II Antibacterial Effects of Silver Nitrate as Used for Credé Prophylaxis and of a Colloidal Silver Compound - Hexarginum

Silver nitrate as prophylaxis against gonococcal ophthalmia neonatorum (GON) is still compulsory in many countries, although disputed. In Sweden it is proposed that the use of silver nitrate be discontinued as there is now effective treatment available and because of the present epidemiological situation and good neonatal care. In some communities, however, the socioeconomic situation is such as to justify a continued use of prophylaxis against GON. Therefore it was decided to try Hexarginum (AgNo₃+CH₃NH₂), a colloidal silver compound as an alternative, which is less irritating than silver nitrate. The antibacterial effect in vitro of silver nitrate and Hexarginum on Neisseria gonorrhoeae, Staphylococcus aureus, Streptococcus agalactiae, Diplococcus pneumoniae and Haeomophilus infruenzae was compared. Both compounds were found to be very active in killing gonococci. The effectiveness against other species was varying, H. intluenzae being more rapidly killed than the Gram-positive cocci. Hexarginum was consistently less active than silver nitrate by 1–4 dilution steps. It was also tested whether silver nitrate and Hexarginum inhibited the adhesion of gonococci to epithelial cells. Some inhibition was found by silver nitrate although the difference was not significant. The effect by which silver nitrate acts as a prophylactic agent against GON is probably more complex than merely depending on the antibacterial effect; any other compound must be evaluated carefully before it can be recommended as an alternative prophylactic agent against GON.     

III Effects of Silver Nitrate Prophylaxis on Visual Alertness in Neonates

In a series of investigations we have studied whether silver nitrate used as prophylaxis against neonatal gonococcal ophthalmia has mainly positive or negative consequences. In this study 39 newborns, randomly divided into three groups given silver nitrate or the less irritating Hexarginum or physiological saline (placebo) as prophylaxis were studied. The eye drops were administered two hours after delivery. The groups were observed on days 2 and 4 post partum. The soothing effect and the effect on visual alertness were compared between the groups when infants were lifted from supine position to the shoulder. On day 2 infants in the silver nitrate group showed less alertness and scanning behaviour than did children in the Hexarginum and saline groups. There were no indications that the chemical conjunctivitis caused by silver nitrate interfered with soothability on either day 2 or day 4 or with visual stimulation on the fourth day of life. The design of the study permitted parental eye contact with the infant during the first two hours of life. It is still an open question whether or not silver nitrate administered within a few minutes after delivery, which would prevent the early eye contact, would have any long-lasting effects on visual alertness or on parent-infant relationship.     

Interaction between mothers and infants born at risk during the first six months of corrected age

Abstract The effects of preterm birth and the perinatal infant health condition on mother-infant interactions were analysed in 278 mother-infant pairs, divided into four groups according to infants' gestational age at birth: group 1. 23–31 weeks; group 2,32–36 weeks; group 3, 37–42 weeks; and group 4, a control group of healthy full-term infants. The methodological approach was based on observation of the pairs at 2,4 and 6 months of infants" corrected age (± 1 week) during undressing of the infant and face-to-face interaction. It was found that mother-infant pairs with preterm infants (groups 1 and 2) did not differ in interactional variables from those of the control group. On the other hand, the birth of a full-term infant in need of neonatal intensive care (group 3) affected maternal and infant interactive behaviour. Additionally, infants from group 3 did not show stability in their interactive behaviour between any ages of measurement. This result suggests that interactive behaviour of full-term infants in need of neonatal intensive care are rather unpredictable during their first 6 months of life, which might have contributed to the less optimal interactive pattern observed for their mothers compared with mothers of the control group.     

Exposure to maternal smoking in the first year of life interferes in breast-feeding protective effect against the onset of respiratory allergy from birth to 5 yr

