Early Human Development

Editorial Board

2012-06-01

Underinvolved Relationship Disorder and related factors in a sample of young children

2012-06-01

Abstract: Background and aims: The interaction between the infant and the caregiver is stated to be very important in the development of a child. When there is inadequacy of interaction, several emotional and developmental problems can emerge. We aimed to investigate the socio-demographic and clinical features of children diagnosed with Underinvolved Relationship Disorder according to the DC:0–3R classification system.Study design and methods: Four hundred and fifty seven children aged between 1 and 59 months, who had been admitted to an infant mental health clinic were assessed using the DC:0–3R classification system and the whole sample was divided into two groups, the group in which Underinvolved Relationship Disorder between the child and the caregiver had been detected (URD), and the group in which this had not been detected (NURD). These two groups were compared with regard to socio-demographic features, reasons for referral, primary diagnoses, relational disorders, medical/developmental conditions, psychosocial stressors and the Parent–Infant Relationship Global Assessment Scale (PIRGAS) scores of children.Results: Language delay, insufficient social interaction and aggression were found to be significantly more frequent reasons for referral in URD. Disorders of Relating and Communicating (equivalent to the Pervasive Developmental Disorders in DSM IV) and Deprivation/Maltreatment Disorder were more frequent primary diagnoses, Verbally or Physically Abusive Relationship Disorder was significantly more frequent relational disorder in URD. Mild and moderate mental retardation were significantly more frequent in URD, and social environment, educational/child care and health-care access challenges were found to be more frequent psychosocial stressors in the parents of URD. The Mean PIRGAS scores were significantly lower in URD connoting that the parent–infant relationship is poorer.Conclusions: The diagnosis of Underinvolved Relationship Disorder according to the DC:0–3R classification system is related to some developmental and psychosocial problems.

Association between cocaine abuse in pregnancy and placenta-associated syndromes using propensity score matching approach

2012-06-01

Abstract: Aims: We used propensity scores matching techniques to assess the association between maternal cocaine abuse in pregnancy and the occurrence of placenta-associated syndromes (PAS).Study design: Mothers who abused cocaine (n=5026) were matched to controls (n=5026) from a sample of 1,693,197, unexposed mothers in Florida from 1998 to 2007. Cocaine abuse was identified using the ICD-9 principal and secondary diagnosis codes (304.2 for cocaine dependence and 305.6 for cocaine abuse). The outcome of interest, PAS, was identified as any indication in diagnosis field of ICD-9-CM codes for: placental abruption (641.2), oligohydramnios (658.0), placental infarction (656.7, 656.8, 656.9), gestational hypertension (642.3, 642.9), preeclampsia (642.4, 642.5, and 642.7) or eclampsia (642.6).Results: Nearly 6% of mothers in the study sample experienced a condition associated with PAS prior to matching. Women who abused cocaine were 58% more likely to have PAS when compared to women who did not (OR=1.48, 95% confidence interval: 1.33, 1.66). Women who abused cocaine were at elevated odds for placental abruption, placenta infarction and preeclampsia with the most pronounced odds noted for placental abruption (OR=2.79, 95% confidence interval: 2.19, 3.55).Conclusions: These findings indicate that cocaine abuse during pregnancy is associated with more placenta-related disorders than previously reported.

Impact of maternal probiotic-supplemented dietary counseling during pregnancy on colostrum adiponectin concentration: A prospective, randomized, placebo-controlled study

