center

Williams, Patricia Hrusa; Oravecz, Linda M.

2016-01-01

Research highlights the vulnerability of Black mothers and their infants, who experience higher rates of stress, preterm birth, low birth weight, and infant mortality than other racial groups. This article describes the development and implementation of the Relationships and Parenting Support (RAPS) Program, a community-based, family-focused…

Impact of a standardized hand hygiene program on the incidence of nosocomial infection in very low birth weight infants.

PubMed

Capretti, Maria Grazia; Sandri, Fabrizio; Tridapalli, Elisabetta; Galletti, Silvia; Petracci, Elisabetta; Faldella, Giacomo

2008-08-01

This study examined the effects of a standardized hand hygiene program on the rate of nosocomial infection (NI) in very low birth weight (VLBW) infants (birth weight < 1500 g) admitted to our neonatal intensive care unit (NICU). We compared the rate of NI in VLBW infants in 2 separate periods. In the first period, staff were encouraged to perform handwashing using a plain fluid detergent (0.5% triclosan). In the second period, a standardized hand hygiene program was implemented using antimicrobial soap (4% chlorhexidine gluconate) and alcohol-based hand rubs. NI after 72 hours of life was detected in 16 of the 85 VLBW infants in the first period and in 5 of the 80 VLBW infants in the second period. The rate of central venous catheter colonization was significantly lower in the second period (5.8%) than in the first period (16.6%). In our NICU, the incidence of NI in VLBW infants was significantly reduced after the introduction of a standardized handwashing protocol. In our experience, a proper hand hygiene program can save approximately 10 NI episodes/year, at a cost of $10,000 per episode. Therefore, improving hand hygiene practice is a cost-effective program in the NICU.

Clinical Manifestations, Outcomes, and Etiologies of Perinatal Stroke in Taiwan: Comparisons between Ischemic, and Hemorrhagic Stroke Based on 10-year Experience in A Single Institute.

PubMed

Lee, Chien-Chung; Lin, Jainn-Jim; Lin, Kuang-Lin; Lim, Wai-Ho; Hsu, Kai-Hsiang; Hsu, Jen-Fu; Fu, Ren-Huei; Chiang, Ming-Chou; Chu, Shih-Ming; Lien, Reyin

2017-06-01

Perinatal stroke is a common cause of established neurological sequelae. Although several risk factors have been identified, many questions regarding causes and clinical outcomes remain unanswered. This study investigated the clinical manifestations and outcomes of perinatal stroke and identified its etiologies in Taiwan. We searched the reports of head magnetic resonance imaging and computed tomography performed between January 2003 and December 2012. The medical records of enrolled infants with perinatal stroke were also reviewed. Thirty infants with perinatal stroke were identified; 10 infants had perinatal arterial ischemic stroke (PAIS) and 20 had perinatal hemorrhagic stroke (PHS). Neonatal seizure was the most common manifestation and presented in 40% of infants with PAIS and 50% of infants with PHS. All survivors with PAIS and 77% of the surviving infants with PHS developed neurological sequelae. Acute seizure manifestation was associated with poststroke epilepsy in infants with PHS but not in infants with PAIS (86% vs. 0%, p=0.005). PAIS was mostly caused by dysfunctional hemostasis (20%) and embolism (20%), whereas PHS was mostly attributable to birth asphyxia (30%). Perinatal stroke is associated with high mortality and morbidity rates in infants. Clinically, it can be difficult to distinguish PAIS and PHS. One should keep a high level of suspicion, especially for PHS, if infants develop unexplained seizure, cyanosis, conscious change, anemia, and/or thrombocytopenia. A systematic diagnostic approach is helpful in identifying the etiologies of perinatal stroke. Copyright © 2016. Published by Elsevier B.V.

Lessons from the polybrominated diphenyl ethers (PBDEs): precautionary principle, primary prevention, and the value of community-based body-burden monitoring using breast milk.

PubMed

Hooper, Kim; She, Jianwen

2003-01-01

Levels of chemicals in humans (body burdens) are useful indicators of environmental quality and of community health. Chemical body burdens are easily monitored using breast milk samples collected from first-time mothers (primiparae) with infants 2-8 weeks of age. Currently, there is no body-burden monitoring program using breast milk in the United States, although ad hoc systems operate successfully in several European countries. In this article we describe the value of such monitoring and important considerations of how it might be accomplished, drawing from our experiences with pilot monitoring projects. Breast milk has several advantages as a sampling matrix: It is simple and noninvasive, with samples collected by the mother. It monitors body burdens in reproductive-age women and it estimates in utero and nursing-infant exposures, all important to community health. Time-trend data from breast milk monitoring serve as a warning system that identifies chemicals whose body burdens and human exposures are increasing. Time trends also serve as a report card on how well past regulatory actions have reduced environmental chemical exposures. Body-burden monitoring using breast milk should include educational programs that encourage breast-feeding. Finally, and most important, clean breast milk matters to people and leads to primary prevention--the limiting of chemical exposures. We illustrate these advantages with polybrominated diphenyl ethers (PBDEs), a formerly obscure group of brominated flame retardants that rose to prominence and were regulated in Sweden when residue levels were found to be rapidly increasing in breast milk. A community-based body-burden monitoring program using breast milk could be set up in the United States in collaboration with the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). WIC has a large number of lactating first-time mothers: It has 6,000 clinics nationwide and serves almost half (47%) the infants born in the United States. Educational programs (e.g., those run by WIC) are needed that encourage breast-feeding, especially in lower-income communities where breast-feeding rates are low and where breast-feeding may help protect the infant from the effects of environmental chemical exposures. Education is also needed about reducing chemical body burdens. A body-burden monitoring program would provide valuable data on time trends, background levels, and community hot spots in need of mitigation and follow-up health studies; develop analytic methods for new chemicals of concern; and archive breast milk samples for future analyses of other agents.

Effect of multivitamin supplementation on measles vaccine response among HIV-exposed uninfected Tanzanian infants.

PubMed

Sudfeld, Christopher R; Duggan, Christopher; Histed, Alex; Manji, Karim P; Meydani, Simin N; Aboud, Said; Wang, Molin; Giovannucci, Edward L; Fawzi, Wafaie W

2013-08-01

Immunization and nutritional interventions are mainstays of child health programs in sub-Saharan Africa, yet few published data exist on their interactions. HIV-exposed (but uninfected) infants enrolled in a randomized placebo-controlled trial of multivitamin supplements (vitamins B complex, C, and E) conducted in Tanzania were sampled for an assessment of measles IgG quantity and avidity at 15 to 18 months. Infants were vaccinated between 8.5 and 12 months of age, and all mothers received high-dose multivitamins as the standard of care. Of 201 HIV-exposed infants who were enrolled, 138 (68.7%) were seropositive for measles. There were no effects of infant multivitamin supplementation on measles seroconversion proportions, IgG concentrations, or IgG avidity (P > 0.05). The measles seroconversion proportion was greater for HIV-exposed infants vaccinated at 10 to 11 months of age than for those vaccinated at 8.5 to 10 months (P = 0.032) and greater for infants whose mothers had a CD4 T-cell count of <200 cells/μl than for infants whose mothers had a CD4 T-cell count of >350 cells/μl (P = 0.039). Stunted infants had a significantly decreased IgG quantity compared to nonstunted infants (P = 0.012). As for measles avidity, HIV-exposed infants vaccinated at 10 to 11 months had increased antibody avidity compared to those vaccinated at 8.5 to 10 months (P = 0.031). Maternal CD4 T-cell counts of <200 cells/μl were associated with decreased avidity compared to counts of >350 cells/μl (P = 0.047), as were lower infant height-for-age z-scores (P = 0.016). Supplementation with multivitamins containing B complex, C, and E does not appear to improve measles vaccine responses for HIV-exposed infants. Studies are needed to better characterize the impact of maternal HIV disease severity on the immune system development of HIV-exposed infants and the effect of malnutrition interventions on vaccine responses. (This study has been registered at ClinicalTrials.gov under registration no. NCT00197730.).

Effect of Multivitamin Supplementation on Measles Vaccine Response among HIV-Exposed Uninfected Tanzanian Infants

PubMed Central

Duggan, Christopher; Histed, Alex; Manji, Karim P.; Meydani, Simin N.; Aboud, Said; Wang, Molin; Giovannucci, Edward L.; Fawzi, Wafaie W.

2013-01-01

Immunization and nutritional interventions are mainstays of child health programs in sub-Saharan Africa, yet few published data exist on their interactions. HIV-exposed (but uninfected) infants enrolled in a randomized placebo-controlled trial of multivitamin supplements (vitamins B complex, C, and E) conducted in Tanzania were sampled for an assessment of measles IgG quantity and avidity at 15 to 18 months. Infants were vaccinated between 8.5 and 12 months of age, and all mothers received high-dose multivitamins as the standard of care. Of 201 HIV-exposed infants who were enrolled, 138 (68.7%) were seropositive for measles. There were no effects of infant multivitamin supplementation on measles seroconversion proportions, IgG concentrations, or IgG avidity (P > 0.05). The measles seroconversion proportion was greater for HIV-exposed infants vaccinated at 10 to 11 months of age than for those vaccinated at 8.5 to 10 months (P = 0.032) and greater for infants whose mothers had a CD4 T-cell count of <200 cells/μl than for infants whose mothers had a CD4 T-cell count of >350 cells/μl (P = 0.039). Stunted infants had a significantly decreased IgG quantity compared to nonstunted infants (P = 0.012). As for measles avidity, HIV-exposed infants vaccinated at 10 to 11 months had increased antibody avidity compared to those vaccinated at 8.5 to 10 months (P = 0.031). Maternal CD4 T-cell counts of <200 cells/μl were associated with decreased avidity compared to counts of >350 cells/μl (P = 0.047), as were lower infant height-for-age z-scores (P = 0.016). Supplementation with multivitamins containing B complex, C, and E does not appear to improve measles vaccine responses for HIV-exposed infants. Studies are needed to better characterize the impact of maternal HIV disease severity on the immune system development of HIV-exposed infants and the effect of malnutrition interventions on vaccine responses. (This study has been registered at ClinicalTrials.gov under registration no. NCT00197730.) PMID:23720367

Benefits of Lactoferrin, Osteopontin and Milk Fat Globule Membranes for Infants.

PubMed

Demmelmair, Hans; Prell, Christine; Timby, Niklas; Lönnerdal, Bo

2017-07-28

The provision of essential and non-essential amino acids for breast-fed infants is the major function of milk proteins. In addition, breast-fed infants might benefit from bioactivities of milk proteins, which are exhibited in the intestine during the digestive phase and by absorption of intact proteins or derived peptides. For lactoferrin, osteopontin and milk fat globule membrane proteins/lipids, which have not until recently been included in substantial amounts in infant formulas, in vitro experiments and animal models provide a convincing base of evidence for bioactivities, which contribute to the protection of the infant from pathogens, improve nutrient absorption, support the development of the immune system and provide components for optimal neurodevelopment. Technologies have become available to obtain these compounds from cow´s milk and the bovine compounds also exhibit bioactivities in humans. Randomized clinical trials with experimental infant formulas incorporating lactoferrin, osteopontin, or milk fat globule membranes have already provided some evidence for clinical benefits. This review aims to compare findings from laboratory and animal experiments with outcomes of clinical studies. There is good justification from basic science and there are promising results from clinical studies for beneficial effects of lactoferrin, osteopontin and the milk fat globule membrane complex of proteins and lipids. Further studies should ideally be adequately powered to investigate effects on clinically relevant endpoints in healthy term infants.

Benefits of Lactoferrin, Osteopontin and Milk Fat Globule Membranes for Infants

PubMed Central

Prell, Christine; Timby, Niklas; Lönnerdal, Bo

2017-01-01

The provision of essential and non-essential amino acids for breast-fed infants is the major function of milk proteins. In addition, breast-fed infants might benefit from bioactivities of milk proteins, which are exhibited in the intestine during the digestive phase and by absorption of intact proteins or derived peptides. For lactoferrin, osteopontin and milk fat globule membrane proteins/lipids, which have not until recently been included in substantial amounts in infant formulas, in vitro experiments and animal models provide a convincing base of evidence for bioactivities, which contribute to the protection of the infant from pathogens, improve nutrient absorption, support the development of the immune system and provide components for optimal neurodevelopment. Technologies have become available to obtain these compounds from cow´s milk and the bovine compounds also exhibit bioactivities in humans. Randomized clinical trials with experimental infant formulas incorporating lactoferrin, osteopontin, or milk fat globule membranes have already provided some evidence for clinical benefits. This review aims to compare findings from laboratory and animal experiments with outcomes of clinical studies. There is good justification from basic science and there are promising results from clinical studies for beneficial effects of lactoferrin, osteopontin and the milk fat globule membrane complex of proteins and lipids. Further studies should ideally be adequately powered to investigate effects on clinically relevant endpoints in healthy term infants. PMID:28788066

[Clinical analysis of three cases with infant botulism and review of literature].

PubMed

Zhang, Jie; Xu, Wenrui; Zhao, Manman; Wu, Ye; Zhang, Xin; Zhang, Chunyu; Wang, Ying; Liu, Xueqin; Lu, Shan; Xu, Xuefang

2016-03-01

To analyze the clinical characteristics and diagnosis of three cases with infant botulism. Clinical data of three clinically diagnosed cases with infant botulism in May 2015 in Peking University First Hospital were retrospectively analyzed. Literature search at databases of PubMed, Wanfang, China National Knowledge Infrastructure and VIP with the key words"infant AND botulism". The date of literature retrieval was from the database founding to November 2015. The characteristics of infant botulism were summarized through review of literature. Three patients were infants of 4-8 months of age, and all had acute onsets of anorexia and poor response. All of them had normal psychomotor development previously, and without clear history of exposure to poisons. The main findings on physical examination were reduced muscle strength and hypotonia, dullness or disappeared pupillary light reflex, reduced facial expression, weak crying and dysphagia. Unexpectedly their states of consciousness were relatively normal. Finally, through identification and PCR genotyping of bacteria in stool, 2 cases were confirmed as Clostridium (C.) botulinum type B infection. Totally 446 reports were retrieved from foreign language literature and 52 reports from Chinese literature. More than 3,000 cases of infant botulism cases were reported in the world. Rare cases were reported in China and only 1 case was reported in 2000. Most cases of infant botulism had no clear exposure history. The main clinical manifestations are hypotonia, cranial nerve paralysis, flaccid paralysis, but different patients may have different presentations. Detection of C. Botulinum and its toxin in stool can help to confirm the diagnosis. Infant botulism is relatively rare in China, which may be related to the insufficient understanding and inspection level of the disease. It might be underestimated in China.

Impact of Malaria at the End of Pregnancy on Infant Mortality and Morbidity

PubMed Central

Sigauque, Betuel; Sanz, Sergi; Maixenchs, María; Ordi, Jaume; Aponte, John J; Mabunda, Samuel; Alonso, Pedro L; Menéndez, Clara

2011-01-01

Background. There is some consensus that malaria in pregnancy may negatively affect infant's mortality and malaria morbidity, but there is less evidence concerning the factors involved. Methods. A total of 1030 Mozambican pregnant women were enrolled in a randomized, placebo-controlled trial of intermittent preventive treatment with sulfadoxine-pyrimethamine, and their infants were followed up throughout infancy. Overall mortality and malaria morbidity rates were recorded. The association of maternal and fetal risk factors with infant mortality and malaria morbidity was assessed. Results. There were 58 infant deaths among 997 live-born infants. The risk of dying during infancy was increased among infants born to women with acute placental infection (odds ratio [OR], 5.08 [95% confidence interval (CI), 1.77–14.53)], parasitemia in cord blood (OR, 19.31 [95% CI, 4.44–84.02]), low birth weight (OR, 2.82 [95% CI, 1.27–6.28]) or prematurity (OR, 3.19 [95% CI, 1.14–8.95]). Infants born to women who had clinical malaria during pregnancy (OR, 1.96 [95% CI, 1.13–3.41]) or acute placental infection (OR, 4.63 [95% CI, 2.10–10.24]) had an increased risk of clinical malaria during infancy. Conclusions. Malaria infection at the end of pregnancy and maternal clinical malaria negatively impact survival and malaria morbidity in infancy. Effective clinical management and prevention of malaria in pregnancy may improve infant's health and survival. PMID:21199881

Solemnity: A Clinical Risk Index for Iron Deficient Infants.

ERIC Educational Resources Information Center

Honig, Alice Sterling; Oski, Frank A.

1984-01-01

Studies four groups of infants with iron deficiency but without anemia in an attempt to discover behavioral signs that can be used to index high-risk probability for iron deficiency. Solemnity in well-attached infants is suggested as a clinical sign to indicate the need for biochemical screening for iron deficiency. (AS)

Building Competency in Infant Mental Health Practice: The Edith Cowan University Pregnancy to Parenthood Clinic

ERIC Educational Resources Information Center

Matacz, Rochelle; Priddis, Lynn

2016-01-01

This article describes a unique Australian infant mental health (IMH) service for families from pregnancy through to early parenthood (0-3 years) and training center for postgraduate clinical psychology students. The Australian Association for Infant Mental Health Incorporated, West Australia Branch (AAIMHI WA) "Competency Guidelines"®…

The incidence of oropharyngeal dysphagia in infants with GERD-like symptoms.

PubMed

Fishbein, Mark; Branham, Christina; Fraker, Cheryl; Walbert, Laura; Cox, Sibyl; Scarborough, Donna

2013-09-01

Symptoms of infantile gastroesophageal reflux disease (GERD) may overlap with oropharyngeal dysphagia, but the evaluation and treatment of these conditions vary greatly. In this investigation, the incidence of oropharyngeal dysphagia in infants with GERD-like symptoms is determined. A retrospective chart review was performed on infants referred to a pediatric gastroenterology clinic for GERD-like symptoms. A feeding screen was performed in all infants. Standardized bedside swallow evaluation and modified barium swallow (MBS) studies were then performed when clinically indicated. A similarly aged cohort of normal participants also underwent a standard bedside swallow evaluation for group comparison. Study population included 67 infants. A swallow evaluation was recommended in 39 of 67 infants with abnormalities noted in all. Swallowing abnormalities were more frequent and clustered in infants with GERD-like symptoms vs controls. MBS was abnormal in 16 of 17 qualifying infants. Characteristics of at-risk infants included extreme prematurity, developmental delay, or symptoms refractory to antireflux medications. Oropharyngeal dysphagia is prominent in infants with GERD-like symptoms.

Effectiveness of public health spending on infant mortality in Florida, 2001-2014.

PubMed

Bernet, Patrick M; Gumus, Gulcin; Vishwasrao, Sharmila

2018-05-26

Studies investigating the effectiveness of public health spending typically face two major challenges. One is the lack of data on individual program spending, which restricts researchers to rely on aggregate expenditures. The other is the failure to address issues of endogeneity and serial correlation between health outcomes and spending. In this study, we demonstrate that the use of specific spending items as opposed to overall spending, combined with Generalized Method of Moments estimation techniques can do a far better job in revealing the effectiveness of public health services on health outcomes. As an example, we consider the effects of infant-related public health programs on infant mortality rates. Focus on programs expressly related to maternal and infant health was made possible by a unique longitudinal dataset from the Florida Department of Health containing information for all 67 Florida counties spanning 2001 through 2014. Our empirical methodology, by addressing potential endogeneity issues along with serial correlation, allows us to estimate the causal impact of specific public health investments in maternal and infant-related programs on infant mortality. We find that a 10 percent increase in targeted public health spending per infant leads to a 2.07 percent decrease in infant mortality rates. We also find that targeted spending may be more effective in reducing infant mortality among blacks than among whites. The use of targeted spending data along with the Generalized Method of Moments technique can provide stronger evidence to guide future resource allocation and policy decisions in public health. Copyright © 2018 Elsevier Ltd. All rights reserved.

Northern infant syndrome: a deficiency state?

PubMed

Godel, J C; Hart, A G

1984-08-01

A syndrome is described that affected 16 Indian and Inuit infants roughly 3 months old, most of whom were born in settlements in the Canadian Arctic. The infants presented with a clinical picture that included hepatitis, hemolytic anemia, rickets and respiratory distress, a combination that resembled a syndrome first described in malnourished infants at the turn of the century by von Jaksch and Luzet. The clinical course was self-limited, and all the infants survived without sequelae. The cause of the syndrome was not determined; no infectious agents were discovered. However, low levels of vitamins A, C, D and E were found in a few infants in whom assays were done. The implications of these findings and their relation to the possible cause of this "northern infant syndrome" are discussed.

An Official American Thoracic Society Clinical Practice Guideline: Classification, Evaluation, and Management of Childhood Interstitial Lung Disease in Infancy

PubMed Central

Kurland, Geoffrey; Deterding, Robin R.; Hagood, James S.; Young, Lisa R.; Brody, Alan S.; Castile, Robert G.; Dell, Sharon; Fan, Leland L.; Hamvas, Aaron; Hilman, Bettina C.; Langston, Claire; Nogee, Lawrence M.; Redding, Gregory J.

2013-01-01

Background: There is growing recognition and understanding of the entities that cause interstitial lung disease (ILD) in infants. These entities are distinct from those that cause ILD in older children and adults. Methods: A multidisciplinary panel was convened to develop evidence-based guidelines on the classification, diagnosis, and management of ILD in children, focusing on neonates and infants under 2 years of age. Recommendations were formulated using a systematic approach. Outcomes considered important included the accuracy of the diagnostic evaluation, complications of delayed or incorrect diagnosis, psychosocial complications affecting the patient’s or family’s quality of life, and death. Results: No controlled clinical trials were identified. Therefore, observational evidence and clinical experience informed judgments. These guidelines: (1) describe the clinical characteristics of neonates and infants (<2 yr of age) with diffuse lung disease (DLD); (2) list the common causes of DLD that should be eliminated during the evaluation of neonates and infants with DLD; (3) recommend methods for further clinical investigation of the remaining infants, who are regarded as having “childhood ILD syndrome”; (4) describe a new pathologic classification scheme of DLD in infants; (5) outline supportive and continuing care; and (6) suggest areas for future research. Conclusions: After common causes of DLD are excluded, neonates and infants with childhood ILD syndrome should be evaluated by a knowledgeable subspecialist. The evaluation may include echocardiography, controlled ventilation high-resolution computed tomography, infant pulmonary function testing, bronchoscopy with bronchoalveolar lavage, genetic testing, and/or lung biopsy. Preventive care, family education, and support are essential. PMID:23905526

Effects of maternal postpartum depression in a well-resourced sample: Early concurrent and long-term effects on infant cognitive, language, and motor development.

PubMed

Smith-Nielsen, Johanne; Tharner, Anne; Krogh, Marianne Thode; Vaever, Mette Skovgaard

2016-12-01

This study examined early and long-term effects of maternal postpartum depression on cognitive, language, and motor development in infants of clinically depressed mothers. Participants were 83 mothers and their full-term born children from the urban region of Copenhagen, Denmark. Of this group, 28 mothers were diagnosed with postnatal depression three to four months postpartum in a diagnostic interview. Cognitive, language, and motor development was assessed with the Bayley Scales of Infant and Toddler Development third edition, when the infants were 4 and 13 months of age. We found that maternal postpartum depression was associated with poorer cognitive development at infant age four months, the effect size being large (Cohen's d = 0.8) and with similar effects for boys and girls. At 13 months of age infants of clinical mothers did not differ from infants of non-clinical mothers. At this time most (79%) of the clinical mothers were no longer, or not again, depressed. These results may indicate that maternal depression can have an acute, concurrent effect on infant cognitive development as early as at four months postpartum. At the same time, in the absence of other risk factors, this effect may not be enduring. The main weaknesses of the study include the relatively small sample size and that depression scores were only available for 35 of the non-clinical mothers at 13 months. © 2016 Scandinavian Psychological Associations and John Wiley & Sons Ltd.

Validation of clinical case definition of acute intussusception in infants in Viet Nam and Australia.

PubMed

Bines, Julie E; Liem, Nguyen Thanh; Justice, Frances; Son, Tran Ngoc; Carlin, John B; de Campo, Margaret; Jamsen, Kris; Mulholland, Kim; Barnett, Peter; Barnes, Graeme L

2006-07-01

To test the sensitivity and specificity of a clinical case definition of acute intussusception in infants to assist health-care workers in settings where diagnostic facilities are not available. Prospective studies were conducted at a major paediatric hospital in Viet Nam (the National Hospital of Pediatrics, Hanoi) from November 2002 to December 2003 and in Australia (the Royal Children's Hospital, Melbourne) from March 2002 to March 2004 using a clinical case definition of intussusception. Diagnosis of intussusception was confirmed by air enema or surgery and validated in a subset of participants by an independent clinician who was blinded to the participant's status. Sensitivity of the definition was evaluated in 584 infants aged<2 years with suspected intussusception (533 infants in Hanoi; 51 in Melbourne). Specificity was evaluated in 638 infants aged<2 years presenting with clinical features consistent with intussusception but for whom another diagnosis was established (234 infants in Hanoi; 404 in Melbourne). In both locations the definition used was sensitive (96% sensitivity in Hanoi; 98% in Melbourne) and specific (95% specificity in Hanoi; 87% in Melbourne) for intussusception among infants with sufficient data to allow classification (449/533 in Hanoi; 50/51 in Melbourne). Reanalysis of patients with missing data suggests that modifying minor criteria would increase the applicability of the definition while maintaining good sensitivity (96-97%) and specificity (83-89%). The clinical case definition was sensitive and specific for the diagnosis of acute intussusception in infants in both a developing country and a developed country but minor modifications would enable it to be used more widely.

Program for Infant/Toddler Caregivers. Infant/Toddler Caregiving: A Guide to Culturally Sensitive Care.

ERIC Educational Resources Information Center

Mangione, Peter L., Ed.

This guide is intended to be used in conjunction with the fourth module of the Program for Infant/Toddler Caregivers (PITC), a four-module video training course for providers of family and center day care. The videos illustrate key concepts and caregiving techniques for a specific area of care, and the guides provide extensive and in-depth…

The effect of mothers’ empowerment program on premature infants’ weight gain and duration of hospitalization

PubMed Central

Mohammaddoost, Fatemeh; Mosayebi, Ziba; Peyrovi, Hamid; Chehrzad, Minoo-Mitra; Mehran, Abbas

2016-01-01

Background: The readiness of mothers to take care for infants at discharge is a critical issue. Poor readiness of mothers in taking care of premature infants at the time of discharge is associated with potential adverse consequences. This study examined the effect of implementing mothers’ empowerment program on the weight gain and duration of hospitalization in premature infants. Materials and Methods: This study was a quasi-experimental before-after study with a control group, in which 80 mothers with premature infants who were hospitalized in NICU Level II of two hospitals were recruited in the study. Mothers’ empowerment program was implemented as a three-stage training program for the intervention group. Mothers’ readiness questionnaire was completed by the mothers before the intervention and at the discharge time. The changes in mean of mothers’ readiness scores were compared in both the groups. Results: The mean of daily weight gain in infants of the intervention group (3.95 g) was significantly higher than that of the infants in the control group (−0.9 g) (P = 0.003). The average duration of hospitalization for infants in the intervention and control groups was 15.45 days and 20.95 days, respectively, showing a statistically significant difference (P = 0.003). Conclusions: Providing training to the mothers regarding how to care for premature infants can be a useful and effective method in the process of weight gain of premature and low-birth newborns, and may shorten the duration of infants’ hospitalization. PMID:27563317

Clinical Impact and Cost-effectiveness of Diagnosing HIV Infection During Early Infancy in South Africa: Test Timing and Frequency.

PubMed

Francke, Jordan A; Penazzato, Martina; Hou, Taige; Abrams, Elaine J; MacLean, Rachel L; Myer, Landon; Walensky, Rochelle P; Leroy, Valériane; Weinstein, Milton C; Parker, Robert A; Freedberg, Kenneth A; Ciaranello, Andrea

2016-11-01

 Diagnosis of human immunodeficiency virus (HIV) infection during early infancy (commonly known as "early infant HIV diagnosis" [EID]) followed by prompt initiation of antiretroviral therapy dramatically reduces mortality. EID testing is recommended at 6 weeks of age, but many infant infections are missed.  We simulated 4 EID testing strategies for HIV-exposed infants in South Africa: no EID (diagnosis only after illness; hereafter, "no EID"), testing once (at birth alone or at 6 weeks of age alone; hereafter, "birth alone" and "6 weeks alone," respectively), and testing twice (at birth and 6 weeks of age; hereafter "birth and 6 weeks"). We calculated incremental cost-effectiveness ratios (ICERs), using discounted costs and life expectancies for all HIV-exposed (infected and uninfected) infants.  In the base case (guideline-concordant care), the no EID strategy produced a life expectancy of 21.1 years (in the HIV-infected group) and 61.1 years (in the HIV-exposed group); lifetime cost averaged $1430/HIV-exposed infant. The birth and 6 weeks strategy maximized life expectancy (26.5 years in the HIV-infected group and 61.4 years in the HIV-exposed group), costing $1840/infant tested. The ICER of the 6 weeks alone strategy versus the no EID strategy was $1250/year of life saved (19% of South Africa's per capita gross domestic product); the ICER for the birth and 6 weeks strategy versus the 6 weeks alone strategy was $2900/year of life saved (45% of South Africa's per capita gross domestic product). Increasing the proportion of caregivers who receive test results and the linkage of HIV-positive infants to antiretroviral therapy with the 6 weeks alone strategy improved survival more than adding a second test.  EID at birth and 6 weeks improves outcomes and is cost-effective, compared with EID at 6 weeks alone. If scale-up costs are comparable, programs should add birth testing after strengthening 6-week testing programs. © The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail journals.permissions@oup.com.

Family-based obesity prevention for infants: Design of the "Mothers & Others" randomized trial.

PubMed

Wasser, Heather M; Thompson, Amanda L; Suchindran, Chirayath M; Hodges, Eric A; Goldman, Barbara D; Perrin, Eliana M; Faith, Myles S; Bulik, Cynthia M; Heinig, M Jane; Bentley, Margaret E

2017-09-01

Our goal is to test the efficacy of a family-based, multi-component intervention focused on infants of African-American (AA) mothers and families, a minority population at elevated risk for pediatric obesity, versus a child safety attention-control group to promote healthy weight gain patterns during the first two years of life. The design is a two-group randomized controlled trial among 468 AA pregnant women in central North Carolina. Mothers and study partners in the intervention group receive anticipatory guidance on breastfeeding, responsive feeding, use of non-food soothing techniques for infant crying, appropriate timing and quality of complementary feeding, age-appropriate infant sleep, and minimization of TV/media. The primary delivery channel is 6 home visits by a peer educator, 4 interim newsletters and twice-weekly text messaging. Intervention families also receive 2 home visits from an International Board Certified Lactation Consultant. Assessments occur at 28 and 37weeks gestation and when infants are 1, 3, 6, 9, 12, and 15months of age. The primary outcome is infant/toddler growth and likelihood of overweight at 15months. Differences between groups are expected to be achieved through uptake of the targeted infant feeding and care behaviors (secondary outcomes) and change in caregivers' modifiable risk factors (mediators) underpinning the intervention. If successful in promoting healthy infant growth and enhancing caregiver behaviors, "Mothers and Others" will have high public health relevance for future obesity-prevention efforts aimed at children younger than 2years, including interventional research and federal, state, and community health programs. ClinicalTrials.gov, NCT01938118, August 9, 2013. Copyright © 2017 Elsevier Inc. All rights reserved.

Placental malaria and the risk of malaria in infants in a high malaria transmission area in ghana: a prospective cohort study.

PubMed

Asante, Kwaku Poku; Owusu-Agyei, Seth; Cairns, Matthew; Dodoo, Daniel; Boamah, Ellen Abrafi; Gyasi, Richard; Adjei, George; Gyan, Ben; Agyeman-Budu, Akua; Dodoo, Theophilus; Mahama, Emmanuel; Amoako, Nicholas; Dosoo, David Kwame; Koram, Kwadwo; Greenwood, Brian; Chandramohan, Daniel

2013-11-01

Whether the risk of malaria is increased in infants born to mothers who experience malaria during pregnancy is uncertain.  We investigated malaria incidence among an infant cohort born to 355 primigravidae and 1500 multigravidae with or without placental malaria (PM) in a high malaria transmission area of Ghana. PM was assessed using placental histology. The incidence of all episodes of malaria parasitemia or clinical malaria was very similar among 3 groups of infants: those born to multigravidae without PM, multigravidae with PM, and primigravidae with PM. Infants born to primigravidae without PM experienced a lower incidence of malaria parasitemia or clinical malaria than the other 3 groups: adjusted hazard ratio, 0.64 (95% confidence interval [CI], .48-.86, P < .01) and 0.60 (95% CI, .43-.84, P < .01), respectively. The incidence of malaria parasitemia or clinical malaria was about 2 times higher in most poor infants compared to least poor infants. There was no suggestion that exposure to PM directly increased incidence of malaria among infants of multigravidae. In our study area, absence of placental malaria in primigravidae is a marker of low exposure, and this probably explains the lower incidence of malaria-related outcomes among infants of PM-negative primigravidae.