The aim of this study was to evaluate the interaction between the exclusive breast-feeding protective effect and the exposure to tobacco smoke at domicile in the first year of life, on the onset of respiratory allergy (asthma and rhinitis) in children until 5 yr of age. This is prospective cohort study, observational, institutional based. Three hundred children born in a public hospital of Salvador-Bahia (Brazil) were followed from birth to 5 yr of age. Data from 268 children at 60 months of life were analyzed. Occurrence of allergic symptoms were studied and correlated with gender, allergic relatives in first degree, exclusive breast-feeding duration, smoking mother, and presence of other smoker at home, considering the first year of life. Exclusive breast-feeding for at least 6 months showed a protection effect against the onset of respiratory allergy in children from birth to 5 yr (p < 0.05); odds ratio (OR): 0.33 (95% CI: 0.18–0.59). Breast-fed children for less then 6 months compared with those breast-fed for 6 months or more, presented a higher risk (OR: 2.34–95% CI: 1.4–3.74) for developing allergic respiratory symptoms just to 5 yr. The protective effect of exclusive prolonged breast-feeding on the onset of respiratory allergy in children from birth until 5 yr was lost when their mothers were smokers (OR: 2.50–95% CI 1.19–5.19). Therefore, the protective effect of breast-feeding in the first year of life on the onset of allergic symptoms until the age of 5 yr was confirmed. This study proposes a confounding effect of maternal smoking on this protection, exposed by a higher risk for present allergic symptoms until the age of 5 yr, in children exclusively breast-fed for 6 months or more, when their mothers smoked.     

Single daily bottle use in the early weeks postpartum and breast-feeding outcomes.

A prospective study of breast-feeding mothers was undertaken to determine the effects of limited bottle use and infant temperament on breast-feeding outcomes. White, married, primigravida women who were committed prenatally to breast-feeding for at least 6 weeks (n = 121) were randomly assigned to one of two groups: a planned bottle group that would offer one bottle daily between the second and sixth weeks postpartum and a total breast-feeding group that would avoid bottles during the same period. Group assignment had no effect on the occurrence of breast-feeding problems, on mothers' achievement of 90% of their prenatal breast-feeding duration goals, or on weeks to weaning across the study period. At 6 months postpartum, 59% of the planned bottle group and 69% of the total breast-feeding group were still breast-feeding. No main or interactive effects of infant temperament on breast-feeding outcomes were found.     

Prophylaxis of ophthalmia neonatorum: comparison of silver nitrate, tetracycline, erythromycin and no prophylaxis.

From November, 1989, to October, 1991, 4544 neonates were born at our hospital. Neonatal ocular prophylaxis immediately after birth was used with 1% tetracycline ophthalmic ointment in 1156 neonates, 0.5% erythromycin ophthalmic ointment in 1163 neonates and 1% silver nitrate drops in 1082 neonates. No prophylaxis for neonatal conjunctivitis was given to 1143 neonates. A total of 302 infants (6.7%) developed conjunctivitis during the first 4 weeks of life. Between December, 1991, and January, 1992, 425 neonates were born at our hospital and all were given 0.5% erythromycin ophthalmic ointment twice in the first 24 hours after birth for ocular prophylaxis. Thirty-one (7.3%) infants developed conjunctivitis during the neonatal period. The incidence rates of neonatal chlamydial conjuctivitis in the tetracycline, erythromycin, silver nitrate, no prophylaxis and erythromycin twice groups were 1.3, 1.5, 1.7, 1.6 and 1.4%, respectively. We conclude that neonatal ocular prophylaxis with erythromycin (one or two doses) or tetracycline or silver nitrate does not significantly reduce the incidence of neonatal chlamydial conjunctivitis compared with that in those given no prophylaxis.     

Breast-feeding in neonatal intensive care

Objective : To determine the incidence of breast-feeding in very preterm babies while in neonatal intensive care.
Methodology : A retrospective records analysis of all 151 babies with gestational age less than 35 weeks admitted to the neonatal intensive care unit (NICU) of a major teaching hospital in 1993.
Results : On discharge 64% of babies were having some breast milk (45% having breast milk alone, 19% both breast milk and formula), and 38% some breast-feeding (17% being solely breast-fed, the other 21% combining breast-feeding with either bottle-feeding or an intragastric tube [IGT]). Breast milk was the first milk for 41% of babies, with 83% having breast milk at some stage.
Increasing gestational age was associated with a decreased likelihood of first milk being breast milk (73% of those less than 29 weeks compared to 21% of those aged 33–34 weeks, P <0.001), but with increased rates of breast-feeding (23 compared to 59%, P = 0.01) and breast milk consumption (42 compared to 73%, P = 0.04).
Conclusions : Breast-feeding rates in NICU are well below those found on discharge for full term babies. Both maternal and staff-related factors contribute to this. More and better education of mothers, doctors and nurses as well as changes to some unit practices could increase these rates.     

A controlled study of silver nitrate prophylaxis and the incidence of nasolacrimal duct obstruction

The caustic property of silver nitrate prompted a double-blind, controlled study of a possible causal relationship between use of the agent for prophylaxis against ophthalmic infection in the newborn and the subsequent development of nasolacrimal duct obstruction. Follow-up of 145 newborns randomized either to 1% silver nitrate prophylaxis or to 1% tetracycline prophylaxis revealed no statistically significant difference in the incidence of nasolacrimal duct obstruction between the two groups at either two weeks or two months of age. It is concluded that silver nitrate prophylaxis does not predispose to nasolacrimal duct obstruction in the newborn.     