Raakel Luoto, Kirsi Laitinen, Merja Nermes, Erika Isolauri — 2012-06-01

Abstract: Background: The breast milk bioactive substances such as adiponectin, have a presumably long-term impact upon the health and well-being of a child.Aim: To determine the impact of probiotic-supplemented dietary counseling during pregnancy on colostrum adiponectin concentration.Study design and subjects: Altogether 256 pregnant women were randomized into three study groups: dietary intervention with probiotics (diet/probiotics) or with placebo (diet/placebo) and a control group (control/placebo). The intervention group received dietary counseling provided by a nutritionist, the main focus being the amount and the type of dietary fat. The probiotics used were Lactobacillus rhamnosus GG and Bifidobacterium lactis in combination. Dietary intake was evaluated by food records at every trimester of pregnancy. Breast milk samples were collected after birth (colostrum) for adiponectin concentration analysis (n=181).Results: The dietary intervention increased the colostrum adiponectin concentration (ng/mL, geometric mean [95% CI]), the difference being significant when comparing to the control group; 12.7 [10.6–29.7] vs. 10.2 [9.9–13.2], P=0.024. Maternal weight gain during pregnancy (kg) correlated inversely with colostrum adiponectin concentration; β (SE)=−1.7 (0.1), P=0.020, and gestational diabetes mellitus was associated with the likelihood of adiponectin concentration falling into the lowest quartile; OR 2.36, 95% CI 1.1–3.2, P=0.028.Conclusions: In showing that the colostrum adiponectin concentration is markedly dependent on maternal diet and nutritional status during pregnancy, and considering that colostrum adiponectin has potential effects on metabolism, nutrition, and immune function in the neonates, the results of this study underscore the importance of the metabolic homeostasis of the mother for the child's initial nutritional environment.

Oral and nonoral sensorimotor interventions facilitate suck–swallow–respiration functions and their coordination in preterm infants

Sandra Fucile, David H. McFarland, Erika G. Gisel, Chantal Lau — 2012-06-01

Abstract: Background: Preterm infants are at high risk of encountering oral feeding difficulties. Early sensorimotor interventions may improve oral feeding skills in preterm infants.Aim: To further explore the effects of an oral (O), tactile/kinesthetic (T/K), and combined (O+T/K) sensorimotor intervention on preterm infants' nutritive sucking, swallowing and their coordination with respiration.Study design: Seventy-five infants (29 [0.3, standard error of mean, SEM] weeks gestation, 49 males/26 females) were randomly assigned to an O group involving sensorimotor input to the oral structures; a T/K group involving sensorimotor input to the trunk and limbs; a combined (O+T/K) group; and a control group.Outcome measures: Stage of sucking, suction and expression amplitudes (mmHg), suck–swallow ratio, stability of suck–swallow interval, and swallow–respiration patterns.Results: The O group had significantly more advanced sucking stages, and greater suction and expression amplitudes than controls [p≤0.035, effect size (ES) >0.6]. The suck–swallow ratio and stability of suck–swallow intervals did not significantly differ among groups (p≥0.181, ES≤0.3). The three interventions led to fewer swallows bracketed by prolonged respiratory pauses compared to controls (pause–swallow–pause, p≤0.044, ES≥0.7). The T/K and combined (O+T/K) groups had greater occurrence of swallows bracketed by expiration than the control and O groups (expiration–swallow–expiration, p≤0.039, ES≥0.3).Conclusion: The O intervention enhanced specific components of nutritive sucking. All three interventions resulted in improved swallow–respiration coordination. Sensorimotor interventions have distributed beneficial effects that go beyond the specific target of input.

The relation of maternal job strain and cortisol levels during early pregnancy with body composition later in the 5-year-old child: The ABCD study

2012-06-01

Abstract: Background: Prenatal exposure to maternal stress may program the fetal HPA axis, potentially leading to altered metabolism in later life, associated with adiposity and diabetes.Aims: This association is little studied in humans, and thus we explore whether high maternal job strain during early pregnancy, as well as maternal cortisol levels are associated with increased body mass index (BMI), central adiposity or body fat mass in the offspring at age five. Additionally, we explore whether these associations are modified by gender or mediated by gestational age and fetal growth restriction.Study design: 2939 pregnant women (ABCD cohort study) completed a questionnaire around gestational week 16 including the Job Content Questionnaire, assessing job strain. Serum total cortisol was assessed in a subsample (n=1320). Gestational age (≥37weeks), standardized birth weight and information on many covariates were available. At the age five health check, height, weight (BMI, kg/m2), waist circumference (waist-to-height ratio, WHtR) and Fat Mass Index (FMI, kg/m2) were assessed.Results: Job strain was not associated with higher BMI, WHtR or FMI. Higher maternal cortisol was independently associated with marginally higher FMI in girls, but marginally lower FMI in boys (β 0.09 and β −0.10 per 100 unit increase in serum cortisol, respectively. p<0.01). This association was not mediated by gestational age or fetal growth restriction.Conclusions: Results show that prenatal maternal job strain and cortisol may not program obesity and adiposity in the next generation in humans, but gender differences should always be considered.