A qualitative study of clinical reasoning in physiotherapy with preterm infants and their parents: Action and interaction.

PubMed

Håkstad, Ragnhild B; Obstfelder, Aud; Øberg, Gunn Kristin

2018-09-01

Physiotherapists (PTs) in primary health care provide services to preterm infants and their parents after hospital discharge. The service should be collaborative and individualized to meet the family's needs. In this study, we analyze pediatric PTs' collaborative work in the clinical setting and investigate the PTs' emerging clinical reasoning (CR) in interaction with the infant and parent(s). The study is based on observations of 20 physical therapy sessions and 20 interviews with PTs. We performed a systematic content analysis informed by enactive theory regarding the interactions and co-creation of meaning. CR emerged in reciprocity with the PTs' interaction with the infant and parent(s). Based on the sensitivity to the infant's motor abilities and signs of engagement as well as the parents' need of support and education, the PTs individualized and reasoned about their therapeutic approach. This interactional CR was vulnerable: infant disengagement, parent expectations, and PT preoccupations could obfuscate interactions and hamper CR. Through mutuality and engagement with the infant and parent(s), the PTs allow the autonomy of interaction to emerge and shape the translation of CR into successful therapeutic actions and learning together with the infant and parent(s).

Selenium deficiency and the effects of supplementation on preterm infants

PubMed Central

Freitas, Renata Germano B. O. N.; Nogueira, Roberto José N.; Antonio, Maria Ângela R. G. M.; Barros-Filho, Antonio de Azevedo; Hessel, Gabriel

2014-01-01

Objective: This study aimed to review the literature about blood concentrations of selenium associated with gestational age, feeding, supplementation and related clinical features in preterm infants. Data sources: Systematic review in the following databases: MEDLINE, PubMed, Google academics, SciELO. org, ScienceDirect (Elsevier) and CINAHL-Plus with Full Text (EBSCO). Articles published up to January 2013 with the keywords "selenium deficiency", "selenium supplementation", "neonates", "infants", "newborn" and "preterm infants" were selected. Data synthesis: The studies reported that low blood selenium levels are associated with increased risk of respiratory diseases. Preterm infants, especially with low birth weight, presented lower selenium levels. Selenium deficiency has also been associated with the use of oral infant formula, enteral and parenteral nutrition (with or without selenium addition). The optimal dose and length of selenium supplementation is not well-established, since they are based only on age group and selenium ingestion by breastfed children. Furthermore, the clinical status of the infant affected by conditions that may increase oxidative stress, and consequently, selenium requirements is not taken into account. Conclusions: Prematurity and low birth weight can contribute to low blood selenium in premature infants. Selenium supplementation seems to minimize or prevent clinical complications caused by prematurity. PMID:24676200

Affective facial expression in sub-clinically depressed and non-depressed mothers during contingent and non-contingent face-to-face interactions with their infants.

PubMed

Braarud, Hanne Cecilie; Skotheim, Siv; Høie, Kjartan; Markhus, Maria Wik; Kjellevold, Marian; Graff, Ingvild Eide; Berle, Jan Øystein; Stormark, Kjell Morten

2017-08-01

Depression in the postpartum period involves feelings of sadness, anxiety and irritability, and attenuated feelings of pleasure and comfort with the infant. Even mild- to- moderate symptoms of depression seem to have an impact on caregivers affective availability and contingent responsiveness. The aim of the present study was to investigate non-depressed and sub-clinically depressed mothers interest and affective expression during contingent and non-contingent face-to-face interaction with their infant. The study utilized a double video (DV) set-up. The mother and the infant were presented with live real-time video sequences, which allowed for mutually responsive interaction between the mother and the infant (Live contingent sequences), or replay sequences where the interaction was set out of phase (Replay non-contingent sequences). The DV set-up consisted of five sequences: Live1-Replay1-Live2-Replay2-Live3. Based on their scores on the Edinburgh Postnatal Depression Scale (EPDS), the mothers were divided into a non-depressed and a sub-clinically depressed group (EPDS score≥6). A three-way split-plot ANOVA showed that the sub-clinically depressed mothers displayed the same amount of positive and negative facial affect independent of the quality of the interaction with the infants. The non-depressed mothers displayed more positive facial affect during the non-contingent than the contingent interaction sequences, while there was no such effect for negative facial affect. The results indicate that sub-clinically level depressive symptoms influence the mothers' affective facial expression during early face-to-face interaction with their infants. One of the clinical implications is to consider even sub-clinical depressive symptoms as a risk factor for mother-infant relationship disturbances. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

Hyperparasitaemia during clinical malaria episodes in infants aged 0-24 months and its association with in utero exposure to Plasmodium falciparum.

PubMed

Sylvester, Boniphace; Gasarasi, Dinah B; Aboud, Said; Tarimo, Donath; Massawe, Siriel; Mpembeni, Rose; Swedberg, Gote

2018-04-04

Existing information has shown that infants who are prenatally exposed to P. falciparum are susceptible to subsequent malaria infections. However, the effect of prenatal exposure to P. falciparum on parasite density during clinical malaria episodes has not been fully elucidated. This study is a component of a prospective cohort study for which initial results have been published. This component was designed to determine the effect of prenatal exposure to P. falciparum on parasite density during clinical malaria episodes in the first 24 months of life. A total of 215 infants were involved and monitored for clinical malaria episodes defined by fever (≥ 37 °C) and parasitaemia. The geometric mean parasite counts between exposed and unexposed infants were compared using independent samples t test. The effect of in utero exposure to P. falciparum on parasite density was assessed using binary logistic regression. The geometric mean parasite count per µl of blood during clinical malaria episodes in exposed infants was 24,889 (95% CI 18,286-31,490) while in unexposed infants it was 14,035 (95% CI 12,111-15,960), P < 0.05. Prenatal exposure to P. falciparum was associated with hyperparasitaemia during clinical malaria episodes (OR 7.04, 95% CI 2.31-21.74), while other factors were not significantly associated (P > 0.05).

Music and 25% glucose pain relief for the premature infant: a randomized clinical trial.

PubMed

Cardoso, Maria Vera Lúcia Moreira Leitão; Farias, Leiliane Martins; de Melo, Gleicia Martins

2014-10-01

To analyze the total Premature Infant Pain Profile scores of premature infants undergoing arterial puncture during music and 25% glucose interventions, and to assess their association with neonatal and therapeutic variables. A randomized clinical trial with 80 premature infants; 24 in the Experimental Group 1 (music), 33 in the Experimental Group 2 (music and 25% glucose), 23 in the Positive Control Group (25% glucose). All premature infants were videotaped and a lullaby was played for ten minutes before puncture in Experimental Groups 1 and 2; 25% glucose administered in Experimental Group 2 and the Positive Control Group two minutes before puncture. 60.0% of premature infants had moderate or maximum pain; pain scores and intervention groups were not statistically significant. Statistically significant variables: Experimental Group 1: head and chest circumference, Apgar scores, corrected gestational age; Experimental Group 2: chest circumference, Apgar scores, oxygen therapy; Positive Control group: birth weight, head circumference. Neonatal variables are associated with pain in premature infants. Brazilian Registry of Clinical Trials: UTN: U1111-1123-4821.

Converging Streams of Opportunity for Prison Nursery Programs in the United States

PubMed Central

GOSHIN, LORIE SMITH; BYRNE, MARY WOODS

2009-01-01

Prison nursery programs allow departments of correction to positively intervene in the lives of both incarcerated mothers and their infant children. The number of prison nurseries in the United States has risen dramatically in the past decade, yet there remains a significant gap between predominant correctional policy in this area and what is known about parenting and infant development. Using Kingdon’s streams metaphor, this article examines the recent convergence of problem, policy, and political events related to incarcerated women with infant children and argues that this has created a window of opportunity for development of prison nursery programs. Aday’s policy analysis criteria are also used to analyze available evidence regarding the effectiveness, efficiency, and equity of prison nursery programs as policy alternatives for incarcerated women with infant children. PMID:19865610

The Effect of Nursing Quality Improvement and Mobile Health Interventions on Infant Sleep Practices: A Randomized Clinical Trial.

PubMed

Moon, Rachel Y; Hauck, Fern R; Colson, Eve R; Kellams, Ann L; Geller, Nicole L; Heeren, Timothy; Kerr, Stephen M; Drake, Emily E; Tanabe, Kawai; McClain, Mary; Corwin, Michael J

2017-07-25

Inadequate adherence to recommendations known to reduce the risk of sudden unexpected infant death has contributed to a slowing in the decline of these deaths. To assess the effectiveness of 2 interventions separately and combined to promote infant safe sleep practices compared with control interventions. Four-group cluster randomized clinical trial of mothers of healthy term newborns who were recruited between March 2015 and May 2016 at 16 US hospitals with more than 100 births annually. Data collection ended in October 2016. All participants were beneficiaries of a nursing quality improvement campaign in infant safe sleep practices (intervention) or breastfeeding (control), and then received a 60-day mobile health program, in which mothers received frequent emails or text messages containing short videos with educational content about infant safe sleep practices (intervention) or breastfeeding (control) and queries about infant care practices. The primary outcome was maternal self-reported adherence to 4 infant safe sleep practices of sleep position (supine), sleep location (room sharing without bed sharing), soft bedding use (none), and pacifier use (any); data were collected by maternal survey when the infant was aged 60 to 240 days. Of the 1600 mothers who were randomized to 1 of 4 groups (400 per group), 1263 completed the survey (78.9%). The mean (SD) maternal age was 28.1 years (5.8 years) and 32.8% of respondents were non-Hispanic white, 32.3% Hispanic, 27.2% non-Hispanic black, and 7.7% other race/ethnicity. The mean (SD) infant age was 11.2 weeks (4.4 weeks) and 51.2% were female. In the adjusted analyses, mothers receiving the safe sleep mobile health intervention had higher prevalence of placing their infants supine compared with mothers receiving the control mobile health intervention (89.1% vs 80.2%, respectively; adjusted risk difference, 8.9% [95% CI, 5.3%-11.7%]), room sharing without bed sharing (82.8% vs 70.4%; adjusted risk difference, 12.4% [95% CI, 9.3%-15.1%]), no soft bedding use (79.4% vs 67.6%; adjusted risk difference, 11.8% [95% CI, 8.1%-15.2%]), and any pacifier use (68.5% vs 59.8%; adjusted risk difference, 8.7% [95% CI, 3.9%-13.1%]). The independent effect of the nursing quality improvement intervention was not significant for all outcomes. Interactions between the 2 interventions were only significant for the supine sleep position. Among mothers of healthy term newborns, a mobile health intervention, but not a nursing quality improvement intervention, improved adherence to infant safe sleep practices compared with control interventions. Whether widespread implementation is feasible or if it reduces sudden and unexpected infant death rates remains to be studied. clinicaltrials.gov Identifier: NCT01713868.

Home Visiting Family Support Programs: Benefits of the Maternal, Infant, and Early Childhood Home Visiting Program. Fact Sheet

ERIC Educational Resources Information Center

Home Visiting Campaign, 2015

2015-01-01

The federally funded, locally administered Maternal, Infant, and Early Childhood Home Visiting Program sponsors family support programs that are often called "home visiting" because they take place in the homes of at-risk families. These families often lack support, experience, and knowledge of basic parenting skills. Because children…

Diagnostic markers of serious bacterial infections in febrile infants younger than 90 days old.

PubMed

Nosrati, Adi; Ben Tov, Amir; Reif, Shimon

2014-02-01

The aim of this study was to assess correlations between demographic, clinical and laboratory characteristics and the risk of serious bacterial infection (SBI) in febrile <90-day-old infants. Medical records of all infants younger than 90 days old hospitalized at Dana-Dwek Children's Hospital (2006-2008) for evaluation of fever were retrospectively reviewed. Data on clinical, laboratory and demographic characteristics were retrieved and evaluated. Forty-eight of the 401 study infants (12%) had SBI: most of them had urinary tract infection (43 infants; 90% of all SBI), three infants had bacteremia, one had bacterial pneumonia and one had bacterial meningitis. Significant independent clinical predictors for the diagnosis of SBI included duration of fever, absence of rhinitis and the absence of lung and skin manifestations. Significant independent laboratory predictors were absolute neutrophil count (ANC), platelets, blood urea nitrogen and C-reactive protein (CRP) level. On receiver operating characteristic curve analysis, the CRP area under the curve (0.819) was significantly superior to ANC and leukocyte count. Of the clinical and laboratory variables selected for evaluation, qualitative CRP was the strongest independent predictor for diagnosing SBI and a significantly better diagnostic marker than clinical characteristics, ANC and white blood cell count. © 2013 The Authors. Pediatrics International © 2013 Japan Pediatric Society.

Clinical and demographic factors associated with urinary tract infection in young febrile infants.

PubMed

Zorc, Joseph J; Levine, Deborah A; Platt, Shari L; Dayan, Peter S; Macias, Charles G; Krief, William; Schor, Jeffrey; Bank, David; Shaw, Kathy N; Kuppermann, Nathan

2005-09-01

Previous research has identified clinical predictors for urinary tract infection (UTI) to guide urine screening in febrile children <24 months of age. These studies have been limited to single centers, and few have focused on young infants who may be most at risk for complications if a UTI is missed. The objective of this study was to identify clinical and demographic factors associated with UTI in febrile infants who are < or =60 days of age using a prospective multicenter cohort. We conducted a multicenter, prospective, cross-sectional study during consecutive bronchiolitis seasons. All febrile (> or =38 degrees C) infants who were < or =60 days of age and seen at any of 8 pediatric emergency departments from October through March 1999-2001 were eligible. Clinical appearance was evaluated using the Yale Observation Scale. UTI was defined as growth of a known bacterial pathogen from a catheterized specimen at a level of (1) > or =50000 cfu/mL or (2) > or =10000 cfu/mL in association with a positive dipstick test or urinalysis. We used bivariate tests and multiple logistic regression to identify demographic and clinical factors that were associated with the likelihood of UTI. A total of 1025 (67%) of 1513 eligible patients were enrolled; 9.0% of enrolled infants received a diagnosis of UTI. Uncircumcised male infants had a higher rate of UTI (21.3%) compared with female (5.0%) and circumcised male (2.3%) infants. Infants with maximum recorded temperature of > or =39 degrees C had a higher rate of UTI (16.3%) than other infants (7.2%). After multivariable adjustment, UTI was associated with being uncircumcised (odds ratio: 10.4; bias-corrected 95% confidence interval: 4.7-31.4) and maximum temperature (odds ratio: 2.4 per degrees C; 95% confidence interval: 1.5-3.6). Factors that were reported previously to be associated with risk for UTI in infants and toddlers, such as white race and ill appearance, were not significantly associated with risk for UTI in this cohort of young infants. Being uncircumcised and height of fever were associated with UTI in febrile infants who were < or =60 days of age. Uncircumcised male infants were at particularly high risk and may warrant a different approach to screening and management.

Effects on motor development of kicking and stepping exercise in preterm infants with periventricular brain injury: a pilot study.

PubMed

Campbell, Suzann K; Gaebler-Spira, Deborah; Zawacki, Laura; Clark, April; Boynewicz, Kara; deRegnier, Raye-Ann; Kuroda, Maxine M; Bhat, Rama; Yu, Jinsheng; Campise-Luther, Rose; Kale, Dipti; Bulanda, Michelle; Zhou, Xiaohong Joe

2012-01-01

Preterm infants with periventricular brain injury (PBI) have a high incidence of atypical development and leg movements. Determine whether kicking and treadmill stepping intervention beginning at 2 months corrected age (CA) in children with PBI improves motor function at 12 months CA when compared with control subjects. In a multi-center pilot study for a controlled clinical trial, sixteen infants with PBI were randomly assigned to home exercise consisting of kicking and treadmill stepping or a no-training control condition. Development was assessed at 2, 4, 6, 10, and 12 months CA with the Alberta Infant Motor Scale (AIMS). At 12 months children were classified as normal, delayed, or with cerebral palsy (CP). At 12 months CA 3 of 7 (43%) of the exercise group children walked alone or with one hand held versus 1 of 9 (11%) in the control group (p=0.262), but no significant differences in AIMS scores were found at any age. Half of the subjects had CP or delay; the outcomes of these infants were not improved by exercise. Compliance with the home program was lower than requested and may have affected results. Although not statistically significant with a small sample size, self-produced kicking and treadmill exercise may lower age at walking in infants with normal development following PBI, but improvements of the protocol to increase and document compliance are needed before a larger study is implemented.

Effects on Motor Development of Kicking and Stepping Exercise in Preterm Infants with Periventricular Brain Injury: A Pilot Study

PubMed Central

Campbell, Suzann K.; Gaebler-Spira, Deborah; Zawacki, Laura; Clark, April; Boynewicz, Kara; deRegnier, Raye-Ann; Kuroda, Maxine M.; Bhat, Rama; Yu, Jinsheng; Campise-Luther, Rose; Kale, Dipti; Bulanda, Michelle; Zhou, Xiaohong Joe

2013-01-01

Background Preterm infants with periventricular brain injury (PBI) have a high incidence of atypical development and leg movements. Objective Determine whether kicking and treadmill stepping intervention beginning at 2 months corrected age (CA) in children with PBI improves motor function at 12 months CA when compared with control subjects. Method In a multi-center pilot study for a controlled clinical trial, sixteen infants with PBI were randomly assigned to home exercise consisting of kicking and treadmill stepping or a no-training control condition. Development was assessed at 2, 4, 6, 10, and 12 months CA with the Alberta Infant Motor Scale (AIMS). At 12 months children were classified as normal, delayed, or with cerebral palsy (CP). Results At 12 months CA 3 of 7 (43%) of the exercise group children walked alone or with one hand held versus 1 of 9 (11%) in the control group (p=.262), but no significant differences in AIMS scores were found at any age. Half of the subjects had CP or delay; the outcomes of these infants were not improved by exercise. Compliance with the home program was lower than requested and may have affected results. Conclusion Although not statistically significant with a small sample size, self-produced kicking and treadmill exercise may lower age at walking in infants with normal development following PBI, but improvements of the protocol to increase and document compliance are needed before a larger study is implemented. PMID:22543889

A Transactional Model of Sleep–Wake Regulation in Infants Born Preterm or Low Birthweight

PubMed Central

Poehlmann, Julie

2009-01-01

Objective To test a transactional model of sleep–wake development in infants born preterm or low birthweight (PT LBW), which may inform clinical practice, interventions, and future research in this at risk population. Methods One hundred and twenty-eight mother–infant dyads participated from hospital discharge to 4 months postterm. Assessments of prematurity, infant sleep–wake patterns, maternal interaction quality, depression, feeding route, and sociodemographic factors were conducted. Results Path analyses revealed that maternal interactions directly related to infant sleep patterns and family sociodemographic risks related to less optimal parenting. In addition, bottle fed infants experienced fewer night wakings and more nighttime sleep. Conclusions Two potential pathways to sleep patterns in PT LBW infants were identified. The findings suggest directions for clinical work, such as supporting healthy infant sleep through parenting interventions or supporting interpersonal relations between parents and their PT LBW infants by encouraging more daytime naps. Additionally, clinicians should assess parents’ nighttime sleep concerns within the larger sociodemographic and feeding context. PMID:19098064

Clinical signs of dysphagia in infants with acute viral bronchiolitis☆

PubMed Central

Barbosa, Lisiane De Rosa; Gomes, Erissandra; Fischer, Gilberto Bueno

2014-01-01

Objective: To determine the occurrence of clinical signs of dysphagia in infants with acute viral bronchiolitis, to compare the respiratory parameters during deglutition, and to ensure the intra- and inter- examiners agreement, as well as to accomplish intra and interexaminators concordance of the clinical evaluation of the deglutition. Methods: This was a cross-sectional study of 42 infants aged 0-12 months. The clinical evaluation was accompanied by measurements of respiratory rate and pulse oximetry. A score of swallowing disorders was designed to establish associations with other studied variables and to ensure the intra- and interrater agreement of clinical feeding assessments. Caregivers also completed a questionnaire about feeding difficulties. Significance was set at p<0.05. Results: Changes in the oral phase (prolonged pauses) and pharyngeal phase (wheezing, coughing and gagging) of swallowing were found. A significant increase in respiratory rate between pre- and post-feeding times was found, and it was determined that almost half of the infants had tachypnea. An association was observed between the swallowing disorder scores and a decrease in oxygen saturation. Infants whose caregivers reported feeding difficulties during hospitalization stated a significantly greater number of changes in the swallowing evaluation. The intra-rater agreement was considered to be very good. Conclusions: Infants with acute viral bronchiolitis displayed swallowing disorders in addition to changes in respiratory rate and measures of oxygen saturation. It is suggested, therefore, that infants displaying these risk factors have a higher probability of dysphagia. PMID:25479843

77 FR 47856 - Agency Information Collection Activities: Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-10

... and development outcomes for at risk children through evidence-based home visiting programs. Under...: Proposed Project: Maternal, Infant and Early Childhood Home Visiting Program FY 2012 Competitive Grant Non... the Maternal, Infant, and Early Childhood Home Visiting Program, ( http://frwebgate.access.gpo.gov/cgi...

Using noninvasive NIRS to evaluate the metabolic capability of infant brain

NASA Astrophysics Data System (ADS)

Huang, Lan; Ding, Haishu; Hou, Xinling; Zhou, Congle; Lie, Zhiguang; Wang, Guangzhi; Tian, Fenghua

2005-01-01

The value of cerebral oxygenation saturation is important for optimal treatment and prognosis in neonates during perinatal period. The purpose of this study was to investigate the cerebral oxygen in newborn infants and obtain clinical characteristic parameters by using steady state spatially resolved near infrared spectroscopy. The subjects consist of 239 infants selected from two hospital. The results show that the values of regional cerebral oxygen saturation (rSO2) for preterm infants with gestational ages of 27 - 32 weeks were different from term infants and the value of rSO2 for sick term infants after treatment were better than that of before treatment. Above results suggest that the value of rSO2 may be used as a clinical parameter to assess cerebral oxygen for preterm and sick infants avoiding hypoxia.

Research-Informed Policy Options for Infant and Toddler Early Care and Education: Research-to-Policy Resources

ERIC Educational Resources Information Center

Stephens, Samuel A.

2016-01-01

This Research-to-Policy Resource List compiles research-based policy documents published in 2010 and later on the following topics: Early learning guidelines for infants and toddlers; Program standards for settings serving infants and toddlers; Core competencies and credentials for caregivers of infants and toddlers; Use of infant/toddler…

Infant Mental Health and Early Head Start: Lessons for Early Childhood Programs.

ERIC Educational Resources Information Center

Fenichel, Emily, Ed.

2001-01-01

"Zero to Three" is a single-focus bulletin of the National Center for Infants, Toddlers, and Families providing insight from multiple disciplines on the development of infants, toddlers, and their families. An outgrowth of the Head Start Forum on Infant Mental Health, this issue focuses on infant mental health and implications for Early…

Effect of Home Visit Training Program on Growth and Development of Preterm Infants: A Double Blind Randomized Controlled Trial

PubMed Central

Edraki, Mitra; Moravej, Hossian; Rambod, Masoume

2015-01-01

Background: Home visit program can be effective in infants’ growth and development. The present study aimed to investigate the effect of home visit program on preterm infants’ growth and development within 6 months. Methods: It was a double-blind clinical trial study. The study was conducted in Hafez, Hazrat-e-Zeinab, and Namazee Hospitals affiliated to Shiraz University of Medical Sciences, Shiraz, Iran from 2010 to 2011. Preterm infants were divided into intervention (n=30) and control groups (n=30) through blocked randomization. The intervention group received home visit training program for 6 months, while the control group only received the hospital’s routine care. Then, the infants’ growth indexes, including weight, height, and head circumference, and development criteria were compared on the first day of admission in Neonatal Intensive Care Unit, and then first, second, third, and sixth months. The data were analyzed using Chi-square, independent t-test, and repeated measures ANCOVA. Results: The mean weight of the intervention and control group infants was 7207.3±1129.74 and 6366.7±922.26 gr in the sixth month. Besides, the intervention group infants’ mean weight was higher compared to the control group after six months (t=-3.05, P=0.03). Also, a significant difference was found between the two groups regarding development indexes, such as following moving objects with the head, keeping the head stable when changing the position from lying to sitting,  producing “Agha” sound, and taking objects by hand (P<0.05) during six months of age. Conclusion: The results showed that the home visit program was effective in preterm infants’ weight gain and some development indexes at the sixth month. Considering the importance of infants’ growth and development, healthcare staff is recommended to incorporate home visit training into their programs, so that steps can be taken towards improvement of preterm infants’ health. Trial Registration Number: IRCT2014082013690N3  PMID:25553330

The Infant Parent Training Institute: A Developmental Model for Training Infant Mental Health Professionals

ERIC Educational Resources Information Center

Arons, Judith; Epstein, Ann; Sklan, Susan

2011-01-01

The Infant Parent Training Institute (IPTI) at Jewish Family and Children's Service of Greater Boston offers integrated clinical and theoretical infant mental health training. The curriculum reflects the belief that nurturing and reflective relationships promote optimal learning and growth. A specialty in infant mental health requires knowledge…

Prime Times: A Handbook for Excellence in Infant and Toddler Programs.

ERIC Educational Resources Information Center

Greenman, Jim; Stonehouse, Anne

This handbook is intended as a guide to caregivers in programs serving children under the age of three, and as a text for students training to work with infants and toddlers. The book includes material to help program developers and directors set up and manage a child care program. The text stresses the importance of good organization, one-to-one…

Maternal vitamin D supplementation during pregnancy and lactation to prevent acute respiratory infections in infancy in Dhaka, Bangladesh (MDARI trial): protocol for a prospective cohort study nested within a randomized controlled trial.

PubMed

Morris, Shaun K; Pell, Lisa G; Rahman, Mohammed Ziaur; Dimitris, Michelle C; Mahmud, Abdullah; Islam, M Munirul; Ahmed, Tahmeed; Pullenayegum, Eleanor; Kashem, Tahmid; Shanta, Shaila S; Gubbay, Jonathan; Papp, Eszter; Science, Michelle; Zlotkin, Stanley; Roth, Daniel E

2016-10-13

Early infancy is a high-risk period for severe acute respiratory infection (ARI), particularly in low-income countries with resource-limited health systems. Lower respiratory tract infection (LRTI) is commonly preceded by upper respiratory infection (URTI), and often caused by respiratory syncytial virus (RSV), influenza and other common community-acquired viral pathogens. Vitamin D status is a candidate modifiable early-life determinant of the host antiviral immune response and thus may influence the risk of ARI-associated morbidity in high-risk populations. In the Maternal Vitamin D for Infant Growth (MDIG) study in Dhaka, Bangladesh (NCT01924013), 1300 pregnant women are randomized to one of five groups: placebo, 4200 IU/week, 16,800 IU/week, or 28,000 IU/week from 2 nd trimester to delivery plus placebo from 0-6 months postpartum; or, 28,000 IU/week prenatal and until 6-months postpartum. In the Maternal Vitamin D for ARI in Infancy (MDARI) sub-study nested within the MDIG trial, trained personnel conduct weekly postnatal home visits to inquire about ARI symptoms and conduct a standardized clinical assessment. Supplementary home visits between surveillance visits are conducted when caregivers make phone notifications of new infant symptoms. Mid-turbinate nasal swab samples are obtained from infants who meet standardized clinical ARI criteria. Specimens are tested by polymerase chain reaction (PCR) for 8 viruses (influenza A/B, parainfluenza 1/2/3, RSV, adenovirus, and human metapneumovirus), and nasal carriage density of Streptococcus pneumoniae. The primary outcome is the incidence rate of microbiologically-positive viral ARI, using incidence rate ratios to estimate between-group differences. We hypothesize that among infants 0-6 months of age, the incidence of microbiologically-confirmed viral ARI will be significantly lower in infants whose mothers received high-dose prenatal/postpartum vitamin D supplements versus placebo. Secondary outcomes include incidence of ARI associated with specific pathogens (influenza A or B, RSV), clinical ARI, and density of pneumococcal carriage. If shown to reduce the risk of viral ARI in infancy, integration of maternal prenatal/postpartum vitamin D supplementation into antenatal care programs in South Asia may be a feasible primary preventive strategy to reduce the burden of ARI-associated morbidity and mortality in young infants. NCT02388516 , registered March 9, 2015.

The cues and care randomized controlled trial of a neonatal intensive care unit intervention: effects on maternal psychological distress and mother-infant interaction.

PubMed

Zelkowitz, Phyllis; Feeley, Nancy; Shrier, Ian; Stremler, Robyn; Westreich, Ruta; Dunkley, David; Steele, Russell; Rosberger, Zeev; Lefebvre, Francine; Papageorgiou, Apostolos

2011-10-01

This study tested the efficacy of a brief intervention (Cues program) with mothers of very low birth weight (VLBW <1500 g) infants. The primary hypothesis was that mothers in the Cues program would report lower levels of anxiety compared with mothers in the control group. Secondary hypotheses examined whether Cues mothers would report less stress, depression, and role restriction, and exhibit more sensitive interactive behavior, than control group mothers. A total of 121 mothers of VLBW infants were randomly assigned to either the experimental (Cues) intervention or an attention control (Care) condition. The Cues program combined training to reduce anxiety and enhance sensitivity. The control group received general information about infant care. Both programs were initiated during the neonatal intensive care unit stay. Maternal anxiety, stress, depression, and demographic variables were evaluated at baseline, prior to randomization. Postintervention outcomes were assessed during a home visit when the infant was ∼6 to 8 weeks of corrected age. Although mothers in the Cues group demonstrated greater knowledge of the content of the experimental intervention than mothers in the Care group, the groups did not differ in levels of anxiety, depression, and symptoms of posttraumatic stress. They were similar in their reports of parental role restrictions and stress related to the infant's appearance and behavior. Cues and Care group mothers were equally sensitive in interaction with their infants. Nonspecific attention was as effective as an early skill-based intervention in reducing maternal anxiety and enhancing sensitive behavior in mothers of VLBW infants.

Infant sleep position practices 2 years into the "back to sleep" campaign.

PubMed

Gibson, E; Dembofsky, C A; Rubin, S; Greenspan, J S

2000-05-01

Since the 1992 American Academy of Pediatrics (AAP) recommendation to put babies to sleep in the nonprone position and the subsequent 1994 "Back to Sleep" campaign, the U.S. rate of sudden infant death syndrome (SIDS) has decreased more than 40%. This study reports sleep position practices in the greater Philadelphia area during 1996 and 1997. Four hundred and ten parents of infants 6 months of age or less answered a questionnaire by interview in Philadelphia clinics and private pediatric offices from December 1995 through February 1997. Sleep position practices and other SIDS risk factors were measured among demographic groups and compared with reported rates in a similar population from 1993 and 1994. Data were analyzed by Chi square after analysis of correlation coefficients. Significance is reported at p < 0.05. Seventy-two percent of all infants surveyed slept nonprone (NP) compared to 31.8% in 1993 and 59.1% in 1994. The population was 61% African-American (AA), 62% clinic patients. The breast feeding rate was 31%, maternal smoking 17%, and cosleeping 46%. AA infants (67% vs. 82%), infants receiving care at a clinic (66% vs. 84%), and infants > 3 months old (65% vs. 76%) are less likely to be placed nonprone. Most parents who place infants on their back report it was recommended by a medical professional (56%). The majority of those placing infants prone do so because their infant is more comfortable or sleeps better (65%), although 73% said their physician/nurse discussed sleep position with them. Nonprone sleeping continues to increase since the initiation of the "Back to Sleep" campaign. Disparity between some demographic groups persists. An excessive number of African-American families and clinic families still choose a prone sleep position. Many who do so cite increased infant comfort, despite knowledge of the AAP recommendation.

Preparation of physical therapists to work with handicapped infants and their families: current status and training needs.

PubMed

Cochrane, C G; Farley, B G; Wilhelm, I J

1990-06-01

The purposes of this study were to determine the current status of physical therapists' preparation to work with handicapped and at-risk infants and their families and to identify needs for infant- and family-focused training materials and curricula. Results of a telephone survey of 73 physical therapy programs and a follow-up mail survey of 14 physical therapy programs with infancy specialization options are presented. Students in entry-level programs and postprofessional master's degree programs with infancy specializations commonly received instruction in infancy-related topics. Many students received minimal or no exposure to family-related content. Family assessment and intervention were identified as the areas of highest priority for development of training materials and curricula. The results of this study provide direction for the design of infant- and family-focused training materials and curricula in physical therapy.

Neurodevelopmental outcome of infants with meconium aspiration syndrome: report of a study and literature review.