Long term enhancement of the IgG2 antibody response to Haemophilus influenzae type b by breast-feeding

SUBJECTS: Sets of sera were obtained from 30 children <6 years of age with invasive type b (Hib) infection and their mothers. Duration and mode of breast-feeding were monitored. Titers of IgG1, IgG2, IgA and IgM antibodies against Hib capsular polysaccharide were determined in sera taken during the acute illness and during early and late convalescence. RESULTS: Children 18 months or older with longer durations of exclusive breast-feeding (13 weeks or more; mean, 19.3 weeks) had higher Hib antibody concentrations of the IgG1, IgG2, IgA and IgM isotypes than those with a shorter duration of exclusive breast-feeding (<13 weeks; mean, 5.4 weeks). The difference was greatest for the IgG2 isotype. In regression analyses the association between the duration of exclusive breast-feeding and the anti-Hib IgG2 concentration was significant when breast-feeding, type of Hib infection, maternal Hib antibody titer and age were used as explanatory factors. In the group of 14 children <18 months of age no significant differences were noted. DISCUSSION: This study indicates the presence of a long lasting enhancing effect of breast-feeding on the antibody response to Hib in children, in particular on IgG2 Hib antibody production. This may result from the content in the milk of IFN-gamma and IFN-gamma-producing cells and possibly other factors, which can support IgG2 antibody production.     

The Duration for Which Exclusive Breast-feeding Is Adequate

ABSTRACT. The object of this study was to determine the length of time for which exclusive breast-feeding supported adequate growth in a cohort of infants from families in and around Amman, Jordan. The infants were described as "faltering" if their incremental growth over 4 weeks fell below 2 standard deviations of the increments reported by Fomon in the USA. The infants were examined every 2 weeks until they faltered, or, without faltering, were started on supplementary foods. In general, up to the time of faltering, growth was satisfactory by international standards. The median time of faltering was 6 months. The results support the view that, at least in this relatively well-nourished community, exclusive breast-feeding is satisfactory for 4–6 months. However, further examination is needed of the risk factors that lead to early faltering in some breast-fed children.     

Somatostatin Levels in Plasma in Nonsmoking and Smoking Breast-Feeding Women

ABSTRACT. The objective of the study was to record how somatostatin levels in plasma are altered in response to breast-feeding during the lactation period and to relate somatostatin levels to the success of the lactational performance and to smoking habits. Fifty-two women were investigated 4 days post partum and 3-4 months later. Blood samples were collected and the levels of somatostatin-like immunoreactivity (below referred to as SLI) were measured with radioimmunoassay. The periods of exclusive breast-feeding and of mixed feeding were assessed as well as the milk yield. Smoking habits were noted. SLI levels were found to be significantly lower on day 4 after delivery, compared to 3-4 months later. Also the type of response to breast-feeding was different. Thus, a significant fall of SLI was seen during breast-feeding at the maternity unit, but not 3–4 months later. Smoking women breast-fed fully for a significantly shorter time than nonsmokers and had significantly higher SLI levels at onset of breast-feeding day 4 post partum. Whether the high somatostatin levels recorded in connection with breast-feeding in smokers are related to the shorter period of breast-feeding seen in this group remains to be established. In addition, the highest levels of somatostatin were seen the day after the very last breast-feeding and a possible role for somatostatin in the weaning process should be explored.     

UNICEF/WHO baby-friendly hospital initiative: does the use of bottles and pacifiers in the neonatal nursery prevent successful breastfeeding?

To promote breastfeeding, UNICEF/WHO have launched the “baby-friendly hospital initiative” focusing on hospital care routines during delivery and the first days of life. In industrialised countries, two aspects of the initiative have raised controversy: how do restriction of supplemental feedings and ban of bottles and pacifiers affect long-term breastfeeding performance? From ten centres 602 healthy newborns were randomly assigned either to a UNICEF group with restrictive fluid supplements and avoidance of bottles and pacifiers during the first 5 days of life, or to a standard group with conventional feeding practice. Breastfeeding was encouraged in both groups. The main study endpoints were the prevalences of breast-feeding on day 5, and after 2, 4 and 6 months. Of the newborns 46% violated the UNICEF protocol, mostly because of maternal requests to give a pacifier or supplements by bottle. In the standard group, the drop-out rate was 9.7%. No significant differences in breastfeeding frequency and duration could be found: (UNICEF vs standard) day 5: 100% vs 99%; 2 months: 88% vs 88%; 4 months: 75% vs 71%; 6 months: 57% vs 55%. Inclusion of drop-outs due to pacifier use did not alter the results. Conclusion In our study population fluid supplements offered by bottle with or without the use of pacifiers during the first 5 days of life were not associated with a lower frequency or shorter duration of breastfeeding during the first 6 months of life.     