Impact of a strategy to prevent the introduction of non-breast milk and complementary foods during the first 6months of life: A randomized clinical trial with adolescent mothers and grandmothers

2012-06-01

Abstract: Introduction: Although the disadvantages of introducing non-breast milk and the early introduction of complementary foods are known, such practices are common worldwide.Objective: To evaluate the efficacy of counseling about breastfeeding and complementary feeding in preventing the introduction of non-breast milk and complementary foods in the first 6months.Methods: This randomized clinical trial enrolled 323 adolescent mothers and their newborns and 169 maternal grandmothers; 163 mothers and 88 grandmothers received five counseling sessions on breastfeeding while in the hospital and at 7, 15, 30, and 60days, and one session on complementary feeding at 120days. Data about infant feeding were collected monthly. The impact was evaluated by comparing the Kaplan–Meier survival curves for the time of introduction of non-breast milk and complementary foods of the control and intervention groups. Median time of introduction of milk was calculated in the two groups.Results: The survival curves showed that the intervention postponed the introduction of non-breast milk and complementary foods. At 4months, 41% (95% CI, 32.8–49.2) of the infants in the control group received complementary foods in comparison to 22.8% (95% CI, 15.9–29.7) of the intervention group. Counseling postponed the introduction of non-breast milk, which occurred at 95days (95% CI, 8.7–111.3) in the control group and at 153days (95% CI, 114.6–191.4) in the intervention group.Conclusions: Counseling sessions on infant's first 4months were an efficacious strategy to prevent the introduction of non-breast milk and complementary foods in the 6months of life.

Change in cognitive abilities over time during preschool age in low risk preterm children

Barbara Caravale, Nadia Mirante, Cristina Vagnoni, Stefano Vicari — 2012-06-01

Abstract: Background: More information is needed on ‘low-risk’ preterm infants' neurological outcome so that they can be included in follow-up programs at least until school age.Objective: To examine the neuropsychological outcome in a group of low-risk low birth weight (LBW) children without neurological impairment followed from birth to 5years of age.Patients: 26 intellectually normal children born preterm (30–34weeks gestation) without major neurological disabilities and 23 control children born at term and matched for age, sex, and parental educational and occupational status.Methods: Subjects already evaluated at 3years of age underwent assessment again at 5years using as neuropsychological outcome measures a wide range of tests including perceptual and visual–motor function, language comprehension and expression, and attention skills.Results: When tested at 5years, children born preterm still obtained significantly lower mean scores than controls on visual motor integration test (57 vs 64, p=0.01), visual perception test (41 vs 43, p=0.002) and a trend toward a lower score in the picture vocabulary test (81 vs 85.5, p=0.07). The group of premature infants and controls improved their performance over time in the neuropsychological abilities investigated and, in some skills such as visual perception. Children born preterm took longer than those born at term to reach similar performance levels, 5 versus 3years.Conclusion: Ex low-risk children born preterm achieve lower scores over time in visual–motor and perceptual ability scales and in some language tests than children born at term. Like high-risk premature infants even those at low risk deserve regular follow-up with long-term programs.

Melatonin concentration in umbilical cord blood depends on mode of delivery

2012-06-01

Abstract: Background and aims: Melatonin (MT) is rapidly transferred from the maternal to fetal circulation in humans. There is little knowledge about factors which influence the MT concentration (MTc) in the umbilical cord (UC) blood during delivery. The aim of our study was to evaluate the MT status in the UC blood according to the time and mode of delivery.Subjects and methods: Blood samples from umbilical artery (UA) and vein (UV) were collected from spontaneous vaginal deliveries (SVD, n=122) and cesarean section deliveries (CSD, n=188). MTc was measured using a commercially available radioimmunoassay.Results: The MTc was not significantly different between UA and UV blood both at daytime and at nighttime (p=0.216 and p=0.440, respectively). Both in UA and in UV, the MTc was significantly higher at nighttime than at daytime (p<0.0001). Compared with the CSD group, MTc in the SVD group was significantly higher both at night- and daytime (p<0.05). MTc both in UA and in UV was found to be not significantly different between patients with and without risk factors for stress including pregnancy complications (e.g., preeclampsia) and intrapartum complications (e.g., emergency section, pathological doppler, and pathological cardiotocography) (p>0.05).Conclusion: Our study revealed for the first time that MTc both in UA and in UV depends on modus of labor. In agreement with other studies, we found a clear circadian MT rhythm in the UC blood of neonates. The results of our study may suggest to a physiological role of MT at the onset of labor.