PubMed

Beligere, N; Rao, R

2008-12-01

There is a paucity of information on long-term outcome of infants who have suffered from meconium aspiration syndrome (MAS) in the neonatal period. We analyzed long-term developmental outcome data of 35 infants who were admitted to the neonatal intensive care unit (NICU) at the University of Illinois Hospital at Chicago (UICMC) with a diagnosis of MAS, and we reviewed the literature pertinent to the subject. The objective of the study was to assess the neurodevelopment status of MAS infants and compare the possible effects of different variables that are known to affect the later developmental outcome. The variables included mode of delivery, APGAR score, cord pH, mode of treatment, and neurological findings during the course of NICU. The infants were enrolled in the developmental follow-up program (DFUP) after discharge from the nursery for assessment of long-term developmental status and neurodevelopmental outcome. In order to assess the impact of the treatment on long-term outcome and compare our findings with previously published reports, we also reviewed the previously published literature on neurodevelopment outcome of infants treated for MAS (with different modalities) during the last three decades. Total of 35 infants with a diagnosis of MAS admitted to the NICU at UICMC were followed in the DFUP clinic for 3 years during January 1999 to September 2001. The medical records of these infants were reviewed for the mode of delivery, APGAR score, birth weight (BW), gestational age, mode of treatment during the neonatal period, and neurodevelopment status. 19/35 (54%) infants were delivered vaginally, 16/35 (46%) by cesarean section (C-section). All were treated in the delivery room using the standard resuscitation protocol. Following initial resuscitation, all except three required intubation and ventilation for varying duration. One infant required inhaled nitric oxide therapy, and two required extracorporeal membrane oxygenation treatment. Subsequent to discharge, the infants were evaluated in the clinic at 2 months of age, and then every 4 months up to 3 years. The developmental assessment of mental development index (MDI), psychomotor development index (PDI), and behavior rating scale (BRS) were obtained using the Bayley II infant motor scale, and neurodevelopment evaluation was performed using the Amiel-Tison technique. Speech evaluation was performed in infants >18 months using the Rossetti Infant-Toddler language scale. Infants were considered normal when MDI and PDI scores were >85 to 110; mildly delayed when scores were >70 to 84; and severely delayed if the scores were <69. In addition, neurological evaluation also confirmed the disability. The report is based on the final analysis of 29 infants. Data of six infants were not included in the final analysis because of incomplete information. The mean BW of the infants was 3269+/-671 g; mean gestational age was 39.5+/-3.1 weeks. The median APGAR score at 1' was 4, and at 5' was 6. Out of 29, 11 (38%) infants were normal. Out of 29, 2 infants (7%) had cerebral palsy (CP) and 4 (14%) had severe delay at 12 months of age. Out of 29, 2 who were neurologically disabled had PDI <69. Out of 29, 12 (41%) had mild delay in speech. No statistical difference in neurodevelopment was found in infants born vaginally or by C-section. Our findings show poor outcome (CP and global delay) in 21% of infants who suffered MAS, even though the majority of the infants (26/29) responded to conventional ventilator support alone. No difference was found in the outcome of infants between NSVD vs C-section delivery. These findings suggest that infants with the diagnosis of MAS manifest later neurodevelopmental delays, even if they respond well to conventional treatment. This abstract was presented at the Society for Pediatric Research Annual Meeting, 2000.

A retrospective study of chiropractic treatment of 276 danish infants with infantile colic.

PubMed

Wiberg, Karin R; Wiberg, Jesper M M

2010-09-01

The aim of this study was to investigate if the outcome of excessively crying infants treated with chiropractic manipulation (1) was associated with age and/or (2), at least partially, can be explained by age according to the natural decline in crying. This was a retrospective evaluation of clinical records of 749 infants from a private Danish chiropractic practice. All of the infants were healthy, thriving infants born to term within the age of 0 to 3 months who fulfilled the diagnostic criteria for excessively crying infants (infantile colic), whose parents sought chiropractic treatment. The infants were treated using chiropractic management as decided by the treating doctor of chiropractic, and changes in crying based upon the parents' report were noted as improved, uncertain, or nonrecovered. Age predictor groups were cross-tabulated against the outcome variables, and difference between classification groups was tested with χ(2) tables and confidence intervals. Slightly older age was found to be linked to excessively crying infants who experienced clinical improvement. However, no apparent link between the clinical effect of chiropractic treatment and a natural decline in crying was found for this group of infants. The findings of this study do not support the assumption that effect of chiropractic treatment of infantile colic is a reflection of the normal cessation of this disorder. Copyright © 2010 National University of Health Sciences. Published by Mosby, Inc. All rights reserved.

Early intervention in South Africa: moving beyond hearing screening.

PubMed

Storbeck, Claudine; Pittman, Paula

2008-01-01

Since little information is available on the outcome of early hearing intervention programs in South Africa, this article examines data on infants and families registered with a family-centred, home-based intervention program (HI HOPES) over a 12-month period in order to track the effectiveness of the holistic unbiased support to families of infants and toddlers with a hearing-loss. The aim of HI HOPES, which is based on the SKI-HI model of early intervention in the USA, is to ensure that families are enabled to make informed choices for their unique infant. Data were gathered on 32 infants ages birth to three years and their families using both qualitative and quantitative measures which included analysis of demographic data, quarterly language assessments, and parent satisfaction surveys. The report on the pilot year of this early intervention program shows that, though the sample is small, there is significant improvement in infant receptive and expressive language for infants identified before seven months of age, as well as a high level of satisfaction from families who have received services.

Point-of-care CD4 testing to inform selection of antiretroviral medications in south african antenatal clinics: a cost-effectiveness analysis.

PubMed

Ciaranello, Andrea L; Myer, Landon; Kelly, Kathleen; Christensen, Sarah; Daskilewicz, Kristen; Doherty, Katie; Bekker, Linda-Gail; Hou, Taige; Wood, Robin; Francke, Jordan A; Wools-Kaloustian, Kara; Freedberg, Kenneth A; Walensky, Rochelle P

2015-01-01

Many prevention of mother-to-child HIV transmission (PMTCT) programs currently prioritize antiretroviral therapy (ART) for women with advanced HIV. Point-of-care (POC) CD4 assays may expedite the selection of three-drug ART instead of zidovudine, but are costlier than traditional laboratory assays. We used validated models of HIV infection to simulate pregnant, HIV-infected women (mean age 26 years, gestational age 26 weeks) in a general antenatal clinic in South Africa, and their infants. We examined two strategies for CD4 testing after HIV diagnosis: laboratory (test rate: 96%, result-return rate: 87%, cost: $14) and POC (test rate: 99%, result-return rate: 95%, cost: $26). We modeled South African PMTCT guidelines during the study period (WHO "Option A"): antenatal zidovudine (CD4 ≤350/μL) or ART (CD4>350/μL). Outcomes included MTCT risk at weaning (age 6 months), maternal and pediatric life expectancy (LE), maternal and pediatric lifetime healthcare costs (2013 USD), and cost-effectiveness ($/life-year saved). In the base case, laboratory led to projected MTCT risks of 5.7%, undiscounted pediatric LE of 53.2 years, and undiscounted PMTCT plus pediatric lifetime costs of $1,070/infant. POC led to lower modeled MTCT risk (5.3%), greater pediatric LE (53.4 years) and lower PMTCT plus pediatric lifetime costs ($1,040/infant). Maternal outcomes following laboratory were similar to POC (LE: 21.2 years; lifetime costs: $23,860/person). Compared to laboratory, POC improved clinical outcomes and reduced healthcare costs. In antenatal clinics implementing Option A, the higher initial cost of a one-time POC CD4 assay will be offset by cost-savings from prevention of pediatric HIV infection.

An empirical assessment of the Healthy Early Childhood Program in Rio Grande do Sul State, Brazil.

PubMed

Ribeiro, Felipe Garcia; Braun, Gisele; Carraro, André; Teixeira, Gibran da Silva; Gigante, Denise Petrucci

2018-01-01

We investigate the effect of a family-based primary health care program (Healthly Early Childhood Program) on infant mortality in the state of Rio Grande do Sul, Brazil. We estimate infant mortality's counterfactual trajectories using the differences-in-differences approach, combined with the use of longitudinal data for all municipalities in the state of Rio Grande do Sul. Our main result is that the program reduced the number of deaths caused by external causes. The length of exposure to the program seems to potentiate the effects. For the number of deaths by general causes, there is no evidence of impact. Our findings are consistent with the nature of the program that aims to improve adults care with children. The Healthly Early Childhood Program is effective in reducing the number of avoidable deaths in infants.

Theory! The Missing Link in Understanding the Performance of Neonate/Infant Home-Visiting Programs to Prevent Child Maltreatment: A Systematic Review

PubMed Central

Segal, Leonie; Sara Opie, Rachelle; Dalziel, Kim

2012-01-01

Context Home-visiting programs have been offered for more than sixty years to at-risk families of newborns and infants. But despite decades of experience with program delivery, more than sixty published controlled trials, and more than thirty published literature reviews, there is still uncertainty surrounding the performance of these programs. Our particular interest was the performance of home visiting in reducing child maltreatment. Methods We developed a program logic framework to assist in understanding the neonate/infant home-visiting literature, identified through a systematic literature review. We tested whether success could be explained by the logic model using descriptive synthesis and statistical analysis. Findings Having a stated objective of reducing child maltreatment—a theory or mechanism of change underpinning the home-visiting program consistent with the target population and their needs and program components that can deliver against the nominated theory of change—considerably increased the chance of success. We found that only seven of fifty-three programs demonstrated such consistency, all of which had a statistically significant positive outcome, whereas of the fifteen that had no match, none was successful. Programs with a partial match had an intermediate success rate. The relationship between program success and full, partial or no match was statistically significant. Conclusions Employing a theory-driven approach provides a new way of understanding the disparate performance of neonate/infant home-visiting programs. Employing a similar theory-driven approach could also prove useful in the review of other programs that embody a diverse set of characteristics and may apply to diverse populations and settings. A program logic framework provides a rigorous approach to deriving policy-relevant meaning from effectiveness evidence of complex programs. For neonate/infant home-visiting programs, it means that in developing these programs, attention to consistency of objectives, theory of change, target population, and program components is critical. PMID:22428693

Theory! The missing link in understanding the performance of neonate/infant home-visiting programs to prevent child maltreatment: a systematic review.

PubMed

Segal, Leonie; Sara Opie, Rachelle; Dalziel, Kim

2012-03-01

Home-visiting programs have been offered for more than sixty years to at-risk families of newborns and infants. But despite decades of experience with program delivery, more than sixty published controlled trials, and more than thirty published literature reviews, there is still uncertainty surrounding the performance of these programs. Our particular interest was the performance of home visiting in reducing child maltreatment. We developed a program logic framework to assist in understanding the neonate/infant home-visiting literature, identified through a systematic literature review. We tested whether success could be explained by the logic model using descriptive synthesis and statistical analysis. Having a stated objective of reducing child maltreatment-a theory or mechanism of change underpinning the home-visiting program consistent with the target population and their needs and program components that can deliver against the nominated theory of change-considerably increased the chance of success. We found that only seven of fifty-three programs demonstrated such consistency, all of which had a statistically significant positive outcome, whereas of the fifteen that had no match, none was successful. Programs with a partial match had an intermediate success rate. The relationship between program success and full, partial or no match was statistically significant. Employing a theory-driven approach provides a new way of understanding the disparate performance of neonate/infant home-visiting programs. Employing a similar theory-driven approach could also prove useful in the review of other programs that embody a diverse set of characteristics and may apply to diverse populations and settings. A program logic framework provides a rigorous approach to deriving policy-relevant meaning from effectiveness evidence of complex programs. For neonate/infant home-visiting programs, it means that in developing these programs, attention to consistency of objectives, theory of change, target population, and program components is critical. © 2012 Milbank Memorial Fund.

The interface of self psychology, infant research, and neuroscience in clinical practice.

PubMed

Rustin, Judith

2009-04-01

This article focuses on the integration of self psychology with findings from infant research and neuroscience. While Kohut's psychology of the self provides a useful theoretical model for psychoanalytic practice, aspects of infant research and neuroscience offer specificity and nuance to basic self-psychological concepts. Kohut proposed that self-psychological psychoanalysis ameliorates derailed development through patient-analyst interaction, while a listening stance of empathic immersion begins the curative process of derailed development and sets the stage for reparative psychoanalytic work. Findings from infant research delineate much more specifically the nature of attunement both in early mother-infant and analyst-patient interactions. Findings from neuroscientific research delineate how early mother-infant experiences are encoded in implicit memory and explicates the emotional substrate of affects and feelings. This emotional substrate exists at birth and provides a means of communication both in infancy and adulthood. Additionally, infant research delineates the mutuality of the interactive process. Thus, both infant research and neuroscience add subtlety and nuance to basic self-psychological concepts. This subtlety opens up new ways of understanding patients and expands the clinical repertoire. Three clinical vignettes demonstrate how this nuance and expansion of self-psychological concepts are applied in the context of an ongoing psychoanalytic treatment.

Infant Satellite Nurseries: Family Day Care with a Difference. Parent-Child Program Series, Report No. 4.

ERIC Educational Resources Information Center

Rosenfeld, Anne H.

Part of a series on early childhood demonstration programs designed to improve early parent-child relationships, stimulate positive child development, and prevent later behavior difficulties, the pamphlet describes the Infant Satellite Nursery Program, developed in Honolulu, Hawaii, to provide low-income families with subsidized, home-based care…

Day Care and Intervention Programs for Infants.

ERIC Educational Resources Information Center

Haith, Marshall M.

This guide represents an attempt to organize the available literature on day care programs currently in operation or in the proposal stage for infants under two years of age. Special emphases are placed on program goals for psychological development in the first two years, the curricula which have been developed to accomplish these goals, and the…

Educational Intervention to Modify Bottle-Feeding Behaviors among Formula-Feeding Mothers in the WIC Program: Impact on Infant Formula Intake and Weight Gain

ERIC Educational Resources Information Center

Kavanagh, Katherine F.; Cohen, Roberta J.; Heinig, M. Jane; Dewey, Kathryn G.

2008-01-01

Objective: Formula-fed infants gain weight faster than breastfed infants. This study evaluated whether encouraging formula-feeding caregivers to be sensitive to infant satiety cues would alter feeding practices and reduce infant formula intake and weight gain. Design: Double-blind, randomized educational intervention, with intake and growth…

Near-infrared spectroscopy as a predictor of clinical deterioration: a case report of two infants with duct-dependent congenital heart disease.

PubMed

Mebius, Mirthe J; du Marchie Sarvaas, Gideon J; Wolthuis, Diana W; Bartelds, Beatrijs; Kneyber, Martin C J; Bos, Arend F; Kooi, Elisabeth M W

2017-03-16

Some infants with congenital heart disease are at risk of in-hospital cardiac arrest. To better foresee cardiac arrest in infants with congenital heart disease, it might be useful to continuously assess end-organ perfusion. Near-infrared spectroscopy is a non-invasive method to continuously assess multisite regional tissue oxygen saturation. We report on two infants with duct-dependent congenital heart disease who demonstrated a gradual change in cerebral and/or renal tissue oxygen saturation before cardiopulmonary resuscitation was required. In both cases, other clinical parameters such as heart rate, arterial oxygen saturation and blood pressure did not indicate that deterioration was imminent. These two cases demonstrate that near-infrared spectroscopy might contribute to detecting a deteriorating clinical condition and might therefore be helpful in averting cardiopulmonary collapse and need for resuscitation in infants with congenital heart disease.

Necrotizing Enterocolitis in the Premature Infant

PubMed Central

Gregory, Katherine E.; DeForge, Christine E.; Natale, Kristan M.; Phillips, Michele; Van Marter, Linda J.

2013-01-01

Necrotizing enterocolitis (NEC) remains one of the most catastrophic comorbidities associated with prematurity. In spite of extensive research, the disease remains unsolved. The aims of this paper are to present the current state of the science on the pathogenesis of NEC, summarize the clinical presentation and severity staging of the disease, and highlight the nursing assessments required for early identification of NEC and ongoing care for infants diagnosed with this gastrointestinal disease. The distributions of systemic and intestinal clinical signs that are most sensitive to nursing assessment and associated with Bell Staging Criteria are presented. This descriptive data is representative of 117 cases of NEC diagnosed in low gestational age infants (<29 weeks gestation). The data highlights the clinical signs most commonly observed in infants with NEC, and thus, provides NICU nurses an evidence-based guide for assessment and care of infants with NEC. PMID:21730907

Optimizing the rapid measurement of detection thresholds in infants

PubMed Central

Jones, Pete R.; Kalwarowsky, Sarah; Braddick, Oliver J.; Atkinson, Janette; Nardini, Marko

2015-01-01

Accurate measures of perceptual threshold are difficult to obtain in infants. In a clinical context, the challenges are particularly acute because the methods must yield meaningful results quickly and within a single individual. The present work considers how best to maximize speed, accuracy, and reliability when testing infants behaviorally and suggests some simple principles for improving test efficiency. Monte Carlo simulations, together with empirical (visual acuity) data from 65 infants, are used to demonstrate how psychophysical methods developed with adults can produce misleading results when applied to infants. The statistical properties of an effective clinical infant test are characterized, and based on these, it is shown that (a) a reduced (false-positive) guessing rate can greatly increase test efficiency, (b) the ideal threshold to target is often below 50% correct, and (c) simply taking the max correct response can often provide the best measure of an infant's perceptual sensitivity. PMID:26237298

Implementing Community Baby Showers to Address Infant Mortality in Oklahoma.

PubMed

Thornberry, Timothy; Han, Jennifer; Thomas, Linda

2017-03-01

IMPORTANCE: Oklahoma has one of the highest rates of infant mortality and poor birth outcomes in the U.S., particularly among minority populations. OBJECTIVES: To describe the formation and implementation of a state-led infant mortality prevention program which sought to: educate minorities about their disproportionate risk for infant mortality; improve pregnancy, infancy, and early childhood outcomes; and prevent infant mortality. DESIGN, SETTING, AND PARTICIPANTS: Participants completed one of many community baby shower events and were evaluated pre- and post-shower on infant mortality and well-baby knowledge. INTERVENTION: The "A Healthy Baby Begins with You" program. Main outcomes and measures. Pre- and post-intervention questionnaires assessing participant knowledge about infant mortality and willingness to share learned knowledge with others in the community. RESULTS: Preliminary results suggest that community baby showers were well-received. Respondents tended to be American Indians, non-Hispanic Whites, or Blacks/African Americans, young adults (aged 20 to 29 years), pregnant women, and mothers of grandparents of young children. Showers were successful in increasing participant knowledge of infant mortality, although these results varied by respondent race and age. Most respondents reported intent to share knowledge acquired during community baby showers with others. CONCLUSIONS AND RELEVANCE: Preliminary findings suggest community baby showers may increase participant knowledge, although future studies are needed to ensure effectiveness across all participant subgroups. This study documents the feasibility and acceptability of a community-based educational program targeting dissemination of infant mortality and well-child information. Barriers and future directions for research and prevention are discussed.

Perceptual and Motor Development in Infants and Children. Second Edition.

ERIC Educational Resources Information Center

Cratty, Bryant J.

Motor behavior, motor performance, and motor learning are discussed at length within the context of infant and child development. Individual chapters focus on the following: the sensory-motor behavior of infants; analysis of selected perceptual-motor programs; beginnings of movement in infants; gross motor attributes in early childhood; visual…

Infants and Toddlers, 1999-2000.

ERIC Educational Resources Information Center

Kroenke, Lillian DeVault, Ed.

2000-01-01

This document is comprised of the four 1999-2000 issues of a quarterly journal for teachers and parents of children in Montessori infant and toddler programs. The May 1999 issue presents articles on eating in the prepared environment and meeting infants' basic needs for food. The August 1999 issue includes articles discussing infants' sensory…

The Ecology of Infant Day Care.

ERIC Educational Resources Information Center

Elardo, Richard

This paper explores some of the attributed of quality day care programs for infants, age 0 to 30 months. High-quality interactions with adults result in positive developmental outcomes for infants. Adults involved in day care should focus on providing an environment of stimulating experiences, which help infants to develop satisfactorily. Other…

Tuned in Parenting and Infant Sleep Patterns

ERIC Educational Resources Information Center

Priddis, Lynn E.

2009-01-01

This paper focuses on infant sleep behaviour that is of concern to mothers of young infants, and disruptive to families. It reports on the incidence of sleep problems in dyads that self-referred to a specialist clinic, and the relationship between the mother's sensitive responsiveness and infant sleep patterns in a sample of 65 Australian infants.…

Training a New Professional Core to Work with Infants, Toddlers and Their Families--The Schwartz Program.

ERIC Educational Resources Information Center

Rosenthal, Miriam K.

This paper overviews the organization, objectives and impact of an experimental interdisciplinary training program at Hebrew University, Jerusalem, Israel, for preparing specialists to work with infants and preschool children. (Author/RH)

The Great Equalizer: Health Care Access and Infant Mortality in Thailand.

PubMed

Gruber, Jonathan; Hendren, Nathaniel; Townsend, Robert M

2014-01-01

This paper analyzes Thailand's 2001 healthcare reform, "30 Baht". The program increased funding available to hospitals to care for the poor and reduced copays to 30 Baht (~$0.75). Our estimates suggest the supply-side funding of the program increased healthcare utilization, especially amongst the poor. Moreover, we find significant impacts on infant mortality: prior to 30 Baht poorer provinces had significantly higher infant mortality rates than richer provinces. After 30 Baht this correlation evaporates to zero. The results suggest that increased access to healthcare among the poor can significantly reduce their infant mortality rates.

The Great Equalizer: Health Care Access and Infant Mortality in Thailand

PubMed Central

Gruber, Jonathan; Hendren, Nathaniel; Townsend, Robert M.

2013-01-01

This paper analyzes Thailand’s 2001 healthcare reform, “30 Baht”. The program increased funding available to hospitals to care for the poor and reduced copays to 30 Baht (~$0.75). Our estimates suggest the supply-side funding of the program increased healthcare utilization, especially amongst the poor. Moreover, we find significant impacts on infant mortality: prior to 30 Baht poorer provinces had significantly higher infant mortality rates than richer provinces. After 30 Baht this correlation evaporates to zero. The results suggest that increased access to healthcare among the poor can significantly reduce their infant mortality rates. PMID:24772234

Monitoring Doppler patterns and clinical parameters may predict feeding tolerance in intrauterine growth-restricted infants.

PubMed

Bozzetti, Valentina; Paterlini, Giuseppe; Gazzolo, Diego; Van Bel, Frank; Visser, Gerard H A; Roncaglia, Nadia; Tagliabue, Paolo E

2013-11-01

To detect predictors of feeding tolerance in intrauterine growth restriction (IUGR) infants with or without brain-sparing effect (BS). We conducted a case-control study in 70 IUGR infants (35 IUGR with BS, matched for gestational age with 35 IUGR infants with no BS). BS was classified as pulsatility index (PI) ratio [umbilical artery (UAPI) to middle cerebral artery (MCAPI) (U/C ratio)] > 1. Clinical parameters of feeding tolerance - days to achieve full enteral feeding (FEF) - were compared between the IUGR with BS and IUGR without BS infants. Age at the start of minimal enteral feeding (MEF) was analysed. Achievement of FEF was significantly shorter in IUGR infants without BS than in IUGR with BS. IUGR with BS started MEF later than IUGR without BS infants. Significant correlation of MEF and FEF with UA PI, U/C ratio and CRIB score was found. Multiple linear regression analysis showed significant correlations with CRIB score and caffeine administration (MEF only), and sepsis (FEF only) and U/C ratio (for both). Impaired gut function can be early detected by monitoring Doppler patterns and clinical parameters. ©2013 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

Assessing Speech Discrimination in Individual Infants

ERIC Educational Resources Information Center

Houston, Derek M.; Horn, David L.; Qi, Rong; Ting, Jonathan Y.; Gao, Sujuan

2007-01-01

Assessing speech discrimination skills in individual infants from clinical populations (e.g., infants with hearing impairment) has important diagnostic value. However, most infant speech discrimination paradigms have been designed to test group effects rather than individual differences. Other procedures suffer from high attrition rates. In this…

[Clinical signs of dysphagia in infants with acute viral bronchiolitis].

PubMed

Barbosa, Lisiane De Rosa; Gomes, Erissandra; Fischer, Gilberto Bueno

2014-09-01

To determine the occurrence of clinical signs of dysphagia in infants with acute viral bronchiolitis, to compare the respiratory parameters during deglutition, and to ensure the intra- and inter- examiners agreement, as well as to accomplish intra and interexaminators concordance of the clinical evaluation of the deglutition. This was a cross-sectional study of 42 infants aged 0-12 months. The clinical evaluation was accompanied by measurements of respiratory rate and pulse oximetry. A score of swallowing disorders was designed to establish associations with other studied variables and to ensure the intra- and interrater agreement of clinical feeding assessments. Caregivers also completed a questionnaire about feeding difficulties. Significance was set at p<0.05. Changes in the oral phase (prolonged pauses) and pharyngeal phase (wheezing, coughing and gagging) of swallowing were found. A significant increase in respiratory rate between pre- and post-feeding times was found, and it was determined that almost half of the infants had tachypnea. An association was observed between the swallowing disorder scores and a decrease in oxygen saturation. Infants whose caregivers reported feeding difficulties during hospitalization stated a significantly greater number of changes in the swallowing evaluation. The intra-rater agreement was considered to be very good. Infants with acute viral bronchiolitis displayed swallowing disorders in addition to changes in respiratory rate and measures of oxygen saturation. It is suggested, therefore, that infants displaying these risk factors have a higher probability of dysphagia. Copyright © 2014 Sociedade de Pediatria de São Paulo. Publicado por Elsevier Editora Ltda. All rights reserved.

Baby Business: a randomised controlled trial of a universal parenting program that aims to prevent early infant sleep and cry problems and associated parental depression

PubMed Central

2012-01-01

Background Infant crying and sleep problems (e.g. frequent night waking, difficulties settling to sleep) each affect up to 30% of infants and often co-exist. They are costly to manage and associated with adverse outcomes including postnatal depression symptoms, early weaning from breast milk, and later child behaviour problems. Preventing such problems could improve these adverse outcomes and reduce costs to families and the health care system. Anticipatory guidance-i.e. providing parents with information about normal infant sleep and cry patterns, ways to encourage self-settling in infants, and ways to develop feeding and settling routines before the onset of problems-could prevent such problems. This paper outlines the protocol for our study which aims to test an anticipatory guidance approach. Methods/Design 750 families from four Local Government Areas in Melbourne, Australia have been randomised to receive the Baby Business program (intervention group) or usual care (control group) offered by health services. The Baby Business program provides parents with information about infant sleep and crying via a DVD and booklet (mailed soon after birth), telephone consultation (at infant age 6-8 weeks) and parent group session (at infant age 12 weeks). All English speaking parents of healthy newborn infants born at > 32 weeks gestation and referred by their maternal and child health nurse at their first post partum home visit (day 7-10 postpartum), are eligible. The primary outcome is parent report of infant night time sleep as a problem at four months of age and secondary outcomes include parent report of infant daytime sleep or crying as a problem, mean duration of infant sleep and crying/24 hours, parental depression symptoms, parent sleep quality and quantity and health service use. Data will be collected at two weeks (baseline), four months and six months of age. An economic evaluation using a cost-consequences approach will, from a societal perspective, compare costs and health outcomes between the intervention and control groups. Discussion To our knowledge this is the first randomised controlled trial of a program which aims to prevent both infant sleeping and crying problems and associated postnatal depression symptoms. If effective, it could offer an important public health prevention approach to these common, distressing problems. Trial registration number ISRCTN: ISRCTN63834603 PMID:22309617

Baby Business: a randomised controlled trial of a universal parenting program that aims to prevent early infant sleep and cry problems and associated parental depression.

PubMed

Cook, Fallon; Bayer, Jordana; Le, Ha N D; Mensah, Fiona; Cann, Warren; Hiscock, Harriet

2012-02-06

Infant crying and sleep problems (e.g. frequent night waking, difficulties settling to sleep) each affect up to 30% of infants and often co-exist. They are costly to manage and associated with adverse outcomes including postnatal depression symptoms, early weaning from breast milk, and later child behaviour problems. Preventing such problems could improve these adverse outcomes and reduce costs to families and the health care system. Anticipatory guidance-i.e. providing parents with information about normal infant sleep and cry patterns, ways to encourage self-settling in infants, and ways to develop feeding and settling routines before the onset of problems-could prevent such problems. This paper outlines the protocol for our study which aims to test an anticipatory guidance approach. 750 families from four Local Government Areas in Melbourne, Australia have been randomised to receive the Baby Business program (intervention group) or usual care (control group) offered by health services. The Baby Business program provides parents with information about infant sleep and crying via a DVD and booklet (mailed soon after birth), telephone consultation (at infant age 6-8 weeks) and parent group session (at infant age 12 weeks). All English speaking parents of healthy newborn infants born at > 32 weeks gestation and referred by their maternal and child health nurse at their first post partum home visit (day 7-10 postpartum), are eligible. The primary outcome is parent report of infant night time sleep as a problem at four months of age and secondary outcomes include parent report of infant daytime sleep or crying as a problem, mean duration of infant sleep and crying/24 hours, parental depression symptoms, parent sleep quality and quantity and health service use. Data will be collected at two weeks (baseline), four months and six months of age. An economic evaluation using a cost-consequences approach will, from a societal perspective, compare costs and health outcomes between the intervention and control groups. To our knowledge this is the first randomised controlled trial of a program which aims to prevent both infant sleeping and crying problems and associated postnatal depression symptoms. If effective, it could offer an important public health prevention approach to these common, distressing problems.

Hospital outcomes of extremely low birth weight infants after introduction of donor milk to supplement mother's milk.

PubMed

Verd, Sergio; Porta, Roser; Botet, Francesc; Gutiérrez, Antonio; Ginovart, Gemma; Barbero, Ana Herranz; Ciurana, Anna; Plata, Isabel Iglesias

2015-04-01

This study evaluated the impact of an exclusive human milk diet to nourish extremely low birth weight infants in the neonatal intensive care unit. This multicenter pre-post retrospective study included all inborn infants <1,000 g admitted to four Level IV neonatal intensive care units either before or after implementing a donor human milk policy. The feeding protocol was unchanged in both periods. Collected data included maternal/infant demographics, infant clinical data, and enteral intake as mother's own milk, donor milk, and formula. Two hundred one infants were enrolled. Infant growth and other clinical outcomes were similar in both groups. Exposure to mother's own milk at discharge was not different. Median time in oxygen and duration of mechanical ventilation were significantly higher among formula-fed infants (63 versus 192 hours [p=0.046] and 24 versus 60 hours [p=0.016], respectively). Our results add evidence supporting the safety of donor milk. This study also found an association between exposure to formula in preterm infants and the requirement for respiratory support, a finding that warrants further investigation.

Parents' perceptions of their infant's pain experience in the NICU.

PubMed

Gale, Gay; Franck, Linda S; Kools, Susan; Lynch, Mary

2004-01-01

Despite numerous advances in the recognition, assessment, and management of pain in neonates over the past two decades, there has been limited improvement in the knowledge base regarding parental responses to their infant's pain. This study examined parents' views of their experiences observing and coping with their infant's pain in the neonatal intensive care unit (NICU). Twelve participants were recruited using purposive sampling from two groups: (a) parents who had infants currently receiving care in the NICU (n=6); and (b) parents whose infants had been discharged from the NICU and were enrolled in the outpatient follow-up clinic at each hospital (n=6). An exploratory, semi-structured format was used to interview parents individually (n=5) or in focus groups (n=7) regarding their infant's clinical course, infant pain experiences, and the parenting experience during and after the NICU stay. Thematic content analysis was used to develop conceptual categories. Two broad themes were identified: (a) infant pain as a source of parental distress and (b) relief of parental distress due to infant's pain.

Washington's Infant Toddler Early Intervention Program Study: Enrollment of Washington Children with Disabilities and Special Health Care Needs in Washington State Public Programs on December 1, 1997.

ERIC Educational Resources Information Center

Lyons, Dorothy; Keenan, Trisha; Cawthon, Laurie; Felming, Jan; Dickey, Rita; Loerch, Sandy; Shureen, Anne

This report presents information on infants and toddlers (ages birth to three) with delaying or disabling conditions, who were enrolled in Washington State public services on December 1, 1997, under the Individuals with Disabilities Education Act, Part H. Major findings included: (1) there was a total enrollment of 5,007 infants and toddlers (2.1…

Role of Federal Food Assistance Programs in Strategies To Reduce Infant Mortality. Hearing before the Domestic Task Force of the Select Committee on Hunger. House of Representatives, One Hundredth Congress, First Session.

ERIC Educational Resources Information Center

Congress of the U.S., Washington, DC. House Select Committee on Hunger.