Prevention of neonatal conjunctivitis in Zaire

With the emergence of chlamydia as a major cause of neonatal conjunctivitis, silver nitrate is no longer the prophylactic agent of choice in many parts of the world. We studied 450 consecutive newborns in north-eastern Zaire in an effort to determine which of two agents provided the most effective prophylaxis. None of 236 newborns treated at birth with 1% silver nitrate and none of 123 treated with 1% tetracycline was found to develop conjunctivitis. Three of 91 "forgotten" babies developed gonococcal conjunctivitis. Nurses, thinking tetracycline was "messy", tended to "forget" to treat babies for whom tetracycline was prescribed. The use of silver nitrate still provides adequate prophylaxis in Zaire. Potential changes in the prophylactic regimen would need to take the perceptions of health care workers into account.     

Short-term effects of early suckling and touch of the nipple on maternal behaviour

The objective was to evaluate the effects of suckling within 30 min after birth when skin-to-skin body contact for mothers and infants was held constant in both cases (n = 32) and control groups (n = 25). Mother-infant interaction during breast-feeding, infants' time spent in nursery and different aspects of breast-feeding were evaluated. Prolactin and gastrin were measured in maternal serum before and after breast-feeding on day 4 post partum. The aim to evaluate effects of early post delivery suckling failed since only six of the 32 case infants did suck at this time. In spite of this, we found three significant differences among cases and controls. In the case group where all infants had touched or licked the areola and nipple, the mothers left the infants in the nursery for a significantly shorter time and significantly more mothers talked to their infants during the short breast-feeding observation. Median gastrin levels were significantly lower in cases than in controls both before (P less than 0.01) and after (P less than 0.03) breast-feeding. In conclusion, the infant's early touch of the mother's areola and nipple seemed to have positively influenced the mother/infant relationship during the first four days after birth. It was also associated with lower maternal gastrin levels which suggests that maternal neuroendocrine functions were also influenced. Ten months after birth, we found no differences between cases and controls.     

Factors related to early termination of breast-feeding in an urban population

A prospective study of breast-feeding mothers was undertaken to determine the effect of formula samples and other hospital-related factors on success in breast-feeding. Of the 166 nursing mothers studied for 4 months postpartum, 83% breast-fed for 1 month, 73% for 10 weeks, and 58% for 4 months or longer. Breast-feeding duration was not affected by formula samples given at discharge from the hospital. Factors correlating significantly with improved breast-feeding rates include maternal age, maternal education, nonsmoking, previous breast-feeding, planned pregnancy, initiation of breast-feeding in the first 16 hours, and minimization of formula supplementation in the nursery. Partial breast-feeding (supplementing more than one bottle of formula per day, measured at 1 month postpartum) was associated with shorter breast-feeding duration. This latter effect was minimized by frequent nursing (seven or more times per day), despite formula supplementation.     

Relation Between Maternal and Infant Blood Folate Activities

The relation between maternal and cord blood folate activity was investigated in a group of 110 primigravidae and their infants. Approximately half of these mothers had received folic acid supplements during their pregnancy, and the effects of this on infant blood folate levels at birth and at 6 weeks were also studied.In unsupplemented pregnancies there was a significant relation between infant and maternal blood folate levels at delivery.The results of folic acid supplementation during pregnancy were reflected by higher cord blood values, but 6 weeks after delivery infant plasma folate levels were essentially the same in both groups and independent of maternal supplies before delivery.     