Fetal, neonatal and developmental outcomes of lithium-exposed pregnancies

2012-06-01

Abstract: Introduction: Many women with a bipolar disorder are of reproductive age and will need to continue lithium treatment during pregnancy. The teratogenic and perinatal effects of lithium are known, but not the long-term effects of lithium on neurodevelopment of the children. This study investigates growth, neurological, cognitive and behavioral development of children exposed to lithium in utero.Method: In an observational retrospective cohort study 15 children who were exposed to lithium in utero were investigated at 3–15years of age. Neurological development was tested using the Hempel or Touwen examination. Cognitive development was assessed with the Bayley Scales of Infant Development III, Wechsler Preschool and Primary Scale of Intelligence or the Wechsler Intelligence Scale for Children. Parents completed the Child Behavior Checklist to assess behavioral development and a standard questionnaire about general development of the child since birth.Results: One child had signs of a minor neurological dysfunction, but without further clinical implications. The results of the cognitive tests were within normal limits, although most children had lower scores on the performance IQ subtest. Growth, behavior and general development were within the normal range.Conclusions: Continuing lithium therapy during pregnancy did not cause adverse effects on growth, neurological, cognitive and behavioral development of exposed children.

Creating a Cambodia-specific developmental milestone screening tool — A pilot study

Chanpheaktra Ngoun, Lina Saem Stoey, Katja van't Ende, Varun Kumar — 2012-06-01

Abstract: Background: Approximately 600million people are living with various types of disabilities throughout the world and over 200million children under age of 5years old not reach their developmental potential. These adverse outcomes can be prevented through early detection and treatment. To accurately assess the development of children, a culturally appropriate screening tool must be used. Cambodia lacks such tool and other studies have shown that western tools are not valid in other cultures.Aims: This study aimed at creating a culturally appropriate screening tool – called the Angkor Hospital for Children Developmental Milestone Assessment Tool (AHC DMAT) – for screening neurodevelopmental disability in Cambodian children.Study design, subject, outcome measures: Western milestones from the DDST II were used with cultural modifications. Children of both genders and aged from 1month to 6years assumed to have normal development were included in two pilot screenings (N=100 and N=63) with further modifications to the AHC DMAT made as necessary after each screening.Results: The final AHC DMAT consists of 140 milestones (49% directly from DDST II, 17% modified DDST II, 34% added through expert opinion).Conclusion: Extensive revision of the DDST II was needed in order to create a more valid Cambodian screening tool. This study was the first step to create a Cambodian-specific screening tool but further large-scale testing of the AHC DMAT is needed to strengthen the tool's validity and to identify the age-range percentiles of each milestone before it can be used for neurodevelopment screening.