This document presents oral and written testimony concerning the effectiveness of federal assistance programs in reducing infant mortality. In opening statements, members of the House Select Committee on Hunger voiced their concern over the persistence of high infant death rates among minorities, the rural poor, and urban populations, despite…

Temperament and Behaviour of Infants Aged 4-12 Months on Admission to a Private Mother-Baby Unit and at 1- and 6-Month Follow-Up

ERIC Educational Resources Information Center

Fisher, Jane; Rowe, Heather; Feekery, Colin

2004-01-01

While infant behaviour is influenced by maternal care, infant crying and dysregulated sleep can reciprocally affect maternal mood. The temperament and behaviour of two 4-12-months-old infant cohorts admitted with their mothers to a residential parenting program were examined using behaviour charts and the Short Infant Temperament Questionnaire…

Effects of recruiting midwives into family physician program on the percentage of low birth weight (LBW) infants in rural areas of Kurdistan

PubMed Central

Hajizadeh, Shayesteh; Tehrani, Fahimeh Ramezani; Simbar, Masoumeh; Farzadfar, Farshad

2017-01-01

Background: LBW is an important factor that can affect infant mortality and represents an index of economic and social development. It is expected that an increase in the density of midwives attending family physician programs will lead to a decrease in LBW in health centers. This study aimed to compare the percentage of LBW infants before and after the implementation of the family physician program in health centers with and without an increase in midwives density. Methods: This cross-sectional study compared the percentage of LBW infants before and after the implementation of family physician programs in rural health centers with and without changes in midwives density in Kurdistan. In this study, we included 668 mothers of 2-month-old children and administered structured interviews in 2005 and 2013. Data were analyzed using the difference-indifferences and the Matchit statistical models. Results: The Matchit model showed a significant average percentage increase 0.08 (0.006–0.17) in LBW infants born between 2005 and 2013 in health centers where the density of midwives increased compared with those where it remained unchanged. The difference-in-differences model showed that the odds ratio of LBW infants is increased by more than twice among participants who had a history of caesarean section. Conclusion: The results of this study showed that an increase in the density of midwives in a family physician program did not have an impact on reducing the percentage of LBW infants born between 2005 and 2013, in health centers where the density of midwives augmented compared to those where it remained unaltered; it indicated that the increase in the density of midwives alone was not efficient. On the other hand, the results of our study show an increase in the risk of infants born at a LBW due to caesarean section. It is recommended that obstetricians and gynecologists must strictly control pregnancies and avoid unnecessary termination of pregnancy

Do Early Childhood Programs Have Lasting Effects on Children? Evaluation Science Brief

ERIC Educational Resources Information Center

National Forum on Early Childhood Program Evaluation, 2008

2008-01-01

"Evaluation Science Briefs" summarize the findings and implications of a recent study evaluating the effects of an early childhood program or environment. This Brief evaluates the study "Early Intervention in Low Birthweight Premature Infants: Results at 18 Years of Age for the Infant Health and Development Program (IHDP)" (M.C. McCormick, J.…

Montessori Infant and Toddler Programs: How Our Approach Meshes with Other Models

ERIC Educational Resources Information Center

Miller, Darla Ferris

2011-01-01

Today, Montessori infant & toddler programs around the country usually have a similar look and feel--low floor beds, floor space for movement, low shelves, natural materials, tiny wooden chairs and tables for eating, and not a highchair or swing in sight. But Montessori toddler programs seem to fall into two paradigms--one model seeming more…

2 CFR 417.865 - How long may my debarment last?

Code of Federal Regulations, 2012 CFR

2012-01-01

... Assistance Program for Women, Infants, and Children (WIC), or as a nonbeneficiary entity in any of the.... 2011, et seq.; (ii) Food Distribution Program on Indian Reservations, 7 U.S.C. 2013(b); (iii) National... Women, Infants, and Children, 42 U.S.C. 1786; (vii) Commodity Supplemental Food Program, 42 U.S.C. 612c...

2 CFR 417.865 - How long may my debarment last?

Code of Federal Regulations, 2011 CFR

2011-01-01

... Assistance Program for Women, Infants, and Children (WIC), or as a nonbeneficiary entity in any of the.... 2011, et seq.; (ii) Food Distribution Program on Indian Reservations, 7 U.S.C. 2013(b); (iii) National... Women, Infants, and Children, 42 U.S.C. 1786; (vii) Commodity Supplemental Food Program, 42 U.S.C. 612c...

2 CFR 417.865 - How long may my debarment last?

Code of Federal Regulations, 2013 CFR

2013-01-01

... Assistance Program for Women, Infants, and Children (WIC), or as a nonbeneficiary entity in any of the.... 2011, et seq.; (ii) Food Distribution Program on Indian Reservations, 7 U.S.C. 2013(b); (iii) National... Women, Infants, and Children, 42 U.S.C. 1786; (vii) Commodity Supplemental Food Program, 42 U.S.C. 612c...

2 CFR 417.865 - How long may my debarment last?

Code of Federal Regulations, 2014 CFR

2014-01-01

... Assistance Program for Women, Infants, and Children (WIC), or as a nonbeneficiary entity in any of the.... 2011, et seq.; (ii) Food Distribution Program on Indian Reservations, 7 U.S.C. 2013(b); (iii) National... Women, Infants, and Children, 42 U.S.C. 1786; (vii) Commodity Supplemental Food Program, 42 U.S.C. 612c...

Evaluating "Baby Think It Over" Infant Simulators: A Comparison Group Study

ERIC Educational Resources Information Center

Barnett, Jerrold E.

2006-01-01

To test the efficacy of Baby-Think-It-Over (BTIO) infant simulators, two versions of a sexuality education program were compared. While the program was designed to include BTIO as an important teaching technique, two schools (49 students) opted not to use them. These students completed all elements of the program except the BTIO activities. Their…

Clinical mimics of infant botulism.

PubMed

Francisco, Ann Marie O; Arnon, Stephen S

2007-04-01

Since 1992, Human Botulism Immune Globulin has been provided by the California Department of Health Services to infants with probable infant botulism, the intestinal toxemia form of human botulism. Human Botulism Immune Globulin became available in California in 1992-1997 within a randomized, controlled, double-blinded, pivotal clinical trial and subsequently became available nationwide in 1998-2003 in an open-label study until its licensure in October 2003 as BabyBIG. Thereafter, Human Botulism Immune Globulin remained available nationwide as an approved orphan-drug product. To achieve prompt neutralization of circulating botulinum toxin, the decision to treat with Human Botulism Immune Globulin has been based on clinical criteria that include a consistent history and physical findings of bulbar palsies, hypotonia, and weakness. After licensure, the charts of patients who did not have laboratory-confirmed infant botulism were reviewed to identify their actual diagnoses. The approximately 5% of 681 patients treated with Human Botulism Immune Globulin who did not have infant botulism fell into 5 categories: spinal muscular atrophy, metabolic disorders, other infectious diseases, miscellaneous, and probable infant botulism lacking laboratory confirmation.

Infants, mothers, and dyadic contributions to stability and prediction of social stress response at 6 months.

PubMed

Provenzi, Livio; Olson, Karen L; Montirosso, Rosario; Tronick, Ed

2016-01-01

The study of infants' interactive style and social stress response to repeated stress exposures is of great interest for developmental and clinical psychologists. Stable maternal and dyadic behavior is critical to sustain infants' development of an adaptive social stress response, but the association between infants' interactive style and social stress response has received scant attention in previous literature. In the present article, overtime stability of infant, maternal, and dyadic behaviors was measured across 2 social stress (i.e., Face-to-Face Still-Face, FFSF) exposures, separated by 15 days. Moreover, infant, maternal, and dyadic behaviors were simultaneously assessed as predictors of infants' social stress to both FFSF exposures. Eighty-one mother-infant dyads underwent the FFSF twice, at 6 months (Exposure 1: the first social stress) and at 6 months and 15 days (Exposure 2: repeated social stress). Infant and mother behavior and dyadic synchrony were microanalytically coded. Overall, individual behavioral stability emerged between FFSF exposures. Infants' response to the first stress was predicted by infant behavior during Exposure 1 Play. Infants' response to the repeated social stress was predicted by infants' response to the first exposure to the Still-Face and by infants' behavior and dyadic synchrony during Exposure 2 Play. Findings reveal stability for individual, but not for dyadic, behavior between 2 social stress exposures at 6 months. Infants' response to repeated social stress was predicted by infants' earlier stress response, infants' own behavior in play, and dyadic synchrony. No predictive effects of maternal behavior were found. Insights for research and clinical work are discussed. (c) 2015 APA, all rights reserved).

Infant botulism: clinical spectrum and epidemiology.

PubMed

Thompson, J A; Glasgow, L A; Warpinski, J R; Olson, C

1980-12-01

Between 1977 and 1979, 12 cases of infant botulism were diagnosed in Utah, and 87 control patients (normal, nonbotulism neurologic disease, and nonbotulism systemic disease) were evaluated. Observations from these patients suggest an expanded clinical spectrum of infant botulism including asymptomatic carriers of organism; mild hypotonia and failure to thrive; typical cases with constipation, bulbar weakness, and hypotonia; and children with a picture compatible with sudden infant death syndrome. Clostridium botulinum was isolated from the stools of three normal control infants and nine control infants who had neurologic diseases that were clearly not infant botulism. These infants were termed "asymptomatic carriers" of the organism. The occurrence of the asymptomatic carrier state suggests that a diagnosis of infant botulism cannot be made on a basis of culture results alone, but must rest in historical documentation and physical confirmation of progressive bulbar and extremity weakness with ultimate complete resolution of symptoms and findings over a period of several months. A common set of environmental features characterizes the home environment of children with infant botulism and "asymptomatic carriers" and includes: nearby constructional or agricultural soil disruption, dusty and windy conditions, a high water table, and alkaline soil conditions.

PREMM: preterm early massage by the mother: protocol of a randomised controlled trial of massage therapy in very preterm infants.

PubMed

Lai, Melissa M; D'Acunto, Giulia; Guzzetta, Andrea; Boyd, Roslyn N; Rose, Stephen E; Fripp, Jurgen; Finnigan, Simon; Ngenda, Naoni; Love, Penny; Whittingham, Koa; Pannek, Kerstin; Ware, Robert S; Colditz, Paul B

2016-08-27

Preterm infants follow an altered neurodevelopmental trajectory compared to their term born peers as a result of the influence of early birth, and the altered environment. Infant massage in the preterm infant has shown positive effects on weight gain and reduced length of hospital stay. There is however, limited current evidence of improved neurodevelopment or improved attachment, maternal mood or anxiety. The aim of this study is to investigate the effects of infant massage performed by the mother in very preterm (VPT) infants. Effects on the infant will be assessed at the electrophysiological, neuroradiological and clinical levels.  Effects on maternal mood, anxiety and mother-infant attachment will also be measured. A randomised controlled trial to investigate the effect of massage therapy in VPT infants. Sixty VPT infants, born at 28 to 32 weeks and 6 days gestational age, who are stable, off supplemental oxygen therapy and have normal cranial ultrasounds will be recruited and randomised to an intervention (infant massage) group or a control (standard care) group. Ten healthy term born infants will be recruited as a reference comparison group. The intervention group will receive standardised massage therapy administered by the mother from recruitment, until term equivalent age (TEA). The control group will receive care as usual (CAU). Infants and their mothers will be assessed at baseline, TEA, 12 months and 24 months corrected age (CA), with a battery of clinical, neuroimaging and electrophysiological measures, as well as structured questionnaires, psychoanalytic observations and neurodevelopmental assessments. Optimising preterm infant neurodevelopment is a key aim of neonatal research, which could substantially improve long-term outcomes and reduce the socio-economic impact of VPT birth. This study has the potential to give insights into the mother-baby relationship and any positive effects of infant massage on neurodevelopment. An early intervention such as massage that is relatively easy to administer and could alter the trajectory of preterm infant brain development, holds potential to improve neurodevelopmental outcomes in this vulnerable population. Australian New Zealand Clinical Trials Registry: ACTRN12612000335897 . Date registered: 22/3/2012.

[Is it ethically acceptable to invite a pregnant woman to enroll in a clinical trial with Tdap if it could entail not being vaccinated with Tdap before delivery?

PubMed

Dal-Ré, Rafael

2017-02-01

Pertussis incidence has increased in recent years, especially among infants aged <2months. A number of Spanish regions have started a vaccination program with Tdap vaccine to all pregnant women in the third trimester of pregnancy. An observational study has shown that this strategy reduces the number of cases of pertussis by 90% in infants aged <2months. Mathematical models showed that a cocooning strategy (i.e. vaccination of the mother at immediate postpartum, and other adults and adolescents who have close contact with the newborn and caregivers) will reduce the incidence of pertussis by 70% in infants aged <2months. It is intended to conduct a clinical trial in which 340 pregnant women will receive Tdap vaccine, whereas another 340 pregnant woman will be vaccinated soon after delivery. Vaccination with Tdap will be offered to all partners and caregivers of the newborn. After assessing both the ethical and scientific reasons supporting the trial, it is concluded that it is ethically and legally acceptable to invite pregnant women living in communities where Tdap vaccination has been implemented to participate in the trial. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

34 CFR 303.21 - Infant or toddler with a disability.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 34 Education 2 2012-07-01 2012-07-01 false Infant or toddler with a disability. 303.21 Section 303... EDUCATION AND REHABILITATIVE SERVICES, DEPARTMENT OF EDUCATION EARLY INTERVENTION PROGRAM FOR INFANTS AND TODDLERS WITH DISABILITIES General Definitions Used in This Part § 303.21 Infant or toddler with a...

34 CFR 303.21 - Infant or toddler with a disability.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 34 Education 2 2013-07-01 2013-07-01 false Infant or toddler with a disability. 303.21 Section 303... EDUCATION AND REHABILITATIVE SERVICES, DEPARTMENT OF EDUCATION EARLY INTERVENTION PROGRAM FOR INFANTS AND TODDLERS WITH DISABILITIES General Definitions Used in This Part § 303.21 Infant or toddler with a...

34 CFR 303.21 - Infant or toddler with a disability.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 34 Education 2 2014-07-01 2013-07-01 true Infant or toddler with a disability. 303.21 Section 303... EDUCATION AND REHABILITATIVE SERVICES, DEPARTMENT OF EDUCATION EARLY INTERVENTION PROGRAM FOR INFANTS AND TODDLERS WITH DISABILITIES General Definitions Used in This Part § 303.21 Infant or toddler with a...

A Manual for Parents and Professionals.

ERIC Educational Resources Information Center

Gerber, Magda, Ed.

This collection of papers describes a way of viewing and caring for infants. Part I begins with practical suggestions for parents on such topics as loving, quality time, and day care centers. Part II explores Magda Gerber's work with Dr. Pikler, the Loczy Model of infant care, respecting infants, the Demonstration Infant Program, language…

Infant botulism: case reports and review.

PubMed

Krishna, S; Puri, V

2001-04-01

Infant Botulism (IB) is a relatively uncommon, though potentially life-threatening neuroparalytic illness caused by the toxins elaborated by Clostridium botulinum (C botulinum). We describe two cases of Infant Botulism. Both these infants presented with a sepsis-like picture and were unsuspectingly treated with the conventional antibiotics ampicillin and gentamicin. The neuroparalytic syndrome of both infants was probably potentiated by the use of gentamicin. We suggest that cefotaxime be carefully considered instead of gentamicin in the initial management of infants presenting with a sepsis-like clinical picture and associated history of constipation, recent onset of hypotonia, poor feeding and/or drooling. Clinical trials evaluating human Botulism Immune Globulin (BIG) are under way by the California Department of Health. This article comes at a very timely moment because once FDA approved, BIG will be the only specific treatment available for this illness.

Building Their Futures: How Early Head Start Programs Are Enhancing the Lives of Infants and Toddlers in Low-Income Families. Volume I: Technical Report.

ERIC Educational Resources Information Center

Love, John M.; Kisker, Ellen Eliason; Ross, Christine M.; Schochet, Peter Z.; Brooks-Gunn, Jeanne; Boller, Kimberly; Paulsell, Diane; Fuligni, Allison Sidle; Berlin, Lisa J.

Early Head Start began with 68 programs in 1995 and today, almost 650 programs serve some 55,000 low-income families with infants and toddlers. This two-generation program provides high-quality child and family development services, a focus on staff development, and a commitment to community partnerships. A rigorous national evaluation, including…

The Infant Fish Oil Supplementation Study (IFOS): design and research protocol of a double-blind, randomised controlled n--3 LCPUFA intervention trial in term infants.

PubMed

Meldrum, S J; D'Vaz, N; Dunstan, J; Mori, T A; Prescott, S L

2011-09-01

The Infant Fish Oil Supplementation Study is a double-blind randomised controlled trial investigating whether the incidence of allergic disease can be reduced and developmental outcomes enhanced through supplementation with omega-3 fatty acids. Infants at high risk of developing allergic disease will be randomised to receive either fish oil or olive oil supplements until 6 months of age and followed up at six postnatal clinic visits to assess allergy outcomes and infant neurodevelopment. Study groups to consist of a treatment group allocated to receive 650 mg of fish oil daily (250-280 mg docosahexaenoic acid and at least 60 mg eicosapentaenoic acid and a placebo group (olive oil) from birth to 6 months of age. Allergy outcomes will be assessed by clinical history, clinical assessments and allergen skin prick tests at the 12, 30 and 60 month visits. Neurodevelopmental assessments to be conducted at 18 months, and language questionnaires at 12, 18 and 30 months. Samples will be collected from mothers antenatally, from infants at birth, and at clinic visits from 6 months onwards for immunological assessments. Fatty acid composition to be measured in erythrocytes and plasma (at birth and after the supplementation period) to assess the effect of the intervention on fatty acid status. Information on medical history, diet and other lifestyle factors at an antenatal clinic visit and postnatal clinic visits will also be collected. This study is designed to examine clinically relevant effects of a novel, non-invasive and potentially low cost approach to reduce the incidence of allergic disease and facilitate neurodevelopment during early childhood. Copyright © 2011 Elsevier Inc. All rights reserved.

Neonatal Candidiasis: Epidemiology, Risk Factors, and Clinical Judgment

PubMed Central

Benjamin, Daniel K.; Stoll, Barbara J.; Gantz, Marie G.; Walsh, Michele C.; Sanchez, Pablo J.; Das, Abhik; Shankaran, Seetha; Higgins, Rosemary D.; Auten, Kathy J.; Miller, Nancy A.; Walsh, Thomas J.; Laptook, Abbot R.; Carlo, Waldemar A.; Kennedy, Kathleen A.; Finer, Neil N.; Duara, Shahnaz; Schibler, Kurt; Chapman, Rachel L.; Van Meurs, Krisa P.; Frantz, Ivan D.; Phelps, Dale L.; Poindexter, Brenda B.; Bell, Edward F.; O’Shea, T. Michael; Watterberg, Kristi L.; Goldberg, Ronald N.

2011-01-01

OBJECTIVE Invasive candidiasis is a leading cause of infection-related morbidity and mortality in extremely low-birth-weight (<1000 g) infants. We quantify risk factors predicting infection in high-risk premature infants and compare clinical judgment with a prediction model of invasive candidiasis. METHODS The study involved a prospective observational cohort of infants <1000 g birth weight at 19 centers of the NICHD Neonatal Research Network. At each sepsis evaluation, clinical information was recorded, cultures obtained, and clinicians prospectively recorded their estimate of the probability of invasive candidiasis. Two models were generated with invasive candidiasis as their outcome: 1) potentially modifiable risk factors and 2) a clinical model at time of blood culture to predict candidiasis. RESULTS Invasive candidiasis occurred in 137/1515 (9.0%) infants and was documented by positive culture from ≥ 1 of these sources: blood (n=96), cerebrospinal fluid (n=9), urine obtained by catheterization (n=52), or other sterile body fluid (n=10). Mortality was not different from infants who had positive blood culture compared to those with isolated positive urine culture. Incidence varied from 2–28% at the 13 centers enrolling ≥ 50 infants. Potentially modifiable risk factors (model 1) included central catheter, broad-spectrum antibiotics (e.g., third-generation cephalosporins), intravenous lipid emulsion, endotracheal tube, and antenatal antibiotics. The clinical prediction model (model 2) had an area under the receiver operating characteristic curve of 0.79, and was superior to clinician judgment (0.70) in predicting subsequent invasive candidiasis. Performance of clinical judgment did not vary significantly with level of training. CONCLUSION Prior antibiotics, presence of a central catheter, endotracheal tube, and center were strongly associated with invasive candidiasis. Modeling was more accurate in predicting invasive candidiasis than clinical judgment. PMID:20876174

7 CFR 247.16 - Certification period.

Code of Federal Regulations, 2011 CFR

2011-01-01

... AGRICULTURE CHILD NUTRITION PROGRAMS COMMODITY SUPPLEMENTAL FOOD PROGRAM § 247.16 Certification period. (a) How long is the certification period? (1) Women, infants, and children. For women, infants, and children, the State agency must establish certification periods that may not exceed 6 months in length...

7 CFR 247.16 - Certification period.

Code of Federal Regulations, 2010 CFR

2010-01-01

... AGRICULTURE CHILD NUTRITION PROGRAMS COMMODITY SUPPLEMENTAL FOOD PROGRAM § 247.16 Certification period. (a) How long is the certification period? (1) Women, infants, and children. For women, infants, and children, the State agency must establish certification periods that may not exceed 6 months in length...

Fiberoptic Endoscopic Evaluation of Swallowing: A Multidisciplinary Alternative for Assessment of Infants With Dysphagia in the Neonatal Intensive Care Unit.

PubMed

Reynolds, Jenny; Carroll, Sandra; Sturdivant, Chrysty

2016-02-01

The standard procedure to assess an infant in the neonatal intensive care unit (NICU) who is suspected of aspirating on oral feedings is a videofluoroscopic swallowing study (VFSS). The VFSS has been used for more than 30 years to assess dysphagia and is considered the gold standard. However, there are challenges to the VFSS, including radiation exposure, transport to radiology, usage of barium, limited positioning options, and cost. An alternative approach is fiberoptic endoscopic evaluation of swallowing (FEES), which uses a flexible endoscope passed transnasally into the pharynx to assess anatomy, movement/sensation of structures, swallow function, and response to therapeutic interventions. Fiberoptic endoscopic evaluation of swallowing has been established as a valid tool for evaluating dysphagia and utilized as an alternative or supplement to the VFSS in both adults and children. This article provides an overview of the current challenges in the NICU with assessing aspiration and introduces a multidisciplinary FEES program for bottle and breastfeeding. A review of the literature of dysphagia, VFSS, and FEES in the adult, pediatric, infant, and neonatal populations was performed. Clinical competency standards were researched and then implemented through an internal process of validation. Finally, a best practice protocol was designed as it relates to FEES in the NICU. Fiberoptic endoscopic evaluation of swallowing is a safe alternative to the VFSS. It can be utilized at the infant's bedside in a NICU for the diagnosis and treatment of swallowing disorders by allowing the clinician the ability to replicate a more accurate feeding experience, therefore, determining a safe feeding plan. Competency and training are essential to establishing a multidisciplinary FEES program in the NICU. Further research is needed to compare the efficacy and validity of FEES versus VFSS for infants in the NICU. Furthermore, evaluating the efficacy of FEES during breastfeeding is warranted.

Pharmacoeconomic spotlight on rotavirus vaccine RIX4414 (Rotarix™) in developed countries.

PubMed

Plosker, Greg L

2012-12-01

The most common cause of severe diarrhea in infants and young children is rotavirus gastroenteritis (RVGE), which is associated with significant morbidity, healthcare resource use, and direct and indirect costs in industrialized nations. The monovalent rotavirus vaccine RIX4414 (Rotarix™) is administered as a two-dose oral series in infants and has demonstrated protective efficacy against RVGE in clinical trials conducted in developed countries. In addition, various naturalistic studies have demonstrated 'real-world' effectiveness after the introduction of widespread rotavirus vaccination programs in the community setting. Numerous cost-effectiveness analyses have been conducted in developed countries in which a universal rotavirus vaccination program using RIX4414 was compared with no universal rotavirus vaccination program. There was a high degree of variability in base-case results across studies even when the studies were conducted in the same country, often reflecting differences in the selection of data sources or assumptions used to populate the models. In addition, results were sensitive to plausible changes in a number of key input parameters. As such, it is not possible to definitively state whether a universal rotavirus vaccination program with RIX4414 is cost effective in developed countries, although results of some analyses in some countries suggest this is the case. In addition, international guidelines advocate universal vaccination of infants and children against rotavirus. It is also difficult to draw conclusions regarding the cost effectiveness of rotavirus vaccine RIX4414 relative to that of the pentavalent rotavirus vaccine, which is administered as a three-dose oral series. Although indirect comparisons in cost-effectiveness analyses indicate that RIX4414 provided more favorable incremental cost-effectiveness ratios when each vaccine was compared with no universal rotavirus vaccination program, results were generally sensitive to vaccine costs. Actual tender prices of a full vaccination course for each vaccine were not known at the time of the analyses and therefore had to be estimated.

Medical Evaluation of the Special Supplemental Food Program for Women, Infants and Children. Select Committee on Nutrition and Human Needs, United States Senate, Ninety-Fourth Congress, 2d Session. Committee Print.

ERIC Educational Resources Information Center

Congress of the U.S., Washington, DC. Senate Select Committee on Nutrition and Human Needs.

This paper reports a medical evaluation of a federal program providing funds for special nutritious food supplements to low income pregnant and lactating women, infants, and children up to four years of age who are nutritional risks. Growth, dietary intake, and biochemical measures were obtained for study infants at the time of enrollment in the…

Computer-based analysis of general movements reveals stereotypies predicting cerebral palsy.

PubMed

Philippi, Heike; Karch, Dominik; Kang, Keun-Sun; Wochner, Katarzyna; Pietz, Joachim; Dickhaus, Hartmut; Hadders-Algra, Mijna

2014-10-01

To evaluate a kinematic paradigm of automatic general movements analysis in comparison to clinical assessment in 3-month-old infants and its prediction for neurodevelopmental outcome. Preterm infants at high risk (n=49; 26 males, 23 females) and term infants at low risk (n=18; eight males, 10 females) of developmental impairment were recruited from hospitals around Heidelberg, Germany. Kinematic analysis of general movements by magnet tracking and clinical video-based assessment of general movements were performed at 3 months of age. Neurodevelopmental outcome was evaluated at 2 years. By comparing the general movements of small samples of children with and without cerebral palsy (CP), we developed a kinematic paradigm typical for infants at risk of developing CP. We tested the validity of this paradigm as a tool to predict CP and neurodevelopmental impairment. Clinical assessment correctly identified almost all infants with neurodevelopmental impairment including CP, but did not predict if the infant would be affected by CP or not. The kinematic analysis, in particular the stereotypy score of arm movements, was an excellent predictor of CP, whereas stereotyped repetitive movements of the legs predicted any neurodevelopmental impairment. The automatic assessment of the stereotypy score by magnet tracking in 3-month-old spontaneously moving infants at high risk of developmental abnormalities allowed a valid detection of infants affected and unaffected by CP. © 2014 Mac Keith Press.

The extended Infant Feeding, Activity and Nutrition Trial (InFANT Extend) Program: a cluster-randomized controlled trial of an early intervention to prevent childhood obesity.

PubMed

Campbell, Karen J; Hesketh, Kylie D; McNaughton, Sarah A; Ball, Kylie; McCallum, Zoë; Lynch, John; Crawford, David A

2016-02-18

Understanding how we can prevent childhood obesity in scalable and sustainable ways is imperative. Early RCT interventions focused on the first two years of life have shown promise however, differences in Body Mass Index between intervention and control groups diminish once the interventions cease. Innovative and cost-effective strategies seeking to continue to support parents to engender appropriate energy balance behaviours in young children need to be explored. The Infant Feeding Activity and Nutrition Trial (InFANT) Extend Program builds on the early outcomes of the Melbourne InFANT Program. This cluster randomized controlled trial will test the efficacy of an extended (33 versus 15 month) and enhanced (use of web-based materials, and Facebook® engagement), version of the original Melbourne InFANT Program intervention in a new cohort. Outcomes at 36 months of age will be compared against the control group. This trial will provide important information regarding capacity and opportunities to maximize early childhood intervention effectiveness over the first three years of life. This study continues to build the evidence base regarding the design of cost-effective, scalable interventions to promote protective energy balance behaviors in early childhood, and in turn, promote improved child weight and health across the life course. ACTRN12611000386932. Registered 13 April 2011.

Infants of Narcotic Addicted Mothers: Developmental Status, Maternal Care, Home Environments and Interventive Efforts During the First Three Months of Life.

ERIC Educational Resources Information Center

Derrick, Sara M.; Hock, Ellen

This study compared infants born to narcotic addicted mothers with infants born to nonaddicted mothers and described the potential of an intervention program. Infants of five addicted women were matched with infants of five nonaddicted women on the basis of age and socioeconomic class of the mothers and on the basis of gestational ages, birth…

[Theoretical Development and Research Trends in Developmental Care].

PubMed

Wang, Yu-Wen; Chang, Ying-Ju

2015-10-01

The Newborn Individualized Developmental Care and Assessment Program (NIDCAP), based on the Synactive Theory, is applied to improve brain development in premature and illness infants within a supportive environment. The NIDCAP has been used widely in the clinical setting. The aim of this article was to systematically review research published between 2000 and 2013 that relates to the evidence and application of developmental care. Most studies support the effectiveness of developmental care in terms of facilitating the healthy growth of premature infants, reducing oxygen dependence, reducing hospitalization times, and improving neurodevelopmental outcomes at two years of age. However, research results related to the effects of developmental care on neurodevelopmental outcomes from 2 years old to school age are not consistent. The heterogeneity of interventions, outcome indicators, and measurements in studies may contribute to these mixed results. In addition, as developmental care has been applied for many years, the contamination of participants in the supportive environment should be considered. Based on current evidence, neonatal healthcare professionals must recognize the core value of developmental care in dealing with premature infants and their families. In order to provide effective interventions for infants, further research is needed to assess the comparative effects of the single intervention and the holistic approach in developmental care.

The effect of the Family Case Management Program on 1996 birth outcomes in Illinois.

PubMed

Keeton, Kristie; Saunders, Stephen E; Koltun, David

2004-03-01

The purpose of this study was to determine if birth outcomes for Medicaid recipients were improved with participation in the Illinois Family Case Management Program. Health program data files were linked with the 1996 Illinois Vital Records linked birth-death certificate file. Logistic regression was used to characterize the variation in birth outcomes as a function of Family Case Management participation while statistically controlling for measurable factors found to be confounders. Results of the logistic regression analysis show that women who participated in the Family Care Management Program were significantly less likely to give birth to very low birth weight infants (odds ratio [OR] = 0.86, 95% confidence interval [CI] = 0.75, 0.99) and low birth weight infants (OR = 0.83, CI = 0.79, 0.89). For infant mortality, however, the adjusted OR (OR = 0.98, CI = 0.82, 1.17), although under 1, was not statistically significant. These results suggest that the Family Case Management Program may be effective in reducing very low birth weight and low birth weight rates among infants born to low-income women.

Chest shielding for prevention of a haemodynamically significant patent ductus arteriosus in preterm infants receiving phototherapy.

PubMed

Bhola, Kavita; Foster, Jann P; Osborn, David A

2015-11-03

Patent ductus arteriosus (PDA) is associated with mortality and morbidity in preterm infants. Phototherapy is a common treatment for jaundice in preterm infants. However, phototherapy has been associated with failure of closure of the ductus arteriosus in preterm infants. To determine if chest shielding of preterm infants receiving phototherapy reduces the incidence of clinically and/or haemodynamically significant PDA and reduces morbidity secondary to PDA. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library; 2015, Issue 3), MEDLINE, EMBASE, CINAHL, previous reviews, cross-references, abstracts, proceedings of scientific meetings, and trial registries through March 2015. Randomised controlled trials (RCTs), cluster-RCTs, or quasi-RCTs of chest shielding during phototherapy compared to sham shielding or no shielding for the prevention of a haemodynamically or clinically significant PDA in preterm infants. Three review authors independently assessed studies for eligibility and quality and extracted data. We defined a clinically significant PDA as the presence of a PDA with clinical signs of an effect on organ function attributable to the ductus arteriosus. We defined a haemodynamically significant PDA as clinical and/or echocardiographic signs of a significant ductus arteriosus effect on blood flow. We included two small trials enrolling very preterm infants (Rosenfeld 1986; Travadi 2006). We assessed both as at high risk of bias. No study reported clinically significant PDA, defined as the presence of a PDA with clinical symptoms or signs attributable to the effect of a ductus arteriosus on organ function. Rosenfeld 1986 reported a non-significant reduction in haemodynamically significant PDA with left atrial to aortic root ratio greater than 1.2 (risk ratio (RR) 0.23, 95% confidence interval (CI) 0.05 to 1.01; 74 infants) but a statistically significant risk difference (RD -0.18, 95% CI -0.34 to -0.03; number needed to treat for an additional beneficial outcome (NNTB) 5, 95% CI 3 to 33). Rosenfeld 1986 reported a significant reduction in PDA detected by murmur (RR 0.50, 95% CI 0.29 to 0.88; RD -0.30, 95% CI -0.52 to -0.08; NNTB 3, 95% CI 2 to 12; 74 infants). Rosenfeld 1986 reported a significant reduction in treatment with indomethacin (RR 0.12, 95% CI 0.02 to 0.88; RD -0.21, 95% CI -0.35 to -0.06; NNTB 5, 95% CI 3 to 17; 74 infants), and only one infant had a ductal ligation in the no-shield group. There were no other significant outcomes, including mortality to discharge or 28 days, days in oxygen, days on mechanical ventilation, days in hospital, intraventricular haemorrhage, retinopathy of prematurity, or exchange transfusion. The available evidence is very low quality and insufficient to assess the safety or efficacy of chest shield during phototherapy for prevention of PDA in preterm infants. Further trials of chest shielding are warranted, particularly in settings where infants are not receiving prophylactic or early echocardiographic targeted cyclo-oxygenase inhibitors for PDA.