口服氟康唑在预防早产儿深静脉置管时真菌感染中的临床意义

目的 探讨口服氟康唑片,在预防出生时胎龄≤32周和(或)出生体重≤1500 g的早产儿深静脉置管(PICC)时侵袭性真菌感染中的临床意义.方法 224例早产儿中未采取预防性使用氟康唑的早产儿(对照组)118例,采用预防性使用氟康唑的早产儿(预防组)106例,回顾性对照分析两组患儿的基本临床特点、侵袭性真菌感染的发生情况以及药物的安全性(谷丙转氨酶、胆红素的变化).结果两组患儿的基本临床特点进行比较,除经阴道分娩对照组56例(47.5%),预防组69例(65.1%),P＜0.005外,其他基本临床特点均无显著差别.将两组患儿引起侵袭性真菌感染的危险因素进行比较,差异均无统计学意义.对照组9例发生侵袭性真菌感染(7.6%),预防组未发生侵袭性真菌感染(0%),校正x2值6.56,P＜0.01,差异有统计学意义.预防组于预防性应用氟康唑后2周、4周查肝功能,将谷丙转氨酶及直接胆红素水平与对照组进行比较,2周时谷丙转氨酶异常者对照组10例(8.5%),预防组12例(11.3%),P=0.47,直接胆红素异常者对照组8例(6.8%),预防组9例(8.5%),P=0.63;4周时谷丙转氨酶异常者对照组4例(3.4%),预防组6例(5.7%),P=0.62,直接胆红素异常者对照组4例(3.4%),预防组9例(8.5%),P=0.15;差异均无统计学意义.结论 对于出生时胎龄≤32周和(或)出生体重≤1500 g,PICC置管的早产儿,采用口服氟康唑预防侵袭性真菌感染有效,且对于早产儿没有明显的肝细胞毒性,亦不会增加胆汁淤积的发生率.     

Smoking trends before, during, and after pregnancy among women and their spouses

Background: Pregnancy and childbirth can act as strong factors motivating parents to spontaneously quit smoking. The aim of the present survey was to establish smoking cessation guidelines for this group. The objectives were to clarify the smoking status of parents before, during and after pregnancy, as well as the factors associated with continuous smoking during pregnancy and post-partum smoking relapse among women who had stopped smoking during pregnancy.
Methods: A cross-sectional survey with self-administered questionnaires was conducted for the parents of the 908 infants who participated in the official medical and dental examination for 18-month-old infants in Itabashi ward, Tokyo, Japan.
Results: The prevalence of smoking among women before, during pregnancy, and at post-partum 18 months at 95% confidence intervals was 29.3% (23.3–35.3%), 9.8% (3.0–16.6%), and 23.1 (16.8%–29.4%), and among their spouses it was 64.3% (60.0–68.6%), 58.1% (53.4–62.7%), and 58.2% (53.5–62.8%), respectively. The positive factors associated with smoking among pregnant women were marriage to a smoker, less education, under stress, and part-time employment rather than unemployment. The positive factors associated with smoking relapse after childbirth among women were breast-feeding <6 months and age under 30 years.
Conclusion: Compared with Western countries, the rate of smoking cessation during pregnancy was relatively high in Japan. It is necessary that smoking cessation intervention and support for men be initiated at the early stages of their spouses' pregnancies. These observations could influence the targeting and design of maternal smoking intervention.     

Breast-feeding in a Danish alternative birth center compared with the obstetrical ward

In 1984 an Alternative Birth Clinic (ABC) was opened at the Copenhagen County Hospital in Glostrup. The ABC was opened on a trial basis to evaluate the demand for a different and more peaceful birth and nursing environment. The study was performed to illustrate how the place of birth can influence the delivery and the duration of breast-feeding. During the observation period of seven months there were 125 uncomplicated births at the ABC, and 170 uncomplicated births at the obstetrical ward. It was not possible to perform this study as a randomized one as delivering at the ABC was on offer to all women in this part of Copenhagen County. The newborn children at the ABC were nursed during the first 30 min after birth by 73.1% of the mothers compared to only 48.1% of the mothers at the obstetrical ward. On the fifth day after delivery 79.7% of the mothers at the ABC breast-fed without supplementary infant formula, while 95.1% of the mothers at the obstetrical ward breast-fed without supplement. Fourteen weeks after delivery 68.4% of the mothers who delivered at the ABC were breast-feeding without supplement, compared to 51.8% of the mothers who delivered at the obstetrical ward. The success of breast-feeding was found to have a positive correlation to higher social groups, delivering at the ABC, the number of antenatal care visits and increasing maternal age. The significance of these factors was tested in a regression analysis which revealed that birthplace and social group were the two factors that could explain the differences in the course of breast-feeding. Women referred to the obstetrical ward because there were no vacancies at the ABC (ABC-refused) followed in all aspects the mothers at the obstetrical ward. In spite of the groups not being randomized we feel that we can conclude, especially taking into consideration the results from the ABC-refused group, that the differences in the success of breast-feeding can be explained by the place of birth, and that making the birthplace and the surroundings more inviting will be very profitable for the length of breast-feeding. If possible the staff should spend more time with the delivering women and later assist them in getting a good start of breast-feeding.