Prevalence and predictors of idiopathic asymmetry in infants born preterm

2012-06-01

Abstract: Background: An idiopathic asymmetry in posture of the head is recognized as a risk factor to develop a deformational plagiocephaly (DP). In our neonatal follow-up clinic, an IA is often observed in infants born preterm at term-equivalent age (TEA).Aims: To explore (1) the prevalence of an idiopathic asymmetry in 192 infants (gestational age ≤32.0weeks) at TEA and 6months corrected age (CA), (2) whether demographical, perinatal, and medical factors were predictors of the asymmetry, and (3) differences in motor maturation between infants with and without asymmetry.Methods: In a retrospective study, frequencies of idiopathic asymmetry and DP, putative predictors, and Alberta Infant Motor Scale scores at 6months CA were abstracted and analyzed with Chi2, Mann–Whitney, logistic regression and T-test.Results: The prevalence rate of a positional preference of the head at TEA was 44.8% (n=86), 10.4% (20/192) had a DP at TEA and 13% (25/192) at 6months CA. Positional preference, multiple birth and male gender predicted the presence of DP (p<.05, odds ratio 3.0, 3.2, and 3.1 respectively). Gross motor maturity at 6months CA was less developed in infants with a positional preference at TEA compared to preterm norms (p=0.01).Conclusions: The high prevalence of a positional preference in infants born preterm at term equivalent age requires extra alertness to prevent the development of a deformational plagiocephaly, especially in boys and twins. Although, considering the lower prevalence of plagiocephaly at 6months CA, therapists should be aware of over treating these infants.

Poor repertoire General Movements predict some aspects of development outcome at 2years in very preterm infants

2012-06-01

Abstract: Background: Observation of the quality of endogenously generated “General Movements” has been proved to be a reliable and sensitive tool in the assessment of fragile neonates. The absence of fidgety movements at 2–4months post-term is highly predictive of Cerebral Palsy. On the contrary, the presence of a poor repertoire pattern during the writhing period is not reliable in predicting motor or neurobehavioral disorders at any stage of development.Aim: To examine if the presence of a PR pattern at 1month post-term was associated with lower neurodevelopmental quotients at 2years.Study design: General Movements evaluation at 1 and 3months and the Griffiths Scales of Mental Development at 2years were administered to a sample of very preterm infants. Infants were divided into two groups: poor repertoire pattern group and normal pattern group. Student's t Test and Chi squared test and ANOVA were used to compare neonatal variables and results between the two groups.Subjects: 79 very preterm infants (birthweight≤1500g or gestational age≤32weeks), born January 2003 to December 2006 who had a follow-up at 2years.Outcome measure: Griffiths developmental quotient at 2years.Results: The Poor Repertoire group had lower Gestational Age, lower Birth Weight, lower Apgar scores at birth and lower Developmental Quotient at 2years. Eye and Hand Coordination (subscale D) was the domain mostly responsible for such a difference. Quality of fidgety movements (normal or abnormal fidgety) at 3months did not show any correlation with outcome measures at 2years.Conclusion: The presence of a PR pattern at 1month post-term seems to predict lower neurodevelopmental scores at 2years especially in the domain of eye and hand coordination. Longer follow-up is necessary in order to ascertain if such difference will continue to persist at older ages.

Preterm birth and Assisted Reproductive Technology/ART: Maternal emotional wellbeing and quality of mother–newborn interaction during the first three months of life

Maria A. Tallandini, Valentina Morsan, Franco Macagno — 2012-06-01

Abstract: Objective: Assisted Reproductive Technology (ART) and premature birth are stressful and difficult experiences for women. No research to date has examined the impact of ART on mother–child relationship in instances of preterm delivery. This study explored the psychological status of preterm infants' ART-mothers and the quality of mother–infant dyadic interaction, up to child age of three months (Corrected Age = CA).Method: Forty-one ART-dyads and 53 Spontaneous Pregnancy (SP) dyads were enrolled. Mother and child were assessed at 5 to 7days after birth (T1), at child discharge from hospital (T2), at one month after discharge (T3); and at 3months CA (T4). The following measures were administered to the mothers: the Gordon Personal Profile Inventory, the Beck Anxiety Inventory, the Beck Depression Inventory, and the Parenting Stress Index S–F. Mother–child interaction was coded by using the Nursing Child Assessment Feeding Scale.Results: At childbirth, the control group mothers showed a higher level of anxiety than the ART-mothers did, but at T2, T3, T4, both groups' parenting stress levels were below threshold. Conversely, ART mothers more frequently provided suitable stimulation for their child's socio-emotional and cognitive development than the control group did. No significant between-group differences were observed in the mothers' capacity to respond to their children's distress, nor in sensitivity to child cues. Both infant groups showed equal ability to send clear signals and to respond to parent-provided care.Conclusions: ART and SP mothers with premature infants showed no differences in degree of emotional burden experienced during the neonatal period. Yet, dyadic interaction was qualitatively better in ART dyads than in SP dyads.