Low absolute neutrophil counts in African infants.

PubMed

Kourtis, Athena P; Bramson, Brian; van der Horst, Charles; Kazembe, Peter; Ahmed, Yusuf; Chasela, Charles; Hosseinipour, Mina; Knight, Rodney; Lugalia, Lebah; Tegha, Gerald; Joaki, George; Jafali, Robert; Jamieson, Denise J

2005-07-01

Infants of African origin have a lower normal range of absolute neutrophil counts than white infants; this fact, however, remains under appreciated by clinical researchers in the United States. During the initial stages of a clinical trial in Malawi, the authors noted an unexpectedly high number of infants with absolute neutrophil counts that would be classifiable as neutropenic using the National Institutes of Health's Division of AIDS toxicity tables. The authors argue that the relevant Division of AIDS table does not take into account the available evidence of low absolute neutrophil counts in African infants and that a systematic collection of data from many African settings might help establish the absolute neutrophil count cutpoints to be used for defining neutropenia in African populations.

[Infant botulism: case report and review].

PubMed

Arriagada S, Daniela; Wilhelm B, Jan; Donoso F, Alejandro

2009-04-01

Botulism is a rare disease in Chile and of the known clinical presentation, infant botulism is the most common. We report the case of a previously healthy seven month old male infant with a two weeks history of rinorrea, cough, fatigue, constipation and progressive weakness after the consumption of honey. Stool cultures were positive for Clostridium botulinum group 1 type A and electromyography was compatible with the diagnosis. The patient evolved with arterial hypertension, interpreted as secondary to autonomic dysfunction, which responded to calcium channel blockers. Muscle tone improved progressively during the following four weeks. Infant botulism is a potentially fatal disease; diagnosis can be difficult given the broad clinical manifestations. Prevention should focus on education of parents of infants as well as medical personnel.

Towards evidence-based resuscitation of the newborn infant.

PubMed

Manley, Brett J; Owen, Louise S; Hooper, Stuart B; Jacobs, Susan E; Cheong, Jeanie L Y; Doyle, Lex W; Davis, Peter G

2017-04-22

Effective resuscitation of the newborn infant has the potential to save many lives around the world and reduce disabilities in children who survive peripartum asphyxia. In this Series paper, we highlight some of the important advances in the understanding of how best to resuscitate newborn infants, which includes monitoring techniques to guide resuscitative efforts, increasing awareness of the adverse effects of hyperoxia, delayed umbilical cord clamping, the avoidance of routine endotracheal intubation for extremely preterm infants, and therapeutic hypothermia for hypoxic-ischaemic encephalopathy. Despite the challenges of performing high-quality clinical research in the delivery room, researchers continue to refine and advance our knowledge of effective resuscitation of newborn infants through scientific experiments and clinical trials. Copyright © 2017 Elsevier Ltd. All rights reserved.

Congenital rubella syndrome: a review of laboratory data from 2002 to 2011.

PubMed

Saraswathy, T S; Rozainanee, M Z; Asshikin, R Nurul; Zainah, S

2013-05-01

Rubella infection in pregnant women during the first trimester of pregnancy can lead to fetal anomalies, commonly known as congenital rubella syndrome (CRS). The objective of our study was to analyze the serological test results among infants suspected of having CRS aged < or = 12 months compared with their clinical status. Between January 2002 and December 2011, 3,279 serum samples from infants aged < or = 12 months from government hospitals in Malaysia were examined for rubella specific IgM and IgG antibodies using a Axsym, automated analyzer (Abbott Laboratories). Forty-eight samples were positive for rubella specific IgM antibodies and 494 samples were positive for rubella specific IgG antibodies. These were then age stratified and their clinical history reviewed for any CRS symptoms. Fifteen of 38 rubella IgM positive infants (39.5%) aged < 3 months, had a clinical appearance compatible with CRS. However, only 1 IgM positive infant aged 3 to 6 months and one infant aged 7 to 11 months had clinical appearance compatible with CRS. The most common abnormal findings in these cases were congenital heart defects and cataracts. Forty-eight point eight percent of IgM positive cases and 53.1% of IgG positive cases, had inadequate information in the chart to determine the presence of CRS. Clinical findings and timely laboratory diagnosis to determine the presence of CRS are important in infants born with congenital defects. Physicians should also be aware of the appropriate interpretation of these findings.

Transient hypothyroidism in the newborn: to treat or not to treat

PubMed Central

Kanike, Neelakanta; Davis, Ajuah

2017-01-01

Transient congenital hypothyroidism (CH) refers to a temporary deficiency of thyroid hormone identified after birth, with low thyroxine (T4) and elevated thyrotropin (TSH), which later recovers to improved thyroxine production, typically in first few months of infancy. Approximately 17% to 40% of children diagnosed with CH by newborn screening (NBS) programs were later determined to have transient hypothyroidism. Causes of transient CH are prematurity, iodine deficiency, maternal thyrotropin receptor blocking antibodies, maternal intake of anti-thyroid drugs, maternal or neonatal iodine exposure, loss of function mutations and hepatic hemangiomas. The classic clinical symptoms and signs of CH are usually absent immediately after birth in vast majority of infants due to temporary protection from maternal thyroxine. NBS has been largely successful in preventing intellectual disability by early detection of CH by performing thyroid function tests in infants with abnormal screening results. In this review we present the evidence for decision making regarding treatment vs. withholding treatment in infants with transient CH and present a rational approach to identifying transient CH based on American Academy of Pediatrics (AAP) recommendation. PMID:29184815

Forging a pediatric primary care-community partnership to support food-insecure families.

PubMed

Beck, Andrew F; Henize, Adrienne W; Kahn, Robert S; Reiber, Kurt L; Young, John J; Klein, Melissa D

2014-08-01

Academic primary care clinics often care for children from underserved populations affected by food insecurity. Clinical-community collaborations could help mitigate such risk. We sought to design, implement, refine, and evaluate Keeping Infants Nourished and Developing (KIND), a collaborative intervention focused on food-insecure families with infants. Pediatricians and community collaborators codeveloped processes to link food-insecure families with infants to supplementary infant formula, educational materials, and clinic and community resources. Intervention evaluation was done prospectively by using time-series analysis and descriptive statistics to characterize and enumerate those served by KIND during its first 2 years. Analyses assessed demographic, clinical, and social risk outcomes, including completion of preventive services and referral to social work or our medical-legal partnership. Comparisons were made between those receiving and not receiving KIND by using χ2 statistics. During the 2-year study period, 1042 families with infants received KIND. Recipients were more likely than nonrecipients to have completed a lead test and developmental screen (both P < .001), and they were more likely to have received a full set of well-infant visits by 14 months (42.0% vs. 28.7%; P < .0001). Those receiving KIND also were significantly more likely to have been referred to social work (29.2% vs. 17.6%; P < .0001) or the medical-legal partnership (14.8% vs. 5.7%; P < .0001). Weight-for-length at 9 months did not statistically differ between groups. A clinical-community collaborative enabled pediatric providers to address influential social determinants of health. This food insecurity-focused intervention was associated with improved preventive care outcomes for the infants served. Copyright © 2014 by the American Academy of Pediatrics.

34 CFR 303.501 - Permissive use of funds by the lead agency.

Code of Federal Regulations, 2014 CFR

2014-07-01

... SPECIAL EDUCATION AND REHABILITATIVE SERVICES, DEPARTMENT OF EDUCATION EARLY INTERVENTION PROGRAM FOR... and necessary for implementing the State's early intervention program for infants and toddlers with disabilities including funds— (a) For direct early intervention services for infants and toddlers with...

34 CFR 303.501 - Permissive use of funds by the lead agency.

Code of Federal Regulations, 2013 CFR

2013-07-01

... SPECIAL EDUCATION AND REHABILITATIVE SERVICES, DEPARTMENT OF EDUCATION EARLY INTERVENTION PROGRAM FOR... and necessary for implementing the State's early intervention program for infants and toddlers with disabilities including funds— (a) For direct early intervention services for infants and toddlers with...

34 CFR 303.501 - Permissive use of funds by the lead agency.

Code of Federal Regulations, 2012 CFR

2012-07-01

... SPECIAL EDUCATION AND REHABILITATIVE SERVICES, DEPARTMENT OF EDUCATION EARLY INTERVENTION PROGRAM FOR... and necessary for implementing the State's early intervention program for infants and toddlers with disabilities including funds— (a) For direct early intervention services for infants and toddlers with...

Prenatal Maternal Stress Programs Infant Stress Regulation

ERIC Educational Resources Information Center

Davis, Elysia Poggi; Glynn, Laura M.; Waffarn, Feizal; Sandman, Curt A.

2011-01-01

Objective: Prenatal exposure to inappropriate levels of glucocorticoids (GCs) and maternal stress are putative mechanisms for the fetal programming of later health outcomes. The current investigation examined the influence of prenatal maternal cortisol and maternal psychosocial stress on infant physiological and behavioral responses to stress.…

77 FR 64524 - Advisory Committee on Infant Mortality; Notice of Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-22

... the Healthy Start Program and Healthy People 2020 infant mortality objectives. Agenda: Topics that will be discussed include the following: HRSA Update; Maternal and Child Health Bureau Update; Healthy Start Program Update; Updates from Partnering Agencies and Organizations; and ACIM's recommendations for...

Professional Development Strategies to Support the Inclusion of Infants and Toddlers with Disabilities in Infant-Family Programs

ERIC Educational Resources Information Center

Corso, Robert; Brekken, Linda; Ducey, Cheryl; Knapp-Philo, Joanne

2006-01-01

This article describes The Hilton/Early Head Start Training Program, a public-private partnership between the Conrad N. Hilton Foundation and the Head Start Bureau, U.S. Department of Health and Human Services, Administration for Children and Families. The purpose of the training program was to develop skills and strategies for including infants…

A Digest and Comparative Analysis of Major Federal Programs Affecting Infants and Toddlers with Handicaps and Their Families.

ERIC Educational Resources Information Center

O'Reilly, Fran E.; And Others

This study analyzes major federal programs designed to provide services to children, from birth through age 2, who have developmental delays or a high probability of developmental delays, and their families. Programs were selected based on their provision of education or health-related services to infants and toddlers with handicaps and their…

Outcomes of a randomized controlled trial of nutrition education to promote farmers' market fruit and vegetable purchases and consumption among women enrolled in the Special Supplemental Nutrition Program for Women, Infants,

USDA-ARS?s Scientific Manuscript database

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides participants seasonal Farmers' Market Nutrition Program (FMNP) vouchers to purchase fruits and vegetables (FV) at farmers' markets and monthly cash value vouchers (CVV) redeemable at farmers' markets. Despite ...

Comprehensive Early Stimulation Program for Infants. Instruction Manual [and] Early Interventionist's Workbook [and] Parent/Caregiver Workbook. William Beaumont Hospital Speech and Language Pathology Series.

ERIC Educational Resources Information Center

Santana, Altagracia A.; Bottino, Patti M.

This early intervention kit includes a Comprehensive Early Stimulation Program for Infants (CESPI) instruction manual, an early interventionist workbook, and ten parent/caregiver workbooks. The CESPI early intervention program is designed to provide therapists, teachers, other health professionals, and parents with a common-sense, practical guide…

[Effects of a Hospital Based Follow-Up Program for Mothers with Very Low Birth Weight Infants].

PubMed

Kim, Min Hee; Ji, Eun Sun

2016-02-01

This paper reports the results of a hospital centered follow-up program on parenting stress, parenting efficacy and coping for mothers with very low birth weight (VLBW) infants. The follow-up program consisted of home visiting by an expert group and self-help program for 1 year. A non-equivalent control group pre-post quasi-experimental design was used. Participants were 70 mothers with low birth weight infants and were assigned to one of two groups, an experimental groups (n=28), which received the family support program; and a control group (n=27), which received the usual discharge education. Data were analyzed using χ²-test, t-test, and ANCOVA with IBM SPSS statistics 20.0. Mothers' parenting stress (F=5.66, p=.004) was significantly decreased in the experimental group. There were also significant increases in parenting efficacy (F=13.05, p<.001) and coping (F=8.91, p=.002) in the experimental group. The study findings suggest that a follow-up program for mothers with VLBW infants is an effective intervention to decrease mothers' parenting stress and to enhance parenting efficacy and coping.

Characteristics and attitudes of parents of children born with the use of assisted reproductive technology.

PubMed

Braverman, A M; Boxer, A S; Corson, S L; Coutifaris, C; Hendrix, A

1998-11-01

To explore the medical issues, attitudes, concerns, and choices that parents have about their children born with the use of assisted reproductive technology (ART). Retrospective and prospective survey. An academic medical center and a private practice. Participants who conceived and were delivered of infants in two ART programs. A total of 373 patients were mailed an anonymous survey, a consent form, and the Parent Child Relationship Inventory. The rate of response was approximately 49% for clinic A and 33% for clinic B. Pregnancy outcomes and attitudes about parenting. Respondents' major concerns during pregnancy revolved around miscarriage and the infant's health; complications occurred in 38.9% of first pregnancies. Parents believed that their children were more appreciated, that their children were not emotionally different, that ART did not create ongoing medical or emotional problems, and they were not overprotective as parents. Gender differences were statistically significant on attitudinal variables. Parents had concerns about pregnancy. Overall, men and women felt positive about ART and their parenting. The ART experience is associated with complex choices, attitudes, and emotions.

Physical activity programs for promoting bone mineralization and growth in preterm infants.

PubMed

Schulzke, Sven M; Kaempfen, Siree; Trachsel, Daniel; Patole, Sanjay K

2014-04-22

Lack of physical stimulation may contribute to metabolic bone disease of preterm infants, resulting in poor bone mineralization and growth. Physical activity programs combined with adequate nutrition might help to promote bone mineralization and growth. The primary objective was to assess whether physical activity programs in preterm infants improve bone mineralization and growth and reduce the risk of fracture.The secondary objectives included other potential benefits in terms of length of hospital stay, skeletal deformities and neurodevelopmental outcomes, and adverse events.Subgroup analysis:• Given that the smallest infants are most vulnerable for developing osteopenia (Bishop 1999), a subgroup analysis was planned for infants with birth weight < 1000 g.• Calcium and phosphorus intake may affect an infant's ability to increase bone mineral content (Kuschel 2004). Therefore, an additional subgroup analysis was planned for infants receiving different amounts of calcium and phosphorus, along with full enteral feeds as follows. ∘ Below 100 mg/60 mg calcium/phosphorus or equal to/above 100 mg/60 mg calcium/phosphorus per 100 mL milk. ∘ Supplementation of calcium without phosphorus. ∘ Supplementation of phosphorus without calcium. The standard search strategy of the Cochrane Neonatal Review Group (CNRG) was used. The search included the Cochrane Central Register of Controlled Trials (CENTRAL) (2012, Issue 9), MEDLINE, EMBASE, CINAHL (1966 to March 2013), and cross-references, as well as handsearching of abstracts of the Society for Pediatric Research and the International Journal of Sports Medicine. Randomized and quasi-randomized controlled trials comparing physical activity programs (extension and flexion, range-of-motion exercises) versus no organized physical activity programs in preterm infants. Data collection, study selection, and data analysis were performed according to the methods of the CNRG. Eleven trials enrolling 324 preterm infants (gestational age 26 to 34 weeks) were included in this review. All were small (N = 16 to 50) single-center studies that evaluated daily physical activity for three and one-half to eight weeks during initial hospitalization. Methodological quality and reporting of included trials were variable.Four trials demonstrated moderate short-term benefits of physical activity for bone mineralization at completion of the physical activity program. The only trial assessing long-term effects on bone mineralization showed no effect of physical activity administered during initial hospitalization on bone mineralization at 12 months corrected age. Meta-analysis from four trials demonstrated a positive effect of physical activity on daily weight gain (weighted mean difference (WMD) 2.21 g/kg/d, 95% confidence interval (CI) 1.23 to 3.19). Data from four trials showed a positive effect on linear growth (WMD 0.12 cm/wk, 95% CI 0.01 to 0.24) but not on head growth (WMD -0.03 cm/wk, 95% CI -0.14 to 0.08) during the study period. Only one trial reported on fractures (this outcome did not occur in intervention and control groups) and complications of preterm birth (no significant differences between intervention and control groups). None of the trials assessed other outcomes relevant to this review. Some evidence suggests that physical activity programs might promote short-term weight gain and bone mineralization in preterm infants. Data are inadequate to allow assessment of harm or long-term effects. Current evidence does not support the routine use of physical activity programs in preterm infants. Further trials incorporating infants with a high baseline risk of osteopenia are required. These trials should address adverse events, long-term outcomes, and the effects of nutritional intake (calories, protein, calcium, phosphorus).

Safety and efficacy of alternative antibiotic regimens compared with 7 day injectable procaine benzylpenicillin and gentamicin for outpatient treatment of neonates and young infants with clinical signs of severe infection when referral is not possible: a randomised, open-label, equivalence trial.

PubMed

Baqui, Abdullah H; Saha, Samir K; Ahmed, A S M Nawshad Uddin; Shahidullah, Mohammad; Quasem, Iftekhar; Roth, Daniel E; Samsuzzaman, A K M; Ahmed, Wazir; Tabib, S M Shahnawaz Bin; Mitra, Dipak K; Begum, Nazma; Islam, Maksuda; Mahmud, Arif; Rahman, Mohammad Hefzur; Moin, Mamun Ibne; Mullany, Luke C; Cousens, Simon; El Arifeen, Shams; Wall, Stephen; Brandes, Neal; Santosham, Mathuram; Black, Robert E

2015-05-01

Severe infections remain one of the main causes of neonatal deaths worldwide. Possible severe infection is diagnosed in young infants (aged 0-59 days) according to the presence of one or more clinical signs. The recommended treatment is hospital admission with 7-10 days of injectable antibiotic therapy. In low-income and middle-income countries, barriers to hospital care lead to delayed, inadequate, or no treatment for many young infants. We aimed to identify effective alternative antibiotic regimens to expand treatment options for situations where hospital admission is not possible. We did this randomised, open-label, equivalence trial in four urban hospitals and one rural field site in Bangladesh to determine whether two alternative antibiotic regimens with reduced numbers of injectable antibiotics combined with oral antibiotics had similar efficacy and safety to the standard regimen, which was also used as outpatient treatment. We randomly assigned infants who showed at least one clinical sign of severe, but not critical, infection (except fast breathing alone), whose parents refused hospital admission, to one of the three treatment regimens. We stratified randomisation by study site and age (<7 days or 7-59 days) using computer-generated randomisation sequences. The standard treatment was intramuscular procaine benzylpenicillin and gentamicin once per day for 7 days (group A). The alternative regimens were intramuscular gentamicin once per day and oral amoxicillin twice per day for 7 days (group B) or intramuscular procaine benzylpenicillin and gentamicin once per day for 2 days, then oral amoxicillin twice per day for 5 days (group C). The primary outcome was treatment failure within 7 days after enrolment. Assessors of treatment failure were masked to treatment allocation. Primary analysis was per protocol. We used a prespecified similarity margin of 5% to assess equivalence between regimens. This study is registered with ClinicalTrials.gov, number NCT00844337. Between July 1, 2009, and June 30, 2013, we recruited 2490 young infants into the trial. We assigned 830 infants to group A, 831 infants to group B, and 829 infants to group C. 2367 (95%) infants fulfilled per-protocol criteria. 78 (10%) of 795 per-protocol infants had treatment failure in group A compared with 65 (8%) of 782 infants in group B (risk difference -1.5%, 95% CI -4.3 to 1.3) and 64 (8%) of 790 infants in group C (-1.7%, -4.5 to 1.1). In group A, 14 (2%) infants died before day 15, compared with 12 (2%) infants in group B and 12 (2%) infants in group C. Non-fatal relapse rates were similar in all three groups (12 [2%] infants in group A vs 13 [2%] infants in group B and 10 [1%] infants in group C). Our results suggest that the two alternative antibiotic regimens for outpatient treatment of clinical signs of severe infection in young infants whose parents refused hospital admission are as efficacious as the standard regimen. This finding could increase treatment options in resource-poor settings when referral care is not available or acceptable. Copyright © 2015 Baqui et al. Open Access article distributed under the terms of CC BY. Published by .. All rights reserved.

Convergence and accommodation development is pre-programmed in premature infants

PubMed Central

Horwood, Anna M; Toor, Sonia S; Riddell, Patricia M

2015-01-01

Purpose This study investigated whether vergence and accommodation development in pre-term infants is pre-programmed or is driven by experience. Methods 32 healthy infants, born at mean 34 weeks gestation (range 31.2-36 weeks) were compared with 45 healthy full-term infants (mean 40.0 weeks) over a 6 month period, starting at 4-6 weeks post-natally. Simultaneous accommodation and convergence to a detailed target were measured using a Plusoptix PowerRefII infra-red photorefractor as a target moved between 0.33m and 2m. Stimulus/response gains and responses at 0.33m and 2m were compared by both corrected (gestational) age and chronological (post-natal) age. Results When compared by their corrected age, pre-term and full-term infants showed few significant differences in vergence and accommodation responses after 6-7 weeks of age. However, when compared by chronological age, pre-term infants’ responses were more variable, with significantly reduced vergence gains, reduced vergence response at 0.33m, reduced accommodation gain, and increased accommodation at 2m, compared to full-term infants between 8-13 weeks after birth. Conclusions When matched by corrected age, vergence and accommodation in pre-term infants show few differences from full-term infants’ responses. Maturation appears pre-programmed and is not advanced by visual experience. Longer periods of immature visual responses might leave pre-term infants more at risk of development of oculomotor deficits such as strabismus. PMID:26275135

75 FR 2545 - National Toxicology Program (NTP); Center for the Evaluation of Risks to Human Reproduction...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-01-15

... infants, and (3) public concern for effects on infant or child development. Following receipt of public... whether exposure to soy infant formula is a hazard to human development. The expert panel also identified... Expert Panel Report on Soy Infant Formula; Request for Public Comment AGENCY: National Institute of...

Feasibility of a Caregiver Assisted Exercise Program for Preterm Infants

PubMed Central

Gravem, Dana; Lakes, Kimberley; Rich, Julia; Hayes, Gillian; Cooper, Dan; Olshansky, Ellen

2013-01-01

Purpose Mounting evidence shows that low birth weight and prematurity are related to serious health problems in adulthood, including increased body fat, decreased fitness, poor bone mineralization, pulmonary problems, and cardiovascular disease. There is data to suggest that increasing physical activity in preterm infants will have effects on short term muscle mass and fat mass, but we also hypothesized that increasing physical activity early in life can lead to improved health outcomes in adulthood. Because few studies have addressed the augmentation of physical activity in premature babies, the objective of this study was to evaluate the feasibility of whether caregivers (mostly mothers) can learn from nurses and other health care providers to implement a program of assisted infant exercise following discharge. Study Design and Methods Ten caregivers of preterm infants were taught by nurses, along with occupational therapists and other health care providers, to perform assisted infant exercise and instructed to conduct the exercises daily for approximately three weeks. The researchers made home visits and conducted qualitative interviews to understand the caregivers’ (mostly mothers’) experiences with this exercise protocol. Quantitative data included a caregiver’s daily log of the exercises completed to measure adherence as well as videotaped caregiver sessions, which were used to record errors as a measure of proficiency in the exercise technique. Results On average, the caregivers completed a daily log on 92% of the days enrolled in the study and reported performing the exercises on 93% of the days recorded. Caregivers made an average of 1.8 errors on two tests (with a maximum of 23 or 35 items on each, respectively) when demonstrating proficiency in the exercise technique. All caregivers described the exercises as beneficial for their infants, and many reported that these interventions fostered increased bonding with their babies. Nearly all reported feeling “scared” of hurting their babies during the first few days of home exercise, but stated that fears were alleviated by practice in the home and further teaching and learning. Clinical Implications Caregivers were willing and able to do the exercises correctly, and they expressed a belief that the intervention had positive effects on their babies and on caregiver-infant interactions. These findings have important implications for nursing practice because nurses are in key positions to teach and encourage caregivers to practice these exercises with their newborn babies. PMID:23618941

Effectiveness of a prevention of mother-to-child HIV transmission program in Guangdong province from 2007 to 2010

PubMed Central

2013-01-01

Background To achieve the goal of United Nations of elimination of new HIV infections, a program of prevention of mother-to-child transmission (PMTCT) was launched in Guangdong province. The objective of this study is to evaluate the effectiveness of the PMTCT program. Methods The retrospective cross-section analysis was conducted using the data of case reported cards of HIV positive mothers and their infants from 2007 to 2010 in Guangdong province, and 108 pairs of eligible subjects were obtained. We described the data and compared the rates of MTCT by various PMTCT interventions respectively. Results The overall rate of HIV MTCT was 13.89% (15) among 108 pairs of HIV positive mothers and their infants; 60.19% (65) of the mothers ever received ARVs, 80.56% (87) of infants born to HIV positive mothers ever received ARVs, but 16.67% (18) of the mothers and infants neither received ARVs. Among all the mothers and infants, who both received ARVs, received triple ARVs, mother received ARVs during pregnancy, and both received ARVs and formula feeding showed the lower rates of HIV MTCT, and the rates were 8.06%, 2.50%, 5.77%, and 6.67% respectively. In infants born to HIV positive mother, who received mixed feeding had a higher HIV MTCT up to 60.00%. Delivery mode might not relative to HIV MTCT. Conclusions The interventions of PMTCT program in Guangdong could effectively reduce the rate of HIV MTCT, but the effectiveness of the PMTCT program were heavily cut down by the lower availability of the PMTCT interventions. PMID:23773623

A prospective evaluation of whole-exome sequencing as a first-tier molecular test in infants with suspected monogenic disorders.

PubMed

Stark, Zornitza; Tan, Tiong Y; Chong, Belinda; Brett, Gemma R; Yap, Patrick; Walsh, Maie; Yeung, Alison; Peters, Heidi; Mordaunt, Dylan; Cowie, Shannon; Amor, David J; Savarirayan, Ravi; McGillivray, George; Downie, Lilian; Ekert, Paul G; Theda, Christiane; James, Paul A; Yaplito-Lee, Joy; Ryan, Monique M; Leventer, Richard J; Creed, Emma; Macciocca, Ivan; Bell, Katrina M; Oshlack, Alicia; Sadedin, Simon; Georgeson, Peter; Anderson, Charlotte; Thorne, Natalie; Melbourne Genomics Health Alliance; Gaff, Clara; White, Susan M

2016-11-01

To prospectively evaluate the diagnostic and clinical utility of singleton whole-exome sequencing (WES) as a first-tier test in infants with suspected monogenic disease. Singleton WES was performed as a first-tier sequencing test in infants recruited from a single pediatric tertiary center. This occurred in parallel with standard investigations, including single- or multigene panel sequencing when clinically indicated. The diagnosis rate, clinical utility, and impact on management of singleton WES were evaluated. Of 80 enrolled infants, 46 received a molecular genetic diagnosis through singleton WES (57.5%) compared with 11 (13.75%) who underwent standard investigations in the same patient group. Clinical management changed following exome diagnosis in 15 of 46 diagnosed participants (32.6%). Twelve relatives received a genetic diagnosis following cascade testing, and 28 couples were identified as being at high risk of recurrence in future pregnancies. This prospective study provides strong evidence for increased diagnostic and clinical utility of singleton WES as a first-tier sequencing test for infants with a suspected monogenic disorder. Singleton WES outperformed standard care in terms of diagnosis rate and the benefits of a diagnosis, namely, impact on management of the child and clarification of reproductive risks for the extended family in a timely manner.Genet Med 18 11, 1090-1096.

Design and development of a sensorized wireless toy for measuring infants' manual actions.

PubMed

Serio, Stefano Marco; Cecchi, Francesca; Assaf, Tareq; Laschi, Cecilia; Dario, Paolo

2013-05-01

The development of grasping is an important milestone that infants encounter during the first months of life. Novel approaches for measuring infants' manual actions are based on sensorized platform usable in natural settings, such as instrumented wireless toys that could be exploited for diagnosis and rehabilitation purposes. A new sensorized wireless toy has been designed and developed with embedded pressure sensors and audio-visual feedback. The fulfillment of clinical specifications has been proved through mechanical and electrical characterization. Infants showed a good grade of acceptance to such kind of tools, as confirmed by the results of preliminary tests that involved nine healthy infants: the dimensions fulfill infants' anthropometrics, the device is robust and safe, the acquired signals are in the expected range and the wireless communication is stable. Although achieved only through preliminary tests, such results confirm the hypothesis that this typology of instrumented toys could be useful for quantitative monitoring and measuring infants' motor development and ready to be evaluated for assessing motor skills through appropriate clinical trials.

Progressive Primary Pulmonary Tuberculosis Presenting as the Sudden Unexpected Death in Infancy: A Case Report

PubMed Central

Dempers, Johan; Sens, Mary Ann; Wadee, Shabbir Ahmed; Kinney, Hannah C.; Odendaal, Hein J.; Wright, Colleen A.

2010-01-01

The classification of an unexpected infant death as the sudden infant death syndrome (SIDS) depends upon a complete autopsy and death scene investigation to exclude known causes of death. Here we report the death of a four-month-old infant in a tuberculosis endemic area that presented as a sudden unexpected death in infancy (SUDI) with no apparent explanation based on the death scene characteristics. The autopsy, however, revealed progressive primary pulmonary tuberculosis with intrathoracic adenopathy, compression of the tracheobronchial tree and miliary lesions in the liver. This case underscores the clinical difficulties in the diagnosis of infantile tuberculosis, as well as the possibility of sudden death as part of its protean manifestations. The pathology and clinical progression of tuberculosis in infants differs from older children and adults due to the immature immune response in infants. This case dramatically highlights the need for complete autopsies in all sudden and unexpected infant deaths, as well as the public health issues in a sentinel infant tuberculosis diagnosis. PMID:20705406

Neonatal infrared axillary thermometry.

PubMed

Seguin, J; Terry, K

1999-01-01

The authors compared axillary skin temperatures (AT) measured with an infrared (IR) thermometer (Lightouch Neonate, Exergen Corp) with rectal temperatures (RT) in 16 newly born term infants under radiant warmers (RW) and in cribs. Twelve stable, growing premature infants in incubators were also studied. This new device may be useful because of safety and rapid results (1 second), but clinical accuracy is unknown. For term infants, mean (SD) RT-AT difference was 0.1 (0.48) degree C under RW and 0.25 (0.17) degree C 2 hours later in cribs. For premature infants in incubators the mean RT-AT difference was 0.09 (0.16) degree C. Axillary temperatures measured by IR thermometer approximate RT for newly born term infants in cribs and stable premature infants in incubators. For newly born term infants under RW, RT-AT differences vary more widely, limiting clinical usefulness in this setting. The device, the unique age of this population, and the RW environment may play a role.

Postpartum depression, suicidality, and mother-infant interactions.

PubMed

Paris, Ruth; Bolton, Rendelle E; Weinberg, M Katherine

2009-10-01

To date, few studies have examined suicidality in women with postpartum depression. Reports of suicidal ideation in postpartum women have varied (Lindahl et al. Arch Womens Ment Health 8:77-87, 2005), and no known studies have examined the relationship between suicidality and mother-infant interactions. This study utilizes baseline data from a multi-method evaluation of a home-based psychotherapy for women with postpartum depression and their infants to examine the phenomenon of suicidality and its relationship to maternal mood, perceptions, and mother-infant interactions. Overall, women in this clinical sample (n = 32) had wide ranging levels of suicidal thinking. When divided into low and high groups, the mothers with high suicidality experienced greater mood disturbances, cognitive distortions, and severity of postpartum symptomotology. They also had lower maternal self-esteem, more negative perceptions of the mother-infant relationship, and greater parenting stress. During observer-rated mother-infant interactions, women with high suicidality were less sensitive and responsive to their infants' cues, and their infants demonstrated less positive affect and involvement with their mothers. Implications for clinical practice and future research directions are discussed.