A longitudinal study on the effects of maternal smoking and secondhand smoke exposure during pregnancy on neonatal neurobehavior

2012-06-01

Abstract: Maternal smoking during pregnancy is one of the most modifiable causes of morbidity and mortality for both pregnant women and their fetuses. The long-term effects of prenatal exposure to smoke on child behavior and development have been the subject of more extensive research than have the short-term effects. Therefore, the aim of this work is to examine the effects of smoke exposure during pregnancy on neonatal behavior, including in our study a group of mothers exposed to secondhand smoke. The behavior of 282 healthy full-term newborns was assessed using the Neonatal Behavior Assessment Scale (NBAS) at 48–72h of life. Sixty-two mothers smoked during pregnancy (no mother smoked more than 15cig/day) and 17 were exposed to secondhand smoke. After adjusting for socio-demographic and obstetric factors, both newborns whose mothers smoked and those whose mothers were exposed to secondhand smoke showed significantly lower scores in the habituation cluster than non-smoking mothers. Exposure to secondhand smoke was also related to lower motor system cluster scores as well as some supplementary items and the newborns of smoking mothers showed significantly lower scores in the state regulation cluster and in some items of the state organization cluster than the newborns of non-smoking mothers. We conclude that active and passive smoking during pregnancy affects several aspects of neurobehavioral development, regardless of socio-demographic, obstetric and pediatric factors.

Cerebral and mesenteric tissue oxygenation by positional changes in very low birth weight premature infants

Gamze Demirel, Serife Suna Oguz, Istemi Han Celik, Omer Erdeve, Ugur Dilmen — 2012-06-01

Abstract: Aim: There has been no clear consensus of the appropriate positioning in preterm infants. We aimed to evaluate the changes of cerebral and mesenteric tissue oxygenation in three different positions, by near infrared spectroscopy (NIRS), in stable very low birth weight (VLBW) infants of postnatal >30days.Methods: NIRS monitoring of cerebral and mesenteric tissue oxygenation in three different positions was performed in 29 stable preterm newborns in neonatal intensive care unit (NICU). The patients were observed in three different positions consecutively, each lasting for 4h. The demographic features, cerebral and mesenteric tissue oxygenation with positional changes and feeding periods were recorded.Results: Mean gestational age, mean birth weight and mean postnatal age of the patients were 27.6±1.7weeks, 1046±308g and 42.4±15.7days, respectively. There were no statistically significant differences in cerebral and mesenteric tissue regional SO2 values in each position (p=0.954 and p=0.151, respectively). The values of cerebral and mesenteric tissue regional SO2 before and after feeding did not show any statistically significant difference in each position.Conclusions: Clinically stable very low birth weight infants are able to maintain a stable cerebral and mesenteric tissue oxygenation in different positions, both before and after feeding. Positional changes seem to be safe in VLBW stable infants and this influence should be considered in care of these patients in the NICU.Clinical Trials Identification Number: NCT01255189.

Neonatal factors associated with alteration of palatal morphology in very preterm children: The EPIPAGE cohort study

2012-06-01

Abstract: Background: Altered palatal morphology has been observed among some preterm children, with possible consequences on chewing, speaking and esthetics, but determinants remain unknown.Aim: To explore the role of neonatal characteristics and neuromotor dysfunction in alteration of palatal morphology at 5years of age in very preterm children.Study design: Prospective population-based cohort study.Subjects: 1711 children born between 22 and 32weeks of gestation in 1997 or born between 22 and 26weeks of gestation in 1998 were included in the study. They all had a medical examination at 5years of age.Outcome measures: Alteration of palatal morphology.Results: The prevalence of altered palatal morphology was 3.7% in the overall sample, 5.1% among boys and 2.2% among girls (adj OR: 2.52; 95%CI: 1.44–4.42). The risk for altered palatal morphology was higher for lower gestational age (adj OR: 0.85; 95%CI: 0.74–0.97 per week), small-for-gestational age children (adj OR: 2.11; 95%CI: 1.20–3.72) or children intubated for more than 28days (adj OR: 3.16; 95%CI: 1.11–8.98). Altered palatal morphology was more common in case of cerebral palsy or moderate neuromotor dysfunction assessed at 5years. Results were basically the same when neuromotor dysfunction was taken into account, except for intubation.Conclusion: Male sex, low gestational age, small-for-gestational age and long intubation have been identified as probable neonatal risk factors for alteration of palatal morphology at 5years of age in very preterm children. Further studies are needed to confirm these results.