Infant Feeding among Women Attending an Immunisation Clinic at a Tertiary Health Institution in Ibadan, Nigeria

ERIC Educational Resources Information Center

Fatiregun, A. A.; Abegunde, V. O.

2009-01-01

Maternal characteristics can affect a mother's decision to breastfeed. This study used a cross-sectional design to assess maternal variables and infant feeding patterns among nursing mothers attending an immunisation clinic in Ibadan, Nigeria. A total of 264 mothers who consecutively attended the immunisation clinic and met certain inclusion…

GI Symptoms in Infants Are a Potential Target for Fermented Infant Milk Formulae: A Review

PubMed Central

van de Heijning, Bert J. M.; Berton, Amelie; Bouritius, Hetty; Goulet, Olivier

2014-01-01

Besides pre- and pro-biotic-containing infant formulae, fermented infant formulae are commonly used to relieve or prevent symptoms of gastrointestinal (GI) discomfort in young infants. During the fermentation process in cow’s milk-based formulae, the beneficial bacteria modulate the product by forming several beneficial compounds, which contribute to the alleviation of the symptoms observed. This review summarizes the clinical evidence on the impact of fermented infant formulae on common pediatric GI-symptoms. The potential mechanisms involved are discussed: i.e., the lactose and protein (in-) digestibility, effects on gastric emptying and gut transit and modulation of the colonic microbiota. Although initial evidence indicates a beneficial effect of fermented formulae on GI discomfort in newborns, validation and confirmation of the clinical proof obtained so far is warranted, as well as further research to (more fully) understand the mode of action. PMID:25255831

Family risk as a predictor of initial engagement and follow-through in a universal nurse home visiting program to prevent child maltreatment.

PubMed

Alonso-Marsden, Shelley; Dodge, Kenneth A; O'Donnell, Karen J; Murphy, Robert A; Sato, Jeannine M; Christopoulos, Christina

2013-08-01

As nurse home visiting to prevent child maltreatment grows in popularity with both program administrators and legislators, it is important to understand engagement in such programs in order to improve their community-wide effects. This report examines family demographic and infant health risk factors that predict engagement and follow-through in a universal home-based maltreatment prevention program for new mothers in Durham County, North Carolina. Trained staff members attempted to schedule home visits for all new mothers during the birthing hospital stay, and then nurses completed scheduled visits three to five weeks later. Medical record data was used to identify family demographic and infant health risk factors for maltreatment. These variables were used to predict program engagement (scheduling a visit) and follow-through (completing a scheduled visit). Program staff members were successful in scheduling 78% of eligible families for a visit and completing 85% of scheduled visits. Overall, 66% of eligible families completed at least one visit. Structural equation modeling (SEM) analyses indicated that high demographic risk and low infant health risk were predictive of scheduling a visit. Both low demographic and infant health risk were predictive of visit completion. Findings suggest that while higher demographic risk increases families' initial engagement, it might also inhibit their follow-through. Additionally, parents of medically at-risk infants may be particularly difficult to engage in universal home visiting interventions. Implications for recruitment strategies of home visiting programs are discussed. Copyright © 2013 Elsevier Ltd. All rights reserved.

The Efficacy of Parent Counseling and Support Groups on the Stress Levels, Self-Esteem and Degree of Coping of Parents of Developmentally Delayed or Handicapped Children Who Are Involved in an Infant Intervention Program.

ERIC Educational Resources Information Center

La Fountain, Rebecca; Geoffroy, Kevin

This study was conducted to investigate the effect that a parent support group and a counseling group had on the stress levels, self-esteem, and degree of coping of parents (N=48) of developmentally delayed or handicapped infants enrolled in an infant intervention program. It was hypothesized that, compared to parents in the control group, parents…

Trends in Intussusception Hospitalizations Among US Infants, 1993–2004: Implications for Monitoring the Safety of the New Rotavirus Vaccination Program

PubMed Central

Tate, Jacqueline E.; Simonsen, Lone; Viboud, Cecile; Steiner, Claudia; Patel, Manish M.; Curns, Aaron T.; Parashar, Umesh D.

2009-01-01

OBJECTIVES In 2006, a new rotavirus vaccine was recommended for routine immunization of US infants. Because a previous rotavirus vaccine was withdrawn in 1999 after it was associated with intussusception, monitoring for this adverse event with the new vaccine is important. The objectives of this study were to assess intussusception hospitalizations trends among US infants for 1993 to 2004; provide estimates of hospitalization rates for intussusception for 2002–2004; and assess variations in background rates by age, race/ethnicity, and surgical management. METHODS By using the Healthcare Cost and Utilization Project’s State Inpatient Data-base that captures US hospital discharges from 16 states representing 49% of the birth cohort during 1993–2004 and from 35 states representing 85% of the birth cohort in 2002–2004, we examined hospitalizations among infants (<12 months of age) with an International Classification of Disease, Ninth Revision, Clinical Modification code for intussusception (560.0). Incidence rates were calculated by using census data, and rate ratios with 95% confidence intervals were calculated by using Poisson regression data. RESULTS Annual intussusception hospitalization rates declined 25% from 1993 to 2004 but have remained stable at ~35 cases per 100 000 infants since 2000. Rates were very low for infants younger than 9 weeks (<5 per 100 000) then increased rapidly, peaking at ~62 per 100 000 at 26 to 29 weeks, before declining gradually to 26 per 100 000 at 52 weeks. Compared with rates among non-Hispanic white infants (27 per 100 000), rates were greater among non-Hispanic black infants (37 per 100 000) and Hispanic infants (45 per 100 000); however, rates did not differ by race/ethnicity for infants who were younger than 16 weeks. CONCLUSIONS This assessment of US hospitalizations provides up-to-date and nationally representative prevaccine rates of intussusception. Because rates varied almost 12-fold by week of age and to a lesser extent by race/ethnicity during the age of vaccination, adjusting baseline rates to reflect the demographics of the vaccinated population will be crucial for assessing risk for intussusception after rotavirus vaccination. PMID:18450856

Trends in intussusception hospitalizations among US infants, 1993-2004: implications for monitoring the safety of the new rotavirus vaccination program.

PubMed

Tate, Jacqueline E; Simonsen, Lone; Viboud, Cecile; Steiner, Claudia; Patel, Manish M; Curns, Aaron T; Parashar, Umesh D

2008-05-01

In 2006, a new rotavirus vaccine was recommended for routine immunization of US infants. Because a previous rotavirus vaccine was withdrawn in 1999 after it was associated with intussusception, monitoring for this adverse event with the new vaccine is important. The objectives of this study were to assess intussusception hospitalizations trends among US infants for 1993 to 2004; provide estimates of hospitalization rates for intussusception for 2002-2004; and assess variations in background rates by age, race/ethnicity, and surgical management. By using the Healthcare Cost and Utilization Project's State Inpatient Database that captures US hospital discharges from 16 states representing 49% of the birth cohort during 1993-2004 and from 35 states representing 85% of the birth cohort in 2002-2004, we examined hospitalizations among infants (<12 months of age) with an International Classification of Disease, Ninth Revision, Clinical Modification code for intussusception (560.0). Incidence rates were calculated by using census data, and rate ratios with 95% confidence intervals were calculated by using Poisson regression data. Annual intussusception hospitalization rates declined 25% from 1993 to 2004 but have remained stable at approximately 35 cases per 100,000 infants since 2000. Rates were very low for infants younger than 9 weeks (<5 per 100,000) then increased rapidly, peaking at approximately 62 per 100,000 at 26 to 29 weeks, before declining gradually to 26 per 100,000 at 52 weeks. Compared with rates among non-Hispanic white infants (27 per 100,000), rates were greater among non-Hispanic black infants (37 per 100,000) and Hispanic infants (45 per 100,000); however, rates did not differ by race/ethnicity for infants who were younger than 16 weeks. This assessment of US hospitalizations provides up-to-date and nationally representative prevaccine rates of intussusception. Because rates varied almost 12-fold by week of age and to a lesser extent by race/ethnicity during the age of vaccination, adjusting baseline rates to reflect the demographics of the vaccinated population will be crucial for assessing risk for intussusception after rotavirus vaccination.

Clinical features and prevalence of gastroesophageal reflux disease in infants attending a pediatric gastroenterology reference service.

PubMed

Koda, Yu Kar Ling; Ozaki, Marcos J; Murasca, Kelly; Vidolin, Eliana

2010-01-01

In infants, it is not always easy to distinguish between pathological and physiological gastroesophageal reflux based only on clinical criteria. In Brazil, studies about gastroesophageal reflux disease in infants are few and are even rare those that used prolonged esophageal pH monitoring for its evaluation. To describe the clinical features of gastroesophageal reflux disease and to determine its prevalence in infants with gastroesophageal reflux attending a tertiary Pediatric Gastroenterology Service and submitted to esophageal pH monitoring for investigation. Descriptive study in 307 infants in whom esophageal pH monitoring (Mark III Digitrapper, Synectics Medical AB, Sweden) was performed during the period December, 1998-December, 2008. The clinical features studied were age group (1-12 months and 13-24 months), and clinical manifestations that motivated the indication of pH monitoring. One hundred twenty-four (40.4%) were female and 183 (59.6%) male with mean age 12.2 +/- 6.2 months (1-23 months). The prevalence of gastroesophageal reflux disease was 18.2% (56/307). One hundred forty-eight (48.2%) were 1-12 months old and 159 (51.8%), 13-24 months. No significant difference was found between the prevalence of these two age groups (P = 0.3006). Gastroesophageal reflux disease was more frequent in those with digestive manifestations (24.2%), crisis of cyanosis/apnea (23.8%) and mixed manifestations (21.5%). Respiratory manifestations were the most frequent indication (39.1%) of pH monitoring. However, the prevalence of gastroesophageal reflux disease was lower (12.5%) in this group compared with in those with digestive manifestations (P = 0.0574), crisis of cyanosis/apnea (P = 0.0882) and mixed manifestations (P = 0.1377). All infants that presented clinical manifestations as crisis of cyanosis/apnea and abnormal pH-metry were < 3 months of age. In our Service, the prevalence of gastroesophageal reflux disease associated with acid reflux in infants revealed elevated. Infants with crisis of cyanosis/apnea constitute risk population for gastroesophageal reflux disease in which diagnostic investigation needs to be considered.

Fellowship Training in the Emerging Fields of Fetal-Neonatal Neurology and Neonatal Neurocritical Care.

PubMed

Smyser, Christopher D; Tam, Emily W Y; Chang, Taeun; Soul, Janet S; Miller, Steven P; Glass, Hannah C

2016-10-01

Neonatal neurocritical care is a growing and rapidly evolving medical subspecialty, with increasing numbers of dedicated multidisciplinary clinical, educational, and research programs established at academic institutions. The growth of these programs has provided trainees in neurology, neonatology, and pediatrics with increased exposure to the field, sparking interest in dedicated fellowship training in fetal-neonatal neurology. To meet this rising demand, increasing numbers of training programs are being established to provide trainees with the requisite knowledge and skills to independently deliver care for infants with neurological injury or impairment from the fetal care center and neonatal intensive care unit to the outpatient clinic. This article provides an initial framework for standardization of training across these programs. Recommendations include goals and objectives for training in the field; core areas where clinical competency must be demonstrated; training activities and neuroimaging and neurodiagnostic modalities which require proficiency; and programmatic requirements necessary to support a comprehensive and well-rounded training program. With consistent implementation, the proposed model has the potential to establish recognized standards of professional excellence for training in the field, provide a pathway toward Accreditation Council for Graduate Medical Education certification for program graduates, and lead to continued improvements in medical and neurological care provided to patients in the neonatal intensive care unit. Copyright © 2016 Elsevier Inc. All rights reserved.

Women, Infants & Children

Science.gov Websites

; Children Page Content WIC is the Special Supplemental Nutrition Program for Women, Infants and Children . This public health program is designed to improve health outcomes and influence lifetime nutrition and health behaviors in targeted, at-risk populations. Nutrition education is the cornerstone of the WIC

Prediction of Early Childhood Outcome of Term Infants using Apgar Scores at 10 Minutes following Hypoxic-Ischemic Encephalopathy

PubMed Central

Laptook, Abbot R.; Shankaran, Seetha; Ambalavanan, Namasivayam; Carlo, Waldemar A.; McDonald, Scott A.; Higgins, Rosemary D.; Das, Abhik

2010-01-01

Context Death or severe disability is so common following an Apgar score of 0 at 10 minutes in observational studies that the Neonatal Resuscitation Program suggests considering discontinuation of resuscitation after 10 minutes of effective CPR. Objective To determine if Apgar scores at 10 minutes are associated with death or disability in early childhood following perinatal hypoxic-ischemic encephalopathy (HIE). Design, Setting, and Patients This is a secondary analysis of infants enrolled in the NICHD Neonatal Research Network hypothermia trial. Infants ≥ 36 weeks gestation had clinical and/or biochemical abnormalities at birth, and encephalopathy at < 6 hours. Logistic regression and classification and regression tree (CART) analysis was used to determine associations between Apgar scores at 10 minutes and neurodevelopmental outcome adjusting for covariates. Associations are expressed as odds ratios (OR) and 95% confidence interval (CI). Main Outcome Measure Death or disability (moderate or severe) at 18–22 months of age. Results Twenty of 208 infants were excluded (missing data). More than 90% of infants had Apgar scores of 0–2 at 1 minute and Apgars at 5 and 10 minutes shifted to progressively higher values; at 10 minutes 27% of infants had Apgar scores of 0–2. After adjustment each point decrease in Apgar score at 10 minutes was associated with a 45% increase in the odds of death or disability (OR 1.45, CI 1.22–1.72). Death or disability occurred in 76, 82 and 80% of infants with Apgar scores at 10 minutes of 0, 1 and 2, respectively. CART analysis indicated that Apgar scores at 10 minutes were discriminators of outcome. Conclusion Apgar scores at 10 minutes provide useful prognostic data before other evaluations are available for infants with HIE. Death or moderate/severe disability is common but not uniform with Apgar scores < 3; caution is needed before adopting a specific time interval to guide duration of resuscitation. PMID:19948631

White Matter Microstructural Integrity and Neurobehavioral Outcome of HIV-Exposed Uninfected Neonates.

PubMed

Tran, Linh T; Roos, Annerine; Fouche, Jean-Paul; Koen, Nastassja; Woods, Roger P; Zar, Heather J; Narr, Katherine L; Stein, Dan J; Donald, Kirsten A

2016-01-01

The successful implementation of prevention programs for mother-to-child human immunodeficiency virus (HIV) transmission has dramatically reduced the prevalence of infants infected with HIV while increasing that of HIV-exposed uninfected (HEU) children. Neuropsychological assessments indicate that HEU children may exhibit differences in neurodevelopment compared to unexposed children (HUU). Pathological mechanisms leading to such neurodevelopmental delays are not clear. In this observational birth cohort study we explored the integrity of regional white matter microstructure in HEU infants, shortly after birth. Microstructural changes in white matter associated with prenatal HIV exposure were evaluated in HEU infants (n = 15) and matched controls (n = 22) using diffusion tensor imaging and tract-based spatial statistics. Additionally, diffusion values were extracted and compared for white matter tracts of interest, and associations with clinical outcomes from the Dubowitz neonatal neurobehavioral tool were investigated. Higher fractional anisotropy in the middle cerebellar peduncles of HEU compared to HUU neonates was found after correction for age and gender. Scores on the Dubowitz abnormal neurological signs subscale were positively correlated with FA (r = 0.58, P = 0.038) in the left uncinate fasciculus in HEU infants. This is the first study to present data suggesting that prenatal HIV exposure without infection is associated with altered white matter microstructural integrity in the neonatal period. Longitudinal studies of HEU infants as their brains mature are necessary to understand further the significance of prenatal HIV and antiretroviral treatment exposure on white matter integrity and neurodevelopmental outcomes.

Adult separation anxiety and unsettled infant behavior: Associations with adverse parenting during childhood and insecure adult attachment.

PubMed

Kohlhoff, Jane; Barnett, Bryanne; Eapen, Valsamma

2015-08-01

This study examined the prevalence and correlates of Adult Separation Anxiety Disorder (ASAD) and Adult Separation Anxiety (ASA) symptoms in a sample of first-time mothers with an unsettled infant during the first postpartum year. Eighty-three primiparous women admitted to a residential parent-infant program participated in a structured clinical interview for DSM-IV diagnosis and questionnaires assessing ASA symptoms, adult attachment and childhood parenting experiences. Nurses recorded infant behavior using 24-hour charts. The prevalence of ASAD in this sample was 19.3% and women with ASAD were, on average, more likely to be diagnosed with depression and anxiety disorders, report aversive parenting experiences during childhood and show adult attachment style insecurity. Both ASAD and ASA symptoms were predicted by adult attachment anxiety, and ASAD was associated with unsettled infant behavior. Attachment anxiety and attachment avoidance mediated relations between parental over-control and ASAD diagnosis, and between parental abuse and ASAD diagnosis. Attachment anxiety mediated the relation between parental over-control and ASA symptoms, and attachment avoidance mediated the relations of parental over-control and parental abuse with ASA symptoms. This study highlights the prevalence of ASAD among first time mothers experiencing early parenting difficulties and the roles of childhood parenting experiences and adult attachment style in the development of the disorder. This points to the importance of introducing universal screening for ASAD in postnatal settings, and for the development of targeted interventions. Crown Copyright © 2015. Published by Elsevier Inc. All rights reserved.

Heart Transplantation for Congenital Heart Disease in the First Year of Life

PubMed Central

Chinnock, Richard E; Bailey, Leonard L

2011-01-01

Successful infant heart transplantation has now been performed for over 25 years. Assessment of long term outcomes is now possible. We report clinical outcomes for322 patients who received their heart transplant during infancy. Actuarial graft survival for newborn recipients is 59% at 25 years. Survival has improved in the most recent era. Cardiac allograft vasculopathy is the most important late cause of death with an actuarial incidence at 25 years of 35%. Post-transplant lymphoma is estimated to occur in 20% of infant recipients by25 years. Chronic kidney disease grade 3 or worse is present in 31% of survivors. The epidemiology of infant heart transplantation has changed through the years as the results for staged repair improved and donor resources remained stagnant. Most centers now employ staged repair for hypoplastic left heart syndrome and similar extreme forms of congenital heart disease. Techniques for staged repair, including the hybrid procedure, are described. The lack of donors is described with particular note regarding decreased donors due to newer programs for appropriate infant sleep positioning and infant car seats. ABO incompatible donors are a newer resource for maximizing donor resources, as is donation after circulatory determination of death and techniques to properly utilize more donors by expanding the criteria for what is an acceptable donor. An immunological advantage for the youngest recipients has long been postulated, and evaluation of this phenomenon may provide clues to the development of accommodation and/or tolerance. PMID:22548030

Experience of the Manitoba Perinatal Screening Program, 1965-85.

PubMed Central

Fox, J G

1987-01-01

The Manitoba Perinatal Screening Program is guided by a committee of medical specialists with skills in the diagnosis and management of disorders of metabolism in the newborn. The program is voluntary and is centralized at Cadham Provincial Laboratory, in Winnipeg. A filter card blood specimen is collected from newborns on discharge from hospital, and a filter card urine sample is collected and mailed to the laboratory by the mother when the infant is about 2 weeks of age. The overall compliance rates for the blood and urine specimens are approximately 100% and 84% respectively. The blood specimen is screened for phenylalanine and other amino acids, thyroxine, galactose, galactose-1-phosphate and biotinidase. The urine specimen is screened for amino acids, including cystine, as well as methylmalonic acid and homocystine. Between 1965 and 1985, 83 cases of metabolic disorders were detected, including 23 cases of primary hypothyroidism, 14 of classic phenylketonuria, 5 of galactosemia variants, 3 of galactosemia, 2 of maple syrup urine disease and 1 of hereditary tyrosinemia. The direct cost per infant screened is $5.50, and the cost:benefit ratio is approximately 7.5:1. Maternal serum alpha-fetoprotein screening is being made available as the necessary supporting clinical facilities become available. On the basis of this experience, the author outlines the components that are important for an effective screening program. PMID:3676929

Factors associated with coverage of cotrimoxazole prophylaxis in HIV-exposed children in South Africa.

PubMed

Moodley, Dhayendre; Reddy, Leanne; Mahungo, Wisani; Masha, Rebotile

2013-01-01

The World Health Organisation and the Joint United Nations Programme in 2006 reaffirmed the earlier recommendation of 2000 that all HIV-exposed infants in resource-poor countries should commence cotrimoxazole (CTX) prophylaxis at 6-weeks of life. CTX prophylaxis should be continued until the child is confirmed HIV-uninfected and there is no further exposure to breastmilk transmission. We determined CTX coverage and explored factors associated with CTX administration in HIV-exposed infants at a primary health clinic in South Africa. In a cross-sectional study of HIV-exposed infants 6-18 months of age attending a child immunisation clinic, data from the current visit and previous visits related to CTX prophylaxis, feeding practice and infant HIV testing were extracted from the child's immunisation record. Further information related to the administration of CTX prophylaxis was obtained from an interview with the child's mother. One-third (33.0%) HIV-exposed infants had not initiated CTX at all and breastfed infants were more likely to have commenced CTX prophylaxis as compared to their non-breastfed counterparts (78.7% vs 63.4%) (p = 0.008). Availability of infant's HIV status was strongly associated with continuation or discontinuation of CTX after 6 months of age or after breastfeeding cessation. Maternal self-reports indicated that only 52.5% (95%CI 47.5-57.5) understood the reason for CTX prophylaxis, 126 (47%) did not dose during weekends; 55 (21%) dosed their infants 3 times a day and 70 (26%) dosed their infants twice daily. A third of HIV-exposed children attending a primary health care facility in this South African setting did not receive CTX prophylaxis. Not commencing CTX prophylaxis was strongly associated with infants not breastfeeding and unnecessary continued exposure to CTX in this paediatric population was due to limited availability of early infant diagnosis. Attendance at immunization clinics can be seen as missed opportunities for early infant diagnosis of HIV and related care.

Factors Associated with Coverage of Cotrimoxazole Prophylaxis in HIV-Exposed Children in South Africa

PubMed Central

Moodley, Dhayendre; Reddy, Leanne; Mahungo, Wisani; Masha, Rebotile

2013-01-01

Background The World Health Organisation and the Joint United Nations Programme in 2006 reaffirmed the earlier recommendation of 2000 that all HIV-exposed infants in resource-poor countries should commence cotrimoxazole (CTX) prophylaxis at 6-weeks of life. CTX prophylaxis should be continued until the child is confirmed HIV-uninfected and there is no further exposure to breastmilk transmission. We determined CTX coverage and explored factors associated with CTX administration in HIV-exposed infants at a primary health clinic in South Africa. Methods In a cross-sectional study of HIV-exposed infants 6–18 months of age attending a child immunisation clinic, data from the current visit and previous visits related to CTX prophylaxis, feeding practice and infant HIV testing were extracted from the child's immunisation record. Further information related to the administration of CTX prophylaxis was obtained from an interview with the child's mother. Results One-third (33.0%) HIV-exposed infants had not initiated CTX at all and breastfed infants were more likely to have commenced CTX prophylaxis as compared to their non-breastfed counterparts (78.7% vs 63.4%) (p = 0.008). Availability of infant's HIV status was strongly associated with continuation or discontinuation of CTX after 6 months of age or after breastfeeding cessation. Maternal self-reports indicated that only 52.5% (95%CI 47.5–57.5) understood the reason for CTX prophylaxis, 126 (47%) did not dose during weekends; 55 (21%) dosed their infants 3 times a day and 70 (26%) dosed their infants twice daily. Conclusion A third of HIV-exposed children attending a primary health care facility in this South African setting did not receive CTX prophylaxis. Not commencing CTX prophylaxis was strongly associated with infants not breastfeeding and unnecessary continued exposure to CTX in this paediatric population was due to limited availability of early infant diagnosis. Attendance at immunization clinics can be seen as missed opportunities for early infant diagnosis of HIV and related care. PMID:23667599

Optimizing care of ventilated infants by improving weighing accuracy on incubator scales.

PubMed

El-Kafrawy, Ula; Taylor, R J

2016-01-01

To determine the accuracy of weighing ventilated infants on incubator scales and whether the accuracy can be improved by the addition of a ventilator tube compensator (VTC) device to counterbalance the force exerted by the ventilator tubing. Body weights on integral incubator scales were compared in ventilated infants (with and without a VTC), with body weights on standalone electronic scales (true weight). Individual and series of trend weights were obtained on the infants. The method of Bland and Altman was used to assess the introduced bias. The study included 60 ventilated infants; 66% of them weighed <1000 g. A total of 102 paired-weight datasets for 30 infants undergoing conventional ventilation and 30 undergoing high frequency oscillator ventilation (HFOV) supported by a SensorMedics oscillator, (with and without a VTC) were obtained. The mean differences and (95% CI for the bias) between the integral and true scale weighing methods was 60.8 g (49.1 g to 72.5 g) without and -2.8 g (-8.9 g to 3.3 g) with a VTC in HFOV infants; 41.0 g (32.1 g to 50.0 g) without and -5.1 g (-9.3 g to -0.8 g) with a VTC for conventionally ventilated infants. Differences of greater than 2% were considered clinically relevant and occurred in 93.8% without and 20.8% with a VTC in HFOV infants and 81.5% without and 27.8% with VTC in conventionally ventilated infants. The use of the VTC device represents a substantial improvement on the current practice for weighing ventilated infants, particularly in the extreme preterm infants where an over- or underestimated weight can have important clinical implications for treatment. A large-scale clinical trial to validate these findings is needed.

Intestinal blood loss during cow milk feeding in older infants: quantitative measurements.

PubMed

Jiang, T; Jeter, J M; Nelson, S E; Ziegler, E E

2000-07-01

To determine the response, in terms of fecal hemoglobin excretion and clinical symptoms, of normal 9 1/2-month-old infants to being fed cow milk. Longitudinal (before-after) trial in which each infant was fed formula for 1 month (baseline) followed by 3 months during which cow milk was fed. Healthy infants living in Iowa City, Iowa, a town with a population of about 60,000. Hemoglobin concentration in spot stools, 96-hour quantitative fecal hemoglobin excretion, stool characteristics, feeding-related behaviors, and iron nutritional status. Fecal hemoglobin concentration during formula feeding (baseline) was higher than previously observed in younger infants. Nine of 31 infants responded to cow milk feeding with increased fecal hemoglobin concentration. Fecal hemoglobin concentration (mean +/- SD) of the 9 responders rose from 1,395 +/- 856 microg/g of dry stool (baseline) to 2,711 +/- 1,732 microg/g of dry stool (P=.01). The response rate (29%) was similar to that in younger infants, but the intensity of the response was much less. Quantitative hemoglobin excretion was in general agreement with estimates based on spot stool hemoglobin concentrations. Cow milk feeding was not associated with recognizable changes in stool characteristics, nor were there clinical signs related to fecal blood loss. Iron status was similar, except that after 3 months of cow milk feeding responders showed lower (P= .047) ferritin concentrations than nonresponders. Cow milk-induced blood loss is present in 9 1/2-month-old infants but is of such low intensity that its clinical significance seems questionable. Nevertheless, infants without cow milk-induced blood loss were in better iron nutritional status than infants who showed blood loss.

The impact of food supplementation on infant weight gain in rural Bangladesh; an assessment of the Bangladesh Integrated Nutritional Program (BINP).

PubMed

Begum, Housne Ara; Mascie-Taylor, Cgn; Nahar, Shamsun

2007-01-01

To examine the efficiency of the Bangladesh Integrated Nutritional Program (BINP) in identifying which infants should be supplemented, whether full supplementation was given for the stipulated period of time, and whether the correct exit criteria from the supplementation programme were used. To test whether targeted food supplementation of infants between 6-12 months of age resulted in enhanced weight gain. Mallickbari Union, Bhaluka, a rural area located about 100 km north of Dhaka, Bangladesh. Five hundred and twenty-six infants followed for 6 to 12 months. Of the 526 infants studied, 368 should have received supplementation based on BINP criteria but only 111 infants (30%) did so, while a further 13% were incorrectly given supplementation. So in total over half (52.8%) of the sample was incorrectly identified for supplementation. In addition, less than a quarter of the infants received the full 90 days of supplementation and close to half of the infants exited the programme without the requisite weight gain. Infants were assigned to one of four groups: correctly supplemented, correctly non-supplemented, incorrectly supplemented or incorrectly non-supplemented. This classification provided natural controls; the correctly supplemented infants versus the incorrectly non-supplemented infants, and the correctly non-supplemented infants versus the incorrectly supplemented infants. There were no significant differences in weight gain between the correctly supplemented group and the incorrectly non-supplemented group or between the correctly non-supplemented and the incorrectly supplemented groups, nor was there any evidence of growth faltering in the incorrectly non-supplemented group. This study found serious programmatic deficiencies - inability to identify growth faltering in infants, failure to supplement for the full time period and incorrect exit procedures. There was no evidence that food supplementation had any impact on improving infant weight gain.

Diagnostic testing for serious bacterial infections in infants aged 90 days or younger with bronchiolitis.

PubMed

Liebelt, E L; Qi, K; Harvey, K

1999-05-01

To describe the different laboratory tests that are performed on young infants aged 90 days or younger with bronchiolitis and to identify historical and clinical predictors of infants on whom laboratory tests are performed. Cross-sectional study whereby information was obtained by retrospective review of medical records from November through March 1992 to 1995 of all infants with a clinical diagnosis of bronchiolitis. Urban pediatric emergency department. Two hundred eleven consecutive infants aged 90 days or younger (median age, 54 days) with 216 episodes of bronchiolitis. Historical and clinical data on each infant in addition to laboratory data that included a white blood cell count, urinalysis, and blood, urine, and cerebrospinal fluid cultures. Two or more laboratory tests (not including chest radiographs) were obtained in 48% of all infants and 78% of febrile infants. Of the 91 infants with a history of a temperature of 38.0 degrees C or more or temperature on presentation of 38.0 degrees C or more, white blood cell counts were obtained in 77%, blood cultures in 75%, urinalyses in 53%, urine cultures in 60%, and analyses-cultures of cerebrospinal fluid in 47%. Febrile infants were 10 times more likely to get at least 2 laboratory tests than afebrile infants (P<.01). All 6 studies were done in 42 (58%) of 72 febrile infants compared with 7 (16%) of 43 afebrile infants (P<.001). Multiple logistic regression analysis identified a history of a temperature of 38.0 degrees C or more or temperature on presentation of 38.0 degrees C or more (odds ratio [OR] 10.0; 95% confidence interval [CI], 4.8%-21.0%; P<.001), oxygen saturation less than 92% on presentation (OR, 4.7; 95% CI, 1.9%-12.1%; P<.01), and history of apnea (OR, 0.1; 95% CI, 0.02-0.35; P<.001) as significant clinical predictors of whether laboratory studies were obtained. History of preterm gestation, aged younger than 28 days, previous antibiotic use, and presence of otitis media were not associated with obtainment of laboratory studies. No cases of bacteremia, urinary tract infection, or meningitis were found among all infants with bronchiolitis who had blood, urine, and/or cerebrospinal fluid cultures. There is wide variability in the diagnostic testing of infants aged 90 days or younger with bronchiolitis. The risks of bacteremia, urinary tract infection, and meningitis in infants with bronchiolitis seems to be low. History or a documented temperature of 38.0 degrees C or more; oxygen saturation of less than 92%, and history of apnea were associated with laboratory testing for bacterial infections.

Food safety education using an interactive multimedia kiosk in a WIC setting: correlates of client satisfaction and practical issues.

PubMed

Trepka, Mary Jo; Newman, Frederick L; Huffman, Fatma G; Dixon, Zisca

2010-01-01

To assess acceptability of food safety education delivered by interactive multimedia (IMM) in a Supplemental Nutrition Program for Women, Infants and Children Program (WIC) clinic. Female clients or caregivers (n=176) completed the food-handling survey; then an IMM food safety education program on a computer kiosk. Satisfaction with program, participant demographics, and change in food-handling behavior were assessed by univariate analyses. Over 90% of the participants enjoyed the kiosk, and most (87.5%) reported using computers a lot. Compared with participants with education beyond high school, participants with less education were more likely to report enjoying the kiosk (98.2% vs 88.1%, P = .007), preferred learning with the kiosk (91.7% vs 79.1%, P = .02), and would like to learn about other topics using IMM (95.4% vs 86.6%, P = .04). Food safety education delivered by IMM was well accepted by inner-city WIC clinic clients, including those with less education. Copyright 2010 Society for Nutrition Education. Published by Elsevier Inc. All rights reserved.