Longitudinal study of vitamins A, E and lipid oxidative damage in human milk throughout lactation

2012-06-01

Abstract: Background: Little is known about the intensity of oxidative damage in human milk resulting from maternal oxidative stress. The aim of our study was to explore the changes in Total Antioxidant Status (TAS) and concentrations of antioxidative vitamins and isoprostanes (markers of oxidative stress) in human colostrum and mature milk.Methods: The study included 49 postpartum women with normal, spontaneous full term delivery. The exclusion criteria included active and passive smoking, acute and chronic disorders, and pharmacotherapy other than vitamin supplementation. Colostrum samples were collected on the 3rd day after delivery and breast milk samples between the 30th and the 32nd day after delivery. TAS of colostrum/breast milk was determined by Rice-Evans and Miller method. The amount of vitamins A and E was measured by HPLC. Isoprostane concentrations in colostrum/mature milk and urine were determined immunoenzymatically.Results: No significant differences were observed in maternal dietary intakes of vitamins A and E determined prior to the colostrum and mature milk sampling. The TAS of mature milk was significantly higher compared to colostrum (P=0.002), while vitamin A and E concentrations were significantly lower (P=0.003 and P=0.001). Although the isoprostane concentration of mature milk was significantly higher than the colostrum concentration, this difference was not significant (P=0.129).Conclusion: Human milk is a source of antioxidative vitamins and their concentrations decrease throughout the lactation, while their total antioxidative properties increase. The phase of lactation does not affect the degree of human milk's lipid oxidative damage.

Is the association between ACE genes and blood pressure mediated by postnatal growth during the first 3years?

2012-06-01

Abstract: Unlike the defined role of angiotensin-converting enzyme (ACE) gene in adult hypertension, ACE gene did not show direct influence on childhood blood pressure (BP), rather, seemed to be related to childhood growth with age-dependent characteristics. Thus, we examined intermediate effects of postnatal growth between the ACE polymorphisms and BP. We analyzed data from 257 children born in 2001–04 at Ewha Womans University Hospital in Seoul, Korea, and followed them up until 3years of age. Children with excessive adiposity had higher BP, as rapid growers did to no-change and decelerated growers. The ACE II genotype was associated with greater growth acceleration than the DD genotype (II: 46.8% vs. DD: 23.9%), and with a higher BP. The interactions between ACE genotype and adiposity at age 3 were significant on the BP levels. The highest BP increase with the same degree of adiposity was observed in those with the II genotype [β (SE) for BMI: 1.9 (0.9), p=0.04]; particularly, only rapid grown II carriers demonstrated statistical significance on this linear association. These results suggested that ACE polymorphisms and BP association are mediated by postnatal growth. Further studies are required to determine the age-specific ACE genetic effects and its undefined biological mechanism.

Fetal habituation in assisted conception

Jolly Joy, Neil McClure, Peter G. Hepper, Inez Cooke — 2012-06-01

Abstract: Background: Neurodevelopment outcomes of children conceived by Assisted Reproductive Technology (ART)have been the subject of much recent attention. To date there are no reports of neurodevelopmental performance before birth in this group.Aims: To compare habituation (a measure of brain function) in fetuses conceived by assisted reproduction techniques (ART) with naturally conceived (NC) fetuses.Study design: Case control study.Subjects: Women with singleton pregnancies matched for maternal age, parity and smoking were recruited in 2 groups: ART (n=20) and NC (n=20).Outcome measures: Sound stimuli (250Hz, 110dB) at 10second intervals lasting 2s were administered to the fetus. The end point was habituation (cessation of movement for five consecutive stimuli) or a maximum of 30 stimuli. Responses of the fetus were observed with ultrasound at 28, 32 and 36weeks' gestation, video-recorded and anonymised for analysis.Results: At 28weeks' gestation significantly more ART fetuses responded to sound of 250Hz, 110dB (p=0.02) but this difference did not persist at 32 and 36weeks'. There was a significant increase in nonresponders as gestation advanced in the ART group. There was no difference in habituation or mean number of trials to habituate at all three gestations.Conclusions: ART fetuses demonstrated no differences in habituation suggesting that there is no neurodevelopment delay. However, a decrease in response to sound as gestation advances might be a harbinger for poor perinatal outcomes and needs exploration.