Mode of Birth Influences Preterm Infant Intestinal Colonization with Bacteroides Over the Early Neonatal Period

PubMed Central

Gregory, Katherine E.; LaPlante, Rose D.; Shan, Gururaj; Kumar, Deepak Vijaya; Gregas, Matt

2015-01-01

Background Intestinal colonization during infancy is important to short and long term health outcomes. Bacteroides, an early member of the intestinal microbiome, are necessary for breaking down complex molecules within the intestine and function to assist the body’s immune system in fighting against potentially harmful pathogens. Little is known about the colonization pattern of Bacteroides in preterm infants during the early neonatal period. Purpose This study measured Bacteroides colonization during the early neonatal period in a population of preterm infants based on clinical factors including mode of birth, antibiotics, and nutrition. Methods Bacterial DNA was isolated from 144 fecal samples from 29 preterm infants and analyzed using quantitative real time polymerase chain reaction (PCR). Analyses included liner mixed models to determine which clinical factors affect Bacteroides colonization of the infant gut. Results We found that infants born via vaginal canal had a higher rate of increase in Bacteroides than infants born via Cesarean section (p<.001). We did not find significant associations between antibiotic administration and differences in nutritional exposures with Bacteroides colonization. Implications for Practice These findings highlight the significant influence of mode of birth on Bacteroides colonization. While mode of birth is not always modifiable, these study findings may help develop interventions for preterm infants born via Cesarean section aimed at overcoming delayed Bacteroides colonization. Implications for Research Greater study of the intestinal microbiome and the clinical factors relevant to the preterm infant is needed so that interventions may be developed and tested, resulting in optimal microbial and immune health. PMID:26551793

Longitudinal Regional Brain Development and Clinical Risk Factors in Extremely Preterm Infants.

PubMed

Kersbergen, Karina J; Makropoulos, Antonios; Aljabar, Paul; Groenendaal, Floris; de Vries, Linda S; Counsell, Serena J; Benders, Manon J N L

2016-11-01

To investigate third-trimester extrauterine brain growth and correlate this with clinical risk factors in the neonatal period, using serially acquired brain tissue volumes in a large, unselected cohort of extremely preterm born infants. Preterm infants (gestational age <28 weeks) underwent brain magnetic resonance imaging (MRI) at around 30 weeks postmenstrual age and again around term equivalent age. MRIs were segmented in 50 different regions covering the entire brain. Multivariable regression analysis was used to determine the influence of clinical variables on volumes at both scans, as well as on volumetric growth. MRIs at term equivalent age were available for 210 infants and serial data were available for 131 infants. Growth over these 10 weeks was greatest for the cerebellum, with an increase of 258%. Sex, birth weight z-score, and prolonged mechanical ventilation showed global effects on brain volumes on both scans. The effect of brain injury on ventricular size was already visible at 30 weeks, whereas growth data and volumes at term-equivalent age revealed the effect of brain injury on the cerebellum. This study provides data about third-trimester extrauterine volumetric brain growth in preterm infants. Both global and local effects of several common clinical risk factors were found to influence serial volumetric measurements, highlighting the vulnerability of the human brain, especially in the presence of brain injury, during this period. Copyright © 2016 Elsevier Inc. All rights reserved.

Randomized controlled trial to determine the effectiveness of an interactive multimedia food safety education program for clients of the special supplemental nutrition program for women, infants, and children.

PubMed

Trepka, Mary Jo; Newman, Frederick L; Davila, Evelyn P; Matthew, Karen J; Dixon, Zisca; Huffman, Fatma G

2008-06-01

Pregnant women and the very young are among those most susceptible to foodborne infections and at high risk of a severe outcome from foodborne infections. To determine if interactive multimedia is a more effective method than pamphlets for delivering food safety education to Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) clients. A randomized controlled trial of WIC clients was conducted. Self-reported food safety practices were compared between pre- and postintervention questionnaires completed >or=2 months after the intervention. Pregnant WIC clients or female caregivers (usually mothers) of WIC clients who were 18 years of age or older and able to speak and read English were recruited from an inner-city WIC clinic. Participants were randomized to receive food safety pamphlets or complete an interactive multimedia food safety education program on a computer kiosk. Change from pre- to postintervention food safety scores. A mean food safety score was determined for each participant for the pre- and postintervention questionnaires. The scores were used in a two-group repeated measures analysis of variance. Of the 394 participants, 255 (64.7%) completed the postintervention questionnaire. Satisfaction with the program was high especially among those with no education beyond high school. When considering a repeated measures analysis of variance model with the two fixed between-subject effects of group and age, a larger improvement in score in the interactive multimedia group than in the pamphlet group (P=0.005) was found, but the size of the group effect was small (partial eta(2)=0.033). Women aged 35 years or older in the interactive multimedia group had the largest increase in score. The interactive multimedia was well-accepted and resulted in improved self-reported food safety practices, suggesting that interactive multimedia is an effective option for food safety education in WIC clinics.

Women and Children First...Or Last? A Report on the Special Supplemental Food Program for Women, Infants and Children.

ERIC Educational Resources Information Center

Fleming, Virginia

This booklet examines the first 2 1/2 years of The Special Supplemental Food Program for Women, Infants, and Children (WIC), designed by Congress to provide food and nutrition information for low-income pregnant women, nursing mothers, and children up to age 4. Problems with the implementation and functioning of the nutrition program are…

The Development of a Prototype Infant, Preschool and Child Day Care Center in Metropolitan Toronto. Year I Progress Report: Program Development.

ERIC Educational Resources Information Center

Fowler, William; And Others

The project reported on is designed to develop a model program of infant and child day care in a municipal setting. The development of the program is discussed under the following topics: (1) physical caregiving routines; (2) guided learning through play; (3) supervising children in free play; (4) staff guidance and communication: inservice…

Clinical utility of the Structured Observation of Motor Performance in Infants within the child health services

PubMed Central

Persson, Kristina; Sonnander, Karin; Magnusson, Margaretha; Sarkadi, Anna; Lucas, Steven

2017-01-01

Aim This study aimed to evaluate the clinical utility of the Structured Observation of Motor Performance in Infants (SOMP-I) when used by nurses in routine child healthcare by analyzing the nurses’ SOMP-I assessments and the actions taken when motor problems were suspected. Method Infants from three child health centers in Uppsala County, Sweden, were consecutively enrolled in a longitudinal study. The 242 infants were assessed using SOMP-I by the nurse responsible for the infant as part of the regular well-child visits at as close to 2, 4, 6 and 10 months of age as possible. The nurses noted actions taken such as giving advice, scheduling an extra follow-up or referring the infant to specialized care. The infants’ motor development was reassessed at 18 months of age through review of medical records or parental report. Results The assessments of level of motor development at 2 and 10 months showed a distribution corresponding to the percentile distribution of the SOMP-I method. Fewer infants than expected were assessed as delayed at 4 and 6 months or deficient in quality at all assessment ages. When an infant was assessed as delayed in level or deficient in quality, the likelihood of the nurse taking actions increased. This increased further if both delay and quality deficit were found at the same assessment or if one or both were found at repeated assessments. The reassessment of the motor development at 18 months did not reveal any missed infants with major motor impairments. Interpretation The use of SOMP-I appears to demonstrate favorable clinical utility in routine child healthcare as tested here. Child health nurses can assess early motor performance using this standardized assessment method, and using the method appears to support them the clinical decision-making. PMID:28723929

Cost-effectiveness of a long-term dental health education program for the prevention of early childhood caries.

PubMed

Kowash, M B; Toumba, K J; Curzon, M E J

2006-09-01

To evaluate the benefit-cost (B/C) and cost-effectiveness (C/E) of a long-term dental health education program to prevention early childhood caries (ECC) through home visits. The data collected over a three year period in a dental health education programme (DHE), previously reported [Kowash et al., 2000] for infants aged 8 months at start were analysed for B/C and C/E. Dental caries indices (BASCD) for dmft and dmfs were used. Costs were based on British National Health Service (UK) fees for treating children by general dental practitioners and salaries for community dental officers in the Community Dental Services in the UK. Comparisons were made for B/C and C/E with results from a clinical trial of a slow releasing fluoride device (SRFD), community water fluoridation (CMF) and a school based fissure sealant program (FSP) using the hypothetical community of Niessen and Douglass, [1984]. The cavities, as ECC, saved over the three year period indicated a B/C ratio for the DHE of 5.21 compared with SRFD of 4.17; CWF of 1.15 and FSP of 0.42. The C/E results were 1.92, 2.40, 8.66 and 23.74 respectively. A dental health education program of home visits with mothers of young infants to prevent early childhood caries and starting at 8 months of age, gave better benefit-costs and costs effectiveness ratios than other preventive programs.

Case Definitions for Conditions Identified by Newborn Screening Public Health Surveillance.

PubMed

Sontag, Marci K; Sarkar, Deboshree; Comeau, Anne M; Hassell, Kathryn; Botto, Lorenzo D; Parad, Richard; Rose, Susan R; Wintergerst, Kupper A; Smith-Whitley, Kim; Singh, Sikha; Yusuf, Careema; Ojodu, Jelili; Copeland, Sara; Hinton, Cynthia F

2018-01-01

Newborn screening (NBS) identifies infants with rare conditions to prevent death or the onset of irreversible morbidities. Conditions on the Health and Human Services Secretary's Recommended Uniform Screening Panel have been adopted by most state NBS programs, providing a consistent approach for identification of affected newborns across the United States. Screen-positive newborns are identified and referred for confirmatory diagnosis and follow-up. The designation of a clinically significant phenotype precursor to a clinical diagnosis may vary between clinical specialists, resulting in diagnostic variation. Determination of disease burden and birth prevalence of the screened conditions by public health tracking is made challenging by these variations. This report describes the development of a core group of new case definitions, along with implications, plans for their use, and links to the definitions that were developed by panels of clinical experts. These definitions have been developed through an iterative process and are piloted in NBS programs. Consensus public health surveillance case definitions for newborn screened disorders will allow for consistent categorization and tracking of short- and long-term follow-up of identified newborns at the local, regional, and national levels.

Case Definitions for Conditions Identified by Newborn Screening Public Health Surveillance

PubMed Central

Sontag, Marci K.; Sarkar, Deboshree; Comeau, Anne M.; Hassell, Kathryn; Botto, Lorenzo D.; Parad, Richard; Rose, Susan R.; Wintergerst, Kupper A.; Smith-Whitley, Kim; Singh, Sikha; Yusuf, Careema; Ojodu, Jelili; Copeland, Sara; Hinton, Cynthia F.

2018-01-01

Newborn screening (NBS) identifies infants with rare conditions to prevent death or the onset of irreversible morbidities. Conditions on the Health and Human Services Secretary’s Recommended Uniform Screening Panel have been adopted by most state NBS programs, providing a consistent approach for identification of affected newborns across the United States. Screen-positive newborns are identified and referred for confirmatory diagnosis and follow-up. The designation of a clinically significant phenotype precursor to a clinical diagnosis may vary between clinical specialists, resulting in diagnostic variation. Determination of disease burden and birth prevalence of the screened conditions by public health tracking is made challenging by these variations. This report describes the development of a core group of new case definitions, along with implications, plans for their use, and links to the definitions that were developed by panels of clinical experts. These definitions have been developed through an iterative process and are piloted in NBS programs. Consensus public health surveillance case definitions for newborn screened disorders will allow for consistent categorization and tracking of short- and long-term follow-up of identified newborns at the local, regional, and national levels.

Influence of Early Intervention on the Social Relationship Between Mother and Infant.

ERIC Educational Resources Information Center

Mills, Pamela Jean

The study was conducted to determine the impact of day care intervention on the relationship between 60 mothers and their infants, 30 infants being at high risk for progressive, developmental retardation. Ss were divided into three groups: the high risk experimental group (HRE), the infants which were in the day care program; the high risk control…

"I Didn't Think He Remembered": Healing the Impact of Domestic Violence on Infants and Toddlers

ERIC Educational Resources Information Center

Ellison, James R.

2014-01-01

The First Steps Domestic Violence Program (First Steps) was developed to address the mental health needs of infants and toddlers entering a domestic violence shelter. When domestic violence occurs, the primary caregiver's ability to help restore a sense of safety for the infant--through regulation of the infant's emotions, sleep, arousal, and…

Solving Sleep Behavior Disorders in Infants and Toddlers: The Munich Research and Intervention Program for Fussy Babies

ERIC Educational Resources Information Center

Papousek, Mechthild

2009-01-01

Sleep behavior disorders do not only affect infants' well-being, they also challenge the parents' physical and emotional resources, promote risks for the growing parent-infant relationships, and burden the parents' co-parenting relationship. Sleep-onset and night waking problems are widely spread among otherwise healthy infants, and they tend to…

An Ordinal Pattern Analysis of Four Hypotheses Describing the Interactions between Drug-Addicted, Chronically Disadvantaged, and Middle-Class Mother-Infant Dyads.

ERIC Educational Resources Information Center

Brinker, Richard P.; And Others

1994-01-01

Investigated interactions among 18 African American mother-infant pairs participating in an early intervention program for infants with developmental delays or at risk for developmental disabilities. The hypothesis that mothers would become less responsive to infants over time as a function of drug addiction, poverty, or serious developmental…

WIC Partnerships and the Nurturing Parent.

ERIC Educational Resources Information Center

Hartline, Heather; Henchy, Geri

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is a federally funded preventive health and nutrition program administered by the U.S. Department of Agriculture through state and local agencies and provides services to nutritionally at risk low-income pregnant women, postpartum women, infants, and children up to…

78 FR 19180 - Special Supplemental Nutrition Program for Women, Infants and Children (WIC): Income Eligibility...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-29

... DEPARTMENT OF AGRICULTURE Food and Nutrition Service Special Supplemental Nutrition Program for Women, Infants and Children (WIC): Income Eligibility Guidelines Correction In notice document 2013-6547 appearing on pages 17631-17632 in the issue of Friday, March 22, 2013, make the following correction: On...

7 CFR 246.16 - Distribution of funds.

Code of Federal Regulations, 2011 CFR

2011-01-01

... AGRICULTURE CHILD NUTRITION PROGRAMS SPECIAL SUPPLEMENTAL NUTRITION PROGRAM FOR WOMEN, INFANTS AND CHILDREN... request only if FNS determines there has been a significant reduction in infant formula cost containment... percent of its total grant. These funds are to be used in the next fiscal year for the development of a...

42 CFR 457.301 - Definitions and use of terms.

Code of Federal Regulations, 2012 CFR

2012-10-01

... under the Child Care and Development Block Grant Act of 1990; (4) Is authorized to determine eligibility of an infant or child to receive assistance under the special nutrition program for women, infants... (CONTINUED) STATE CHILDREN'S HEALTH INSURANCE PROGRAMS (SCHIPs) ALLOTMENTS AND GRANTS TO STATES State Plan...

42 CFR 457.301 - Definitions and use of terms.

Code of Federal Regulations, 2011 CFR

2011-10-01

... under the Child Care and Development Block Grant Act of 1990; (4) Is authorized to determine eligibility of an infant or child to receive assistance under the special nutrition program for women, infants... (CONTINUED) STATE CHILDREN'S HEALTH INSURANCE PROGRAMS (SCHIPs) ALLOTMENTS AND GRANTS TO STATES State Plan...

42 CFR 457.301 - Definitions and use of terms.

Code of Federal Regulations, 2010 CFR

2010-10-01

... under the Child Care and Development Block Grant Act of 1990; (4) Is authorized to determine eligibility of an infant or child to receive assistance under the special nutrition program for women, infants... (CONTINUED) STATE CHILDREN'S HEALTH INSURANCE PROGRAMS (SCHIPs) ALLOTMENTS AND GRANTS TO STATES State Plan...

7 CFR 246.16 - Distribution of funds.

Code of Federal Regulations, 2012 CFR

2012-01-01

... AGRICULTURE CHILD NUTRITION PROGRAMS SPECIAL SUPPLEMENTAL NUTRITION PROGRAM FOR WOMEN, INFANTS AND CHILDREN... request only if FNS determines there has been a significant reduction in infant formula cost containment... percent of its total grant. These funds are to be used in the next fiscal year for the development of a...

7 CFR 246.16 - Distribution of funds.

Code of Federal Regulations, 2013 CFR

2013-01-01

... AGRICULTURE CHILD NUTRITION PROGRAMS SPECIAL SUPPLEMENTAL NUTRITION PROGRAM FOR WOMEN, INFANTS AND CHILDREN... request only if FNS determines there has been a significant reduction in infant formula cost containment... percent of its total grant. These funds are to be used in the next fiscal year for the development of a...

42 CFR 457.301 - Definitions and use of terms.

Code of Federal Regulations, 2013 CFR

2013-10-01

... under the Child Care and Development Block Grant Act of 1990; (4) Is authorized to determine eligibility of an infant or child to receive assistance under the special nutrition program for women, infants... (CONTINUED) STATE CHILDREN'S HEALTH INSURANCE PROGRAMS (SCHIPs) ALLOTMENTS AND GRANTS TO STATES State Plan...

7 CFR 246.16 - Distribution of funds.

Code of Federal Regulations, 2014 CFR

2014-01-01

... AGRICULTURE CHILD NUTRITION PROGRAMS SPECIAL SUPPLEMENTAL NUTRITION PROGRAM FOR WOMEN, INFANTS AND CHILDREN... request only if FNS determines there has been a significant reduction in infant formula cost containment... percent of its total grant. These funds are to be used in the next fiscal year for the development of a...

42 CFR 457.301 - Definitions and use of terms.

Code of Federal Regulations, 2014 CFR

2014-10-01

... under the Child Care and Development Block Grant Act of 1990; (4) Is authorized to determine eligibility of an infant or child to receive assistance under the special nutrition program for women, infants... (CONTINUED) STATE CHILDREN'S HEALTH INSURANCE PROGRAMS (SCHIPs) ALLOTMENTS AND GRANTS TO STATES State Plan...

77 FR 9257 - Agency Information Collection Activities: Proposed Collection: Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2012-02-16

...: Maternal, Infant, and Early Childhood Home Visiting Program Information System (OMB No. 0915-xxxx)--[New... Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program, the Act responds to the diverse needs of children and families in communities at risk and provides an unprecedented opportunity for...

76 FR 44019 - Agency Information Collection Activities: Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-22

... improve health and development outcomes for at-risk children through evidence-based home visiting programs... system that promotes maternal, infant, and early childhood health, safety and development, and strong... authorizing the creation of the Maternal, Infant, and Early Childhood Home Visiting Program, ( http...

Effectiveness of the "Baby Think It Over" Teen Pregnancy Prevention Program.

ERIC Educational Resources Information Center

Somers, Cheryl L.; Fahlman, Mariane M.

2001-01-01

Examined the effectiveness of computerized infant simulator that provided realistic infant care experience to prevent teen pregnancy. Surveys examined changes in intervention and control group students' attitudes and sexual behaviors. Overall, the program did not significantly affect intervention students. Many students reported that it taught…

Impact of policy changes on infant feeding decisions among low-income women participating in the Special Supplemental Nutrition Program for Women, Infants, and Children.

PubMed

Whaley, Shannon E; Koleilat, Maria; Whaley, Mike; Gomez, Judy; Meehan, Karen; Saluja, Kiran

2012-12-01

We present infant feeding data before and after the 2009 Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) food package change that supported and incentivized breastfeeding. We describe the key role of California WIC staff in supporting these policy changes. We analyzed WIC data on more than 180,000 infants in Southern California. We employed the analysis of variance and Tukey (honestly significant difference) tests to compare issuance rates of postpartum and infant food packages before and after the changes. We used analysis of covariance to adjust for poverty status changes as a potential confounder. Issuance rates of the "fully breastfeeding" package at infant WIC enrollment increased by 86% with the package changes. Rates also increased significantly for 2- and 6-month-old infants. Issuance rates of packages that included formula decreased significantly. All outcomes remained highly significant in the adjusted model. Policy changes, training of front-line WIC staff, and participant education influenced issuance rates of WIC food packages. In California, the issuance rates of packages that include formula have significantly decreased and the rate for those that include no formula has significantly increased.

Influence of a Phototherapy Unit on Detection of Neonatal Jaundice and Hyperbilirubinemia

PubMed Central

Jolly, Donald T.

1984-01-01

The introduction of a phototherapy unit in a rural community hospital resulted in a significant increase in the detection of neonatal jaundice and hyperbilirubinemia in otherwise healthy term infants. Jaundiced newborns who were either missed or ignored in the past were now identified and monitored. Both the number of breast-fed infants and the number of primiparous women delivered increased significantly after the unit was obtained. However, these factors alone did not account for the marked increase in the detection rate of jaundice and hyperbilirubinemia. A sub-population of 94 infants was selected to evaluate the clinical assessment of jaundice in the term infant. The accuracy rate for clinical assessment was 70%; 13.8% of newborns with serum bilirubins above 10 mg/dl (170 umol/L) were not identified clinically. PMID:21279119

BUILDING A WORKFORCE COMPETENCY-BASED TRAINING PROGRAM IN INFANT/EARLY CHILDHOOD MENTAL HEALTH.

PubMed

Priddis, Lynn E; Matacz, Rochelle; Weatherston, Deborah

2015-01-01

This article describes findings from a project conducted in Western Australia (Mental Health Commission WA, 2015) that investigated the education and training needs of the Infant/Early Childhood Mental Health (I/ECMH) workforce. We examined international training programs and models of delivery in infant mental health, including a review of the current training available in Australia. Data collected from over 60 interviews were analyzed, and a staged delivery model for I/ECMH training and supervision that aligned with the Michigan Association for Infant Mental Health (2014) Competency Guidelines was recommended. These findings led to the purchase of the Michigan Association for Infant Mental Health (2014) for use in Western Australia. In a very short time, use of the Michigan Competency Framework by the Australian Association for Infant Mental Health West Australian Branch Incorporated has begun to change the training and education opportunities for upskilling the infant and early childhood workforce in Western Australia. It has resulted in a map to guide and develop training in the I/ECMH field for individual practitioners and professionals as well as for workplaces that will ultimately benefit Western Australian infants, young children, and their families during the perinatal period and in the early years. © 2015 Michigan Association for Infant Mental Health.

Respiratory muscle function in infants with spinal muscular atrophy type I.

PubMed

Finkel, Richard S; Weiner, Daniel J; Mayer, Oscar H; McDonough, Joseph M; Panitch, Howard B

2014-12-01

To determine the feasibility and safety of respiratory muscle function testing in weak infants with a progressive neuromuscular disorder. Respiratory insufficiency is the major cause of morbidity and mortality in infants with spinal muscular atrophy type I (SMA-I). Tests of respiratory muscle strength, endurance, and breathing patterns can be performed safely in SMA-I infants. Useful data can be collected which parallels the clinical course of pulmonary function in SMA-I. An exploratory study of respiratory muscle function testing and breathing patterns in seven infants with SMA-I seen in our neuromuscular clinic. Measurements were made at initial study visit and, where possible, longitudinally over time. We measured maximal inspiratory (MIP) and transdiaphragmatic pressures, mean transdiaphragmatic pressure, airway occlusion pressure at 100 msec of inspiration, inspiratory and total respiratory cycle time, and aspects of relative thoracoabdominal motion using respiratory inductive plethysmography (RIP). The tension time index of the diaphragm and of the respiratory muscles, phase angle (Φ), phase relation during the total breath, and labored breathing index were calculated. Age at baseline study was 54-237 (median 131) days. Reliable data were obtained safely for MIP, phase angle, labored breathing index, and the invasive and non-invasive tension time indices, even in very weak infants. Data obtained corresponded to the clinical estimate of severity and predicted the need for respiratory support. The testing employed was both safe and feasible. Measurements of MIP and RIP are easily performed tests that are well tolerated and provide clinically useful information for infants with SMA-I. © 2014 Wiley Periodicals, Inc.

Infants, Mothers, and Dyadic Contributions to Stability and Prediction of Social Stress Response at 6 Months

ERIC Educational Resources Information Center

Provenzi, Livio; Olson, Karen L.; Montirosso, Rosario; Tronick, Ed

2016-01-01

The study of infants' interactive style and social stress response to repeated stress exposures is of great interest for developmental and clinical psychologists. Stable maternal and dyadic behavior is critical to sustain infants' development of an adaptive social stress response, but the association between infants' interactive style and social…

Objective Evaluation of Muscle Strength in Infants with Hypotonia and Muscle Weakness

ERIC Educational Resources Information Center

Reus, Linda; van Vlimmeren, Leo A.; Staal, J. Bart; Janssen, Anjo J. W. M.; Otten, Barto J.; Pelzer, Ben J.; Nijhuis-van der Sanden, Maria W. G.

2013-01-01

The clinical evaluation of an infant with motor delay, muscle weakness, and/or hypotonia would improve considerably if muscle strength could be measured objectively and normal reference values were available. The authors developed a method to measure muscle strength in infants and tested 81 typically developing infants, 6-36 months of age, and 17…

Coping with Crying in Babies and Toddlers

ERIC Educational Resources Information Center

High, Pamela

2012-01-01

Pamela High, MS, MD, co-director of the Infant Behavior, Cry and Sleep Clinic at the Brown Center for the Study of Children at Risk, discusses the phenomena of infant crying and the impact it has on families. In most cases, infant crying will peak and resolve in the early months, but infant irritability can increase the risk of maternal…

Description of 13 Infants Born During October 2015-January 2016 With Congenital Zika Virus Infection Without Microcephaly at Birth - Brazil.

PubMed

van der Linden, Vanessa; Pessoa, André; Dobyns, William; Barkovich, A James; Júnior, Hélio van der Linden; Filho, Epitacio Leite Rolim; Ribeiro, Erlane Marques; Leal, Mariana de Carvalho; Coimbra, Pablo Picasso de Araújo; Aragão, Maria de Fátima Viana Vasco; Verçosa, Islane; Ventura, Camila; Ramos, Regina Coeli; Cruz, Danielle Di Cavalcanti Sousa; Cordeiro, Marli Tenório; Mota, Vivian Maria Ribeiro; Dott, Mary; Hillard, Christina; Moore, Cynthia A

2016-12-02

Congenital Zika virus infection can cause microcephaly and severe brain abnormalities (1). Congenital Zika syndrome comprises a spectrum of clinical features (2); however, as is the case with most newly recognized teratogens, the earliest documented clinical presentation is expected to be the most severe. Initial descriptions of the effects of in utero Zika virus infection centered prominently on the finding of congenital microcephaly (3). To assess the possibility of clinical presentations that do not include congenital microcephaly, a retrospective assessment of 13 infants from the Brazilian states of Pernambuco and Ceará with normal head size at birth and laboratory evidence of congenital Zika virus infection was conducted. All infants had brain abnormalities on neuroimaging consistent with congenital Zika syndrome, including decreased brain volume, ventriculomegaly, subcortical calcifications, and cortical malformations. The earliest evaluation occurred on the second day of life. Among all infants, head growth was documented to have decelerated as early as 5 months of age, and 11 infants had microcephaly. These findings provide evidence that among infants with prenatal exposure to Zika virus, the absence of microcephaly at birth does not exclude congenital Zika virus infection or the presence of Zika-related brain and other abnormalities. These findings support the recommendation for comprehensive medical and developmental follow-up of infants exposed to Zika virus prenatally. Early neuroimaging might identify brain abnormalities related to congenital Zika infection even among infants with a normal head circumference (4).

FDA Approves Immunotherapy for a Cancer that Affects Infants and Children | Poster

Cancer.gov

By Frank Blanchard, Staff Writer The U.S. Food and Drug Administration (FDA) recently approved dinutuximab (ch14.18) as an immunotherapy for neuroblastoma, a rare type of childhood cancer that offers poor prognosis for about half of the children who are affected. The National Cancer Institute’s (NCI) Biopharmaceutical Development Program (BDP) at the Frederick National Laboratory for Cancer Research produced ch14.18 for the NCI-sponsored clinical trials that proved the drug’s effectiveness against the disease.

Simplified antibiotic regimens for treatment of clinical severe infection in the outpatient setting when referral is not possible for young infants in Pakistan (Simplified Antibiotic Therapy Trial [SATT]): a randomised, open-label, equivalence trial.

PubMed

Mir, Fatima; Nisar, Imran; Tikmani, Shiyam S; Baloch, Benazir; Shakoor, Sadia; Jehan, Fyezah; Ahmed, Imran; Cousens, Simon; Zaidi, Anita K M

2017-02-01

Parenteral antibiotic therapy for young infants (aged 0-59 days) with suspected sepsis is sometimes not available or feasible in countries with high neonatal mortality. Outpatient treatment could save lives in such settings. We aimed to assess the equivalence of two simplified antibiotic regimens, comprising fewer injections and oral rather than parenteral administration, compared with a reference treatment for young infants with clinical severe infection. We undertook the Simplified Antibiotic Therapy Trial (SATT), a three-arm, randomised, open-label, equivalence trial in five communities in Karachi, Pakistan. We enrolled young infants (aged 0-59 days) who either presented at a primary health-care clinic or were identified by a community health worker with signs of clinical severe infection. We included infants who were not critically ill and whose family refused admission. We randomly assigned infants to either intramuscular procaine benzylpenicillin and gentamicin once a day for 7 days (reference); oral amoxicillin twice daily and intramuscular gentamicin once a day for 7 days; or intramuscular procaine benzylpenicillin and gentamicin once a day for 2 days followed by oral amoxicillin twice daily for 5 days. The primary outcome was treatment failure within 7 days of enrolment and the primary analysis was per protocol. We judged experimental treatments as efficacious as the reference if the upper bound of the 95% CI for the difference in treatment failure was less than 5·0. This trial is registered at ClinicalTrials.gov, number NCT01027429. Between Jan 1, 2010, and Dec 26, 2013, 2780 infants were deemed eligible for the trial, of whom 2453 (88%) were enrolled. Because of inadequate clinical follow-up or treatment adherence, 2251 infants were included in the per-protocol analysis. 820 infants (747 per protocol) were assigned the reference treatment of procaine benzylpenicillin and gentamicin, 816 (751 per protocol) were allocated amoxicillin and gentamicin, and 817 (753 per protocol) were assigned procaine benzylpenicillin, gentamicin, and amoxicillin. Treatment failure within 7 days of enrolment was reported in 90 (12%) infants who received procaine benzylpenicillin and gentamicin (reference), 76 (10%) of those given amoxicillin and gentamicin (risk difference with reference -1·9, 95% CI -5·1 to 1·3), and 99 (13%) of those treated with procaine benzylpenicillin, gentamicin, and amoxicillin (risk difference with reference 1·1, -2·3 to 4·5). Two simplified antibiotic regimens requiring fewer injections are equivalent to a reference treatment for young infants with signs of clinical severe infection but without signs of critical illness. The use of these simplified regimens has the potential to increase access to treatment for sick young infants who cannot be referred to hospital. The Saving Newborn Lives initiative of Save the Children, through support from the Bill & Melinda Gates, and by WHO and USAID. Copyright © 2017 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY license. Published by Elsevier Ltd.. All rights reserved.

Diagnosis and management of bacteremic urinary tract infection in infants.

PubMed

Roman, Heidi K; Chang, Pearl W; Schroeder, Alan R

2015-01-01

To report the prevalence of bacteremia by age in a sample of infants<1 year of age with urinary tract infections (UTIs), to compare characteristics of infants with UTIs with and without bacteremia, and to describe treatment courses and 30-day outcomes in infants with UTIs with and without bacteremia. We used a retrospective cross-sectional design to determine the prevalence of bacteremia in infants with UTIs at our institution. A double cohort design matching for age and gender was used to compare clinical characteristics and outcomes between infants with bacteremic versus nonbacteremic UTIs. We identified 1379 UTIs, with blood cultures obtained in 52% of cases. The prevalence of bacteremia was 4.1% (95% confidence interval 3.1%-5.3%) for all UTIs and 8% (95% confidence interval 6.1%-10.2%) for UTIs in which blood culture was obtained. Fifty-five infants with bacteremic UTIs were compared with 110 infants with nonbacteremic UTIs. Except for minor differences in the urinalysis and serum band count, there were no significant differences in clinical presentation between the 2 groups. Bacteremic infants received longer parenteral treatment courses than nonbacteremic infants (mean 6.7 vs 2.4 days, P<.001). Treatment courses in the bacteremic group were variable and predicted by age but not severity of illness. No bacteremic infant had recurrent UTI or bacteremia with the same organism within 30 days of discharge. Treatment was variable but outcomes were excellent in infants with bacteremic UTIs. Copyright © 2015 by the American Academy of Pediatrics.

Single and multiple food allergies in infants with proctocolitis.

PubMed

Koksal, B T; Barıs, Z; Ozcay, F; Yilmaz Ozbek, O

Food protein-induced allergic proctocolitis is a frequent cause of rectal bleeding in infants. Characteristics of infants with multiple food allergies have not been defined. This study aimed to identify characteristics of infants with proctocolitis and compare infants with single and multiple food allergies. A total of 132 infants with proctocolitis were evaluated retrospectively. All of the infants were diagnosed by a paediatric allergist and/or a paediatric gastroenterologist according to guidelines. Clinical features of the infants, as well as results of a complete blood count, skin prick test, specific immunoglobulin E, and stool examinations or colonoscopy were recorded. Cow's milk (97.7%) was the most common allergen, followed by egg (22%). Forty-five (34.1%) infants had allergies to more than one food. Infants with multiple food allergies had a higher eosinophil count (613±631.2 vs. 375±291.9) and a higher frequency of positive specific IgE and/or positive skin prick test results than that of patients with a single food allergy. Most of the patients whose symptoms persisted after two years of age had multiple food allergies. There is no difference in clinical presentations between infants with single and multiple food allergies. However, infants with multiple food allergies have a high blood total eosinophil count and are more likely to have a positive skin prick test and/or positive specific IgE results. Copyright © 2017 SEICAP. Published by Elsevier España, S.L.U. All rights reserved.

Evaluating Infant-Family Programs.

ERIC Educational Resources Information Center

Fenichel, Emily, Ed.

2003-01-01

"Zero to Three" is a single-focus bulletin of the National Center for Infants, Toddlers, and Families providing insight from multiple disciplines on the development of infants, toddlers, and their families. Compiling articles from participants of the Leadership Development Initiative Class of 2001-2002, this issue focuses on evaluation…

34 CFR 303.443 - Impartial due process hearing.

Code of Federal Regulations, 2014 CFR

2014-07-01

... AND REHABILITATIVE SERVICES, DEPARTMENT OF EDUCATION EARLY INTERVENTION PROGRAM FOR INFANTS AND... early intervention services of the infant or toddler, as determined under State statute, State... in the early intervention services or care of the infant or toddler; or (B) A person having a...

34 CFR 303.443 - Impartial due process hearing.

Code of Federal Regulations, 2013 CFR

2013-07-01

... AND REHABILITATIVE SERVICES, DEPARTMENT OF EDUCATION EARLY INTERVENTION PROGRAM FOR INFANTS AND... early intervention services of the infant or toddler, as determined under State statute, State... in the early intervention services or care of the infant or toddler; or (B) A person having a...

78 FR 14763 - Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-07

... States Department of Agriculture's (USDA) Special Supplemental Nutrition Program for Women, Infants and Children (WIC) serves a highly-vulnerable population low-income pregnant and post-partum women, infants... it displays a currently valid OMB control number. Food and Nutrition Service Title: WIC Infant and...

Acculturation, Cultural Values, and Breastfeeding in Overweight or Obese, Low-Income, Hispanic Women at 1 Month Postpartum.

PubMed

Shin, Cha-Nam; Reifsnider, Elizabeth; McClain, Darya; Jeong, Mihyun; McCormick, David P; Moramarco, Michael

2018-05-01

Most Hispanic infants are fed formula during the first 6 weeks, and although 80% of Hispanic women initiate breastfeeding, rates of exclusive breastfeeding are much lower. Research aim: The purpose was to examine the influence of acculturation and cultural values on the breastfeeding practices of pregnant women of Mexican descent participating in the Special Supplemental Nutrition Program for Women, Infants, and Children who were enrolled in a prospective randomized clinical trial that aimed to reduce child obesity. The data were abstracted from a larger randomized clinical trial focused on prevention of child obesity. The sample consisted of 150 women of Mexican origin who were enrolled at the time of these analyses from the randomized clinical trial and had a prepregnancy body mass index of ≥ 25 and spoke English and/or Spanish. All breastfeeding data for this report came from data collection at 1 month postpartum. A higher score on the Anglo orientation scale of the Acculturation Rating Scale for Mexican Americans was associated with less breastfeeding at 1 month postpartum and less exclusive breastfeeding. Acculturation plays a role in breastfeeding practice. Exploring acculturation associated with breastfeeding can guide us to design culturally relevant interventions to promote breastfeeding exclusivity among immigrant mothers.

Time to Send the Preemie Home? Additional Maturity at Discharge and Subsequent Health Care Costs and Outcomes

PubMed Central

Silber, Jeffrey H; Lorch, Scott A; Rosenbaum, Paul R; Medoff-Cooper, Barbara; Bakewell-Sachs, Susan; Millman, Andrea; Mi, Lanyu; Even-Shoshan, Orit; Escobar, Gabriel J

2009-01-01

Objective To determine whether longer stays of premature infants allowing for increased physical maturity result in subsequent postdischarge cost savings that help counterbalance increased inpatient costs. Data Sources One thousand four hundred and two premature infants born in the Northern California Kaiser Permanente Medical Care Program between 1998 and 2002. Study Design/Methods Using multivariate matching with a time-dependent propensity score we matched 701 “Early” babies to 701 “Late” babies (developmentally similar at the time the earlier baby was sent home but who were discharged on average 3 days later) and assessed subsequent costs and clinical outcomes. Principal Findings Late babies accrued inpatient costs after the Early baby was already home, yet costs after discharge through 6 months were virtually identical across groups, as were clinical outcomes. Overall, after the Early baby went home, the Late–Early cost difference was $5,016 (p<.0001). A sensitivity analysis suggests our conclusions would not easily be altered by failure to match on some unmeasured covariate. Conclusions In a large integrated health care system, if a baby is ready for discharge (as defined by the typical criteria), staying longer increased inpatient costs but did not reduce postdischarge costs nor improve postdischarge clinical outcomes. PMID:19207592

Understanding sickle cell carrier status identified through newborn screening: a qualitative study

PubMed Central

Miller, Fiona A; Paynter, Martha; Hayeems, Robin Z; Little, Julian; Carroll, June C; Wilson, Brenda J; Allanson, Judith; Bytautas, Jessica P; Chakraborty, Pranesh

2010-01-01

The expansion of newborn screening (NBS) is increasing the generation of incidental results, notably carrier results. Although carrier status is generally understood to be clinically benign, concerns persist that parents may misunderstand its meaning, with deleterious effects on children and their families. Expansion of the NBS panel in Ontario, Canada in 2006 to include sickle cell disorders drew attention to the policy challenge of incidental carrier results. We conducted a study of consumer and provider attitudes to inform policy on disclosure. In this paper, we report the results of (i) qualitative interviews with health-care providers, advocates and parents of carrier infants and (ii) focus groups with new parents and individuals active with the sickle cell community. Lay and provider participants generally believed that carrier results were clinically insignificant. However, some uncertainty persisted among lay consumers in the form of conjecture or doubt. In addition, consumers and advocates who were most informed about the disease articulated insistent yet dissonant claims of clinical significance. Meanwhile, providers referenced research knowledge to offer an equivocal assessment of the possibility and significance of clinically symptomatic carrier status. We conclude that many interpretations of carrier status are in circulation, failing to fit neatly into the categories of ‘clinically significant' or ‘benign.' This creates challenges for communicating clearly with parents – challenges exacerbated by inconsistent messages from screening programs regarding the significance of sickle cell carrier status. Disclosure policy related to incidentally generated infant carrier results needs to account for these complex realities. PMID:19809482

Teaching pediatric laboratory medicine to pathology residents.

PubMed

Pysher, Theodore J; Bach, Philip R; Geaghan, Sharon M; Hamilton, Marilyn S; Laposata, Michael; Lockitch, Gillian; Brugnara, Carlo; Coffin, Cheryl M; Pasquali, Marzia; Rinaldo, Piero; Roberts, William L; Rutledge, Joe C; Ashwood, Edward R; Blaylock, Robert C; Campos, Joseph M; Goldsmith, Barbara; Jones, Patricia M; Lim, Megan; Meikle, A Wayne; Perkins, Sherrie L; Perry, Deborah A; Petti, Cathy A; Rogers, Beverly B; Steele, Paul E; Weiss, Ronald L; Woods, Gail

2006-07-01

Laboratory data are essential to the medical care of fetuses, infants, children, and adolescents. However, the performance and interpretation of laboratory tests on specimens from these patients, which may constitute a significant component of the workload in general hospitals and integrated health care systems as well as specialized perinatal or pediatric centers, present unique challenges to the clinical pathologist and the laboratory. Therefore, pathology residents should receive training in pediatric laboratory medicine. Children's Health Improvement through Laboratory Diagnostics, a group of pathologists and laboratory scientists with interest and expertise in pediatric laboratory medicine, convened a task force to develop a list of curriculum topics, key resources, and training experiences in pediatric laboratory medicine for trainees in anatomic and clinical pathology or straight clinical pathology residency programs and in pediatric pathology fellowship programs. Based on the experiences of 11 training programs, we have compiled a comprehensive list of pediatric topics in the areas of clinical chemistry, endocrinology, hematology, urinalysis, coagulation medicine, transfusion medicine, immunology, microbiology and virology, biochemical genetics, cytogenetics and molecular diagnostics, point of care testing, and laboratory management. This report also includes recommendations for training experiences and a list of key texts and other resources in pediatric laboratory medicine. Clinical pathologists should be trained to meet the laboratory medicine needs of pediatric patients and to assist the clinicians caring for these patients with the selection and interpretation of laboratory studies. This review helps program directors tailor their curricula to more effectively provide this training.

Effects of a Home-Based Family-Centred Early Habilitation Program on Neurobehavioural Outcomes of Very Preterm Born Infants: A Retrospective Cohort Study

PubMed Central

Poggioli, Michela; Minichilli, Fabrizio; Bononi, Tiziana; Meghi, Pasquina; Andre, Paolo; Crecchi, Alessandra; Rossi, Bruno; Carboncini, Maria Chiara; Ottolini, Alberto

2016-01-01

Preterm children have an increased risk of neurodevelopmental impairments which include psychomotor and language retardation. The objectives of the present retrospective cohort study were to examine the effects of an individually adapted, home-based, and family-centred early developmental habilitation program on neurodevelopmental and behavioural outcomes of very preterm children compared with a standard follow-up at 2 years' corrected age. Enrolled infants were retrospectively assigned to the intervention group (61 subjects) or to the control group (62 subjects) depending on whether they had or had not carried out a home-based family-centred early developmental habilitation program focused on environmental enrichment, parent-guided environmental interaction, and infant development. Developmental outcome was assessed for both groups at 24 months' corrected age using the Bayley Scales of Infant Development 2nd Edition. Intervention significantly improved both cognitive and behavioural outcomes. In addition, males had significantly lower scores than females either before or after treatment. However, the treatment was effective in both genders to the same extent. In conclusion, a timely updated environment suitable to the infant's developmental needs could provide the best substrate where the parent-infant relationship can be practised with the ultimate goal of achieving further developmental steps. PMID:28090357

Effects of a Home-Based Family-Centred Early Habilitation Program on Neurobehavioural Outcomes of Very Preterm Born Infants: A Retrospective Cohort Study.

PubMed

Poggioli, Michela; Minichilli, Fabrizio; Bononi, Tiziana; Meghi, Pasquina; Andre, Paolo; Crecchi, Alessandra; Rossi, Bruno; Carboncini, Maria Chiara; Ottolini, Alberto; Bonfiglio, Luca

2016-01-01

Preterm children have an increased risk of neurodevelopmental impairments which include psychomotor and language retardation. The objectives of the present retrospective cohort study were to examine the effects of an individually adapted, home-based, and family-centred early developmental habilitation program on neurodevelopmental and behavioural outcomes of very preterm children compared with a standard follow-up at 2 years' corrected age. Enrolled infants were retrospectively assigned to the intervention group (61 subjects) or to the control group (62 subjects) depending on whether they had or had not carried out a home-based family-centred early developmental habilitation program focused on environmental enrichment, parent-guided environmental interaction, and infant development. Developmental outcome was assessed for both groups at 24 months' corrected age using the Bayley Scales of Infant Development 2nd Edition. Intervention significantly improved both cognitive and behavioural outcomes. In addition, males had significantly lower scores than females either before or after treatment. However, the treatment was effective in both genders to the same extent. In conclusion, a timely updated environment suitable to the infant's developmental needs could provide the best substrate where the parent-infant relationship can be practised with the ultimate goal of achieving further developmental steps.

Are prenatal care resources distributed efficiently across high-risk and low-risk mothers?

PubMed

Mukhopadhyay, Sankar; Wendel, Jeanne

2008-09-01

The Institute for Clinical Systems Improvement recommends reducing the number of prenatal care visits recommended for low-risk women, citing evidence from a randomized clinical trial indicating that the reduction would not adversely impact infant health. We investigate the implicit hypothesis that prenatal care resources are not distributed efficiently across high-risk and low-risk women. Using clinic-reported prenatal care and an inclusive measure of infant health, we report evidence indicating inefficient resource utilization: prenatal care only boosts infant health when mothers have specific pre-existing diagnoses, but women with high potential to benefit from care do not obtain more care than other women.

Infant bonding and attachment to the caregiver: insights from basic and clinical science.

PubMed

Sullivan, Regina; Perry, Rosemarie; Sloan, Aliza; Kleinhaus, Karine; Burtchen, Nina

2011-12-01

Early life infant-caregiver attachment is a dynamic, bidirectional process that involving both the infant and caregiver. Infant attachment appears to have a dual function. First, it ensures the infant remains close to the caregiver in order to receive necessary care for survival. Second, the quality of attachment and its associated sensory stimuli organize the brain to define the infant's cognitive and emotional development. Here we present attachment within an historical view and highlight the importance of integrating human and animal research in understanding infant care. Copyright © 2011 Elsevier Inc. All rights reserved.

Population-Based Microcephaly Surveillance in the United States, 2009 to 2013: An Analysis of Potential Sources of Variation

PubMed Central

Cragan, Janet D.; Isenburg, Jennifer L.; Parker, Samantha E.; Alverson, C.J.; Meyer, Robert E.; Stallings, Erin B.; Kirby, Russell S.; Lupo, Philip J.; Liu, Jennifer S.; Seagroves, Amanda; Ethen, Mary K.; Cho, Sook Ja; Evans, MaryAnn; Liberman, Rebecca F.; Fornoff, Jane; Browne, Marilyn L.; Rutkowski, Rachel E.; Nance, Amy E.; Anderka, Marlene; Fox, Deborah J.; Steele, Amy; Copeland, Glenn; Romitti, Paul A.; Mai, Cara T.

2017-01-01

Background Congenital microcephaly has been linked to maternal Zika virus infection. However, ascertaining infants diagnosed with microcephaly can be challenging. Methods Thirty birth defects surveillance programs provided data on infants diagnosed with microcephaly born 2009 to 2013. The pooled prevalence of microcephaly per 10,000 live births was estimated overall and by maternal/infant characteristics. Variation in prevalence was examined across case finding methods. Nine programs provided data on head circumference and conditions potentially contributing to microcephaly. Results The pooled prevalence of microcephaly was 8.7 per 10,000 live births. Median prevalence (per 10,000 live births) was similar among programs using active (6.7) and passive (6.6) methods; the interdecile range of prevalence estimates was wider among programs using passive methods for all race/ethnicity categories except Hispanic. Prevalence (per 10,000 live births) was lowest among non-Hispanic Whites (6.5) and highest among non-Hispanic Blacks and Hispanics (11.2 and 11.9, respectively); estimates followed a U-shaped distribution by maternal age with the highest prevalence among mothers <20 years (11.5) and ≥40 years (13.2). For gestational age and birth weight, the highest prevalence was among infants <32 weeks gestation and infants <1500 gm. Case definitions varied; 41.8% of cases had an HC ≥ the 10th percentile for sex and gestational age. Conclusion Differences in methods, population distribution of maternal/infant characteristics, and case definitions for microcephaly can contribute to the wide range of observed prevalence estimates across individual birth defects surveillance programs. Addressing these factors in the setting of Zika virus infection can improve the quality of prevalence estimates. PMID:27891783

[Multiprofessional intermittent psychiatric treatment of children in preschool age and their parents in a family day clinic].

PubMed

Postert, Christian; Achtergarde, Sandra; Wessing, Ida; Romer, Georg; Fürniss, Tilman; Averbeck-Holocher, Marlies; Müller, Jörg Michael

2014-01-01

Psychiatric treatment of children in preschool age (0-6 years) and their parents is an expanding field of research due to its high clinical significance. Specific family psychiatric treatment programs have been developed to meet the demands of this young age group, but are little known. A multiprofessional intermittent treatment approach sensitive to developmental and family context has been established in the Preschool Family Day Hospital for Infants, Toddlers and Preschoolers and their Families at Münster University Hospital, Germany. Group and individual therapeutic interventions for both children and parents, video-based parent-child-interaction therapy, psychiatric and psychotherapeutic treatments of parents and family therapeutic interventions integrating siblings are supporting and enhancing each other in an innovative and integrated family psychiatric program. First results of evaluation studies are reported that show that this treatment is effective.

Effect of an Internet-Based Program on Weight Loss for Low-Income Postpartum Women: A Randomized Clinical Trial.

PubMed

Phelan, Suzanne; Hagobian, Todd; Brannen, Anna; Hatley, Karen E; Schaffner, Andrew; Muñoz-Christian, Karen; Tate, Deborah F

2017-06-20

Postpartum weight retention increases lifetime risk of obesity and related morbidity. Few effective interventions exist for multicultural, low-income women. To test whether an internet-based weight loss program in addition to the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC program) for low-income postpartum women could produce greater weight loss than the WIC program alone over 12 months. A 12-month, cluster randomized, assessor-blind, clinical trial enrolling 371 adult postpartum women at 12 clinics in WIC programs from the California central coast between July 2011 and May 2015 with data collection completed in May 2016. Clinics were randomized to the WIC program (standard care group) or the WIC program plus a 12-month primarily internet-based weight loss program (intervention group), including a website with weekly lessons, web diary, instructional videos, computerized feedback, text messages, and monthly face-to-face groups at the WIC clinics. The primary outcome was weight change over 12 months, based on measurements at baseline, 6 months, and 12 months. Secondary outcomes included proportion returning to preconception weight and changes in physical activity and diet. Participants included 371 women (mean age, 28.1 years; Hispanic, 81.6%; mean weight above prepregnancy weight, 7.8 kg; mean months post partum, 5.2 months) randomized to the intervention group (n = 174) or standard care group (n = 197); 89.2% of participants completed the study. The intervention group produced greater mean 12-month weight loss compared with the standard care group (3.2 kg in the intervention group vs 0.9 kg in standard care group, P < .001; difference, 2.3 kg (95% CI, 1.1 to 3.5). More participants in the intervention group than the standard care group returned to preconception weight by 12 months (32.8% in the intervention group vs 18.6% in the standard care group, P < .001; difference, 14.2 percentage points [95% CI, 4.7 to 23.5]). The intervention group and standard care group did not significantly differ in 12-month changes in physical activity (mean [95% CI]: -7.8 min/d [-16.1 to 0.4] in the intervention group vs -7.2 min/d [-14.6 to 0.3] in the standard care group; difference, -0.7 min/d [95% CI, -42.0 to 10.6], P = .76), calorie intake (mean [95% CI]: -298 kcal/d [-423 to -174] in the intervention group vs -144 kcal/d [-257 to -32] in the standard care group; difference, -154 kcal/d [-325 to 17], P = .06), or incidences of injury (16 in the intervention group vs 16 in the standard care group) or low breastmilk supply from baseline to month 6 (21 of 61 participants in the intervention group vs 23 of 72 participants in the standard care group) and from month 6 to 12 (13 of 32 participants in the intervention group vs 14 of 37 participants in the standard care group). Among low-income postpartum women, an internet-based weight loss program in addition to the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC program) compared with the WIC program alone resulted in a statistically significant greater weight loss over 12 months. Further research is needed to determine program and cost-effectiveness as part of the WIC program. clinicaltrials.gov Identifier: NCT01408147.

A new infant hybrid respiratory simulator: preliminary evaluation based on clinical data.

PubMed

Stankiewicz, Barbara; Pałko, Krzysztof J; Darowski, Marek; Zieliński, Krzysztof; Kozarski, Maciej

2017-11-01

A new hybrid (numerical-physical) simulator of the respiratory system, designed to simulate spontaneous and artificial/assisted ventilation of preterm and full-term infants underwent preliminary evaluation. A numerical, seven-compartmental model of the respiratory system mechanics allows the operator to simulate global and peripheral obstruction and restriction of the lungs. The physical part of the simulator is a piston-based construction of impedance transformer. LabVIEW real-time software coordinates the work of both parts of the simulator and its interaction with a ventilator. Using clinical data, five groups of "artificial infants" were examined: healthy full-term infants, very low-birth-weight preterm infants successfully (VLBW) and unsuccessfully extubated (VLBWun) and extremely low-birth-weight preterm infants without (ELBW) and with bronchopulmonary dysplasia (ELBW_BPD). Pressure-controlled ventilation was simulated to measure peak inspiratory pressure, mean airway pressure, total (patient + endotracheal tube) airway resistance (R), total dynamic compliance of the respiratory system (C), and total work of breathing by the ventilator (WOB). The differences between simulation and clinical parameters were not significant. High correlation coefficients between both types of data were obtained for R, C, and WOB (γ R  = 0.99, P < 0.0005; γ C  = 0.85, P < 0.005; γ WOB  = 0.96, P < 0.05, respectively). Thus, the simulator accurately reproduces infant respiratory system mechanics.

Music Therapy with Premature Infants

ERIC Educational Resources Information Center

Standley, Jayne

2003-01-01

Over 20 years of research and clinical practice in music therapy with premature infants has been compiled into this text designed for Board Certified Music Therapists specializing in Neonatal Intensive Care clinical services, for NICU medical staff incorporating research-based music therapy into developmental care plans, and for parents of…

Impact of internet vs traditional Special Supplemental Nutrition Program for Women, Infants, and Children nutrition education on fruit and vegetable intake.

PubMed

Bensley, Robert J; Anderson, Judith V; Brusk, John J; Mercer, Nelda; Rivas, Jason

2011-05-01

The purpose of this project was to compare the impact of Internet nutrition education to traditional nutrition education on Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) participant fruit and vegetable consumption. Interventions were delivered at 15 WIC clinics after normal WIC clinic operations or delivered online. A total of 692 and 872 participants from eight WIC agencies self-enrolled into two phases. A quasi-experimental design using an interrupted time series to determine the impact of two methods of nutrition education and follow-up nutrition counseling was used. Data were collected online and at Michigan WIC clinics during 2005-2007 at 3-month intervals during a 9-month period (per phase). Two Internet nutrition education modules were compared to WIC traditional nutrition education, which included either group classes or a self-guided nutrition education information mall. All interventions were based on the same program learning objectives. Optional motivational negotiation counseling followed 3 months post-intervention. Stage of change progression, belief in ability to change, and fruit and vegetable consumption were measured at baseline, immediately after the intervention, and 3 and 6 months post-intervention. Significance (P<0.05) was analyzed using independent samples t tests, χ(2) distribution, and sample tests for differences in binomial proportions. The Internet group experienced substantial positive differences in stage of change progression, perception that the intervention was helpful and easy to use, and fruit and vegetable consumption. Traditional nutrition education required follow-up counseling to achieve fruit and vegetable consumption levels similar to the Internet nutrition education group. Based on these findings, this study supports Internet nutrition education as a viable alternative to traditional nutrition education for increasing fruit and vegetable consumption in some WIC clients. Copyright © 2011 American Dietetic Association. Published by Elsevier Inc. All rights reserved.

Hidden Treasure; Parents Search for Quality in Programs for Infants and Toddlers.

ERIC Educational Resources Information Center

Mazyck, Aurelia; And Others

The things that one can see in a child care program that identify it as a good program for babies and their families are described. The two main questions that are answered are: What is quality in an arrangement for infant care? and How is a parent to recognize it when it is found. The topics discussed are: (1) Involvement with Parents, Home, and…

Assessment of Children's Psychological Development and Data Analytic Framework in New York City Infant Day Care Study.

ERIC Educational Resources Information Center

Golden, Mark

This report briefly describes the procedures for assessing children's psychological development and the data analytic framework used in the New York City Infant Day Care Study. This study is a 5-year, longitudinal investigation in which infants in group and family day care programs and infants reared at home are compared. Children in the study are…

Neonatal Bathing and Massage Intervention with Fathers, Behavioural Effects 12 Weeks after Birth of the First Baby: The Sunraysia Australia Intervention Project.

ERIC Educational Resources Information Center

Scholz, Kim; Samuels, Curtis A.

1992-01-01

Examined the effect on father-infant relationships of a parent training program on infant massage and bathing. Infants in the treatment group greeted fathers with more eye contact, smiles, vocalizing, reaching, and orienting responses and showed less avoidance behavior than did control group infants. Fathers in the treatment group showed greater…

Using Volunteers to Help Expectant Mothers and Their Infants.

ERIC Educational Resources Information Center

Landolt, Terry

1985-01-01

Describes new Appalachian Regional Commission model health care program linking expectant mothers/infants with volunteers familiar with available resources to provide prenatal medical care, assistance in modifying personal habits potentially harmful to unborn infants, nutritional supplements and advice, and social service assistance. Includes 1982…

Progress in Mental Development of Retarded Cerebral Palsied Infants

ERIC Educational Resources Information Center

Banham, Katharine M.

1972-01-01

Reported were scores on the Cattell Infant Intelligence Scale, the Stanford Binet Intelligence Scale (Form L-M), the Quick Screening Scale of Mental Development, and the Vineland Social Maturity Scale achieved by 102 retarded, cerebral palsied infants who were in a hospital rehabilitation program. (GW)

The effectiveness of interventions to improve uptake and retention of HIV-infected pregnant and breastfeeding women and their infants in prevention of mother-to-child transmission care programs in low- and middle-income countries: protocol for a systematic review and meta-analysis.

PubMed

Puchalski Ritchie, Lisa M; van Lettow, Monique; Hosseinipour, Mina C; Rosenberg, Nora E; Phiri, Sam; Landes, Megan; Cataldo, Fabian; Straus, Sharon E

2015-11-03

Despite recent improvements, uptake and retention of mothers and infants in prevention of mother-to-child transmission (PMTCT) services remain well below target levels in many low- and middle-income countries (LMICs). Identification of effective interventions to support uptake and retention is the first step towards improvement. We aim to complete a systematic review and meta-analysis to evaluate the effectiveness of interventions at the patient, provider or health system level in improving uptake and retention of HIV-infected mothers and their infants in PMTCT services in LMICs. We will include studies comparing usual care or no intervention to any type of intervention to improve uptake and retention of HIV-infected pregnant or breastfeeding women and their children from birth to 2 years of age attending PMTCT services in LMICs. We will include randomized controlled trials (RCTs), cluster RCTs, non-randomized controlled trials, and interrupted time series. The primary outcomes of interest are percentage of HIV-infected women receiving/initiated on anti-retroviral prophylaxis or treatment, percentage of infants receiving/initiated on anti-retroviral prophylaxis, and percentage of women and infants completing the anti-retroviral regimen/retained in PMTCT care. The following databases will be searched from inception: Ovid MEDLINE and EMBASE, The WHO Global Health Library, CAB abstracts, EBM Reviews, CINAHL, HealthSTAR and Web of Science databases, Scopus, PsychINFO, POPLINE, Sociological Abstracts, ERIC, AIDS Education Global Information System, NLM Gateway, LILACS, Google Scholar, British Library Catalogue, DARE, ProQuest Dissertation & Theses, the New York Academy of Grey Literature, Open Grey, The Cochrane Library, WHO International Clinical Trials Registry, Controlled Clinical Trials, and clinicaltrials.gov. Reference lists of included articles will be hand searched and study authors and content experts contacted to inquire about eligible unpublished or in progress studies. Screening, data abstraction, and risk of bias appraisal using the Cochrane Effective Practice and Organization of Care criteria will be conducted independently by two team members. Results will be synthesized narratively and a meta-analysis conducted using the DerSimonian Laird random effects method if appropriate based on assessment of clinical and statistical heterogeneity. Our findings will be useful to PMTCT implementers, policy makers, and implementation researchers working in LMICs. PROSPERO CRD42015020829.

Therapeutic Observation of an Infant in Foster Care

ERIC Educational Resources Information Center

Wakelyn, Jenifer

2011-01-01

The paper describes a clinical research study of therapeutic observation of an infant in foster care. Infants and children under five represent more than half of all children entering care in the UK. The emotional needs of this population tend to be overlooked. This study aimed to find out about the experience of an infant or young child in care,…

Thyroid dysfunctions of prematurity and their impacts on neurodevelopmental outcome.

PubMed

Chung, Mi Lim; Yoo, Han Wok; Kim, Ki-Soo; Lee, Byong Sop; Pi, Soo-Young; Lim, Gina; Kim, Ellen Ai-Rhan

2013-01-01

Thyroid dysfunction is very common and is associated with neurodevelopmental impairments in preterm infants. This study was conducted to determine the incidence and natural course of various thyroid dysfunctions and their impacts on neurodevelopmental outcomes among premature infants. A total of 177 infants were enrolled who were born at <34 weeks or whose birth weight was <1500 g and who underwent repeat thyroid function tests. We analyzed how various thyroid dysfunctions affected neurodevelopmental outcomes at 18 months of corrected age. Thyroid dysfunction was noted in 88 infants. Hypothyroxinemia was observed in 23 infants, and their thyroid function was influenced by variable clinical factors. Free T4 levels were all normalized without thyroxine medication, and neurodevelopmental outcomes were not affected. In contrast, hyperthyrotropinemia was not associated with other clinical factors. Among 58 subjects who had hyperthyrotropinemia, only 31 infants showed normal thyroid-stimulating hormone (TSH) levels at follow-up tests. The remaining 27 infants had persistently high TSH levels, which significantly and poorly influenced the neurodevelopmental outcomes. Thyroid dysfunction is common among preterm infants. With the exception of persistent hyperthyrotropinemia, it generally does not affect neurodevelopmental outcomes. However, the beneficial effects of thyroid hormone therapy in patients with persistent hyperthyrotropinemia merits further study.

Babies on Campus: Service to Infants and Families among Competing Priorities in University Child Care Programs

ERIC Educational Resources Information Center

McMullen, Mary Benson; Lash, Martha

2012-01-01

University early childhood programs attempt to balance a traditional tri-part mission: service to children and families; professional development of caregivers/teachers, clinicians, and researchers; and research on child development, learning, and/or education. Increasingly, infants receive care and education on university campuses, yet little is…

Pride in Parenting Training Program: A Curriculum for Training Lay Home Visitors.

ERIC Educational Resources Information Center

Jarrett, Marian H.; Katz, Kathy S.; Sharps, Phyllis; Schneider, Susan; Diamond, Linda T.

1998-01-01

Describes the Pride in Parenting Training Curriculum developed by an interdisciplinary team to reduce infant mortality in minority populations. The program has been used to train lay home visitors to deliver a home-visiting curriculum focused on effective use of health-care services and improved infant development. (Author/CR)

Early Learning in Psychomotor Training of Down's Syndrome.

ERIC Educational Resources Information Center

Sanz Aparicio, Maria Teresa; Menendez Balana, Javier

2003-01-01

Compared effectiveness of modeling from a clinician to that of written instructions to train parents to use a motor stimulation program with their infants with Down syndrome. Obtained motor development quotients prior to the program and at 6, 12, 18, and 24 months. Found that infants of parents trained by modeling obtained higher motor…

42 CFR 431.635 - Coordination of Medicaid with Special Supplemental Food Program for Women, Infants, and Children...

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 4 2012-10-01 2012-10-01 false Coordination of Medicaid with Special Supplemental Food Program for Women, Infants, and Children (WIC). 431.635 Section 431.635 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE...

42 CFR 431.635 - Coordination of Medicaid with Special Supplemental Food Program for Women, Infants, and Children...

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Coordination of Medicaid with Special Supplemental Food Program for Women, Infants, and Children (WIC). 431.635 Section 431.635 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE...

42 CFR 431.635 - Coordination of Medicaid with Special Supplemental Food Program for Women, Infants, and Children...

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 4 2014-10-01 2014-10-01 false Coordination of Medicaid with Special Supplemental Food Program for Women, Infants, and Children (WIC). 431.635 Section 431.635 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE...

From Research to Practice: Strategies for Supporting School Readiness in Programs Serving Infants and Toddlers

ERIC Educational Resources Information Center

Powers, Stefanie

2012-01-01

Fostering healthy social and emotional development provides the foundation for school readiness in programs serving infants, toddlers, and their families. In this article, the author explores four key concepts that make the link between social and emotional development and early learning: 1) Cognitive and social-emotional development are…

Programs for Infants and Young Children. Part IV: Facilities and Equipment.

ERIC Educational Resources Information Center

Sale, June

This manual is designed to facilitate planning for day care center facilities. Goals and principles of day care are discussed in relation to programs for infants, toddlers, and preschoolers with special attention to staff, parents, and community. Suggestions are presented for indoor and outdoor planning for such topics as equipment, supplies,…