Comparison of two strategies to improve infant sleep problems, and associated impacts on maternal experience, mood and infant emotional health: A single case replication design study

Stephen Matthey, Rudi Črnčec — 2012-06-01

Abstract: Background: Infant sleep problems (ISP) are common and have known effects on parental mood. There is debate as to whether treatment strategies may impact on the infant's emotional health.Aims: To compare the effectiveness of two treatment strategies for ISP on the infant's sleep, maternal mood, and the infant's emotional health. The two strategies are 1) systematic ignoring with minimal check (‘SI-mc’: commonly known as ‘controlled crying’), and 2) a new, but similar, method where parents feign sleep inside the infant's room before intervening (parental presence with minimal check: ‘PP-mc’).Design: Participants were randomised to one of the two conditions. Measures were taken at baseline, then three weeks and four months post-intervention.Subjects: Data were collected from 16 families with infants aged 6–18months who were seeking professional help with their infant's sleep difficulties.Outcome measures: Measures of infant sleep, maternal experiences and mood, and infant emotional health were collected.Results: Both treatments were effective, with a third to a half of families reporting decreased ISP by 3week post intervention, and nearly all reporting decreased ISP by follow-up. Similarly, most mothers in both treatments reported improvements to their experiences or mood, and there was no discernable disruption to infant emotional health.Conclusions: These findings support previous research into the effectiveness of SI-mc. The study also expands the research into the effectiveness of parental presence by showing that with the inclusion of the minimal check component, which may be preferred by both parents and clinicians over non-responding to the crying infant, the strategy is as effective as SI-mc.

Tongue movement and intra-oral vacuum of term infants during breastfeeding and feeding from an experimental teat that released milk under vacuum only

2012-06-01

Abstract: Background: Recent literature supports the theory that vacuum is integral to the removal of milk from the breast rather than peristaltic compression of the breast.Aim: We aimed to determine if breastfed infants could remove breast milk from an experimental teat designed to release milk only when a vacuum is applied.Methods: Submental ultrasound images and intra-oral vacuum measurements were recorded simultaneously during both a breastfeed and a feed with the experimental teat.Results: Infants placed the nipple and teat a similar distance from the nipple hard–soft palate junction when the tongue was lowered (4.7mm vs 5.3mm). As the tongue lowered the nipple and teat expanded evenly although the nipple expanded more than the teat (3.1mm vs 1.5mm). Both baseline (−31mm Hg vs −12mm Hg) and peak vacuum (−122mm Hg vs −67mm Hg) applied to the breast were significantly higher than for the teat.Conclusion: Breastfed infants are able to remove milk from a teat using only vacuum with a similar tongue movement to that of breastfeeding. This evidence supports the theory that vacuum is a critical factor in the removal of milk from the breast.

Spectral power differences in the brain activity of growth-restricted and normal fetuses

2012-06-01

Abstract: Using non-invasive fetal magnetoencephalography (fMEG), we investigated spontaneous brain activity in 28 fetuses diagnosed with intrauterine growth restriction (IUGR) and compared the results to 47 normal-growth fetuses. The fetal gestational age ranged from 28 to 39weeks with post-natal recordings obtained on 17 of the IUGR fetuses. Power spectrum was computed and was divided into four frequency bands. A significant difference in the relative spectral power in delta, theta and beta bands (P<0.01) was observed only in the 28–32week gestation age group with alpha band showing a similar trend (P=0.054). This observation suggests that growth restriction may have a more pronounced effect on the fetal brain in early gestation. Larger population studies could reveal the potential value of fMEG as an additional surveillance tool for growth-restricted fetuses.